Preoperative Plan of Care
From assessment to an actionable plan
The preoperative plan of care translates assessment data into prioritized nursing diagnoses, measurable expected outcomes, and specific interventions. It is developed with the patient and family, not for them, and it is dynamic - revised when new information arrives, even after the patient reaches the OR. A complete plan addresses positioning and pressure management, special equipment, instrumentation and implants, prophylactic antibiotic selection and timing (generally within 60 minutes before incision; within 120 minutes for vancomycin and fluoroquinolones), venous thromboembolism prophylaxis, normothermia measures, glycemic control, skin antisepsis, specimen handling, latex or other sensitivities, cultural and language needs, and the anticipated phase of recovery and discharge destination.
Common traps
Candidates lose points by confusing documents. The preference card lists supplies a surgeon typically uses; it is not the plan of care. The surgeon's brief operative note is not a nursing care plan. Another trap is writing goals that cannot be measured - 'patient will be comfortable' fails, while 'patient will report pain at or below 3 on a 0-10 scale within 30 minutes of intervention' works. Also watch for the assumption that a plan written preoperatively is fixed; intraoperative findings, a change in procedure, or a new allergy must trigger reassessment and revision, documented and communicated.
Rule of thumb
If the goal cannot be measured, it is not an outcome. Test each answer choice by asking whether it is patient-centered, measurable, time-bound, and appropriate to nursing scope - the choice that meets all four is generally the correct answer.