A client with a diagnosis of early-stage vascular dementia is preparing for an elective cholecystectomy. The medical record includes a durable power of attorney for healthcare (DPOA-HC) naming the client's eldest child as the surrogate. The client accurately describes the surgical risks and benefits but firmly states, 'I have changed my mind; I do not want this surgery.' The eldest child presents the DPOA-HC document to the practical nurse (PN) and insists that preoperative preparations continue. Which action should the PN take?
- Halt all preoperative interventions and immediately notify the attending surgeon of the client's verbal refusal.Answer
- BProceed with the preoperative checklist after verifying the DPOA-HC document is legally authenticated in the chart.
- CRequest that the eldest child sign a formal consent override form to authorize the continuation of surgical preparations.
- DAdminister a structured cognitive assessment to formally validate whether the client currently lacks decision-making capacity.
Answer
Halt all preoperative interventions and immediately notify the attending surgeon of the client's verbal refusal.
The correct action is to halt the preoperative interventions and notify the attending surgeon. Clients have the fundamental right to refuse medical treatment at any time, even after initially providing consent. A durable power of attorney for healthcare (DPOA-HC) is only activated when a client is deemed to lack decision-making capacity by a healthcare provider. Because this client is able to accurately articulate the risks and benefits of the surgery, they currently demonstrate capacity. The practical nurse must advocate for the client's expressed wishes and escalate the situation to the provider, who will address the family.
Step-by-Step Solution
Key Concept
Client Rights and Advocacy: Informed Refusal and Advance Directives