A client with a mild exacerbation of chronic obstructive pulmonary disease is resting in bed. The client is alert and fully oriented, and has already signed the healthcare provider's informed consent document for a scheduled thoracentesis. The client's adult child, who is the designated durable power of attorney for healthcare (DPOA-HC), arrives on the unit, demands the procedure be canceled, and requests to read the client's medical record. Which actions should the practical nurse (PN) take? (Select all that apply.)
- Inform the adult child that their medical decision-making authority only takes effect if the client loses capacity.Answer
- Ask the client privately if they wish to share their medical information with the adult child.Answer
- CAllow the adult child to review the medical record since they are the legally designated healthcare proxy.
- DExplain the detailed risks and alternative treatments for the thoracentesis to the adult child to resolve the conflict.
- ENotify the charge nurse that this client must be reassigned to a registered nurse due to the family dispute.
- FPrepare to apply bilateral soft wrist restraints if the client becomes agitated by the adult child's demands.
Answer
The correct actions are to inform the adult child that their proxy authority is not currently active and to privately ask the competent client if they wish to share their medical information.
When a client is alert and oriented, they retain full autonomy over their healthcare decisions and the right to medical privacy. A durable power of attorney for healthcare only becomes active when the client loses the capacity to make decisions. Therefore, the nurse must advocate for the client by clarifying this legal boundary to the family and by securing the client's explicit permission before disclosing any protected health information.
Step-by-Step Solution
Key Concept
Client autonomy, confidentiality (HIPAA), and the activation requirements for advance directives (DPOA-HC).