Special Preoperative Considerations

Core Concepts

Age-related considerations

Older adults often have multiple chronic conditions, several medications (polypharmacy), and changes in hearing, vision, cognition, skin, and mobility. The nurse verifies every medication and supplement, assesses baseline cognitive and functional status, keeps sensory aids (hearing aids, glasses) available, and protects fragile skin. Confusion in an unfamiliar setting is a risk, so orientation, familiar support, and careful handoff matter. Children need family-centered care: preparation that matches developmental level, a parent or guardian present for consent and support, and attention to fluid balance and temperature regulation, which differ from adults. In both groups, the individual — not the age group — is the unit of care.

Chronic conditions and comorbidity

Common chronic conditions that shape the plan include diabetes, heart disease, hypertension, asthma and COPD, kidney disease, liver disease, and conditions requiring anticoagulation or long-term corticosteroids. The nurse's role: report current status, verify the provider has a plan for each condition (for example, how glucose-lowering medication or anticoagulants will be managed around surgery), and teach the person what to do — including what to report, such as a new cough, chest pain, or glucose readings outside the provider's target range. The nurse never independently holds, adjusts, or adds medications. Laboratory and diagnostic testing is ordered by the provider; the nurse ensures ordered tests are completed and results available.

Substance use and lifestyle history

Smoking, alcohol use, and use of prescription or recreational drugs all affect anesthesia and recovery, but people often underreport them out of shame or fear. The nurse asks nonjudgmentally, explains why it matters (withdrawal risk, altered tolerance to anesthesia or pain medication, effects on healing), and shares the information with the team as appropriate. Alcohol or sedative withdrawal can be dangerous perioperatively, so honesty — encouraged by a nonjudgmental approach — is a safety issue, not a personal one.

Pregnancy

Pregnancy changes nearly every body system, and elective surgery is often deferred until after delivery when possible. When surgery must occur, the team plans for maternal and fetal considerations, and the nurse verifies the provider and anesthesia team know about the pregnancy. Timing and approach decisions belong to the care team.

Language, culture, health literacy, and disability

Effective communication is a safety system. A professional interpreter (in person, by phone, or video) should be used when the person and provider do not share a language — not a family member, who may filter information or lack medical vocabulary. Teaching should match the person's health literacy, verified by teach-back. Cultural, religious, and spiritual needs — preferences about blood products, prayer, or who may be present — should be asked about respectfully and documented. People with disabilities may need adapted education, extra time, or a communication device; the plan accommodates, rather than assumes.

Emergency surgery

Emergency surgery compresses all of this into minutes. The person may not have fasted, may be in pain or distress, may not be able to consent (for example, due to unconsciousness), and may have incomplete history. The team works from whatever information is available — the person, family, prior records, medication lists, and identification — and documents what could not be verified. Special considerations are still applied, but they are prioritized: life-saving treatment comes first, and the team gathers what it can, when it can.

Common Confusions