Hypothetical situation - What's right?

[nptobee]

Here's a situation I thought about today.

A patient comes in for follow-up after having had a large polyp removed 6 months ago. Pt is a 24 y/o female. On this visit she tell the nurse that she's pregnant, but plans to terminate the pregnancy, so she can still have sedation. Your hospital uses propofol, but anesthesia won't touch her as she could change her mind about the termination. Would you as a nurse administer conscious sedation? My drug book says Versed is contraindicated in pregnancy. Fentanyl or Demerol to be used with caution. Situation would be scary to me, and I would refuse.

So would you do it?

Do you think it's appropriate to be reprimanded for refusing to do it?

Thanks.

[sirI, MSN, APRN, NP]

Here's a situation I thought about today.

A patient comes in for follow-up after having had a large polyp removed 6 months ago. Pt is a 24 y/o female. On this visit she tell the nurse that she's pregnant, but plans to terminate the pregnancy, so she can still have sedation. Your hospital uses propofol, but anesthesia won't touch her as she could change her mind about the termination. Would you as a nurse administer conscious sedation? My drug book says Versed is contraindicated in pregnancy. Fentanyl or Demerol to be used with caution. Situation would be scary to me, and I would refuse.

So would you do it?

Do you think it's appropriate to be reprimanded for refusing to do it?

Thanks.

Hello, nptobee,

First need a clarification: I do not understand what procedure she is to have? You said this was a follow up visit AFTER a polyp removed (where.....cervix/GI)?

[nptobee]

Sorry, Siri. I was thinking it was a f/u after having a polyp removed during a colonoscopy.

[sirI, MSN, APRN, NP]

Sorry, Siri. I was thinking it was a f/u after having a polyp removed during a colonoscopy.

So, this woman is having a f/u polypectomy?

This is an elective procedure.

So, the question is, is this to potentially save her life? Or, is it strictly elective and not really a risk of Ca?

If the latter, the procedure can wait, if she is pregnant.

If the former, does not matter if she is pregnant or not, the procedure must be performed.

Now, the ULTIMATE decision should be made by the phisician and the woman.

I would say, no, it is not the RN/NM place to refuse the sedation based on the fact the woman MAY back out of the termination.

[ZASHAGALKA, RN]

I would say, no, it is not the RN/NM place to refuse the sedation based on the fact the woman MAY back out of the termination.

Of course you have the right to refuse.

A woman has the 'right' to terminate a pregnancy. BUT UNTIL SHE DOES, you have 2 patients.

I agree that if it's life or death, the Mom's health comes first.

Anything else, and the baby's health must also be considered. And a patient advocate advocates for ALL of their patients.

~faith,

Timothy.

[nptobee]

Thank you both for your responses. I was thinking in terms of a lawsuit, or loss of license for giving these medications to a pregnant woman.

[sirI, MSN, APRN, NP]

Thank you both for your responses. I was thinking in terms of a lawsuit, or loss of license for giving these medications to a pregnant woman.

I was just thinking about a hypothetical situation where the woman is pregnant and the physician and the woman have collectively decided to do the surgery.

I would still say the nurse should not refuse to give sedation just because the woman may back out of the termination.

[MQ Edna]

I think the RN should write a progress note stating that the doctor and patient discussed the fact that the women was pregnant, all information was given to pt concerning potential side effects and that the women made the informed decision to continue with sedation. I would say that the MD should be the person to write this, but I know that probably wouldnt occur.

I then being the type of person I am, would make a copy of this note and keep in your own file.