HCA322 Week 1 Way point Assignment Informed Consent

User Generated

Ongpng09

Health Medical

HCA322

ashford university

Description

Waypoint Assignment

Informed Consent


Below are four examples (see attached documents) of commonly used informed consent forms.

  • Review one of them and identify the five requirements within that consent form; explain where and how each element is noted within the actual form itself.
  • Then, analyze the purpose for such consent forms from both the patient’s and organization’s viewpoints.

Your paper should be two to three pages in length, excluding the title and reference pages; include at least two scholarly sources, in addition to the text; and be written in APA format.

Carefully review the Grading Rubric (Links to an external site.)Links to an external site. for the criteria that will be used to evaluate your assignment.

Unformatted Attachment Preview

ANESTHESIA CONSENT FORM Because you, in consultation with your surgeon, have decided to have surgery requiring anesthesia, IT IS IMPORTANT THAT YOU, THE PATIENT, READ THIS CONSENT FORM CAREFULLY. General anesthesia involves making the patient unconscious using intravenous drugs (such as sedatives, narcotics, and muscle relaxants) and inhalational agents (such as nitrous oxide, oxygen, and anesthetic gases). This frequently involves the use of a breathing tube, which is inserted into the windpipe to insure proper breathing while you are under anesthesia. It is not possible to inform you of every agent to be used or dosage to be given since this is determined by the patient's reactions and the needs of surgery. Side effects and complications of general anesthesia are relatively uncommon, but can occur. While it is impossible to advise you of every conceivable complication, some possible examples are; Soreness of the throat and hoarseness are very common occurrences. Aspiration (inhaling stomach contents into the lungs), asthma attacks, and Pneumonia. Nerve injuries and possible weakness or paralysis. Allergic-type reactions leading to cardiac arrest and death. Nodules, polyps, or other damage to the vocal cords or windpipe. Possible traumatic damage to larynx (voice box), pharynx (throat), esophagus, lung or surrounding structures. Blood transfusions may be required. If so, there is some risk of hepatitis, AIDS, or other infections or reactions. No tests exist which can prevent every possibility of blood infected with hepatitis or AIDS being transfused. Rarely, there may be recall of events during the procedure. This is more common during anesthesia for cesarean section, heart and emergency surgery. Sometimes dreams during anesthesia are confused with recall of real events. A breathing machine may be required after surgery, which could lead to damage to the windpipe. Medical complications involving damage to the eyes, heart, lungs, and circulatory system such as blindness, stroke, blood clots, abnormal heart rhythms, phlebitis, collapsed lung, and heart attack. Possible traumatic injury to the jaw which may include dislocation, arthritis, temporomanidibular joint (TMJ) disorder or chronic pain. Teeth and dental prosthetics may become loose, broken, or dislodged, especially if loose or in poor repair regardless of the care provided by the anesthesiology provider. By signing this consent you are acknowledging that your anesthesia providers and Martin Memorial Health Systems will not be liable for any dental damage or repairs. MAC (Monitored Anesthesia Care): MAC is not General Anesthesia. MAC involves local anesthesia or nerve blocks performed by the surgeon, with monitoring of the patient's vital signs and selection and administration of sedatives and tranquilizers by the anesthetist. Unlike General Anesthesia, the patient maintains their heart and lung function without direct support or intervention on the part of the anesthetist. The patient is usually very sedated, but may still be able to hear and respond to their medical providers and remembers some or all of their experience. In surgery of the eye, sometimes the anesthesiologist will numb the eye with a nerve block and also provide Monitored Anesthesia Care. The potential complications or side effects during MAC are the same as those reviewed above and below for General Anesthesia and Regional Anesthesia. Regional Anesthesia: Regional Anesthesia involves one of a number of methods for producing numbness in the area of surgery and is performed by the anesthesia provider. These methods include; Local: Local anesthesia is injected into and around the area of the surgery to produce numbness Nerve Block: A nerve block involves the injection of local anesthetic around the major nerves going to the area of surgery to produce numbness. Intravenous regional: This technique involves the injection of a local anesthetic into a vein in the arm or leg and keeping it there using a tourniquet, causing the arm or leg to get numb. Spinal: Spinal anesthesia involves injecting a local anesthetic directly into the fluid surrounding the spinal cord in the back. Epidural:Epidural anesthesia involves injecting