Preoperative Assessment and Planning
Core concepts
Preoperative assessment for the pediatric perioperative patient is a systematic risk-stratification process, not a checklist. Candidates must know the components: a complete history (birth history, prematurity, congenital anomalies, prior anesthetics and any complications), a focused physical exam, a medication and allergy review including latex and food cross-reactivity, and an airway assessment. Recognize that children are not small adults: they have limited physiologic reserve, higher metabolic and oxygen demands, and rapidly decompensate with dehydration or hypothermia. Fasting guidelines follow age-based clear-liquid intervals; prolonged fasting in infants risks hypoglycemia and dehydration, so the nurse should question unnecessarily long fasts. Screening for upper respiratory infection matters because recent URI increases bronchospasm and laryngospasm risk; the decision to proceed is a team judgment, not a fixed rule. Preoperative laboratory testing should be targeted, not routine; a healthy child having minor surgery rarely needs a full panel. Also identify children at risk for emergence delirium, postoperative nausea and vomiting, and malignant hyperthermia susceptibility by family history.
Traps in questions
Watch for absolutes like "always" or "never." A common trap is choosing to cancel surgery solely for a mild URI, or ordering routine labs for an asymptomatic child. Another trap confuses fasting rules across ages, or assumes parents understood instructions without teach-back. Latex precautions are frequently tested: children with spina bifida, myelomeningocele, or multiple prior surgeries are high risk.
Rule of thumb
Use teach-back: ask the parent to repeat fasting instructions and medication holds in their own words before you document understanding. If they cannot, reteach rather than sign off.