Pre-operative responsibilities
Informed consent items appear on almost every exam. The provider performing the procedure is responsible for explaining the procedure, the risks, the benefits and the alternatives. The nurse's role is to witness the client's signature, confirm that the client appears to understand and is signing voluntarily, and to stop the process and notify the provider if the client expresses confusion or changes their mind. A nurse who explains the surgery to fill a knowledge gap has stepped outside their role, and that option is wrong.
Consent also requires capacity. A client who has received pre-operative sedation cannot give valid consent, so consent must be obtained before sedation. For minors, a parent or legal guardian consents, with recognised exceptions such as emancipated minors and certain categories of care that vary by jurisdiction. Emergency life-saving treatment may proceed under implied consent when no decision-maker is available.
The pre-operative checklist covers identity and site verification, allergies including latex, NPO status, removal of jewellery, dentures, prostheses and nail polish per policy, baseline vital signs, laboratory results, voiding before transfer, and documentation of the client's medications, including anticoagulants, herbal supplements and any diabetes medication held for the procedure.
- •Provider explains, nurse witnesses the signature
- •Consent must precede sedation
- •Verify allergies, NPO status, site marking and removal of prostheses
- •A confused or reluctant client means stop and notify the provider
Immediate post-anaesthesia priorities
In the post-anaesthesia care unit, the priority order is fixed and reliably tested: airway first, then breathing and oxygenation, then circulation, then level of consciousness, then surgical site and pain. A client whose airway is compromised by residual anaesthesia or laryngospasm outranks everything else in the room.
Common early complications include airway obstruction from tongue relaxation, hypoventilation from residual anaesthetic or opioid effect, hypothermia with shivering, nausea and vomiting with aspiration risk, and hypotension from fluid loss or vasodilation. Position the still-drowsy client on their side or with the head turned unless contraindicated, keep suction available, and monitor for bleeding at the site and beneath the client where blood may pool unseen.
Malignant hyperthermia deserves specific memorisation. It is a rare inherited reaction to certain anaesthetic agents presenting with an unexplained rise in end-tidal carbon dioxide, muscle rigidity often starting in the jaw, tachycardia and a late, very high fever. Treatment is immediate discontinuation of the triggering agent, dantrolene, and aggressive cooling. Ask about family history of anaesthetic problems pre-operatively.
| Post-op day | Likely complication | Key findings | Nursing action |
|---|---|---|---|
| Day 0–1 | Haemorrhage, airway compromise | Falling BP, rising pulse, saturated dressing | Assess airway, apply pressure, notify provider |
| Day 1–2 | Atelectasis | Low-grade fever, diminished breath sounds | Deep breathing, incentive spirometry, ambulate |
| Day 3–5 | Wound or urinary infection | Fever, purulent drainage, dysuria | Assess site, obtain cultures, notify provider |
| Day 5–7 | Deep vein thrombosis | Unilateral calf swelling, pain, warmth | Do not massage; notify provider |
| Day 5–10 | Dehiscence or evisceration | Sudden 'give' at the wound, drainage, protruding tissue | Sterile saline gauze, low Fowler's, knees bent, call for help |
Preventing and managing complications
Prevention is where most teaching items sit. Deep breathing and coughing every one to two hours while awake, incentive spirometry with the same frequency, splinting the incision with a pillow during coughing, early and progressive ambulation, leg exercises, adequate hydration and effective pain control that permits movement all reduce complications substantially. Pain control is itself a prevention measure, because a client in severe pain will not deep breathe or ambulate.
Wound dehiscence and evisceration are emergencies with a specific answer. Do not attempt to reinsert protruding tissue. Cover the wound with sterile gauze moistened with sterile normal saline, position the client in low Fowler's with the knees bent to reduce abdominal tension, keep them NPO, monitor for shock and notify the surgeon immediately.
Paralytic ileus, urinary retention and thromboembolism round out the common set. Absent bowel sounds with distension and no flatus suggests ileus, managed with NPO status, possible nasogastric decompression and ambulation. Inability to void within the expected post-operative window requires bladder assessment before any assumption. For suspected deep vein thrombosis, never massage the limb.
- •Incentive spirometry and early ambulation prevent most pulmonary complications
- •Splint the incision when coughing to reduce pain and improve effort
- •Evisceration: sterile moist gauze, low Fowler's with knees bent, urgent notification
- •Never massage a limb with suspected DVT
Studying perioperative content
The most efficient way to learn this material is as a timeline rather than a list. Build one sheet with three columns for pre-operative, intra-operative and post-operative responsibilities, and a second sheet mapping complications to their typical post-operative day. Almost every surgical item you encounter can be answered from those two sheets.
Perioperative content overlaps heavily with fundamentals, infection control and pain management, so practise it in mixed sets. In particular, watch for items combining surgical care with delegation, since post-operative clients are frequently used in assignment questions as the unstable client the registered nurse must keep.
Review rationales carefully on positioning and wound items, since these carry precise correct answers that are easy to lose marks on if you approximate.