Preoperative Care

A missed allergy, an unreported herbal supplement, or an undetected cardiac murmur before surgery can turn a routine procedure into a crisis. The preoperative assessment is where you catch what no one else asked.

Preoperative assessment is the systematic baseline data collection that determines a patient's surgical risk and readiness. You gather a comprehensive health history: current medications (including OTC, herbals, and supplements), allergies with documented reaction type, previous anesthesia experiences (personal and family history of malignant hyperthermia), substance use (alcohol, tobacco, recreational drugs — all alter anesthesia response), and existing comorbidities. Physical assessment establishes the baseline you'll compare everything to postoperatively — vital signs, heart and lung sounds, neurovascular status, skin integrity, and cognitive function. Key lab work to verify before surgery includes CBC, BMP (especially potassium and glucose), coagulation studies (PT/INR, aPTT), type and screen, and urinalysis. Abnormal values require provider notification before proceeding. You confirm NPO status — typically nothing by mouth for 6-8 hours for solids (8 hours for fatty/heavy meals) and 2 hours for clear liquids per ASA and facility guidelines. You verify that informed consent is signed and on the chart, document the operative site marking (verified with the patient awake), remove jewelry, dentures, prosthetics, and nail polish (to monitor capillary refill and pulse oximetry). A preoperative checklist is completed and signed, confirming all elements are addressed before handoff to the OR team.

Key Distinctions

Don't confuse preoperative assessment (baseline data collection and risk identification) with preoperative teaching (education about what to expect, coughing/deep breathing, incentive spirometry) — assessment finds the problems, teaching prepares the patient. Students often overlook herbal supplements like ginkgo, garlic, and ginseng that increase bleeding risk; these must be stopped at least 2 weeks before surgery. NPO means nothing — not even chewing gum — unless specifically ordered otherwise.

Clinical Pearl

Think 'MAAL' before the OR: Medications reviewed, Allergies verified with reaction type, Abnormal labs reported, Last oral intake confirmed. Miss one and the case shouldn't go.

Preoperative Teaching

Preoperative teaching is the nurse's responsibility and covers what the patient needs to know, do, and expect before, during, and after surgery. Timing matters: teaching should occur at least 1–2 days before elective surgery when possible, because high anxiety on the day of surgery impairs retention. Content falls into four domains. (1) Procedural information — what will happen and the expected timeline. (2) Sensory information — what the patient will feel, hear, and see (e.g., recovery room sounds, sore throat from intubation). (3) Psychomotor skills — deep breathing with incentive spirometry (sustain inspiration for 3–5 seconds, 10 times per hour while awake), coughing and splinting the incision with a pillow, leg exercises (ankle circles, quadriceps sets, foot pumps every 1–2 hours), and early ambulation expectations. (4) Behavioral expectations — NPO timing per facility protocol and current guidelines (e.g., clear liquids may be allowed up to 2 hours before anesthesia per ASA guidelines), medication instructions (which home meds to take or hold the morning of surgery), and when to remove jewelry, dentures, and nail polish. Always assess literacy level, language needs, and cultural considerations before teaching. Document that teaching occurred AND that the patient demonstrated understanding through teach-back.

Key Distinctions

Don't confuse preoperative teaching (nurse-driven education about exercises, expectations, and self-care) with informed consent (provider-driven explanation of risks, benefits, and alternatives). Students often list deep breathing exercises under postop nursing interventions, but the teaching happens preoperatively — postop you're reinforcing and supervising what was already taught. Teach-back is the gold standard for verifying comprehension, not simply handing the patient a brochure and documenting 'education provided.'

Clinical Pearl

Think 'BS-TILE' — Breathing exercises, Splinting, Turning, Incentive spirometry, Leg exercises, Early ambulation. Teach it before surgery so they can do it after.