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Fundamentals of Nursing Practice · Perioperative Care

Preoperative Nursing Care

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On this page 7 sections
  1. In 30 seconds
  2. Why this matters
  3. The college version
  4. Eli explains
  5. Worked example
  6. Key takeaway
  7. Study tools

In 30 seconds

Preoperative nursing care is the first phase of the period and prepares a person physically, emotionally, and legally for surgery. The nurse completes a comprehensive assessment, verifies medications and allergies, confirms fasting status, supports , and teaches postoperative skills such as coughing, deep breathing, , and leg exercises. The nurse also participates in a preoperative checklist and safety verification to reduce risk and prevent errors.

Why this matters

Informed consent is a legal and ethical requirement rooted in client autonomy. If a client cannot consent (due to capacity, sedation, or emergency), consent is governed by jurisdiction-specific laws, advance directives, or a legally authorized representative. Nurse Practice Acts, institutional policies, fasting protocols, and documentation standards vary by jurisdiction and institution, so the nurse must follow local requirements. Advocacy means the nurse speaks up when a client's understanding, consent validity, or safety is in question.

The college version

1. The Perioperative Continuum and Surgery Classification

The perioperative period spans three phases: preoperative (before surgery), intraoperative (during), and postoperative (after). Surgery is classified by urgency — elective (planned and non-urgent, such as a cataract repair), urgent (needed within hours to days, such as a fractured hip), and emergency (needed immediately to save life or limb) — and by extent, as major (extensive, higher risk, such as open-heart surgery) or minor (limited, lower risk, such as a skin biopsy). Classification shapes how quickly assessment and preparation must occur.

2. Preoperative Assessment

The preoperative assessment builds a complete picture of the person's readiness for anesthesia and surgery. The nurse gathers the health history (past surgeries, chronic conditions, pregnancy status), performs a focused physical review, and conducts a medication review including prescription, over-the-counter, herbal, and recreational substances, because many affect bleeding or anesthesia. The nurse verifies allergies — to drugs, latex, food, and environmental agents — and documents reactions, since a true allergy differs from a nonallergic side effect and changes safety planning. Laboratory and diagnostic results (ordered by the provider) are reviewed as part of readiness.

Informed consent is the process by which a competent client voluntarily agrees to a procedure after understanding its purpose, benefits, risks, and alternatives. The surgeon is responsible for explaining the procedure and obtaining consent; the nurse's role is to witness the signature, confirm the person understands and is signing voluntarily, and act as an advocate by clarifying questions and notifying the surgeon if the client appears confused or pressured. Fasting (NPO) before anesthesia reduces the risk of aspiration, and the nurse follows provider or institutional protocol for how long food and fluids are withheld. A preoperative checklist and safety verification (confirming identity, site, procedure, consents, and results) complete readiness and help prevent wrong-site or wrong-procedure errors.

How it works

  1. The surgical team schedules the procedure and the surgeon explains risks, benefits, and alternatives.
  2. The nurse completes the health history and medication review and verifies allergies.
  3. The nurse confirms fasting status and documents it according to institutional protocol.
  4. The nurse supports informed consent by witnessing the signature and clarifying understanding.
  5. The nurse teaches pulmonary hygiene, leg exercises, and early-mobility skills.
  6. The team completes the preoperative checklist and safety verification before transfer to the operating room.

Common confusions

Do not confuseWithDifference
Nurse witnessing consentObtaining consentThe surgeon explains and obtains consent; the nurse witnesses and advocates
Elective surgeryUrgent/emergency surgeryElective is planned; urgent is days, emergency is immediate
AllergySide effectAllergy is an immune-mediated reaction; a side effect is an expected, non-immune response
Preoperative phasePerioperative periodPreoperative is one phase within the larger perioperative period
Fasting protocolStanding medical orderFasting follows provider/institutional protocol, not a universal fixed rule

Memory aids

P-R-E-O-P — Prepare (assessment, history), Review (medications, allergies), Ensure (consent, fasting), Outline teaching (pulmonary hygiene, leg exercises), Perform checks (checklist, safety verification).

Quick review

Topic Recap

Preoperative nursing care prepares a person for safe surgery through assessment, medication and allergy review, fasting and consent support, and teaching that readies the lungs and legs for recovery. The nurse's advocacy role in consent and safety verification is central to preventing errors and honoring client autonomy.

