25.1 Preadmission Assessment and Education

The perioperative surgical experience includes the preoperative phase, intraoperative phase, and the postoperative phase.
The preoperative phase starts when the decision is made to proceed with a surgery or procedure and ends upon transfer to the operating room and is crucial to ensure patient safety.
The preoperative phase requires a nurse to possess strong communication, teamwork, and patient assessments skills to promote optimal outcomes and avoid errors or adverse events.
Preadmission care provides the nurse and anesthesia provider the opportunity to ensure that the patient is safe and in a stable condition prior to a procedure or surgery.
Preadmission assessment includes obtaining many variables, such as the patient’s demographics, allergies, height, weight, medications, health history, surgical history, any potential problems with anesthesia, pertinent family history, history of falls, any metal or implants in the body, and social history of smoking, as well as alcohol or recreational drug use.
Preadmission testing may vary and is dependent on surgeon orders or anesthesia protocol.
Preoperative education includes arrival time, surgery start time, clothing, showering, medications, corrective devices that cannot be worn in surgery, transportation, advanced directives, and that the postoperative nurse will provide recovery education prior to discharge from the facility.

25.2 Preoperative Nursing Priorities

Preoperative nurses have several responsibilities and priorities, including documentation, preoperative assessment, physical assessment, and preoperative patient care.
Documentation should include any assessments, testing, education, and interventions. Informed consent should be verified and documented prior to surgery in order to ensure that the patient is willingly undergoing the procedure and was given all the information regarding the procedure, alternatives, risks, and benefits.
The preoperative physical assessment ensures that the patient is stable enough for surgery and identifies any issues that should be addressed prior to surgery. The preoperative physical assessment evaluates the respiratory, cardiovascular, renal and hepatic, and endocrine systems and should consider fluid and nutritional status, medications, immune system function, drug and alcohol use, and psychosocial status.
Patient care in the preoperative setting may include skin and bowel preparation. Any preparations should be followed as ordered by the surgeon or per facility protocol.

The preoperative nursing care plan includes interventions aimed at preparing the patient both physically and psychologically for the procedure while prioritizing patient safety.
The preoperative nurse ensures patient safety by verifying the patient’s identity, performing assessments, evaluating the stability of the patient, obtaining vital signs, obtaining any laboratory tests that were not done preoperatively or need to be repeated, verifying medications taken or held for surgery, and taking steps to prevent a wrong-site surgery.
The preoperative nurse completes interventions to aid in preventing surgical complications.
Examples include following established protocols and taking steps to decrease complications such as risk for aspiration, injury, and SSI.
Not only does the preoperative nurse care for the patient, but also for the family. Patient and family-centered care focuses on providing education, reducing anxiety and fear, and providing emotional support.

The National Patient Safety Goals aim to promote patient safety and include identifying patients correctly, improving staff communication, using medicines safely, using alarms safely, preventing infection, identifying patient safety risks, and preventing mistakes in surgery.
Special considerations are required for unplanned or emergency surgeries when immediate intervention is warranted. A quicker, but thorough, assessment should be performed with the patient or their family.
Older adults not only have age-related changes that can impact the course of their surgical process, but they often also have comorbidities that affect the surgical course and outcomes.
Meticulous care is warranted with bariatric surgeries due to the complications or risks associated with obesity.
Patients with mental and physical disabilities may need accommodations for the use of needed assistive devices, modified education, or additional assistance with transferring or positioning.
Cultural considerations the preoperative nurse must remember including language, eye contact, gender, touch, and spirituality. It is essential that the nurse be culturally competent to avoid cultural bias or insensitivity.