An older client with advanced dementia refuses a blood transfusion. Which action should the nurse take?

An older client with advanced dementia refuses a blood transfusion. Which action should the nurse take?

• A. Consult mental health.
• B. Document the treatment as refused.
• C. Explain to the client why the blood is necessary.
• D. Administer the blood after the client calms down.

Answer: (B)

Respecting a patient’s autonomy means honoring a treatment refusal when the patient has decision-making capacity and understands the consequences. In dementia, capacity can vary, so the nurse should first determine if the client can comprehend what a blood transfusion involves, articulate a clear choice, and appreciate the outcomes. If capacity is present and the client clearly refuses, the decision is respected and documented, with the physician informed and ongoing monitoring for any change in status. If capacity is lacking, involve a legally authorized surrogate and document that surrogate’s decision. Coercing or trying to persuade the patient, or administering the transfusion after “calming down,” would violate autonomy. Therefore, once a competent refusal is established, the appropriate action is to document the refusal.

Respecting a patient’s autonomy means honoring a treatment refusal when the patient has decision-making capacity and understands the consequences. In dementia, capacity can vary, so the nurse should first determine if the client can comprehend what a blood transfusion involves, articulate a clear choice, and appreciate the outcomes. If capacity is present and the client clearly refuses, the decision is respected and documented, with the physician informed and ongoing monitoring for any change in status. If capacity is lacking, involve a legally authorized surrogate and document that surrogate’s decision. Coercing or trying to persuade the patient, or administering the transfusion after “calming down,” would violate autonomy. Therefore, once a competent refusal is established, the appropriate action is to document the refusal.