Comprehensive Guide to Perioperative Care for NCLEX Success
A complete review of the three phases of perioperative care, with key NCLEX focus points and critical nursing responsibilities throughout the surgical experience.
Understanding Perioperative Care: The Complete Surgical Journey
1
Preoperative Phase
Begins when the decision for surgery is made and ends when the client is transferred to the operating room table.
Focus: Assessment, education, and preparation
2
Intraoperative Phase
Begins when the client is transferred to the OR table and ends with admission to the Post-Anesthesia Care Unit (PACU).
Focus: Patient safety, aseptic technique, and teamwork
3
Postoperative Phase
Begins with admission to the PACU and ends with follow-up evaluation in the clinical or home setting.
Focus: Recovery monitoring and complication prevention
The primary goal throughout all phases is patient safety and the prevention of complications.
Preoperative Phase: Key Nursing Assessments
Health History & Baseline Data
  • Past medical conditions
  • Previous surgical procedures
  • Baseline vital signs
  • Current health status
Allergies Assessment
  • Medications and anesthetic agents
  • Latex sensitivity
  • Adhesives and tapes
  • Antiseptic solutions
Medication Reconciliation
  • Prescription medications
  • Over-the-counter drugs
  • Herbal supplements

NCLEX Tip: Bleeding Risk
The nurse must specifically inquire about medications that increase bleeding risk, including anticoagulants (warfarin), antiplatelets (aspirin, clopidogrel), and certain herbal supplements (Ginkgo, Ginseng, Garlic) which are often discontinued days before surgery.
Preoperative Risk Factor Assessment
Obesity
  • Increased risk for impaired wound healing
  • Higher incidence of surgical site infections
  • Potential for respiratory complications
  • Anesthesia challenges
Smoking
  • Decreased oxygen delivery to tissues
  • Higher risk for respiratory complications
  • Impaired wound healing
  • Increased anesthesia requirements
Alcohol Use
  • Risk for withdrawal during hospitalization
  • Potential liver dysfunction affecting medication metabolism
  • Increased bleeding risk
  • Nutritional deficiencies
Identifying these risk factors allows for proactive interventions to reduce postoperative complications and improve surgical outcomes.
Informed Consent: Roles and Responsibilities

NCLEX Tip
The roles in informed consent are frequently tested on the NCLEX exam!
Surgeon's Role
Obtains informed consent by explaining:
  • The specific procedure
  • Associated risks and benefits
  • Alternative treatment options
  • Potential outcomes
Nurse's Role
Witnesses the signature and ensures:
  • Client is competent to give consent
  • Consent is given voluntarily
  • Client indicates understanding
  • Proper documentation is completed
Client Questions Protocol
If client says "I don't understand what the doctor will do":
  • Notify the surgeon immediately
  • Do not attempt to explain the procedure
  • Document client's statement
  • Delay procedure until clarification
Preoperative Patient Education: Preventing Complications
Effective preoperative education reduces anxiety and decreases the risk of postoperative complications.
Deep Breathing & Coughing
Teach proper technique to prevent atelectasis and pneumonia after surgery.
Incision Splinting
Demonstrate holding a pillow against abdominal or thoracic incisions when coughing to reduce pain and support the wound.
VTE Prophylaxis
Instruct on ankle pumps, anti-embolism stockings, and sequential compression devices to prevent blood clots.
Early Ambulation
Emphasize that getting out of bed as soon as possible after surgery is crucial for preventing multiple complications.
Final Preoperative Preparation
1
Day Before Surgery
  • Complete all preoperative testing
  • Review discharge planning needs
  • Address questions and concerns
  • Begin NPO status as directed
2
Morning of Surgery
  • Verify NPO status compliance
  • Remove jewelry, dentures, prosthetics
  • Administer preoperative medications
  • Apply anti-embolism stockings if ordered
3
Immediate Pre-Surgery
  • Verify signed consent form
  • Confirm allergies are documented
  • Check ID band placement
  • Complete pre-surgical checklist
  • Document baseline vital signs
NPO Status: Typically nothing by mouth for 6-8 hours before surgery to prevent aspiration during anesthesia.
Intraoperative Phase: Nursing Roles
Circulating Nurse
Non-sterile RN who serves as the patient's primary advocate in the OR.
  • Manages OR environment
  • Monitors patient safety
  • Documents all aspects of care
  • Coordinates communication
  • Performs surgical counts with scrub nurse
  • Ensures compliance with protocols
Scrub Nurse/Tech
Sterile team member working directly in the surgical field.
  • Sets up the sterile field
  • Prepares instruments and supplies
  • Passes instruments to surgeon
  • Maintains sterile count of sponges, sharps, and instruments
  • Anticipates surgeon's needs
  • Manages specimens
Intraoperative Patient Safety: Surgical Time-Out

