Behaviors take away from A&Ox4?

[CaringGerinurse525]

I recently admitted a resident to the ltc facility where I work. Without too many details, she was admitted for IV antibiotics for an acute infection. The resident was able to tell me name, date, where they were, and why they were at the facility. (Also able to describe hospital stay and medical choices she made and why.)

Resident has behaviors and was made a two for all care because she was attention seeking and would make false accusations towards staff. It was well documented in hospital notes that resident did not believe she needed 24 hr care but d/t insurance she came to our facility. She is just very "woes is me".

Long story short, I reported to next shift that she was A&Ox4 but was a 2 because she had behaviors. The oncoming nurse insisted she couldn't be A&Ox4 because of the behaviors. She stated that if a person has behaviors they obviously have a mental disorder which interferes with their ability to be oriented.

I think a person can be completely oriented and still display behaviors. So I was just wondering what everyone else's thoughts were on this?

Please forgive any spelling or grammatical errors as I am posting from my not always so smart phone! 😁

[elkpark]

Whether or not someone is oriented has nothing to do with whether they have a "mental disorder." Plenty of folks who do clearly have a serious psychiatric disorder know who they are, where they are, what the date is, and what's going on around them. There are also plenty of folks who are needy, attention-seeking, and like to stir up trouble who don't have a formal psychiatric disorder. I don't know where your colleague would have gotten the idea that these concepts are always linked.

[dexm]

If a patient is alert and able to state their name, date, where they are, and why they're at the hospital then they're A&Ox4. This is assessing their neuro status, not their mental status.

[CaringGerinurse525]

Whether or not someone is oriented has nothing to do with whether they have a "mental disorder." Plenty of folks who do clearly have a serious psychiatric disorder know who they are, where they are, what the date is, and what's going on around them. There are also plenty of folks who are needy, attention-seeking, and like to stir up trouble who don't have a formal psychiatric disorder. I don't know where your colleague would have gotten the idea that these concepts are always linked.

Thanks! I am glad to hear that I am not the only one confused by her statement. I know plenty of people in my life that display unsavory behaviors but are aware of exactly what they are doing!