Assessing a patient's Alertness & Orientation is the first part of your Primary Assessment following the general impression you form while approaching the patient.
Alertness
When approaching a patient, introducing yourself and asking for their name can help you assess their Level of Consciousness (LOC) or Alertness. If they respond, and appear awake an unaltered they may be considered "Alert" and you can move on to evaluating their orientation.
If they are vague, confused seeming or unresponsive, evaluate their LOC using the AVPU scale.
If they are responsive to pain stimuli only or completely unresponsive, assess their degree of alertness with the Glasgow Coma Scale. The Glasgow Coma Scale is an assessment based on numeric scoring of a patient's responses based on the patient's best response to eye opening, verbal response, and motor response. The patient's score (3 to 15) is determined by adding their highest eye opening, verbal response, and motor response scores.
Orientation
Orientation questions test a patient's mental status by checking on his or her memory and thinking ability. The most common orientation questions are checking awareness of person, place, time, and event. Ask your patient simple open ended questions that can not be answered with yes or no to determine the LOC. For example:
"What is your name?",
"Where are you right now?"
"What time is it?"
"Do you know why EMS was summoned?".
Do not ask your patient simple yes/no questions like "Do you know your name?" or "Do you know were you are right now?" since this gives you little insight into the mental status of the patient.
Reporting and Documentation
Report your results as a patient oriented score from 1 (lowest) to 4 (highest), noting any areas not oriented to. For example, you can state:
The patient is responsive to pain only, GCS 8
The patient is "A and O x 2 and does not know time and place."
The patient is "A and O X 4" (fully alert and oriented)
Level of consciousness and any alterations to mentation should be assessed upon initial contact with your patient and continuously monitored for changes throughout your contact with the patient.
Try to gain an idea of what your patient's baseline mental status is from bystanders or caregivers when assessing a patient who is not AxO 4. Some patients are unable to recall the time or place at baseline, for example.
A patient can be fully capable of conversing and still be altered. Just because your patient is able to have a normal conversation and answer questions does not mean that they are alert and oriented. Make sure you perform a full assessment on all patients.
