You are preparing a child for IV conscious sedation before the repair of a facial laceration. What information should you report immediately to the physician?
A. The child suddenly pulls out the IV
B. The parent is not sure regarding the child's tetanus immunization status
C. The parent wants information about the IV conscious sedation
D. The parent's refusal of the administration of the IV sedation
Correct Answer: D. The parent’s refusal of the administration of the IV sedation.
The refusal of the parents is an absolute contraindication; therefore the physician must be notified. But the autonomy of parents is very obviously different from the autonomy of patients to make decisions for themselves. While adult patients are generally thought to have an absolute right to refuse medical treatment for themselves, we don’t usually think that parents can refuse all medical treatment for their children.
Option A: The RN can reestablish the IV access. Parents’ views might, at least in some circumstances, influence whether or not treatment would be in a child’s best interests. Nurses and doctors are able to administer fluid directly into the veins using IV therapy. IV therapy is a relatively simple process that can be performed by nurses, but there are serious complications associated with it.
Option B: Tetanus status can be addressed later. Tetanus immunization is part of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations. Kids usually get: a series of four doses of DTaP vaccine before 2 years of age. another dose at 4–6 years of age.
Option C: The RN can provide information about conscious sedation. Identifying teachable moments in clinical practice is an effective way to increase workplace learning with all nurses playing a role, not just nurse educators.
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