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. Assessment
In the context of an accident or major trauma, the Emergency Medical Responder performs spiraling (increasingly detailed) assessments which guide the critical first response. Assessment of mental orientation typically lands within the immediate top three priorities: 

Safety - Assess the area safety (potential traffic, fire, overhead/underfoot objects and collapse risks, rushing water, gunfire, chemical/radiation threats, storm conditions, downed power lines, etc. ), wait for the threat to subside, or move the person to safety if and when possible, all without endangering oneself. ABCs - Note conscious or unconscious then assess Airway, Breathing and Circulation factors (with priority to any potential gross or debilitating blood loss.) Orientation - Determine if the person is "awake, alert, and oriented, times three (to person, place, and time)." This is frequently abbreviated AAOx3 which also serves as a mnemonic. The assessment involves asking the patient to repeat his own full name, his present location, and todays date. The assessment is best done right up front, ahead of moving or transporting the victim, because it may illuminate potential internal damage. Event/Situation - A fourth category is now used as well. If the person is oriented to what is going on around them, then they are said to be AAOx4.
Hypoproteinemia is a condition where there is an abnormally low level of protein in the blood. There are several causes that all result in edema once serum protein levels fall below a certain threshold. Causes
Nutritional hypoproteinemia is due to severe limitation of protein intake in the diet. An example of nutritional hypoproteinemia is Kwashiorkor, a type of protein energy malnutrition affecting young children. Malabsorption
Liver disease can also cause hypoproteinemia by decreasing synthesis of plasma proteins like albumin. Renal disease like nephrotic syndrome can also result in hypoproteinemia because plasma proteins are lost in the urine. Sepsis (whole body infection) – macrophages activated in the liver and spleen secrete TNF-alpha into the bloodstream resulting in hypoproteinemia. Pathophysiology
Decreased serum protein reduces the oncotic pressure of the blood, leading to loss of fluid from the intravascular compartment, or the blood vessels, to the interstitial tissues, resulting in edema. This is termed as hypoproteinemia. Diagnosis
Hypoproteinemia is often confirmed by testing for serum albumin and total protein levels. References


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