a local anesthetic directly outside the spinal canal in the epidural space. This is done in the back directly through a needle and/or by threading a plastic tube (catheter) into the epidural space. The needle is then removed, leaving the catheter in place. Local anesthetic agents and/or narcotics are then injected through the catheter. This catheter may be used postoperatively for pain control. The intention of regional anesthesia is to produce numbness in the area of surgery. Like Monitored Anesthesia Care, regional anesthetic methods are usually supplemented by sedatives and tranquilizers which cause drowsiness or sleep. The patient may still be able to hear and respond to their medical providers and remembers some or all of his/her experience. In the vast majority of cases, these techniques are safe, effective methods of providing surgical anesthesia. HOWEVER, SOMETIMES THE ANESTHESIA IS NOT ADEQUATE OR WEARS OFF AND SURGICAL ANESTHESIA MUST BE OBTAINED BY OTHER METHODS INCLUDING GENERAL ANESTHESIA. Side effects and complications of regional anesthesia are relatively uncommon, but can occur. It is impossible to advise you of every conceivable complication, but some possible complications are as follows: Side effects: Swelling, tenderness, bleeding, and bruising at injection site, nausea/vomiting. Very uncommon: Shock or extreme fall in blood pressure, convulsion/seizure. Extremely rare: Nerve damage resulting in numbness, tingling and/or paralysis, which may be temporary or permanent. Respiratory arrest, cardiac arrest/death, allergic reactions to drugs. in the case of eye blocks, blindness is possible. In addition to the above list, spinal/epidural anesthesia may also have the following side effects and complications: Side effects: Mild to moderate fall in blood pressure, headache. Very uncommon: Headache from a "wet tap" (spinal tap) during epidural which may be severe enough to require another epidural for treatment. Headache can also occur after spinal anesthesia, shock or extreme fall in blood pressure and very slow heart rate, high spinal anesthesia (anesthesia level is too high) requiring breathing assistance. Extremely rare: Broken epidural catheter. Epidural hematoma (blood clot around spine). Infection of the spine or meningitis. Paralysis, which may be permanent, and include loss of bowel/bladder control. Emergency surgery of the spine to prevent meningitis or paralysis. In order to minimize the possibility of aspiration, the patient is required not to eat or drink anything for a period of time before surgery. In elective cases, this is usually from midnight prior to surgery. It is extremely important not to eat or drink anything during this time because aspiration of undigested food or of significant quantities of stomach contents can lead to severe pneumonia, respiratory failure, and death. I understand that part of the anesthesia process may require the insertion of special monitoring and /or fluid lines, such as an arterial line, central venous line or Swan Ganz catheter. This will be discussed with you prior to insertion by the Anesthesia personnel. I understand that the surgeons will be occupied solely with the surgery and that the administration, maintenance, and termination of anesthesia are independent functions and will be supplied by, or under the direction and responsibility of, YOUR ANESTHESIA PROVIDERS, WHICH INCLUDES ANESTHESIOLGISTS AND CERTIFIED REGISTERED NURSE ANESTHETISTS (CRNAs). I have been informed that students may be performing some procedures, such as insertion of fluid lines or performing endotracheal intubation under the direct supervision of an Anesthesiologist. I HEREBY CONSENT TO THE ADMINISTRATION OF ANESTHETICS AS MAY BE CONSIDERED NECESSARY OR ADVISABLE. _______ I have read this form or have had it read to me and fully understand the above consent. I have had the opportunity to have my questions answered to my satisfaction. The undersigned physician has fully explained the nature and expected benefits, alternatives and risks involved in the anesthesia I have chosen. I hereby consent to the administration of anesthetics as may be considered necessary or advisable. ________As the patient's designated health care surrogate/proxy I have read this form or I have had the opportunity to have the form read to me and fully understand the above consent. I do not have any questions for the anesthesiologist. I hereby consent to the administration of anesthetics as may be considered necessary or advisable. CONTACT NAME & NUMBER _____________________________________________ ______________________________________________ ________________ Signature of Patient Date/Time ______________________________________________ Witness to Signature _______________________________________________ __________________ Signature of Individual with authority to sign State Relationship _______________________________________________ __________________ Witness to signature Date/Time __ "Language Line" SM used to interpret consent form for patient. I hereby certify that the patient or one authorized to act in his/her