Med-Surg · chapter 25 · Preoperative Care
Special Preoperative Considerations
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
Preoperative safety verification
The preoperative nurse plays a major role in performing or verifying that the proper steps are taken to promote patient safety. For example, the nurse verifies the medication record and implements interventions that promote the prevention of blood clots and surgical site infections.
Emergency preparation limits
When situations like this arise, there is generally not a preadmission testing appointment, and time is limited. Therefore, the patient does not receive presurgical instructions.
Emergency history gathering
These instances require the preoperative nurse to obtain as thorough a history as possible from either the patient or family member to verify medical history, medications, and allergies to try to prevent complications.
Emergent skin preparation
In emergent cases, skin preparation is often done in the OR to prevent delay of getting the patient into the OR.
Older adult surgical risks
People 65 and older not only have age-related changes that can impact the surgical process, but often they present multiple comorbidities that can impact surgical recovery outcomes.
Older adult recovery reserve
When a person reaches an advanced age, the organ systems tend to have lower reserves for recovery and may take longer to “bounce back” to the patient’s baseline after surgery. Cardiac and respiratory complications are common causes of postoperative morbidity and mortality in older adults.
Older adult medication sensitivity
This means that the older adult does not recover as quickly as the younger adult and metabolizes anesthetic agents and pain medications more slowly or are generally more sensitive to those drugs.
Fragile skin precautions
Advancing age is also associated with skin changes like dry, itchy skin that is more fragile. This requires careful precautions when moving older adults from one bed to another.
Low temperature complications
Patients with decreased body temperatures are at risk for surgical site infections, blood loss, altered medication metabolism, increased pain, and cardiac arrythmias (Brooks Bosserman, 2022).
Bariatric healing risk
Decreased oxygenation and reduced circulation are directly related to impaired healing. Reduced oxygenation can cause impaired immune function (de Frel et al., 2020).
Pregnant patient coordination
In the case when a procedure is medically necessary for a pregnant patient, coordination between care team members is key to ensuring the health and safety of both the patient and the fetus. This involves close monitoring of both the mother and baby and taking proactive steps to prevent complications like preterm labor and thrombosis.
Assistive device documentation
The preoperative nurse should verify the needs of the patient, as well as document what type of assistive devices the patient brought with them to the facility and where those items were placed prior to surgery.
Disability transfer communication
Patients that are either unable to hear or understand instructions or unable to move independently will require assistance in the operating room. Therefore, it is important that the preoperative nurse communicate those needs to the intraoperative nurse when transferring care.
Interpreter and language materials
Patients who speak and understand another language require a medically trained interpreter for consent and education. Materials should be provided in the language that the patient reads and understands.
Terms to know
- National Patient Safety Goals
- The National Patient Safety Goals aim to promote patient safety.
- morbidity
- The prevalence or incidence of an illness within a population is called morbidity.
- mortality
- The death of a population measured and expressed as a ratio is called its mortality.
- culturally competent care
- Providing culturally competent care means the nurse should ask the patient and their family what their preferences are regarding care.
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 06:45, a patient brings a walker to the preoperative unit. Before surgery, you place it in the preoperative storage room. Which documentation best supports postoperative staff in returning the patient's belongings?
- Personal assistive device secured in the preoperative storage room before surgery.
- Walker brought from home; to be returned to the patient after surgery.
- Walker used for mobility; postoperative staff informed that the patient brought an assistive device.
- Walker brought from home; placed in the preoperative storage room before surgery.
Answer: Walker brought from home; placed in the preoperative storage room before surgery.
The section directs the nurse to document both the type of assistive device and where it was placed so postoperative staff can return it. The other entries omit either the device type or its storage location.
At 09:00, a patient who does not read or understand English needs surgical consent and preoperative education. A family member offers to interpret. Which planned language accommodations should you include in the preoperative care documentation? Select all that apply.
- Provide written materials in the language the patient reads and understands.
- Arrange a medically trained interpreter for preoperative education.
- Use the bilingual family member instead of a medically trained interpreter for preoperative teaching.
- Arrange a medically trained interpreter for the consent discussion.
- Provide the standard English-language packet with a summary from the family member.
Answer: Provide written materials in the language the patient reads and understands., Arrange a medically trained interpreter for preoperative education., Arrange a medically trained interpreter for the consent discussion.
The section requires a medically trained interpreter for both consent and education, along with materials in the language the patient reads and understands. Substituting a bilingual family member for the interpreter or using an English packet with a family summary does not meet those requirements.
At 07:30, an older adult says, "I feel warm enough," after you apply a warming blanket. You are updating the preoperative note. Which entry best reflects the section's approach to temperature safety?
- Patient reports adequate warmth; comfort goal met and temperature monitoring complete.
- Patient reports adequate warmth; further temperature checks planned only if the patient reports feeling cold.
- Patient comfortable with warming blanket; temperature monitoring deferred while warming continues.
- Patient reports adequate warmth with warming blanket; temperature monitoring will continue.
Answer: Patient reports adequate warmth with warming blanket; temperature monitoring will continue.
An older adult's report of feeling warm may not reflect actual body temperature, so monitoring must continue for safety. Waiting for discomfort, deferring checks during warming, or ending monitoring when comfort improves substitutes subjective comfort or the warming intervention for continued temperature assessment.
Where every quote comes from
Section 25.4 Special Preoperative Considerations 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.