Informed Consent + Pre-op special considerations
When is informed consent revoked?
it can be revoked at any time
Informed consent and cognitive impairment - minor? - emancipated minor? - mentally incompetent? - unconcious? (next of kin is not possible to reach)
minor = the parent or a legally appointed representative or responsible family member may give written consent emancipated minor = minor's decision mentally incompetent = oldest child or legally appointed representative or responsible family member may give written consent unconscious = the true medical emergency may override the need to obtain consent and HCP can begin treatment
How can consent be granted if physical appearance isn't possible?
over the phone
Pre-op care of a pt who is taking Coumadin (Warfarin)
- assess anti-coagulation studies and risk for bleeding - anticipate need for blood transfusion - if annual risk for thromboembolism is low, warfarin therapy may be able to be withheld for 3 days before the procedure without bridging - STOP 5 DAYS BEFORE - POTENTIALLY SWITCH TO HEPARIN 3 DAYS BEFORE
What is the significance of informed consent?
- creates trust between pt and HCP by ensuring good understanding - reduces risk for pt AND HCP (pt weighs their risks and options = less risk of legal action against HCP)
What are some herbs that affect bleeding time in the surgical client?
- garlic - vitamin E - ginkgo - fish oil - all supplements should be stopped for 1 week
Pre-op care of a smoking client?
- gather info about tobacco use - encourage pt to stop smoking at least 6 weeks before surgery - depending on the patient's H&PA, baseline pulmonary function tests and arterial blood gases may be ordered pre-op - anticipate nicotine patch post-op and withdrawal - capillary bed/tissue oxygenation is decreased which affects healing (surgeons may not want to operate)
What are some surgeon's responsibilities prior to surgery?
- obtain pt's consent for surgical treatment - re-educating pt on surgery when necessary pre-op
Pre-op care of a pt who consumes alcohol and/or recreational drugs
- the pt may have hepatic dysfunction and may have an increased periop risk for clotting abnormalities and adverse reactions to drugs - consider history of jaundice, hepatitis, alcohol abuse, or obesity - know the half life of drugs like marijuana - record and document how much they use (needed for anesthesia control and post-op pain control) - if not a week, preferably no drugs within 48H
What is a nurse's responsibility in informed consent?
- witness the signing of the documents (validate that all requirements above were met) - pt advocate! pt understands the information and implications of consent, consent is voluntary - inform surgeon if pt appears to not fully understand information When
What are the 3 conditions that must be met for consent to be valid?
1) - diagnosis - nature and purpose of the proposed treatment - risks and consequences of the proposed treatment - probability of a successful outcome - availability, benefits, and risks of alternative treatments - prognosis if treatment is not instituted 2) the pt must show a clear understanding of the information BEFORE receiving pre-op sedative drugs (surgery will be postponed or cancelled if the pt is sedated prior to signing consent to surgery 3) recipient must give consent voluntarily, not persuaded or coerced
What is informed consent?
an active, shared decision-making process between the HCP and the recipient of care