behalf has been informed, in lay terms understandable to the patient of the nature of the anesthesia procedure, the alternatives as to treatment, and the consequences of and risks to the patient inherent or associated with the procedure and anesthesia. ________________________________________________ _________________ Physician Signature Date /Time MARTIN MEMORIAL HEALTH SYSTEMS STUART, FLORIDA ANESTHESIA CONSENT RM055 New 10/05 G/Consent Forms/anesthesia 055 Rev 12/30/10; 1/18/10; 3/14/11; 7/11; 6/12 REVISIONS MADE TO THIS CONSENT MUST BE APPROVED BY RISK MANAGEMENT. PPATIENT LABEL BLOOD TRANSFUSION CONSENT / REFUSAL I have been fully informed of my medical condition by my physician and I have been advised that I may need blood transfusion therapy in the course of my treatment. The amount of blood I am given will be determined by my treating physicians, depending on my need. I understand that blood is administered intravenously with sterile equipment. Blood and blood components are provided to Martin Memorial Health Systems by the Central Florida Blood Bank. The blood is supplied by the community volunteer donor pool. The blood and blood products are tested and screened for infectious diseases by the Central Florida Blood Bank and by the Martin Memorial Health Systems Blood Bank. The testing is done in accordance with the American Association of Blood Banking, which is regulated by the FDA. I understand that blood transfusion therapy is a common procedure and that it is the only medical treatment which effectively and rapidly replaces excessive blood loss. The possible complications of not receiving blood or blood products range from a delay in recovery to death. Though rare, blood transfusion therapy has potential risks such as discomfort at the site of administration, fever, mild skin reactions, swelling, bruising, allergic reactions with symptoms ranging from mild to severe, even death for unknown reasons, heart failure due to circulatory overload, infectious diseases, such as acquired immunodeficiency syndrome (AIDS), viral hepatitis, both of which may be fatal, bacterial contamination with septic and toxic reaction. If blood transfusion therapy is needed for elective surgery, I may choose to give my own blood if I meet the medical criteria for autologous transfusion or I may choose to have blood donated by family or friends with my same blood type for my use. Autologous and designated donor blood must be arranged in advance and these alternative methods of transfusion carry the same risks as those stated above. CONSENT FOR BLOOD TRANSFUSION This information has been explained to my satisfaction and I have been given ample time to ask questions of my physician. I have been advised of the risks, benefits and alternatives by my physician and understand the risks and implications of blood transfusion therapy. I hereby consent to any blood transfusion deemed necessary by my physician. I authorize my physicians and Martin Memorial to disclose health information related to this treatment or procedure to any friend or family member who has accompanied me or who is waiting for me, even if I am competent or available, with the exception of the following: ___________________________________________________________. Previous reaction to blood transfusion? ( ) Yes ( ) No What was the reaction? _____________________________________________________ __________________________________________ ___________________ Patient/Authorized Surrogate or Proxy Signature Date/Time __________________________________________ __________________ Witness Signature Date/Time ================================================================ REFUSAL OF BLOOD TRANSFUSION I have been advised that my physician has recommended a blood transfusion. I request that no blood or blood products be administered to me. I understand that refusal of such treatment has risks which have been explained to me by my physician. These risks may range from a delay in recovery to death. I hereby release my physicians, Martin Memorial Health Systems, and its personnel, from any responsibility or liability for the consequences of such refusal on my part. ___________________________________________ __________________ Patient/Authorized Surrogate or Proxy Signature Date/Time ___________________________________________ __________________ Witness Signature Date/Time □ “Language Line” SM used to interpret consent form for patient. SPECIAL PROCEDURE CONSENT FORM I have read, or have had read to me, and understand the following authorization for ______________________________________________________________________ ______________________________________________________________________ I authorize Dr. __________________________________ to perform the above described procedure or treatment. I have discussed my medical condition, the proposed treatment or procedure, alternatives to this treatment and the risks associated with them with my physician. I have been informed that in the performance of any invasive procedure, there is the potential for damage to my organs, nerves, and blood vessels, allergic