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8.5 Perioperative Care (Pre-Op and Post-Op)

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

8.5 Perioperative Care (Pre-Op and Post-Op)

Key Takeaways Explain This Topic AI

Pre-operative checklist includes: informed consent signed, NPO status verified, allergies documented, ID band confirmed, and jewelry/dentures removed

Post-operative priority assessment follows ABCs: Airway patency, Breathing/oxygenation, and Circulation (vital signs, bleeding)

Wound dehiscence is separation of wound layers; evisceration is protrusion of organs through the wound - cover evisceration with sterile saline-soaked gauze, flex knees, and notify surgeon immediately

NPO (nothing by mouth) status prevents aspiration during anesthesia; verify last food/fluid intake and hold oral medications as ordered

Post-operative complications include atelectasis (most common on day 1-2), DVT/PE (day 4-7), wound infection (day 5-7), and dehiscence/evisceration (day 6-8)

Last updated: January 2026

Perioperative nursing encompasses the care provided before (preoperative), during (intraoperative), and after (postoperative) surgery. Each phase has specific safety priorities and potential complications that nurses must anticipate and address.

  • Preoperative Phase
  • Goals of Preoperative Care
  • Ensure patient safety through verification procedures
  • Reduce anxiety through education
  • Optimize physical status for surgery
  • Complete required documentation
  • Preoperative Checklist
  • Item Purpose
  • Informed consent signed Legal requirement; patient understands risks/benefits
  • NPO status verified Prevents aspiration during anesthesia
  • Allergies documented Prevents allergic reactions
  • ID band confirmed Correct patient identification
  • Surgical site marked Prevents wrong-site surgery
  • Labs reviewed Ensures patient stable for surgery
  • H&P documented Complete within 24-30 days per facility policy
  • NPO Guidelines

Why NPO? Anesthesia suppresses gag reflex and gastric emptying, increasing aspiration risk.

  • Ingested Item Minimum NPO Time
  • Clear liquids 2 hours
  • Breast milk 4 hours
  • Formula/light meal 6 hours
  • Fatty or heavy meal 8 hours

Note: Many facilities use "NPO after midnight" as a standard, though evidence-based guidelines vary.

Informed Consent

Provider Responsibility:

  • Explain the procedure
  • Describe risks, benefits, and alternatives
  • Answer patient questions

Nurse Responsibility:

  • Verify the consent is signed
  • Witness the signature
  • Ensure patient is competent (not sedated)
  • If patient has new questions, STOP and notify provider

Requirements for Valid Consent:

  • Patient must be competent (alert, oriented, not sedated)
  • Consent must be voluntary (no coercion)
  • Patient must be informed (understands the procedure)
  • Preoperative Teaching
  • Turn, cough, deep breathe - Prevents atelectasis
  • Incentive spirometer use - Maintains lung expansion
  • Leg exercises - Prevents DVT
  • Pain management expectations - Use of pain scale
  • Splinting incision - Reduces pain with movement/coughing
  • Items to Remove Before Surgery
  • Remove Rationale
  • Jewelry Electrocautery burns, loss, swelling
  • Dentures Airway obstruction
  • Hearing aids Communication issues, may be left for pre-op
  • Contact lenses Corneal damage during long procedures
  • Nail polish Interferes with SpO2 monitoring
  • Prosthetics Safety, proper identification
  • Postoperative Phase
  • Immediate Post-Op Assessment (PACU)

Follow ABCs:

  • Priority Assessment Interventions
  • A - Airway Patent? Snoring? Stridor? Position, suction, jaw thrust
  • B - Breathing Rate, depth, SpO2, breath sounds Oxygen, incentive spirometer
  • C - Circulation BP, HR, bleeding, urine output IV fluids, notify for hypotension
  • Vital Sign Monitoring
  • Phase Frequency
  • PACU Every 5-15 minutes
  • Post-Op floor (first hour) Every 15 minutes
  • Then Every 30 minutes x 2, then every hour x 4, then every 4 hours
  • Assessing the Surgical Site

"Dressing and Drain" Assessment:

