A client with end-stage renal disease is admitted to a medical-surgical unit. The client recently established an advance directive designating their adult child as the durable power of attorney for healthcare (DPOA). The client, who is fully alert and oriented, tells the practical nurse, "I do not want to go to my hemodialysis treatment today or ever again." The adult child arrives shortly after and demands that the nurse arrange for transport to dialysis, stating, "I am the DPOA, and I make the medical decisions now." Which action should the practical nurse take?
- Acknowledge the client's refusal, withhold transport to dialysis, and promptly report the situation to the registered nurse.Cevap
- BExplain the specific physiological risks of stopping hemodialysis to the client to ensure the refusal is fully informed.
- CConduct a formal cognitive capacity assessment to verify that the client is mentally competent to decline life-sustaining care.
- DEscort the adult child into the public hallway to review the client's advance directive documents and resolve the conflict.
Cevap
The correct action is to acknowledge the client's refusal, withhold transport to dialysis, and promptly report the situation to the registered nurse.
A Durable Power of Attorney for Healthcare (DPOA) is an advance directive that only becomes active when a client is deemed medically incapacitated or unable to make their own decisions. Because the client in this scenario is fully alert and oriented, they retain the legal right to refuse any medical treatment, including life-sustaining treatments like hemodialysis. The practical nurse must act as an advocate by respecting the competent client's current wishes, preventing the transport to dialysis, and immediately escalating the situation to the registered nurse and healthcare provider to officially address the informed refusal.
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Advance Directives and Client Refusal of Treatment
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