Guide — Perioperative Nursing
Preoperative Nursing Care
The preoperative phase begins when the decision is made to perform surgery and ends when the patient is transferred to the operating room. Thorough preoperative nursing assessment, patient education, and safety verification are essential to preventing surgical complications and ensuring informed, safe care.
11 min read · Perioperative Nursing
Educational use only. This content is intended for nursing students and exam preparation. Perioperative protocols vary by institution and surgical setting. Always follow your facility's preoperative policies and provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Preoperative Assessment
A comprehensive preoperative assessment identifies surgical risk factors, establishes a baseline, and guides perioperative planning. The nurse collects and communicates findings that may alter anesthetic management, surgical technique, or the timing of the procedure.
| Assessment Area | Key Data to Collect | Significance |
|---|---|---|
| Health history | Chronic conditions (cardiac, pulmonary, renal, hepatic, diabetes, coagulopathy), prior surgeries, anesthesia complications, functional status | Identifies increased risk for complications; guides anesthetic choice |
| Allergies | Drug, latex, food, environmental — specific reaction type (rash vs. anaphylaxis) | Latex allergy triggers OR preparation for latex-free environment; drug allergy avoids anaphylaxis |
| Current medications | Prescription, OTC, herbal supplements — especially anticoagulants, antiplatelets, antihypertensives, insulin, corticosteroids, SSRIs | Many drugs require holding or dose adjustment perioperatively |
| Vital signs | Baseline BP, HR, RR, SpO2, temperature, height, weight (for weight-based dosing) | Abnormal values may delay surgery; baseline needed for postoperative comparison |
| Cardiac/pulmonary status | Exercise tolerance, dyspnea, angina, palpitations, active respiratory infection, smoking history | Poor cardiopulmonary reserve = higher anesthesia risk; smoking cessation reduces complications |
| Laboratory and diagnostics | CBC (anemia, thrombocytopenia), BMP (renal function, glucose, electrolytes), coagulation (PT/INR/aPTT), type & screen, ECG (cardiac patients), CXR (pulmonary disease) | Abnormal labs may require correction before surgery |
| Psychosocial | Understanding of procedure, anxiety level, support system, cultural or religious considerations, advance directives/healthcare proxy | Unmanaged anxiety impairs recovery; advance directives must be honored |
NPO (Nothing by Mouth) Guidelines
Purpose: NPO status minimizes the risk of pulmonary aspiration of gastric contents during anesthesia induction — a potentially fatal complication. ASA (American Society of Anesthesiologists) guidelines provide standardized fasting intervals.
| Intake Type | Fasting Interval | Examples |
|---|---|---|
| Clear liquids | 2 hours | Water, clear juice without pulp, carbonated beverages, clear tea or black coffee |
| Breast milk | 4 hours | Infants only |
| Non-human milk / infant formula | 6 hours | Formula, cow's milk |
| Light meal | 6 hours | Toast, crackers — minimal fat/protein content |
| Regular or heavy meal | 8 hours or more | Fried foods, high-fat/protein meals — delays gastric emptying |
| Medications | Varies | Antihypertensives, beta-blockers, anti-seizure drugs typically taken with small sip of water; hold others per anesthesia order |
NCLEX alert: If a patient ate or drank within the NPO window — notify the surgeon and anesthesia provider immediately. Surgery is typically postponed to reduce aspiration risk.
Medication Review — Perioperative Holding
| Drug Class | Typical Management | Rationale |
|---|---|---|
| Anticoagulants (warfarin, heparin) | Hold per provider order — timing depends on procedure and drug; bridge therapy may be needed | Bleeding risk during surgery; INR must reach safe threshold |
| Antiplatelets (aspirin, clopidogrel) | Often held 5–7 days before surgery | Platelet aggregation inhibition increases surgical bleeding |
| NSAIDs (ibuprofen, naproxen) | Often held 3–5 days before surgery | Impair platelet function and renal prostaglandins |
| Antihypertensives (ACE-I, ARBs) | Often held morning of surgery — beta-blockers typically continued | ACE-I/ARBs associated with refractory hypotension under anesthesia; abrupt beta-blocker discontinuation may cause rebound hypertension/tachycardia |
| Insulin | Dose adjustment required — typically 50% of long-acting dose; hold short-acting if NPO | NPO status reduces insulin requirement; hypoglycemia under anesthesia is dangerous |
| Oral hypoglycemics (metformin) | Often held on day of surgery and 24–48 hrs after if contrast used | Metformin + contrast + renal stress = lactic acidosis risk |
| Corticosteroids (chronic use) | Continue — may require stress-dose steroids perioperatively | Adrenal insufficiency risk (HPA axis suppression) under surgical stress |
| Herbal supplements (ginseng, garlic, ginkgo, St. John's Wort) | Hold 1–2 weeks before surgery | Antiplatelet effects, drug interactions, hepatic enzyme induction |
| Anti-seizure medications | Continue — take with sip of water morning of surgery | Seizure threshold reduction if abruptly stopped |
Consent Verification
Nurse's role in consent
The surgeon or provider is responsible for obtaining informed consent — not the nurse. The nurse's role is to: (1) verify the consent form is signed, dated, and complete; (2) confirm the patient understands what they signed; (3) notify the provider if the patient has questions, changed their mind, or appears not to understand.
