Nursing study guide
Perioperative nursing
Prepare safely, communicate across handoffs, prevent complications, and recognize deterioration.
Preoperative
Assessment, optimization, verification, teaching, and readiness before the procedure.
Intraoperative
Asepsis, positioning, counts, specimen and medication safety, monitoring, and advocacy during the procedure.
Postoperative
Airway and recovery, pain and nausea, wounds and drains, mobility, complications, and discharge readiness.
Pre-op assessment
Find risk before it becomes a complication
Escalate unresolved findings before transport or sedation.
History
Procedure, indication, baseline function, prior anesthesia/surgery, allergies, airway/OSA, heart/lung disease, bleeding, infection, pregnancy possibility, substances, and supports.
Medicines
Reconcile prescriptions, anticoagulants/antiplatelets, diabetes medicines, steroids, supplements, and the procedure-specific hold plan.
Readiness
Verify required labs/tests, NPO status, skin/site preparation, valuables/prostheses, transport, and discharge support.
Teach
Expected course, breathing/mobility exercises, pain plan, equipment, restrictions, and who to contact.
Verification
Right patient, procedure, site, plan, and consent
A checklist supports judgment; it does not replace it.
Consent boundary
The authorized provider explains the procedure and alternatives and obtains informed consent. The nurse verifies completion/witnesses according to policy and stops when questions or capacity concerns remain.
Before sedation
Confirm identity, procedure/site marking when applicable, allergies, consent, code/blood considerations, implants/equipment, antibiotics, and team concerns.
NPO is contextual
Follow the anesthesia/procedure plan; report intake rather than independently canceling or concealing it.
Team roles
Different jobs share one safety goal
Exact scope follows licensure, credentialing, policy, and the procedure setting.
| Role | Primary contribution | Nursing connection |
|---|---|---|
| Surgeon/proceduralist | Procedure, surgical decisions, postoperative plan | Clarify orders, findings, restrictions, and escalation pathway. |
| Anesthesia professional | Anesthesia plan, airway, physiologic management, emergence | Communicate risks, medicines, status changes, and recovery concerns. |
| Circulating RN | Patient advocacy, verification, documentation, environment, positioning, counts/specimens/team coordination | Maintains the whole-patient safety view in the room. |
| Scrub person | Sterile field, instruments, supplies, and counts with the circulator | Reports contamination or count concern immediately. |
| PACU RN | Airway, recovery, pain/nausea, surgical assessment, discharge/transfer criteria | Receives structured handoff and trends emergence. |
| UAP/support staff | Assigned stable tasks within training and policy | Reports observations; does not replace nursing assessment or judgment. |
Intraoperative safety
Prevent injury while the patient cannot self-protect
Speak up for a mismatch, break in sterility, pressure risk, or physiologic concern.
Time-out
Pause with the active team to verify the patient, procedure, site, position, critical steps, antibiotics, imaging, equipment, and anticipated concerns.
Positioning
Protect airway access, alignment, nerves, skin, circulation, eyes, and pressure areas; account for duration and devices.
Asepsis + counts
Identify contamination, follow count policy, reconcile discrepancies, and handle specimens and implants with traceability.
Environment
Manage electrosurgical/fire risk, medications/solutions, temperature, traffic, and communication.
PACU
Airway and ventilation come first
Recovery is dynamic; compare the patient with baseline and the handoff.
Immediate
Airway patency, respiratory rate/effort, oxygenation, circulation, consciousness, temperature, pain, nausea, wound, drains, lines, and urine as applicable.
Common threats
Obstruction, hypoventilation, residual blockade, hypotension, bleeding, dysrhythmia, aspiration, agitation, hypothermia, pain, and PONV.
Handoff
Procedure/findings, anesthesia/airway, medicines/fluids/blood, losses, access, devices, restrictions, complications, and pending needs.
Post-op complications
Know what cannot wait
Escalate the pattern, not only a single abnormal value.
| Concern | Possible clues | Nursing priority |
|---|---|---|
| Airway/respiratory | Stridor, obstruction, hypoventilation, falling saturation, dyspnea | Open/support airway, oxygen/ventilation per protocol, reverse causes as ordered, rapid escalation. |
| Bleeding/shock | Drainage, swelling, hypotension, tachycardia, pallor, low urine, mental-status change | Assess site and circulation, quantify loss, maintain access, escalate and prepare ordered treatment. |
| VTE/PE | Unilateral swelling/pain or sudden dyspnea, chest pain, tachycardia, hypoxia | Emergency assessment; prevention includes prescribed mobility and prophylaxis. |
| Infection | Fever pattern, wound change, purulence, rising pain, systemic deterioration | Assess source, cultures/labs as ordered, sepsis pathway when indicated. |
| Ileus/retention | Distention, vomiting, absent progression, inability to void | Assess medicines, intake/output, bowel/bladder status, mobility, and notify per pathway. |
Recovery
Small actions prevent large complications
Adapt the plan to the surgery, restrictions, age, and comorbidities.
Breathe + move
Position, cough/deep breathe or use ordered devices, mobilize early when safe, protect lines, and use VTE prophylaxis.
Comfort
Use multimodal pain and nausea care; reassess sedation, respiration, function, and adverse effects.
Wound + nutrition
Follow dressing/drain orders, hand hygiene, glucose support, hydration, diet progression, and bowel plan.
Discharge
Use teach-back for medicines, wound/device care, activity, diet, follow-up, transport, and specific warning signs.
Delegation
Delegate tasks—not nursing judgment
Delegation depends on state law, facility policy, competence, patient stability, and task predictability.
| May be delegated when appropriate | RN responsibility |
|---|---|
| Routine vital signs, hygiene, intake/output, stable ambulation, specimen transport, and selected equipment tasks | Assess first, choose the right person/task/circumstance, give clear directions and report limits, supervise, and evaluate. |
| Observation of stable findings with explicit report parameters | Interpret findings and decide whether the patient is ready, stable, or deteriorating. |
| Reinforcement after RN teaching when permitted | Initial teaching, individualized education, evaluation of understanding, and care-plan changes. |
Medical abbreviations
Use only approved abbreviations and clarify uncertainty
Abbreviations save space but can also create medication, handoff, and documentation errors.
| Principle | Safe practice | Examples / cautions |
|---|---|---|
| Context controls meaning | Interpret an abbreviation only within the current order, note, specialty, and facility-approved list. | The same letters may mean different things. When meaning is uncertain, stop and clarify with the author. |
| Common clinical shorthand | Learn frequently encountered terms while still using the organization’s approved terminology. | PRN = as needed; NPO = nothing by mouth; PO = by mouth; IV = intravenous; IM = intramuscular; SQ/subcut = subcutaneous; I&O = intake and output; VS = vital signs. |
| Time + frequency | Write times and frequencies clearly and follow the electronic system or facility standard. | Avoid ambiguous legacy forms. Distinguish a clock time from a frequency and verify the complete medication order. |
| Measurements | Use a leading zero below 1 and no trailing zero after a whole number. | Write 0.5 mg, not .5 mg; write 5 mg, not 5.0 mg. Write units clearly. |
| Do-not-use examples | Do not use error-prone abbreviations identified by the organization and safety standards. | Examples include U or u for unit, IU, QD/q.d., QOD/q.o.d., MS, MSO4, MgSO4, and ambiguous trailing-zero or missing-leading-zero notation. |
| Handoff + delegation | Spell out the task, patient-specific limits, timing, expected result, and what must be reported. | An abbreviation never replaces closed-loop communication, read-back when required, supervision, or evaluation. |
Sources
Reference notes
Use current state law, facility policy, procedure protocols, and anesthesia/surgical orders.