Apex: Professional issues Flashcards
A CRNA in meddle management submits a written complaint to the state board about several other CRNAs that are false and defamatory. Which AANA document could be applied to this situation?
A. Code of ethics
B. Practice guidelines
C. Practice standards
D. Position statements
What is the specific act committed by the CRNA in this question called?
A. Code of ethics
Libel
What are authoritative statements that describe minimum rules and responsiblities for which anesthetits are held accountable?
Practice Standards
*nationwide expected behaviors
*they MUST be adhered to (guidelines SHOULD be adhered to)
what are systematically developed statements to assist proividers in clinical decision making that are comonly accepted within the anesthesia community?
Practice guidelines
*SHOULD be adhered to… but not required
What dictates the principles of conduct and professional integrity that guide the decision-making and** behavior **or nurse anesthetists.
AANA code of ethics
The use of unnecessary invasive preop testing is most likely to put the provider in violation of the principle of:
A. respect for autonomy
B. nonmaleficence
C. beneficence
D. justice
B. nonmaleficence
obligation not to do harm (intentially or unintentialy)
Hippocratic oath - primum non nocere (first do no harm)
What refers to the patients ability to choose without controlling interference by others, and without limitations that prevent meaningtul choices?
Autonomy
What ethical principal is associated with informed consent?
Autonomy
primum non nocere
what does it mean
which principle is it associated with
first do no harm
hippocratic oath
nonmaleficence
Which principle is often applied to the appropriate use of** diagnostic testing** with the inherent risk of false-positive or false-negative results?
nonmalfience
hippocratic oath- primum non nocere
durty to do no harm
preop testing
What is beneficence?
states that providers should** act for the benefit of others**
preventing harm and actively helpipng their patients
*underpns evidence-based interventions
benefits outweigh risks
ahhhhh beneficence = benifits lol
Which ethical principle guides evidence-based interventions
Beneficence
benefits should be demonstratable and clearly outweigh risks
What is distributive justice?
that people under similar circumstances and conditions should be treated alike
giving higher quality care to the CEO of the hospital puts the provider in violation of what principle?
justice
T/F: the ethical principles support the position that medical mistakes must be disclosed to the patient
True
Informed consent for anesthesia should include a discussion of which topics? (select 2)
-Description of the recommended type of anesthetic
-Agreement to undergo the scheduled surgery/procedure
-Risks and benefits of each type of appropriate anesthetic
-pt’s preferences, questions and fears
-Risks and benefits of each type of appropriate anesthetic
-pt’s preferences, questions and fears
6 elements of informed consent
- competence
- decision making capacity
- disclosure of information
- understanding of disclosed information
- voluntary consent
- documentation
What does competence mean?
the patient has the leagal aurthority to consent
What describes the pts ability to decide about specific anesthetia care
Decision-making capcity
competence is that the pt has LEGAL AURTHORITY to consent - like 18yo , or emanicpated minor, ect
Pt got versed before anesthesia consent was signed- whoops. Now what?
proivder may need to arrange a legal, ethical, or psych consult to determine CAPACITY
capacity = ability to DECIDE , decision making CAPACITY
How do you get informed consent on an incapacitated patient?
someone must be delegated as the legal decision maker
in accordance with state law and institutional policy
T/F- the risks of not recieivng anesthetic care is part of the minimum requirements for conset
True
- nature and purpose of proposed anesthtic techniques
- risks, benefits, and s/es of each
- alternatives and their risks/beneiftis/ses
- risks of not getting it at all - pretty obvious i’d think lol
What kind of risks should be included in informed consent?
the common ones and the rare ones if they would result in severe morbidity or mortality
T/F: unlesss developmentally inappropriate, minor children should be included in the informed consent discussion and their agreement should be sought
true
*document “assent”
T/F: in an elective case, a provider has no ethical obligation to proivde inappropriate care or acre associated with unreasibly high risks (ie: jehovah’s witness informed refusal of blood products for a high risk case)
True
byeeeeeee
T/F: family members can be used to translate consent in an emergency
True
this is the only time
T/F: if pt prsents with cognitive impairement, you should use a mini-mental state exam (MMSE) to evaluate
True -lol
and designate a legal decision maker
T/F: if pt prsents with cognitive impairement, you should use a mini-mental state exam (MMSE) to evaluate
True -lol
and designate a legal decision maker
What must an anesthesia provider do to obtain informed consent for epidural placement in a parturient who recently received 50mg of meperidine?
A. review the efficacy of current pain managment
B. Document the pt’s dilation, effacement, and station
C. determine that the pt has sufficient capcity
D. get consent from her husband
C
t/F: state law and facility policies should be consulted when a minor is receiving OB services
True
In a case of maternal-fetal conflict, the provider’s respect for maternal ___________________ may oppose what principle in promoting hte well-being of the mother and fetus
mothers autonomy
may oppose benifience
benifit vs risk
In a case of maternal-fetal conflict, the provider’s respect for maternal ___________________ may oppose what principle in promoting hte well-being of the mother and fetus
mothers autonomy
may oppose benifience
benifit vs risk
How to respond if your mom asks what happens if your in an emergency and cant come do my epidural and I’m in a lot of pain waiting for a long itme?
reassure her that alternativie pain management will be available until an anesthesia provider can get to her
What should the provider do if there is a maternal-fetal conflict?
keep open, non-coercive communication with mom while procuring an ethics consult, referencing hospital policy and reviewing state law
A terminal cancer pt with a DNR presents for a cath placement. Which standard of nurse anesthesia practice has the most immediate relevance to the anesthetists preop activities?
A. Standard 2 on thorough preop assessment and evaluation
B. Standard 3 on plan for anesthetic care
C. Standard 4 on infomed consent and related anesthesia services
D. Standard 13 on wellness
C. Standard 4 on informed consent
reconsideration of pre-exissitng AD is a critical component of the informed consent process bc some events that may occur are responses to the anesthetic and not part of the terminal disease process.
T/F: advnaced directives should be routinely suspended preop
false - they require a detailed discussion