Getting a patient oriented with self, place, and time is as part of the exam for

Appearance and general behavior Body habitus, grooming habits, interpersonal style, degree of eye contact, how the patient looks compared with his or her age Disheveled appearance may suggest schizophrenia — Provocative dress may suggest bipolar disorder Appearance: well-groomed, immaculate, attention to detail, unkempt, distinguishing features (e.g., scars, tattoos), ill- or well-appearing Unkempt appearance may suggest depression, psychosis Eye contact: good, fleeting, sporadic, avoided, none Poor eye contact may occur with psychotic disorders General behavior: congenial, cooperative, open, candid, engaging, relaxed, withdrawn, guarded, hostile, irritable, resistant, shy, defensive Paranoid, psychotic patients may be guarded Irritability may occur in patients with anxiety Motor activity Body posture and movement, facial expressions Parkinsonism, schizophrenia, severe major depressive disorder, posttraumatic stress disorder, anxiety, medication effect (e.g., depression), drug overdose or withdrawal, anxiety — Akathisia (restlessness), psychomotor agitation: excessive motor activity may include pacing, wringing of hands, inability to sit still Bradykinesia, psychomotor retardation: generalized slowing of physical and emotional reactions Symptoms may develop within weeks of starting or increasing dosages of antipsychotic agents Catatonia: neurologic condition leading to psychomotor retardation; immobility with muscular rigidity or inflexibility; may present in excited forms, including excessive motor activity Tendency toward exaggerated movements occurs in the manic phase of bipolar disorder and with anxiety Speech Quantity: talkative, expansive, paucity, poverty (alogia) Schizophrenia; substance abuse; depression; bipolar disorder; anxiety; medical conditions affecting speech, such as cerebrovascular accident, Bell palsy, poorly fitting dentures, laryngeal disorders, multiple sclerosis, amyotrophic lateral sclerosis — Rate: fast, pressured, slow, normal Volume and tone: loud, soft, monotone, weak, strong, mumbled Fluency and rhythm: slurred, clear, hesitant, aphasic Coherent/incoherent Mood and affect Affect: physician's objective observation of patient's expressed emotional state
Mood: patient's subjective report of emotional state Depression, bipolar disorder, anxiety, schizophrenia How are your spirits? How would you describe your mood? Have you felt discouraged/low/blue lately? Have you felt angry/irritable/on edge lately? Have you felt energized/high/out of control lately? Thought process Form of thinking, flow of thought Anxiety, depression, schizophrenia, dementia, delirium, substance abuse — Thought content What the patient is thinking about Obsessions, phobias, delusions (e.g., schizophrenia, alcohol or drug intoxication), suicidal or homicidal thoughts Obsessions: Do you have intrusive thoughts or images that you can't get out of your head? Phobias: Do you have an irrational or excessive fear of something? Delusions: Do you think people are stealing from you? Are people talking behind your back? Do you think you have special powers? Do you feel guilty, as if you committed a crime? Do you feel like you are a bad person? (Positive responses to last two questions may also suggest a psychotic depression) Suicidality: Do you ever feel that life is not worth living? Have you ever thought about cutting yourself? Have you ever thought about killing yourself? If so, how would you do it? Homicidality: Have you ever thought about killing others or getting even with those who have wronged you? Perceptual disturbances Hallucinations Schizophrenia, severe unipolar depression, bipolar disorder, dementia, delirium, acute intoxication and withdrawal Do you see things that upset you? Do you ever see/feel/hear/smell/taste things that are not really there? If so, when does it occur? Have you had any strange sensations in your body that others do not seem to have? Sensorium and cognition Sensorium: level and stability of consciousness Underlying medical conditions, dementia, delirium See Tables 2 and 3 Cognition: attention, concentration, memory Insight Patient's awareness and understanding of illness and need for treatment Bipolar disorder, schizophrenia, dementia, depression What brings you here today? What is your understanding of your problems? Do you think your thoughts and moods are abnormal? Judgment Patient's recognition of consequences of actions Bipolar disorder, schizophrenia, dementia What would you do if you found a stamped envelope on the sidewalk? Physician should adapt questions to clinical circumstances and patient's education level

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Documenting level of consciousness
What is orientation to time place and person?
What does it mean for a patient to be oriented?
What is orientation in mental status exam?
What does oriented to self mean?

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Department: … & more: CHART SMART

Documenting level of consciousness

Huntley, Ann RN, APRN, BC, CCRN, MSN

Author Information

Ann Huntley is a clinical nurse specialist at Emory Healthcare in Atlanta, Ga.

Nursing: August 2008 - Volume 38 - Issue 8 - p 63-64

doi: 10.1097/01.NURSE.0000327505.69608.35

In Brief

What is orientation to time place and person?

Orientation is a function of the mind involving awareness of three dimensions: time, place and person. Problems with orientation lead to disorientation, and can be due to various conditions, from delirium to intoxication. Typically, disorientation is first in time, then in place and finally in person.

What does it mean for a patient to be oriented?

What does the patient-oriented healthcare model mean? It means that the patient is the top priority in the system. The patient is the key person of focus. Advancements are centered on what the patient needs.

What is orientation in mental status exam?

Orientation refers to the ability to understand one's situation in space and time. Generally, orientation to place and time is tested. Place may include asking about the building and floor a person is in, as well as the city and state. Orientation to time is tested by asking a person to give the day and date.