A 45-year-old client is admitted to the emergency department with a ruptured appendix and requires urgent surgery. Thirty minutes ago, the client received 2 mg of intravenous hydromorphone for severe pain. The surgeon explains the procedure, risks, and alternatives to the client and their spouse, who is the client's legally designated healthcare proxy. The client is lethargic but accurately repeats the surgical information and states, "I understand the risks. I want the surgery. Give me the pen to sign." Which action by the nurse is legally and ethically required?
- Withhold the consent form from the client and obtain the signature from the spouse.Answer
- BWitness the client's signature on the consent form, documenting their demonstrated understanding of the procedure.
- CAdvise the surgeon to document implied emergency consent to prevent any delays in surgical intervention.
- DRequest an immediate psychiatric consultation to formally determine the client's decision-making capacity.
Answer
The nurse must withhold the consent form from the client and have the spouse sign it, as the client's legal capacity is temporarily impaired by the narcotic medication.
The correct action is to obtain the signature from the spouse. Informed consent requires that the client be voluntarily participating, fully informed, and competent. While this client is informed and willing, the administration of intravenous hydromorphone—a narcotic analgesic—renders them temporarily legally incompetent to sign legal documents. In this situation, decision-making authority immediately falls to the legally designated healthcare proxy (the spouse), who is present and able to consent on the client's behalf.
Step-by-Step Solution
Key Concept
Informed Consent and Chemical Impairment