An older adult fell at home and fractured a hip, which requires ...

[lilldybug07]

An older adult fell at home and fractured a hip, which requires surgical repair. After admittance to the emergency department, the client was given sedation for pain before a surgical permit was signed. What should be done to obtain consent?
 
  1. The physician should have the client's wife sign the consent form.
  2. The physician should wait until the effects of the medication wear off and have the client sign the form.
  3. Because the client has been medicated, the nurse should thoroughly explain the consent form to the client.
  4. This would be considered an emergency situation and consent would be implied.

Question 2

A client being prepared for an invasive procedure questions some of the terminology in the consent form. Which response should the nurse make?
 
  1. Just sign the form, and I'll make sure your physician talks to you before he begins the procedure.
  2. I'll explain whatever you don't understand.
  3. You should have asked your physician when he was in here.
  4. I'll call your physician back in the room to answer your questions.

[jliusyl]

Answer to Question 1

Correct Answer: 1
Rationale 1: A client who is confused, disoriented, or sedated is not considered functionally competent and a legal guardian or representative can provide or refuse consent for the client. In this case, because the client was given medication that sedated him, the wife would be appropriate for giving consent for the surgical procedure.
Rationale 2: Waiting until the effects of the medication wear off would not be in the best interest of the client.
Rationale 3: Thorough explanation may or may not matter in this case because the client is considered functionally incompetent. Besides, it is the physician's responsibility to obtain informed consent.
Rationale 4: Implied consent may be used in a medical emergency, but in this case, there is an appropriate option available.

Answer to Question 2

Correct Answer: 4
Rationale 1: If the client has questions, he should not sign the form. These questions require the physician's attention before the consent is signed.
Rationale 2: If the client has questions, he should not sign the form, and it is not the nurse's responsibility to answer the questions.
Rationale 3: Telling the client what he should have done is demeaning and not an appropriate therapeutic response.
Rationale 4: Obtaining informed consent for specific medical treatment is the responsibility of the person who is going to perform the procedure, in this case the physician. Informed consent suggests that the client has been given complete information, including benefits, risks, and alternatives if the treatment is not given. An element of informed consent is that the client must be given enough information to be the ultimate decision maker. If not, it is the physician's responsibility to make sure the client's understanding is clear. It is important that the person obtaining the consent (the physician in this case) answer the client's questions.