Chapter 18: Preoperative Nursing Care

Preoperative nursing care encompasses systematic patient evaluation, including detailed health history assessment, physical examination, and identification of risk factors across multiple body systems such as cardiovascular, respiratory, neurologic, renal, hepatic, endocrine, and immune function. Nurses conduct thorough medication reviews to manage anticoagulants, antiplatelets, insulin, antihypertensives, and herbal supplements that may interfere with surgical procedures or anesthesia. The chapter explores various surgical classifications including diagnostic procedures like biopsies, curative interventions such as appendectomies, palliative measures including colostomies, preventive surgeries like prophylactic procedures, and reconstructive operations. Contemporary surgical settings are analyzed, contrasting elective versus emergency procedures and examining the growth of ambulatory surgery driven by minimally invasive techniques, reduced infection risks, and enhanced recovery protocols. Critical preoperative responsibilities include obtaining informed consent, completing surgical checklists, verifying patient identification, maintaining NPO status, and administering preoperative medications including benzodiazepines, anticholinergics, opioids, antiemetics, and prophylactic antibiotics. Patient education strategies focus on providing sensory information about the surgical experience, procedural details regarding equipment and devices, and process information covering the perioperative journey from admission through recovery. Special populations receive targeted attention, particularly older adults who face elevated surgical risks due to decreased physiologic reserve, cognitive changes, polypharmacy, and multiple comorbidities. Cultural competence principles guide nursing practice, ensuring respectful accommodation of diverse beliefs, decision-making processes, and communication preferences while maintaining patient safety standards and therapeutic relationships throughout the preoperative period.