reaction, blood clots, inadvertent puncture, laceration, infection, consequent hemorrhage, and very rarely death. I fully understand that it may be necessary to proceed with additional procedures, or possibly surgery, to repair the injury or control and treat the complication. I specifically request my physician to proceed with whatever is deemed medically necessary and request that I be given a full explanation after the effects of sedation have subsided. I agree to the administration of blood or blood products if they are required. (Potential risks of blood transfusions include the risk of hepatitis, AIDS, or other infections or reactions). I agree to the administration of contrast (IV dye) if required. (Potential risk of contrast reaction). I agree that any tissue or parts surgically removed may be disposed of in accordance with the hospital’s accustomed practice. I agree that my physician may permit photographs or video tapes of my procedure or treatment, employing appropriate privacy draping of my person, to record the procedure for the express purpose of medical education or to provide a record to be filed with strict confidence with my medical records. I have been informed that other practitioners may be performing important aspects of the procedure, administering anesthesia or implanting devices that are within their scope of practice. I consent to the observation of my procedure or treatment by individuals for the purposes of medical education and to the presence of a medical representative in the operating/procedure room. I understand medical representative to mean non-medical technician of companies which have furnished operating room/procedural equipment and supplies. During this procedure I may receive MODERATE SEDATION which is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are usually required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The patient is usually very sedated, but may still be able to hear and respond to their medical providers and remembers some or all of their experience. Side effects and complications of moderate sedation are relatively uncommon but can occur. While it is impossible to advise you of every conceivable complication, some possible examples are; • Progression to a deeper level of sedation. Soreness of the throat and hoarseness are very common occurrences • Aspiration (inhaling stomach contents into the lungs), asthma attacks,and pneumonia. • Nerve injuries and possible weakness or paralysis. • Allergic-type reactions leading to cardiac arrest and death. • Nodules, polyps, or other damage to the vocal cords or windpipe. • Sometimes dreams during anesthesia are confused with recall of real events. • Medical complications involving damage to the eyes, heart, lungs, and circulatory system such as corneal abrasions, blindness, stroke, blood clots, abnormal heart rhythms, phlebitis, collapsed lung, and heart attack. • Possible traumatic injury to the jaw which may include dislocation, arthritis, temporomandibular joint (TMJ) disorder or chronic pain. Teeth and dental prosthetics may become loose, broken, or dislodged, especially if loose or in poor repair regardless of the care provided by the provider. By signing this consent you are acknowledging that your providers and Martin Health System will not be liable for any dental damage or repairs. I have had the opportunity to have my questions answered to my satisfaction. I authorize my physicians and Martin Memorial to disclose health information related to this treatment or procedure to any friend or family member who has accompanied me or who is waiting for me, even if I am competent or available, with the exception of the following: ______________________________________________________________________ _____________________________________________ _________________ Patient/Authorized Surrogate or Proxy Signature Date/time _____________________________________________ _________________ Witness Signature Date/time I certify that I have explained the nature, purpose, benefits, risks, complications, and alternatives to the proposed procedure as well as the risks, benefits and alternatives of moderate sedation to the patient or the patient's legal representative. I have answered all questions fully, and I believe that the patient / legal representative fully understand what I have explained. I further certify that I have validated the procedure/site and side and that the correct procedure site has been marked, if indicated, prior to the procedure being performed. The patient has been evaluated and is a candidate for moderate sedation. _____________________________________________ _________________ Practitioner Signature □ “Language Line” SM used to interpret consent form for patient. PATIENT LABEL Date/time MARTIN MEMORIAL HEALTH SYSTEMS STUART, FLORIDA SPECIAL PROCEDURE CONSENT RM058 4/01, 7/07, 10/08, 1/10, 8/11, 5/13 REVISIONS MADE TO THIS CONSENT MUST BE APPROVED BY RISK MANAGEMENT. SURGERY CONSENT FORM DO NOT SIGN WITHOUT READING! I have read, or have had read to me, and understand the following authorization