Preoperative care

Preoperative care is the safety net before anesthesia: consent done right, stomach empty, checklist complete, site marked, and fear reduced enough to teach. What happens after the incision is covered in Perioperative care. Capacity, refusal, and ethics depth live in Ethics and care coordination.

Informed consent: the nurse’s lane

Valid informed consent requires a capable client (or legal surrogate), voluntary agreement, and disclosure of the procedure’s nature, risks, benefits, and alternatives by the provider who will perform it. The nurse’s tested role is verification and advocacy: is the form signed for the correct procedure? Does the client’s behavior match understanding? If the client still thinks “they’re only looking,” stop the process and call the provider back - do not fill the knowledge gap with your own surgical lecture.

Minors, altered mentation, and emergency exceptions follow law and facility policy. On exams, an emergency that threatens life or limb may proceed without signature when delay would cause harm and no surrogate is available - still document the facts. Routine elective cases do not get that shortcut.

NPO, checklist, and physical prep

NPO orders exist because anesthesia blunts airway reflexes; gastric contents then aspirate into the lungs. Confirm what was last taken by mouth and when - including “just water,” gum, and candy when the stem emphasizes it. If intake violates orders, notify anesthesia; do not quietly hope it will be fine.

1. Verify identity, allergies, and procedure name with the client.
2. Ensure consents, H&P, and required labs/tests are on the chart.
3. Baseline vitals; report fever or unstable numbers before induction plans proceed.
4. Have the client void; start ordered IVs/premeds on time.

Jewelry, piercings, and metal concentrate electrosurgical current and can tear tissue under tape or tourniquets - remove or secure per protocol and document disposition. Dentures and partials are usually removed before anesthesia so they are not swallowed or aspirated; hearing aids and glasses may stay until the last moment so the client can communicate, then go to a labeled container. Nail polish may be reduced on at least one nail when pulse-ox reading is a concern, depending on stem cues.

• Allergy bands stay on and visible - latex and antibiotic allergies change the tray.
• Skin prep and hair clipping follow order; avoid razors that nick when the stem offers clippers.
• Preop antibiotics, beta-blockers, and other hold/give meds follow anesthesia/surgeon orders - clarify, do not guess.

Medications, labs, and allergy flags before the OR

Anticoagulants and antiplatelets raise bleeding risk. Hold them as ordered and record the last dose time. Bridging decisions belong to the provider. On stems, sending a client to the OR on a full anticoagulant without acknowledgment is the trap; so is stopping a critical med on your own authority without an order.

Morning-of dosing is anesthesia’s call, not a habit from the med-surg floor. Many beta-blockers and other cardiac meds are given with a sip of water because abrupt stop raises cardiac risk. ACE inhibitors and diuretics are often held to limit intraoperative hypotension - follow the written plan. Insulin and oral hypoglycemics are adjusted for NPO; never invent a full usual home dose into an empty stomach without orders. Herbal products (ginkgo, garlic, ginseng patterns as tested) can affect bleeding or sedation - include them in the med list.

Latex allergy changes the entire case setup - flag it early, not at the door of the OR. Smoking increases airway reactivity and wound complications; honest history and cessation encouragement still help even late. Pacemakers, ICDs, and metal implants matter for cautery and positioning - document device details.

Site marking and preoperative teaching

Wrong-site surgery is a never event. The proceduralist marks the site with the awake client participating when possible. If the mark is missing, wrong, or the client disputes the side, you stop the line and fix it before induction. Nurses do not invent a mark to “keep the schedule.”

Teach incentive spirometry before surgery: seal lips around the mouthpiece, inhale slowly to raise the marker, hold briefly, then exhale. Ten times an hour while awake is a common teaching target - the point is alveolar expansion, not arm exercise. Practice now so opioids and incision pain are not the first time the client meets the device. Anxiety is not fluff content. A client who understands the sequence cooperates with spirometry and ambulation later. Use short sentences, allow questions, and involve a support person when the client wants one. Anxiolytic premeds are given only as ordered and after consents are finalized - sedation before consent voids the point of informed agreement.

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