An 82-year-old conscious, intubated client in the intensive care unit is scheduled for a bedside tracheostomy. The client has bilateral soft wrist restraints in place to prevent accidental extubation. Earlier, the healthcare provider explained the procedure, and the client nodded in agreement. Because the client was unable to sign the consent form, the provider obtained telephone consent from the client's legally designated healthcare proxy. As the provider prepares the sterile field, the client's heart rate elevates to 135 bpm, and the client vigorously shakes their head 'no' while attempting to push the provider's hands away with their elbows. Which action should the nurse take first?
- AAttempt to calm the client by explaining that the legally designated proxy has already authorized this beneficial procedure.
- BAdminister a prescribed as-needed intravenous sedative to suppress the combative behavior and allow the procedure to proceed.
- Halt the procedural setup and advocate for the client by stating they are actively indicating a refusal of the treatment.Cevap
- DDocument the agitation as normal age-related cognitive decline and instruct the client to lie still for the provider.
Cevap
The nurse's priority is to halt the procedural setup and advocate for the client by stating they are actively indicating a refusal of the treatment.
The core principle of informed consent is that a conscious client retains the right to refuse or revoke consent at any time before a procedure begins. Even though the healthcare proxy provided telephone consent because the client physically could not sign, the client's current non-verbal actions clearly indicate a revocation of that consent. The nurse's primary duty as an advocate is to halt the procedure and ensure the client's immediate refusal is respected, preventing potential battery.
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Anahtar Kavram
The right of a conscious client to revoke informed consent at any time prior to a procedure, even non-verbally, supersedes a surrogate's prior authorization.