PREOP ASSESSMENT
This phase begins when the patient decides to have surgery and ends when transferred to the OR table.
What is the preoperative phase?
Rationale: The preoperative phase begins at the decision for surgery and ends at the moment the patient is physically transferred onto the operating room table. This transition point is critical because responsibility shifts from pre-op preparation (assessment, consent, teaching, safety checks) to intraoperative management. Once the patient is on the OR bed, sterile procedures and anesthesia care begin, marking the start of the intraoperative phase
This surgical position places the patient at highest risk for brachial plexus injury.
What is the Trendelenburg position?
Rationale: Improper positioning with arm abduction >90° or shoulder braces can compress/stretch nerves leading to a potential brachial plexus injury.
This is the priority nursing assessment immediately upon arrival to the PACU.
What is airway patency?
Rationale: Priority in PACU = airway, breathing, circulation. Airway obstruction is the most immediate life threat post-anesthesia.
This type of anesthesia blocks pain transmission near a cluster of nerves without causing loss of consciousness.
What is regional anesthesia?
Rationale: Blocks nerve transmission locally (e.g., epidural, spinal) while patient may remain conscious.
The outer one-inch edge of a sterile field is considered this.
What is contaminated?
Rationale: Edges are exposed and cannot be guaranteed sterile and considered contaminated.
This classification requires surgery within 24–30 hours but is not immediately life-threatening.
What is urgent surgery?
Rationale:
Urgent surgery is defined as a procedure that must be performed within a short timeframe (typically 24–30 hours) to prevent deterioration of the patient’s condition, but it is not immediately life-threatening, unlike emergent surgery. This classification helps prioritize surgical scheduling and resource allocation while still allowing limited time for preoperative optimization (e.g., labs, stabilization).
The circulating nurse notices pooling of prep solution under the patient. This type of hazard now exists.
What is a fire hazard?
Rationale: Pooling prep solution, especially alcohol-based, + oxygen + ignition source = fire triangle meaning a high OR fire risk.
A postoperative patient becomes restless, tachycardic, and confused. The nurse should suspect this complication first.
What is hypoxia?
Rationale: Early signs: restlessness, confusion, tachycardia. These occur before cyanosis, making early recognition critical.
Spinal anesthesia may cause this life-threatening cardiovascular complication due to sympathetic blockade
What is hypotension?
Rationale: Sympathetic blockade → vasodilation → ↓ BP. Can lead to decreased organ perfusion.
This surgical team member is responsible for maintaining the sterile field and passing instruments.
Who is the scrub nurse?
Rationales: Maintains sterile field, passes instruments, anticipates surgeon needs.
A patient reports taking St. John’s wort daily. This herbal supplement is concerning because it may cause this anesthetic complication.
What is prolonged sedation or altered anesthetic metabolism?
Rationale: Induces hepatic enzymes → alters metabolism of anesthetics, leading to unpredictable sedation or delayed emergence. Also increases risk of serotonin syndrome.
The anesthesiologist reports the patient’s end-tidal CO₂ is rapidly increasing with muscle rigidity. This is the priority medication to administer.
What is dantrolene?
Rationale: Dantrolene reduces calcium release in skeletal muscle and reverses hypermetabolic state of malignant hyperthermia.
This acid-base imbalance is commonly associated with prolonged nasogastric suctioning postoperatively.
What is metabolic alkalosis?
Rationale: Loss of gastric acid (HCl) → ↑ bicarbonate → metabolic alkalosis.
This postoperative complication is most associated with succinylcholine use and pseudocholinesterase deficiency.
What is prolonged paralysis/apnea?
Rationale: Patients with pseudocholinesterase deficiency cannot metabolize drug → prolonged paralysis requiring ventilation.
The surgical nurse notices moisture on a sterile drape. According to sterile technique principles, the field is now considered this.
What is contaminated?
Rationale: “Strike-through contamination” occurs when fluid carries microbes from non-sterile to sterile surfaces.
The nurse notes a potassium level of 2.9 mEq/L before surgery. This complication is the primary perioperative concern.
What are cardiac dysrhythmias?
Rationales: Low potassium increases risk for ventricular dysrhythmias, especially under anesthesia when cardiac irritability is heightened.
This perioperative complication results from pressure, ischemia, and reperfusion injury during prolonged surgery.
What is compartment syndrome?
Rationale: Prolonged pressure → ischemia → reperfusion injury → swelling within fascia → compromised circulation and tissue necrosis.
A patient suddenly develops severe calf pain, pallor, and absent pedal pulses after surgery. This vascular emergency is suspected.
What is acute arterial occlusion?
Rationale: Classic 6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia → surgical emergency.
A patient receiving opioids postoperatively has a respiratory rate of 6/min. This medication reverses the opioid effects.
What is naloxone?
Rationales: Opioid antagonist that reverses respiratory depression but may cause acute pain or withdrawal.
This infection prevention measure is most effective for reducing surgical site infections within one hour before incision.
What is prophylactic antibiotic administration?
Rationales: Must be given within 60 minutes before incision to ensure therapeutic tissue levels
A patient signed the surgical consent after receiving IV midazolam. This legal issue now exists with the consent.
What is that the consent is invalid?
Rationales: Informed consent must be obtained when the patient is alert and not under sedation. Midazolam impairs memory and decision-making therefore, the consent is legally invalid.
The surgical count is incorrect after abdominal closure begins. According to perioperative standards, this is the immediate next action.
What is notifying the surgeon and initiating a search/radiograph?
Rationale: Standard of care: STOP, notify surgeon, search, and obtain X-ray if needed. Prevents retained surgical items (sentinel event).
A postoperative patient develops petechiae, hypoxemia, and neurologic changes after a femur fracture repair. This syndrome is suspected.
What is fat embolism syndrome?
Rationale: Fat globules enter bloodstream after long bone fracture → triad: hypoxemia, neuro changes, petechiae.
During emergence from anesthesia, laryngospasm places the patient at immediate risk for this physiologic problem.
What is complete airway obstruction?
Rationale: Reflex closure of vocal cords → complete airway obstruction → requires immediate intervention (e.g., positive pressure).
An OR fire requires immediate removal of this element from the “fire triangle” to stop combustion.
What is the oxidizer (oxygen source)?
Rationales: Fire requires: oxygen + fuel + ignition. Removing oxygen source (turn off O₂) is fastest way to stop combustion.