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Difficulty: MediumInformed Consent

The surgical team is preparing an older adult client for an urgent appendectomy. The operating surgeon has reviewed the procedural risks, benefits, and alternatives with the client. When the registered nurse (RN) presents the informed consent document for a signature, the client exhibits resting hand tremors, profuse diaphoresis, and an elevated heart rate. The client pushes the paperwork away, stating, 'I cannot look at this until I get my morning vodka. I drink a pint every day to steady my nerves.' What is the most appropriate action for the RN to take?

  1. A
    Reassure the client that the physical symptoms are a normal response to preoperative anxiety and encourage them to sign the form.
  2. B
    Attribute the client's confusion and hand tremors to expected physiological aging changes and assist the client in signing the document.
  3. Withhold the consent document and immediately notify the surgeon that the client's capacity to provide legal consent is impaired.Answer
  4. D
    Instruct the unlicensed assistive personnel (UAP) to remain with the client to obtain the signature while the RN prepares the preoperative medications.

Answer

The most appropriate action is to withhold the consent document and notify the surgeon that the client's capacity to provide legal consent is impaired.
For informed consent to be legally valid, the client must be competent, understand the provided information, and sign voluntarily. A client experiencing acute alcohol withdrawal is cognitively and physiologically compromised, rendering them temporarily incompetent. The RN acts as the client's advocate by recognizing this impairment, halting the consent process, and notifying the healthcare provider so that alternative legal consent (e.g., from a surrogate) can be obtained.

Step-by-Step Solution

1
Assess the client's physical presentation and verbal statements prior to witnessing the signature.
The client exhibits tremors, diaphoresis, tachycardia, and explicitly states a daily heavy alcohol intake requirement.
The RN must verify that the client is signing the consent form voluntarily and possesses the cognitive capacity to understand the procedure.
2
Evaluate the impact of the assessment findings on legal competence.
The symptoms indicate acute alcohol withdrawal, which severely compromises the client's cognitive function and judgment.
A client under the influence of substances, or experiencing acute withdrawal from them, lacks the legal capacity to provide valid informed consent.
3
Determine the appropriate nursing intervention to protect the client's rights.
The RN halts the consent process and communicates the findings to the healthcare provider.
The RN acts as a client advocate. The surgeon must be notified so that consent can be legally obtained from a designated medical power of attorney or next of kin.

Key Concept

Informed Consent Validity and Client Competence
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Topics

Informed Consent

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