Tuesday, June 25, 2013

Oriented x 4

Sometimes, in clinical notes, you will see O x 4 or O x 3.  This means the patient is oriented to self, location, time and situation. (Some places just use three and exclude situation.)
What I have learned is in assessing orientation, an odd answer doesn’t always correlate with disorientation.
Example One:
There was a time when I had pet bunnies that were litter box trained. I worked on a very small surgical rehab unit and occasionally I would bring them in. Most patients liked giving them a pat and telling me about their pets.
We had a gentleman who did have some confusion and issues with short term memory. (That is fairly common in older people who have had a recent surgery. Hopefully it improves, but it doesn’t always.)  
One day we were having our team meeting and a nurse said she was concerned about this patient.  “I think he is getting more confused.  He keeps telling me about a lady who brings him rabbits.”
Example Two:
I had a friend who worked at a large dementia facility.  When she was new, she interviewed a patient who asked her if she had seen the kangaroo. Well obviously not and she documented that the patient was disorientated. 
Then she interviewed another patient who asks about the kangaroo.    
Yep, turns out this particular facility does have a kangaroo, which is awesome but perhaps not the best choice in a dementia facility.

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