Knowledge Check

  1. Which team member is responsible for obtaining informed consent for surgery?
  2. Why is fasting required before general anesthesia?
  3. Name two postoperative skills the nurse teaches before surgery.
  4. A client states they did not understand the surgeon's explanation of risks. What is the nurse's best action?
  5. Which term describes surgery that must occur within hours to days, such as for a fractured hip?

Answers and Rationales

  1. The surgeon — the provider performing the procedure explains purpose, risks, benefits, and alternatives and obtains consent; the nurse witnesses the signature.
  2. To reduce the risk of aspiration — an empty stomach lowers the chance that stomach contents enter the lungs during anesthesia.
  3. Coughing/deep breathing and leg exercises (and incentive spirometry) — these prevent atelectasis and venous thromboembolism.
  4. Notify the surgeon and pause the process — the nurse advocates by ensuring the client's questions are answered before signing; consent must be informed and voluntary.
  5. Urgent surgery — needed promptly but not immediately life-threatening in the same instant as an emergency.
Eli, the EliExplains learning guide

Eli explains

The same idea, in plain words

Explain it like I’m 10

Think of surgery like preparing for a long trip. Before you leave, you check that your car is safe, pack what you need, make sure you have a clear route, and confirm everyone agrees on the destination. Preoperative nursing care is the "getting ready" step for surgery: the nurse gathers your health story, checks medications, confirms you have an empty stomach when required, makes sure you understand and agree to the plan, and teaches you the exercises that will help your lungs and legs recover afterward. Just as a good trip begins with good preparation, a safe surgery begins with careful preoperative preparation. Where it stops being exact: a car trip rarely carries the same life-and-death stakes, and the "checks" before surgery are backed by legal requirements (like consent) and institutional protocols (like fasting rules) that a road trip does not have.

Simple Example

Ms. Rivera is scheduled for an elective knee replacement. Her nurse confirms she has stopped certain medications as directed, asks about allergies, reviews her fasting status per institutional protocol, ensures her signed informed consent is in the record, and teaches her how to use an incentive spirometer and perform leg exercises before she goes to the operating room.

Worked example

  1. The nurse assesses the client's health history, medications, allergies, and understanding of the planned surgery, and confirms laboratory and diagnostic results are available.
  2. The nurse documents all findings in the health record, including allergies, anticoagulant or herbal supplement use, and any questions the client raises about consent.
  3. The nurse teaches postoperative pulmonary hygiene (coughing, deep breathing, incentive spirometry), leg exercises, and early mobility to prevent complications such as atelectasis and venous thromboembolism.
  4. The nurse verifies fasting status, presence of a signed consent, and completion of the preoperative checklist before transfer.
  5. The nurse communicates any concern — unclear consent, unreported medication, abnormal result — to the surgeon and anesthesia provider and escalates unresolved safety issues before the procedure proceeds.

Key takeaways

  • High yield: The surgeon obtains informed consent; the nurse witnesses the signature and advocates for understanding.
  • High yield: Preoperative fasting follows provider or institutional protocol to reduce aspiration risk.
  • High yield: Preoperative teaching of coughing, deep breathing, incentive spirometry, and leg exercises prevents postoperative complications.
  • A medication review must include over-the-counter, herbal, and recreational substances.
  • Allergy verification distinguishes true allergy from nonallergic side effects.
  • Elective, urgent, and emergency surgery differ by how quickly intervention must occur.
  • The preoperative checklist and safety verification help prevent wrong-site and wrong-procedure errors.

Keep learning

Ready to build on this? Continue to the next lesson.

Study tools & related lessonsYou’ll learn to · Key vocabulary · Related

You’ll learn to

  • Describe the perioperative continuum and classify surgery as elective, urgent, or emergency and as major or minor.
  • Outline the components of a preoperative nursing assessment, including health history, medication review, and allergy verification.
  • Explain the nurse's role in informed consent as witness and client advocate, and in fasting and safety-check procedures.
  • Identify key preoperative teaching content that supports postoperative recovery and complication prevention.

Key vocabulary

Perioperative
The three-phase period around surgery (before, during, after)
Preoperative phase
The preparation period before surgery
Elective/urgent/emergency surgery
Surgery by how quickly it must happen
Major/minor surgery
Surgery by extent and risk
Informed consent
Voluntary, informed agreement to a procedure
Nurse witnessing
Nurse confirms the signature and voluntariness
Fasting (NPO)
Withholding food/fluid before anesthesia
Incentive spirometry
A breathing device used to expand the lungs
DVT prevention
Leg exercises and mobility to reduce clotting

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