for: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ I authorize Dr. ________________________________________to perform the above described procedure or treatment. I have discussed my medical condition, the proposed treatment or procedure, alternatives to this treatment and the risks associated with them with my physician. I have been informed that in the performance of any invasive procedure, there is the potential for damage to my organs, nerves, or blood vessels. There is also the possibility of an allergic reaction, blood clots, inadvertent puncture, laceration, infection, consequent hemorrhage, dislodgement or displacement of implanted devices, paralysis, and very rarely death. I fully understand that it may be necessary to proceed with additional procedures to repair an injury or control and treat the complications. I specifically request my physician to proceed with whatever is deemed medically necessary and request that I be given a full explanation after the effects of sedation have subsided. I agree to the administration of blood or blood products if they are required. (Potential risks of blood transfusions include the risk of hepatitis, AIDS, or other infections or reactions. I agree that any tissue or parts surgically removed may be disposed of in accordance with the hospital's accustomed practice, which may or may not include utilizing any tissue not needed for my care for general research. No personal information will be shared. I agree that my physician may permit photographs or video tapes of my procedure or treatment, employing appropriate privacy draping of my person, to record the procedure for the express purpose of medical education or to provide a record to be filed with my medical records. I consent to the observation of my procedure or treatment by individuals for the purposes of medical education and to the presence of a medical representative in the operating room. I understand medical representative to mean non-medical technician of companies that have furnished and may assist with operation of operating room equipment and supplies. I have been informed that other practitioners may be performing important aspects of the procedure, such as opening and closing, dissecting tissue, removing tissue, harvesting grafts, transplanting tissue, administering anesthesia, implanting devices and placing invasive lines. I have had the opportunity to have my questions answered to my satisfaction. □ “Language Line” SM used for interpretation. I authorize my physicians and Martin Memorial to disclose health information related to this treatment or procedure to any friend or family member who has accompanied me or who is waiting for me, even if I am competent or available, with the exception of the following: ______________________________________________________________________ ________________________________________ ________________________________ Patient/Authorized Surrogate Or Proxy Signature Date/Time ________________________________________ __________________________ Witness Signature Date/Time I certify that I have explained the nature, purpose, benefits, risks, complications, and alternatives of the proposed procedure to the patient or the patient's legal representative. I have answered all questions fully, and I believe that the patient/legal representative fully understands what I have explained. I further certify that I have validated the procedure/site and side, and that the correct procedure site has been marked, if indicated, prior to the procedure being performed. __________________________________________ __________________________ Practitioner Signature Date/Time MARTIN MEMORIAL HEALTH SYSTEMS STUART, FL SURGERY CONSENT RM056 Rev 11/00 2/01, 6/03, 10/05, 2/06, 3/07, 5/07, 4/08, 01/09; 7/11; 1/12; 5/12 G/Consent Forms/surgical consent 056 REVISIONS MADE TO THIS CONSENT MUST BE APPROVED BY RISK MANAGEMENT. Patient Label
Purchase answer to see full attachment
User generated content is uploaded by users for the purposes of learning and should be used following Studypool's honor code & terms of service.

Explanation & Answer

please find the attached file. i look forward to working with you again. good bye

Running head: ANESTHESIA CONSENT FORM

Informed Consent
Name
Institution
Course
Tutor
Date

1

ANESTHESIA CONSENT FORM

2
Informed Consent
Introduction

Informed consent refers to the process of getting permission before conducting a health
care intervention on a patient; suffering from some form of illness. For example, a healthcare
specialist may request patient to consent in order to be accorded therapy. The process of
conducting an informed consent is done while abiding by guidelines from the fields of medical
ethics and research ethics. Informed consent is reached upon a clear appreciation and
understanding of the facts, implications and consequences of an action; being determined by the
ability to respect personal dignity of the patient. In order to conduct an informed consent, the
individu...


Anonymous
Really useful study material!

Studypool
4.7
Trustpilot
4.5
Sitejabber
4.4

Similar Content

Related Tags