Preoperative Assessment and Nursing Responsibilities

These flashcards cover key concepts related to preoperative assessment, nursing responsibilities, and informed consent, aimed at preparing for an exam on surgical nursing.

What does the preoperative phase encompass?

• It begins when the client decides to undergo surgery and ends when the client is transferred to the surgical suite.

To reduce the incidence of surgical errors, The Joint Commission has developed the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery. What are some actions to prevent these errors from occurring?

• To reduce the incidence of surgical errors, The Joint Commission developed a verification process known as Speak Up to ensure that the correct surgical procedure is performed on the correct client and the correct site (such as right leg versus left leg).

• Process involves the client as well as the surgical team and is standardized to include a signed consent, preoperative assessment, laboratory and diagnostic test results, any special equipment required, and marking of the surgical site by a licensed provider who will be present during the procedure. 

What are the nurse's responsibilities during the preoperative phase?

• The nurse is responsible for preoperative assessment, client teaching, and ensuring informed consent is obtained.

What is the main goal of the preoperative assessment?

• To ensure client safety by identifying risk factors for surgery and collecting baseline data.

A nurse is interviewing a client during the preoperative phase. The client reports smoking 6 to 7 cigarettes per day for the past 4 years. The nurse should identify that tobacco use prior to surgery can increase the client’s risk for which of the following complications?

• Blood clots

• Heart attacks (myocardial infarction)

• Infection

• Death

Rationale: tobacco use can lead to slower wound healing. Also, because oxygen is the main source of healing, the client’s risk for developing infections is greater when the client has engaged in recent use of tobacco.

What should a preoperative assessment include?

• A head-to-toe assessment, review of medical history, and any laboratory or diagnostic tests ordered.

The time-out is being performed for a client scheduled for surgery. The time-out occurs during which phase of the perioperative period? (Click this card to reveal the answer.)

• Time-out occurs before starting the procedure

• Before initiation of each procedure

• After surgical procedure is complete

Examples of Patients Who Can Give Informed Consent include:

• Legal age (typically 18+)

• Mentally competent (understands the situation, risks, benefits)

• Giving consent voluntarily (no coercion)

❌ Examples of Patients Who Cannot Give Informed Consent:

❌ Examples:

1. A 4-year-old child – consent must be obtained from a parent or legal guardian.

2. A 30-year-old who is intoxicated – altered mental status prevents legal consent.

3. A 70-year-old with advanced dementia – lacks capacity to understand or decide.

4. A 22-year-old under general anesthesia or heavy sedation – not alert and oriented.

5. A developmentally delayed adult with documented legal incompetence – requires consent from a guardian.

6. A person with a head injury and fluctuating consciousness – not able to give informed consent reliably.

7. A 17-year-old minor without emancipated status – needs parental/guardian consent.

What is the importance of coughing and deep breathing after surgery. This should include techniques for incision splinting and how to use an incentive spirometer.

✅ Why It Matters:

• Prevents atelectasis (collapse of alveoli)

• Reduces risk of pneumonia and other respiratory complications

• Helps clear mucus and secretions from the lungs

• Improves oxygenation and lung expansion

• Promotes circulation and prevents post-op complications
  

🛏 Technique: Incision Splinting

• Used to reduce pain and protect the surgical site during coughing or deep breathing

• Especially important after abdominal or thoracic surgery

How to Perform:

1. Place a pillow, folded blanket, or towel over the surgical incision.

2. Gently but firmly press the pillow against the incision.

3. Take a deep breath in through the nose.

4. Cough strongly while pressing to support the incision.

5. Repeat every 1–2 hours while awake.

Identify tasks and responsibilities that correspond to nursing staff from each of the following departments: Pre-ops, OR, & PACU (post-anesthesia care unit)

🏥 Preoperative Nurse

These nurses focus on preparing the client before surgery.

• ✅ Witness consent

• ✅ Perform teaching on deep breathing and coughing

• ✅ Obtain history of allergies

• ✅ Collect the client's height and weight

🏨 Intraoperative (Circulating or Scrub) Nurse

These nurses are in the OR and handle sterile technique, surgical prep, and communication.

• ✅ Initiate time-out procedure

• ✅ Obtain supplies for the surgery team

• ✅ Document the count of surgical sponges and equipment

🛌 Postoperative (PACU/Recovery Room) Nurse

These nurses care for the client immediately after surgery, focusing on stabilization and pain control.

• ✅ Ensure a patent airway

• ✅ Provide updates to the client's family members

• ✅ Manage nausea

• ✅ Administer pain medications

• ✅ Control shivering

Proper way to use an incentive spirometer include:

📈 How to Use an Incentive Spirometer Purpose:

• Encourages slow, deep breathing to expand the lungs

• Prevents post-op pulmonary complications

Steps:

1. Sit upright in a chair or bed with back supported.

2. Hold the spirometer upright.

3. Exhale normally, then seal lips around the mouthpiece.

4. Inhale slowly and deeply through the mouthpiece to raise the piston/ball.

5. Try to hold the breath for at least 3–5 seconds.

6. Remove the mouthpiece and exhale slowly.

7. Repeat 10 times every hour while awake.

What is malignant hyperthermia?

• A severe reaction to certain medications given during anesthesia that can be life-threatening.

Why is it important to document a client's health history before surgery?

• It helps identify comorbidities and previous complications that could increase surgical risk.

What should be assessed regarding a client's allergies prior to surgery?

• All known allergies to medications and other substances must be identified and documented.

How can tobacco and alcohol use affect surgery risks?

