Age and Culturally Appropriate Health Assessment Techniques

Guidelines:

• Proper preoperative workup to be completed
• Maximize patient autonomy
• Advanced directive!
  • Suspension of DNR/DNI common before surgery, define the details!
  • Decision makers common
• Identify risk populations
  • Dementia worsens with anesthesia
  • Pressure ulcers
  • Comorbidities

Considerations:

• Mental competency
• Old and young first, to avoid prolonged NPO times
  • facility specific
• Consider pre-admission and overnight stay
• Separation from family can be painful
  • some facilities allow parents for induction
  • Pre-op is a terrible family memory
• Do not give false hope
  • “It will be fine”
  • “Nobody has xyz happen”
• Religious items

Nurse’s Role:

• Ensure complete and present advanced directive
• Compassionate ethical bedside care
• Advocate for patient’s desires in the room
  • OK to request swap if uncomfortable, but this is a request. Patient care will happen empathetically regardless

Pitfalls:

• Patient’s sense of humor masks concerns
  • Often based from anxiety
• Vague suspension of DNR/DNI
• Privacy in pre-op and PACU uncertain

Examples:

• Patient desires family pastor to pre-op before surgery (allowed, patient can refuse to roll back whenever they desire, but rescheduling to a different day may occur)
• No blood products requests from a patient (clarify case-specific relevance, such as bovine implant or donor materials)
  • Include provider!

Linchpins (Key Points):

• Nurse serves as the patient’s link between their wants and the healthcare system