Med-Surg · chapter 25 · Preoperative Care
Preadmission Assessment and Education
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Purpose of preadmission assessment
The preadmission assessment and interview provide the nurse and anesthesia provider the opportunity to ensure the patient is safe to continue with the procedure or surgery.
Risk identification
Based on the patient’s health history, the nurse may identify any potential risks, as well as any further testing that may be needed as outlined by the anesthesia provider or surgical protocol.
Preoperative nursing priorities
This phase requires the nurse to utilize clear and concise communication, strong teamwork, and flawless patient assessment skills to promote the patient’s best achievable outcomes and avoid errors or adverse events.
Site and consent verification
The preoperative nurse should ensure the correct site and surgery are verbalized by the patient in their own words, as well as documented correctly both in the patient’s chart and the surgical consent.
Surgical site marking
The surgeon is responsible for marking the correct limb or surgical site. The actual marking must be verified by both the preoperative and intraoperative nurse.
Bedside preoperative assessment
When a patient is already in the facility (for example, admitted as an inpatient, in the ER, or in observation), the preoperative nurse is responsible for doing the interviewing and assessment at the patient’s bedside.
Health history use
The nurse uses current, past, and family health histories obtained during the assessment to identify risks or the need for alternative medications due to an allergy.
Limb restriction assessment
If a patient reports having a previous lumpectomy or mastectomy, or has an AV fistula or graft in place, the nurse should assess for any restrictions with blood pressure or IV placements in either limb.
Anesthesia medication planning
Preadmission assessments can determine if anesthesia medications need to be adjusted from normal dosages, or if the patient may require longer monitoring in the post-anesthesia care unit (PACU) for potential reactions.
Baseline pain assessment
The nurse will assess a baseline pain level acceptable to the patient, so the postoperative nurses can take that into consideration when planning a mutual, patient-centered care plan for pain management after surgery.
Preoperative testing orders
Preoperative tests ordered may vary, depending on the provider’s orders and the nurse’s assessment. Some surgeons request their own testing or simply ask the facility to follow their anesthesia protocol.
Testing timeline
While the patient may have some flexibility, the testing needs to be done in time for the anesthesia team or surgeon to view the results before surgery.
NPO teaching
The nurse will teach that this includes not smoking, not swallowing water or toothpaste, and not using gum or hard candies the morning of surgery. Anything eliciting extra saliva or gastric juice production will need to be avoided.
Medication and supplement review
The nurse must make sure that the patient understands that it’s not only prescribed medications that may need to be stopped or changed—over-the-counter medications and supplements should also be discussed.
Terms to know
- preoperative phase
- The preoperative phase starts when the decision is made to proceed with a surgery or procedure and ends when the patient arrives in the operating room.
- limb alert
- Examples of a limb alert include a colored band to communicate to other care team members that the identified extremity cannot be used for blood draws or IV placement.
- NPO
- The patient should be educated to remain NPO, which means to take nothing by mouth, after midnight the night before surgery.
- advance directive
- An advance directive is a document that allows a patient to convey, in writing, their wishes for care if they are unable to advocate for themselves due to a medical condition.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 0700 before surgery, the nurse finds that the procedure and site listed in the chart match the surgical consent. The patient has not yet described the planned surgery. Which action best completes the procedure-verification documentation?
- Read the listed procedure aloud, ask whether it sounds correct, and document the patient's agreement.
- Document that the procedure and site are verified because the chart and surgical consent agree.
- Ask the patient to describe the surgery and site in their own words, then document whether the description matches the chart and consent.
- Ask the patient to identify the surgical site, then document that both the site and procedure are confirmed.
Answer: Ask the patient to describe the surgery and site in their own words, then document whether the description matches the chart and consent.
The patient's own description provides a safety check against the documented procedure and site. Agreement with a procedure read aloud does not provide the same independent description. Matching paperwork alone omits the patient's account, while identifying only the site does not confirm the procedure.
During a preadmission call 10 days before surgery, a patient reports taking no prescription medications but using over-the-counter aspirin and an herbal sleep supplement. Which entries belong in the medication assessment and education plan? Select all that apply.
- Plan to instruct the patient to stop aspirin exactly 10 days before surgery as a standard requirement.
- Record 'No current medications' because the patient has no prescriptions.
- Record the patient's aspirin use in the medication history.
- Plan to discuss whether over-the-counter medicines and supplements need to be stopped or changed.
- Record the patient's herbal sleep supplement use.
Answer: Record the patient's aspirin use in the medication history., Plan to discuss whether over-the-counter medicines and supplements need to be stopped or changed., Record the patient's herbal sleep supplement use.
The assessment and education must include over-the-counter medications and supplements, including discussion of possible changes before surgery. Recording no medications would omit the reported aspirin and supplement use. The source describes stopping aspirin for up to 10 days as a possible surgeon request that depends on the reason for aspirin therapy, not a universal instruction.
At 0900 during preadmission education, a patient is in a great deal of pain, appears distracted, and says, 'I cannot focus on these instructions.' The nurse has reviewed the planned topics. Which entry best documents the patient's current education needs?
- Readiness to learn adequate; attention to instructions limited by pain.
- Preoperative education completed because all planned topics were reviewed.
- Pain and distraction limiting readiness to learn; further education needed when pain is controlled and the patient is more relaxed.
- Preoperative education completed; postoperative nurses to reinforce the instructions.
Answer: Pain and distraction limiting readiness to learn; further education needed when pain is controlled and the patient is more relaxed.
The source identifies pain and distraction as barriers to understanding, so the entry should reflect limited readiness and the need for further education. Reviewing every topic or planning postoperative reinforcement does not establish that preoperative education is complete. Describing readiness as adequate contradicts the patient's stated inability to focus.
Where every quote comes from
Section 25.1 Preadmission Assessment and Education of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.