Witnessing vs. obtaining consent
When a nurse witnesses a consent signature, they attest that the patient signed voluntarily and appeared competent — NOT that the patient was fully informed (that is the provider's responsibility). Nurses should never pressure a patient to sign and must escalate patient concerns to the provider.
If consent is absent, unclear, or not understood: Do not proceed with surgery preparation. Notify the provider immediately. Surgery should not proceed without valid informed consent except in a true emergency.
WHO Surgical Safety Checklist — Sign-In / Time-Out / Sign-Out
Sign-In
Before induction of anesthesia
- ✓Patient identity confirmed
- ✓Surgical site marked and confirmed
- ✓Anesthesia safety check complete
- ✓Allergies reviewed
- ✓Pulse oximeter on and functioning
Time-Out
Before skin incision
- ✓All team members introduced
- ✓Patient identity reconfirmed
- ✓Procedure and site reconfirmed
- ✓Anticipated critical events reviewed
- ✓Antibiotic prophylaxis confirmed
- ✓Imaging displayed
Sign-Out
Before leaving the OR
- ✓Procedure performed confirmed
- ✓Instrument, sponge, needle count complete and correct
- ✓Specimen labeled correctly
- ✓Equipment problems documented
- ✓Key recovery concerns identified
Patient Teaching
Deep breathing and coughing exercises
Teach incentive spirometer use, controlled coughing, and splinting technique (pillow against incision site while coughing). Practice before surgery so the skill is established before pain makes it difficult.
What to expect after surgery
Prepare patient for expected postoperative experiences: IV lines, monitoring devices, oxygen, possible nasogastric tube, urinary catheter, surgical drains, and wound dressings. Reduces anxiety when these are encountered in recovery.
Pain management options
Explain pain scale assessment, patient-controlled analgesia (PCA) if applicable, and the importance of reporting pain before it becomes severe. Reassure that postoperative pain will be actively managed.
Early ambulation
Explain that early ambulation (getting out of bed) — often beginning the evening of or morning after surgery — is expected and important for preventing complications including DVT, pneumonia, and ileus.
Activity and restriction education
Procedure-specific restrictions: lifting limits, wound care, driving restrictions, when to return to work, sexual activity restrictions, follow-up appointments.
When to call the provider
Fever >101°F (38.3°C), increased pain or redness at incision, wound opening, foul odor or purulent drainage, difficulty breathing, leg pain or swelling, or any other concerning new symptom.
Preoperative Checklist — Nursing Responsibilities
Documentation & Verification
- ✦Informed consent: signed, dated, correct procedure and site
- ✦History and physical completed within 30 days (or 24 hrs pre-op for inpatients)
- ✦Advance directive / healthcare proxy confirmed and noted
- ✦Lab and diagnostic results reviewed and communicated to team
- ✦Allergies documented and bracelet applied (include latex if applicable)
- ✦Surgical site marking by surgeon confirmed
- ✦Blood type and screen / crossmatch completed if required
Physical Preparation
- ✦NPO status confirmed — last intake documented
- ✦IV access established (appropriate gauge for anticipated needs)
- ✦Preoperative medications administered per order (anxiolytic, antibiotics)
- ✦Jewelry, nail polish, and prosthetics removed
- ✦Hearing aids, glasses, dentures removed per protocol
- ✦Identification bracelet correct and readable
- ✦Hospital gown on; patient voided if not catheterized
- ✦Skin prep as ordered (CHG bath, hair removal as ordered)
NCLEX Pearls — Preoperative Nursing
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with AORN Guidelines for Perioperative Practice · American Society of Anesthesiologists (ASA). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →