Perioperative Care
✅ Reviewed by NCLEXDeck Clinical Review Board — Updated June 2026
Comprehensive NCLEX-RN Review — Preoperative, Intraoperative, Postoperative Phases, Complications, and Pain Management
1. Preoperative Phase
Goals
Ensure client is prepared, safe, informed, and consent is valid.
Assessment & Education
- Verify informed consent signed (provider obtains; nurse confirms understanding and witnesses)
- Health history, allergies, current meds (esp. anticoagulants, insulin, herbals), NPO status
- NPO typically 6–8 hr for solids, 2 hr for clear liquids — prevents aspiration
- Baseline vitals and labs; report abnormal results (K+, coagulation, glucose)
- Teach deep breathing, incentive spirometer, coughing/splinting, leg exercises, early ambulation, pain management plan — best done pre-op while alert
- Remove jewelry, dentures, prostheses, nail polish; void before pre-op meds
Pre-op Checklist / Surgical Safety
- Correct site marking and "time-out" to verify right client, right procedure, right site
- Administer pre-op meds as ordered (sedatives, prophylactic antibiotics within 60 min of incision)
⭐ NCLEX TIP
Pre-op teaching and confirming consent + NPO are recurring answers. If a consent isn't fully understood or the client is already sedated, stop and notify the provider — do not proceed.
2. Intraoperative Phase
- Circulating nurse (non-sterile) — advocacy, counts, documentation
- Scrub nurse (sterile field) — instruments, supplies
- Surgical counts (sponges, needles, instruments) before/during/after to prevent retained items
- Maintain sterile field and asepsis; positioning to prevent injury/pressure
Malignant Hyperthermia — Life-Threatening Emergency
Rare reaction to anesthesia (succinylcholine, volatile agents): ↑↑ end-tidal CO₂, rigidity, tachycardia, then rapidly rising temperature.
Treatment: Dantrolene, stop the anesthetic agent, cool the client. Ask about family history of anesthesia reactions pre-op.
3. Postoperative Phase
Immediate (PACU) Priorities — ABCs
- Airway/breathing first: patent airway, O₂ saturation, respiratory depth
- Circulation: vital signs, bleeding, hemodynamics
- Level of consciousness, gag reflex return before oral intake
Ongoing Postoperative Assessment & Complications
| System | Watch For | Prevention / Action |
|---|
| Respiratory | Atelectasis, pneumonia, hypoxia | Incentive spirometer, deep breathing, cough/splint, early ambulation |
| Cardiovascular | Hemorrhage/shock, DVT/PE | Monitor VS & dressing; SCDs, early ambulation, anticoagulants |
| GI | N/V, paralytic ileus | Assess bowel sounds; advance diet as tolerated; ambulate |
| GU | Urinary retention | Assess bladder; catheterize if no void within 6–8 hr |
| Wound | Infection, dehiscence, evisceration | Assess incision; splint when coughing |
| Neuro | Delayed emergence, delirium | Reorient, monitor |
Wound Emergencies
- Dehiscence: separation of wound edges
- Evisceration: protrusion of organs through incision — cover with sterile saline-soaked gauze, keep client NPO, low-Fowler's with knees flexed, notify surgeon immediately (surgical emergency)
VTE Prevention
Major post-op concern. Early ambulation, SCDs/compression, prophylactic anticoagulation, leg exercises, hydration.
- DVT signs: unilateral calf swelling, warmth, pain. Do not massage (embolus risk)
- PE signs: sudden dyspnea + chest pain + tachycardia → O₂, notify, ABCs
⭐ NCLEX TIP
Post-op priority sequence is ABCs → bleeding/circulation → pain → other needs. Tested complications: respiratory (atelectasis), VTE/PE, ileus, and evisceration. Know the immediate nursing action for each.
4. Pain Management (Post-Op)
- Assess pain regularly — self-report is the most reliable indicator
- Multimodal analgesia; PCA (patient-controlled analgesia) — only the client presses the button; educate family not to
- Monitor sedation/respiratory status with opioids; balance pain control with safety