1. What should Mr. J know if his consent for surgery is to be truly informed?

Information that may be included to be revealed:

a. The name of your condition and procedure or treatment that the health care provider
recommends.
b. Patient is expected to be informed of the risk of surgical interventions
c. Pre-operative informed consent requires that the procedures are properly explained that the
patient understands the procedures and their risks, and agrees to undergo them voluntarily
d. One reason for taking informed consent is that it provides assurance that the patient is
neither deceived nor coerced, at legal age, in sound mind and not under the influence of
drugs or any mind-altering substances prior to signing of informed consent.
As much as possible the information to be shared should be stated in vernacular or at the level
of understanding of the patient.
Informed consent is the process in which a health care provider educates a patient about the
risks, benefits, and alternatives of a given procedure or intervention. The patient must be competent to
make a voluntary decision about whether to undergo the procedure or intervention. 

Informed consent is both an ethical and legal obligation of medical practitioners in the US and
originates from the patient's right to direct what happens to their body. Implicit in providing informed
consent is an assessment of the patient's understanding, rendering an actual recommendation, and
documentation of the process.

The Joint Commission requires documentation of all the elements of informed consent "in a
form, progress notes or elsewhere in the record."

The following are the required basic elements for the process of documentation of the informed
consent discussion:

(1) the nature of the procedure

(2) the risks and benefits and the procedure
(3) reasonable alternatives
(4) risks and benefits of alternatives
(5) assessment of the patient's understanding of elements 1 through 4.

Signing informed consent means:

 You have received all the information about your treatment options from your health care
provider.
 You understand the information and you have had a chance to ask questions.
 You use this information to decide if you want to receive the recommended treatment option(s)
that have been explained to you. Sometimes, you may choose to receive only part of the
recommended care. Talk to your health care provider about your options.
 If you agree to receive all or some of the treatment options, you give your consent (agree) by
signing a consent form. The completed and signed form is a legal document that lets your doctor
go ahead with the treatment plan.
The main purpose of the informed consent process is to protect the patient.

A consent form is a legal document that ensures an ongoing communication process between you and
your health care provider. It implies that your health care provider has given you information about your
condition and treatment options and that you have used this information to choose the option that you
feel is right for you.

You have the right to refuse any and all treatment options. You may also choose other treatment
options that have been presented to you by your health care provider, even if they are not as well
proven as the one your health care provider recommends. You may also refuse part of the treatment
options, without refusing all care.

2. What preoperative teaching must be done to prepare him for surgery?

Bronchoscopy is an invasive procedure that permits the direct examination of the larynx,
trachea, and bronchi using either a flexible fiberoptic bronchoscope or a rigid metal
bronchoscope (see gallery below). It is performed by a trained practitioner (pulmonologist or
thoracic surgeons). A non-invasive approach called virtual bronchoscopy includes a series of
computed tomography (CT) scans to visualize the tracheobronchial tree.

While a flexible fiberoptic bronchoscope is used more often and provides a wider view, the rigid
metal bronchoscope, on the other hand, is a method of choice for foreign body removal,
endobronchial lesion excision, and massive hemoptysis control. A bronchial brush, forceps, and
needle may be passed through the bronchoscope to get samples for cytological determination.
There are 2 types of bronchoscope: flexible and rigid. Both types come in different widths.
A rigid bronchoscope is a straight tube. It’s only used to view the larger airways. It may be used within
the bronchi to:
 Remove a large amount of secretions or blood
 Control bleeding
 Remove foreign objects
 Remove diseased tissue (lesions)
 Do procedures, such as stents and other treatments

A flexible bronchoscope is used more often. Unlike the rigid scope, it can be moved down into the
smaller airways (bronchioles). The flexible bronchoscope may be used to:
 Place a breathing tube in the airway to help give oxygen
 Suction out secretions
 Take tissue samples (biopsy)
 Put medicine into the lungs
 Nursing Responsibilities:
 Secure informed consent. A signed consent form is obtained from the patient.
 Obtain medical history. Ask for any history of allergies to anesthetic agents and list of medicines
the patient is taking.
 Check for NPO status. Withheld food and fluids for 6 to 12 hours prior to the exam to decrease
the risk of aspiration.
 Monitor vital signs. Obtain baseline vital signs and inform the practitioner of any abnormal
findings.
 Provide oral hygiene. Instruct the patient to do oral care and remove any dentures if
appropriate.
 Administer preoperative medications as ordered. Explain to the patient that an IV sedative
such as Propofol may be given as an anesthetic agent.
 Prepare for local anesthesia. If the bronchoscopy is not conducted under general anesthesia,
inform the patient that a topical anesthetic (e.g., Lidocaine) will be sprayed on the pharynx to
prevent coughing and gagging as the scope is passed down through the throat. Explain that the
spray may have a bitter taste to it.
 Relieve anxiety. Reassure the patient that airway blockage won’t occur.
 Prepare emergency resuscitation equipment at the bedside. Laryngospasm and respiratory
distress may occur following the procedure.

3. What risk factors for surgical and anesthetic complications might you anticipate for 
   Mr. J? What are the potential interventions that might minimize the risks? 

The risks of this procedure may include:

 Bleeding
 Infection
 Aspiration
 Hole in the airway (bronchial perforation)
 Irritation of the airways (bronchospasm)
 Irritation of the vocal cords (laryngospasm)
 Air in the space between the lung covering (pleural space) that causes the lung to collapse
(pneumothorax). This happens when the lung is punctured during the procedure.
 Bleeding from the site of the biopsy. Bleeding can happen when tissue specimens are taken
during the procedure.
 Fever. A low-grade fever is usually common but it is not always an indicator of an
existing infection.
 Hypoxemia. Low blood oxygen concentration that occurs during the procedure and the level
usually returns to normal without any intervention.
 Dysphagia
 Respiratory distress
 Embolism
 Atelectasis
 Call your healthcare provider if you have any of the below:
 Fever of 100.4°F (38°C) or higher, or as advised by your provider
 Coughing up significant amounts of blood
 Chest pain
 Severe hoarseness
 Trouble breathing
*Expect patient to complain sore throat after the procedure.

https://www.youtube.com/watch?v=jatBhU6LfmE

4. Based on the assessment data provided, write one or more appropriate nursing  

diagnoses.

Formulating nursing diagnoses could be based on the possible complications of the procedure
mentioned above.