Author Question: An older adult with heart failure and mild dementia states the intent to refuse low sodium diet and ... (Read 103 times)

vicotolentino · **on:** Jul 11, 2018

An older adult with heart failure and mild dementia states the intent to refuse low sodium diet and diuretics, stating: It's important to me to live free, without restrictions on what I eat. The family is supportive. Which action, by the nurse

should be done first?

A) Assure that the client understands the consequences of this decision.
B) Discuss this decision with the older adult's family to plan for the future.
C) Document the client's wishes in the plan of care.
D) Notify the primary health care provider of the client's wishes.

Question 2

An older adult client with urosepsis has become nonresponsive. The nurse is to identify the appropriate person to sign the consent forms for an invasive medical procedure. Which of the following actions by the nurse is appropriate?

A) Find the older adult's family member to sign the consent.
B) Inform the health care provider that no consent can be obtained.
C) Move forward with guardianship as the client is incompetent.
D) Review the chart for a health care power of attorney.

kthug · **Reply #1 on:** Jul 11, 2018

Answer to Question 1

Ans: A
All of these actions should be done; however, the primary concern is that the nurse assess the client's understanding of the consequences. During mild-to-moderate stages of dementia, assessment of decision-making ability is based on the person's ability to describe the importance or implications of the choice on his or her future health. Medical decision making is a complex process in which information is shared between clients and clinicians and among family and others who are affected by the outcomes.

Answer to Question 2

Ans: D
The client, at this time, does not have the decision-making capacity to sign consents. Guardianship is a permanent option that is used only when a person has been declared incompetent. When the client does not have the decision-making capacity to sign consents, the durable power of attorney for health care should do so. If there is no power of attorney, the nurse needs to follow the institutional protocol for obtaining consent.