  • Finding Normal Concerning
  • Drainage amount Minimal, decreasing Excessive, increasing
  • Drainage color Serosanguineous Bright red (hemorrhage)
  • Wound appearance Approximated, clean Separation, purulent drainage
  • Surrounding skin Pink, warm Red, hot, swollen (infection)
  • Wound Complications
  • Dehiscence
  • Definition: Separation of wound layers (partial or complete)

Risk Factors:

  • Obesity
  • Malnutrition
  • Infection
  • Coughing/straining
  • Poor wound healing

Assessment Findings:

  • Patient may report "something popped"
  • Increased serosanguineous drainage
  • Visible wound separation

Nursing Actions:

  • Keep patient calm
  • Cover wound with sterile saline-soaked gauze
  • Notify surgeon immediately
  • Keep patient NPO (may need to return to OR)
  • Evisceration
  • Definition: Protrusion of internal organs (usually bowel) through wound opening
  • THIS IS A SURGICAL EMERGENCY

Nursing Actions:

  • Stay with patient (call for help)
  • Do NOT attempt to push organs back in
  • Cover with sterile, saline-soaked gauze
  • Position patient supine with knees flexed (reduces abdominal tension)
  • Notify surgeon immediately
  • Keep patient NPO
  • Prepare for emergency surgery
  • Post-Operative Complications by Timeframe
  • Timeframe Complication Prevention/Detection
  • 0-24 hours Hemorrhage, airway obstruction Vital signs, assessment
  • 24-48 hours Atelectasis Turn, cough, deep breathe, incentive spirometer
  • 48-72 hours Pneumonia Early ambulation, pulmonary hygiene
  • Day 4-7 DVT/PE Early ambulation, SCDs, anticoagulants
  • Day 5-7 Wound infection Assess for redness, drainage, fever
  • Day 6-8 Dehiscence/evisceration Splinting, assess wound healing
  • Preventing Post-Operative Complications
  • Atelectasis Prevention
  • Most common post-op pulmonary complication

Interventions:

  • Turn patient every 2 hours
  • Encourage coughing and deep breathing
  • Use incentive spirometer 10x every hour while awake
  • Splint incision during coughing
  • Early ambulation
  • Pain control (pain limits deep breathing)
  • DVT/PE Prevention

Interventions:

  • Early ambulation (as soon as medically appropriate)
  • Sequential Compression Devices (SCDs)
  • Anticoagulant prophylaxis as ordered
  • Encourage leg exercises in bed
  • Adequate hydration
  • Avoid crossing legs
  • Paralytic Ileus
  • Definition: Temporary cessation of bowel motility after surgery

Assessment:

  • Absent bowel sounds
  • Abdominal distention
  • Nausea, vomiting
  • No flatus or bowel movement

Nursing Actions:

  • NPO until bowel sounds return
  • NG tube to suction if needed
  • Early ambulation promotes peristalsis
  • Assess for return of bowel function before advancing diet
  • Pain Management
  • Assessment
  • Use consistent pain scale (0-10 numeric, Wong-Baker FACES for children)
  • Non-Pharmacological Interventions
  • Positioning
  • Ice/heat (as appropriate)
  • Distraction
  • Relaxation techniques
  • Splinting
  • Pharmacological Management
  • Route Considerations
  • IV Fastest onset, titrate to effect
  • PCA Patient-controlled, prevents over/under-dosing
  • Oral Transition when tolerating PO
  • Epidural Used for major abdominal/thoracic surgery

Key Point: Adequate pain control enables coughing, deep breathing, and ambulation, which prevent complications.

On the Exam

The NCLEX frequently tests:

  • Informed consent requirements and nurse's role
  • NPO guidelines and rationale
  • Priority assessments (ABCs in post-op)
  • Wound complications (especially evisceration management)
  • Timeline of complications (when to expect what)
  • Preventing respiratory complications (incentive spirometer)

Priority Tip: In immediate post-op, always assess ABCs first. Airway patency is the top priority. If you see a question about a patient with evisceration, remember: sterile saline gauze, knees flexed, notify surgeon immediately.