Medical Decision Making & Preoperative Procedures — Quick Reference

Power of Attorney (health care) designates a specific person (e.g., Andrea) to make medical decisions when you are incapacitated.
Advanced Directive is a legal document stating treatment preferences if incapacitated (e.g., avoid feeding tube, avoid CPR; may specify use of vasopressors or oxygen).
Both are legal documents; notarization is typically required.
If no POA exists, decision-making defaults to closest appropriate surrogate: spouse, then parents, then siblings/adult children.
If no one is available, the state can appoint a guardian to make medical decisions.
POA and Advanced Directive can include financial decisions if chosen; focus here is health care decisions.

Surgeon’s role: obtain consent for the procedure in the presence of the patient and a witness; surgeon is solely responsible for obtaining consent.
Preoperative nurse: clarifies information, ensures understanding, but does not complete informed consent; consent is within the surgeon’s responsibility.
Time-out (pause for concern) is performed before surgery to verify safety and correct procedure.

Key checks during time-out: correct patient, correct procedure, correct surgical site.
Identification steps: patient states full name as on ID bracelet and at least one identifier (e.g., birthday, medical record number).
Surgeon marks the correct site; if a discrepancy occurs, a time-out is performed to correct the issue.

Collect: age, allergies (latex), medications (including vitamins/herbal supplements), medical and surgical history, prior anesthesia reactions, last oral intake, implants/devices (e.g., pacemakers, dental implants).
Implants: some devices require the manufacturer’s representative presence or special handling; pacemakers may require specific oversight.
Other important factors: nutritional deficiencies, family history, social history, tobacco and alcohol use, mental health history or abuse, support system, and advanced directives.
Latex allergy prompts latex-free surgical environments.

Smoking increases respiratory risk and anesthesia complications.
Alcohol acts as a depressant and can affect respiratory function and perioperative recovery; address in planning.
These factors are considered during preoperative evaluation to optimize readiness for surgery.