How old of a patient can we start assessing patient's orientation to person, date & place?
My classmate & I have taken care of a 4-year-old who knew her name but did not know her birthday, so we had to ask her dad to identify her. Sometimes, children or even adults, would forget the dates when they're hospitalized, and some people might feel like they've lost time. My clinical instructor said that we could ask them about the month, or any holiday that's coming up.
So from what age can we start assessing a patient's orientation, and from what age should we expect patient to be able to identify their name, month or date, and place (hospital) on his/her own?
Oct 27, '13
In peds you can still assess if a pt is A&O, but it is a bit different. For a 4 year old you can assess if the child knows their own name and if they can identify who their parents are. You might be able to ask them if they know where they are, and they may know they are in the hospital. I would not expect them to know the day/month. Try to make sure a parent is present during your neuro assessment and then you can confer with the parents that the child is at baseline.
Oct 27, '13
No way would you expect a 4 year old to know the date or even what month or year it is. Not all 4 year olds know their birthday. I have a three year old who knows her birthday is in May but sometimes if you ask her when her birthday is, she'll say "it already happened" or "it's next year". And this kid is as oriented as children come. In peds you assess orientation by asking them questions that they know the answer to. A 4 year old may or may not know that it's almost Halloween (and also keep in mind that some cultures do not observe all the big holidays we consider). I'd ask a 4 year old what their name is, how old they are, who the adult sitting at their bedside is, what their teddy bear's name is, what their brother/sister's name(s) are (if they have them). If you ask a hospitalized 4 year old where they are, they might respond "doctor's" and I'd give them credit for that. If this is their first hospitalization they might not know what a hospital is or their parents might not have explained to them that this place is called a hospital. School aged children (over 5/6) should be generally oriented to time- they should be able to tell you what season it is and when their birthday is but they still might not be able to answer you if you ask them "what's the date" or "what day of the week is it?" Hell, I don't know the answer to those questions half the time. They can probably name all the days of the week and all the months of the year. Use the parents to gauge if they're at their baseline or not.
Oct 27, '13
School aged. That's when they start writing dates on papers and looking at calendars. Preschool kids have no idea about time except when it's time for snack!!
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