NCLEX Tip
The surgical time-out is a critical safety step that occurs immediately before the procedure begins and is frequently tested on NCLEX.
During the time-out, all surgical activity stops. The entire team (surgeon, anesthesia provider, nurses) must verbally confirm and agree on:
Correct Patient
Verify patient identity using two identifiers
Correct Procedure
Confirm the exact surgical procedure to be performed
Correct Site
Verify the surgical site and side is marked appropriately
Correct Equipment
Ensure all necessary equipment and implants are available
Intraoperative Considerations: Positioning & Complications
Patient Positioning
Proper positioning is essential for:
  • Surgical access to the operative site
  • Maintaining airway patency
  • Preventing neurovascular injuries
  • Protecting pressure points
The nurse must ensure adequate padding of bony prominences and proper body alignment to prevent complications such as nerve damage, pressure ulcers, and respiratory compromise.
Malignant Hyperthermia
A rare, life-threatening genetic condition triggered by certain anesthetic agents.
Key Signs:
  • Sudden tachycardia
  • Muscle rigidity (especially jaw)
  • Rapid rise in body temperature
  • Elevated end-tidal CO₂
Emergency Treatment:
  • Stop triggering anesthetic
  • Administer dantrolene
  • Provide cooling measures
Immediate Postoperative Care in PACU

NCLEX Tip
The #1 priority for a client arriving in the PACU is to assess and maintain a patent airway.
1
2
3
4
1
Airway
Assess for patency and signs of obstruction
2
Breathing
Monitor respiratory rate, depth, oxygen saturation, and breath sounds
3
Circulation
Evaluate blood pressure, heart rate, pulse quality, and check for bleeding
4
Secondary Assessments
Level of consciousness, pain level, surgical site condition, dressing integrity, drain output, urine output, temperature
Common Postoperative Respiratory & Cardiovascular Complications
Respiratory Complications
Atelectasis
Collapse of alveoli leading to decreased gas exchange.
Prevention: Deep breathing exercises, incentive spirometry, early ambulation
Pneumonia
Inflammation of lung tissue with fluid accumulation.
Signs: Fever, productive cough, crackles, dyspnea
Prevention: Coughing exercises, position changes, early mobility
Cardiovascular Complications
Hemorrhage & Hypovolemic Shock
Signs: Hypotension, tachycardia, weak thready pulse, cool clammy skin, decreased urine output
Intervention: Pressure to site, fluid resuscitation, blood products
Venous Thromboembolism (VTE)
Risk factors: Immobility, surgery >30 min, obesity, cancer
Prevention: Leg exercises, SCDs, prophylactic anticoagulants, early ambulation
Postoperative Gastrointestinal & Wound Complications
Gastrointestinal Complications
Paralytic Ileus
Temporary cessation of peristalsis
Signs: Absent/hypoactive bowel sounds, abdominal distention, no flatus
Interventions: NPO status, nasogastric tube, ambulation, monitor for return of bowel function
Nausea & Vomiting
Common after anesthesia and opioid administration
Interventions: Antiemetics, small sips of clear liquids when allowed, proper positioning
Wound Complications
Infection
Signs: Redness, warmth, purulent drainage, fever
Dehiscence & Evisceration
Emergency action: Cover with sterile, saline-soaked gauze and notify surgeon immediately
Nursing Interventions on the Medical-Surgical Unit
Pain Management
  • Assess pain using appropriate scale
  • Administer analgesics as prescribed
  • Evaluate effectiveness within appropriate timeframe
  • Implement non-pharmacological measures (positioning, relaxation)
  • Document response to interventions
Mobility Promotion
  • Assist with progressive ambulation starting POD #1
  • Help client sit at edge of bed before standing
  • Document distance walked and tolerance
  • Encourage frequent position changes when in bed
  • Teach importance of mobility in preventing complications
Wound Care Management
  • Monitor incision for signs of infection
  • Perform dressing changes using sterile technique
  • Document wound appearance, drainage amount/type
  • Teach patient proper wound care techniques
  • Monitor and empty surgical drains as needed
Nutrition Advancement
  • Begin with clear liquids when bowel sounds return
  • Advance diet as tolerated based on protocol
  • Monitor for nausea, vomiting, or abdominal distention
  • Document intake and tolerance
  • Ensure adequate hydration
NCLEX Success: Key Perioperative Care Takeaways
High-Priority NCLEX Content
  • Airway management is the #1 priority in PACU
  • The nurse's role in informed consent is to witness, not explain procedures
  • Surgical time-out verifies correct patient, procedure, and site
  • For wound evisceration: cover with saline-soaked gauze and notify surgeon immediately
  • Early ambulation prevents multiple postoperative complications
Critical Thinking Application
On the NCLEX, remember to prioritize using:
  1. ABCs (Airway, Breathing, Circulation)
  1. Maslow's Hierarchy (physiological needs first)
  1. Safety over comfort
  1. Assess before intervening
  1. Least invasive interventions first
When facing questions about perioperative care, always consider which phase the patient is in and what the primary nursing responsibilities are for that phase.