a question about A&Ox3 and POE

[Kiddo87]

hey, hey!

just finished the first week of my nurse residency program and have a couple of little questions that popped into my head this morning.

1) can a patient be alert, BUT NOT oriented to person, place, & time? if so, how would you document it?

2) can a confused and disoriented patient still refuse meds even though he's not in his right mind? i witnessed him mutter "i don't want it, i don't want it"...and meds were still given via his feeding tube.

3) if the son of the patient has Power of Attorney, can he give the go to administer meds over the phone? rather than in-person at the hospital?

thanks all.

Peace and Love.

[KelRN215, BSN, RN]

hey, hey!

just finished the first week of my nurse residency program and have a couple of little questions that popped into my head this morning.

1) can a patient be alert, BUT NOT oriented to person, place, & time? if so, how would you document it?

2) can a confused and disoriented patient still refuse meds even though he's not in his right mind? i witnessed him mutter "i don't want it, i don't want it"...and meds were still given via his feeding tube.

3) if the son of the patient has Power of Attorney, can he give the go to administer meds over the phone? rather than in-person at the hospital?

thanks all.

Peace and Love.

1. Yes. Level of consciousness and orientation are not the same thing. Document as follows: LOC: Alert. Orientation: Not oriented to person, not oriented to place, not oriented to time. That's how it would be documented at my institution, at least.

2. I don't see anything wrong with giving meds to a confused/disoriented patient via G-tube despite the patient saying "I don't want it." If he's confused and disoriented, he likely doesn't even know what "it" is.

3. If the patient is in the hospital, consent for medical care has already been obtained upon admission. It is not necessary to obtain consent every time you administer medications.

[Kiddo87]

3. If the patient is in the hospital, consent for medical care has already been obtained upon admission. It is not necessary to obtain consent every time you administer medications.

ahhhh, i see.

with that said, what if it is a NEW medication or treatment that the doctor orders?

are nurses allowed to acquire consent from the POA via phone?

[Altra, BSN, RN]

No - general consent for treatment covers most things other than specific invasive procedures.

[TheCommuter, BSN, RN]

1) can a patient be alert, BUT NOT oriented to person, place, & time? if so, how would you document it?

If the patient is alert but confused (disoriented to person, place, time, and situation), I'll usually document "disoriented x4" or "confused."

[6spdftwtm]

Yeah...documentation is one of the trickiest parts of nursing. But if all else fails, just plain english works great. I would have written it just like you did, Kiddo87.

"Alert, but disoriented to person, place, time" works just fine.