| Author | 13 Posts |
nadiabarati
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Mr. B, a 69-year-old resident of a nursing home, has severe Alzheimer disease. He is dependent on others to carry out all activities of daily living and is incontinent of urine and feces. He does not recognize his family members, and his speech is limited to moaning and crying. He has had fever, a cough producing green sputum and shortness of breath for 48 hours. He is transferred to hospital for treatment of suspected pneumonia. His wishes regarding treatment for pneumonia have not been documented. The nursing home has already notified Mr. B's wife, who is now driving to the hospital and will arrive in about 30 minutes. A. Wait for the wife to give you consent
B. Start Rx as soon as possible
C. Call for his children and ask consent
D. Get consent from nursing home supervisor
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| mjl1717
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Topics: 955
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start Rx
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Smell the coffee! "Is That an Osler move??"
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| nadiabarati
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Is it an emergent case?
How about A or D? Can you exclude them as right choices??
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| msyamp
Forum Fanatic
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start treatment
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If you think you can You can! If you think you cant you are right again!!
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| mjl1717
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In so many words
1) his Alzheimers is NOT new!
2)he has acute infection
3) YOUR A DOC - do the job { forget about he said, she said, hes got. hes demented.} so what?
4)but do no harm.
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Smell the coffee! "Is That an Osler move??"
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| abarbaryan
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If the patient is determined to be incapacitated/incompetent to make health care dicisions, a surrogate dicision must speak for him. If no appropriate surrogate dicision maker is available, the physicians are expected to act in the best interest of the patient until a surrogate is found or appointed. Generally a spouse is the legal surrogate.
answer A
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| nadiabarati
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What if we consider this case as an emergent one? In emergency we don't need consent. IS this case is an emergency one?
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| abarbaryan
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we don't need consent in the following situations as well
1.waiver by patient
2.PATIENT IS INCOMPETENT (as in the case)
3.therapeutic privilege
I think for 69 years old male patient with acute Alzheimer disease a pneumonia could be seen as an emergency situation.
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| nadiabarati
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So the answer is B. Right?
when the patient is incompetent we need to get consent from a close one.
Can you explain the meaning of waiver and therapeutic privilege
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| mjl1717
Forum Hero
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In reference to THIS case----"doc, there is a very sick OLD demented man over there" [with all due respect you cant just twindle your thumbs] - actually I think you could be sued for NOT treating him fast fast. {ill admit medically legally we walk a very thin line] you know what to do treat empirically while you get cultures.
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Smell the coffee! "Is That an Osler move??"
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| nadiabarati
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yes mjl1717. You're totally right. It's an emergent case and we don't need consent and we must start treating him right away. Thanks a lot for correcting me.
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| mjl1717
Forum Hero
Topics: 955
Posts: 5,450
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hope i wasnt too dramatic but most important as you mentioned - [its an acute emergent case with very little time for deliberation]
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Smell the coffee! "Is That an Osler move??"
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| abarbaryan
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therapeutic privilege- in case of unconscious and confused patient physician could deprive patient of autonomy in interest of health
waiver by patient- when patient refuses to get informed consent in advance (doc do what you think is the best )
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