Preoperative Assessment

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 client'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 client 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 client. 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.