A nurse is caring for an 82-year-old client scheduled for an elective total hip arthroplasty. The client has no baseline cognitive deficits and has an adult child designated as the medical power of attorney (healthcare proxy). The nurse administers a prescribed dose of intravenous midazolam for preoperative anxiety. Thirty minutes later, the surgeon arrives to obtain informed consent. The client is now drowsy, disoriented to place, and unable to recall the proposed surgery. The adult child states, 'My parent is just confused because of their advanced age. I will sign the consent form.' Which action by the nurse is most appropriate?
- AWitness the adult child's signature on the document, as sudden confusion is an expected age-related change that legally activates the healthcare proxy.
- BAsk the client, 'Why are you unable to remember the surgery?' to assess their cognitive baseline before proceeding with the consent.
- Notify the surgeon that the consent process must be delayed until the medication's effects dissipate and the client regains decisional capacity.Answer
- DDelegate the task of reading the consent document aloud to the unlicensed assistive personnel (UAP) to help the client understand the procedure.
Answer
The nurse must notify the surgeon that the consent process must be delayed until the medication's effects dissipate and the client regains decisional capacity.
For informed consent to be legally valid, the client must be competent and free from the influence of mind-altering medications (such as midazolam or opioids). Because this is an elective procedure and the client's incapacity is temporary, the client retains the right to autonomous decision-making once the medication wears off. The healthcare proxy should not sign in this scenario, as the client's baseline is cognitively intact and the incapacity is medically induced and fully reversible. The nurse's duty as a client advocate is to notify the surgeon and ensure the procedure is delayed until the client can legally and voluntarily provide consent.
Step-by-Step Solution
Key Concept
Informed consent requires the client to be legally competent and free from the influence of mind-altering medications; temporary sedation for an elective procedure necessitates delaying consent rather than relying on a surrogate.