• Recent tobacco use can increase risks for complications such as blood clots and myocardial infarction,

• While regular alcohol use can lead to bleeding and infections.

What aspects of a client's spiritual beliefs should a nurse consider?

• The nurse should record client requests based on spiritual beliefs and provide culturally competent care.

What is the importance of client teaching before surgery?

• It prepares the client for surgery, reduces anxiety, empowers self-care postoperatively, and supports the family.

What is informed consent in the context of surgery?

• Permission given by the client or their legal representative to provide care or perform a surgical procedure.

Who is responsible for explaining the procedure to the client before surgery?

• The provider is responsible for educating the client about the procedure.

Which tests may be prescribed prior to surgery?

• Tests may include complete blood count (CBC), metabolic panels, coagulation studies, and electrocardiograms.

What should be included in postoperative expectations during client teaching?

• Expectations include pain control methods, importance of coughing and deep breathing, and activity post-surgery.

What are some common laboratory tests done preoperatively?

• Complete blood count (CBC), comprehensive metabolic panel (CMP), basic metabolic panel (BMP), and coagulation studies.

What is the purpose of AORN’s Comprehensive Surgical Checklist?

• To enhance communication among the perioperative team and prevent errors and client harm.

A nurse is assessing a preoperative client with a history of obstructive sleep apnea (OSA). Which of the following should the nurse include in the plan of care?

A. Monitor for signs of hypoglycemia post-op

B. Place the client in a high Fowler’s position post-op

C. Administer supplemental oxygen via face mask continuously

D. Prepare to administer naloxone immediately post-op.

Correct Answer: B.
Rationale: OSA increases risk of airway obstruction; upright positioning supports airway patency post-op.

A client reports a family history of malignant hyperthermia. What is the nurse’s priority action?

A. Educate the client on post-op activity restrictions

B. Notify the anesthesia team immediately

C. Document the finding and proceed with standard prep D. Ask the client to sign the anesthesia consent again.

Correct Answer: B.
Rationale: Malignant hyperthermia is a life-threatening reaction to anesthesia. The intraoperative team must be informed to implement precautions.

A client reports an allergy to latex and bananas. What is the most appropriate nursing action?

A. Document the allergy in the EHR

B. Notify dietary services

C. Apply an allergy ID band and notify the surgical team D. Give diphenhydramine preoperatively.

Correct Answer: C.

Rationale: Latex allergy often correlates with fruit allergies. The entire surgical team must be alerted to use non-latex equipment.

A client taking garlic, vitamin E, and warfarin daily is scheduled for surgery. Which is the priority concern?

A. Risk for post-op constipation

B. Risk for delayed wound healing

C. Risk for excessive bleeding

D. Risk for poor sedation response.

Correct Answer: C.

Rationale: Garlic and vitamin E can potentiate the anticoagulant effect of warfarin, increasing bleeding risk.

A nurse is interviewing a client who smokes daily. Which of the following complications should the nurse anticipate?

A. Hypothermia

B. Myocardial infarction

C. Nausea

D. Jaundice.

Correct Answer: B.

Rationale: Smoking increases the risk for post-op cardiovascular complications, including MI and blood clots.

A client who practices Christian Science expresses concern about receiving medical treatment. Which nursing action is appropriate?

A. Reassure the client and proceed with treatment

B. Document the client’s refusal and notify the provider

C. Educate the client about the benefits of surgery

D. Inform the OR staff that the client may cancel surgery.

Correct Answer: B.

Rationale: Client beliefs must be respected; refusal must be documented and communicated.

A nurse is planning multimodal pain management post-op. Which of the following is the primary advantage of this approach?

A. Promotes dependency on fewer medications

B. Reduces the need for postoperative monitoring

C. Minimizes opioid side effects while managing pain

D. Prevents infection and reduces hospital stay.

Correct Answer: C.

Rationale: Multimodal pain therapy enhances relief while reducing side effects of high-dose opioids.

Why is it important to assess a client’s orientation before surgery?

A. To ensure the client remembers discharge instructions B. To detect early signs of post-op infection

C. To establish a baseline for detecting post-op changes D. To verify understanding of pain rating scales.

Correct Answer: C.

Rationale: Baseline neurologic status helps detect early signs of decline post-op, such as delirium or hypoxia.

In which order should the nurse perform a GI assessment preoperatively?

A. Palpation, percussion, auscultation, inspection

B. Auscultation, palpation, percussion, inspection

C. Inspection, auscultation, percussion, palpation

D. Inspection, auscultation, palpation, percussion.

Correct Answer: D.

Rationale: This order prevents altering bowel sounds and ensures accurate findings.

A client with moderate developmental disability needs a surgical procedure. Who can legally provide informed consent?

A. The client's legal guardian

B. The nurse on duty

C. The client’s case manager

D. The client's sibling.

Correct Answer: A.

Rationale: A legal guardian is required to give consent when the client is not competent to do so.

Which preoperative test provides information about anemia and infection risk?

A. Electrocardiogram

B. Chest x-ray

C. Complete blood count (CBC)

D. Coagulation profile.

Correct Answer: C.

Rationale: A CBC evaluates hemoglobin levels and white blood cell count, indicating anemia or infection.

Which statement by a client indicates understanding of NPO instructions before surgery?

A. "I can eat toast until midnight and drink juice in the morning."

B. "I should stop eating and drinking after midnight before surgery."

C. "I can have coffee as long as there’s no cream."

D. "I’ll take my medications with a glass of milk."

Correct Answer: B.

Rationale: Clients are typically instructed to stop eating and drinking after midnight before surgery