Preoperative Assessment and Planning
Preoperative assessment and planning tests whether the RNFA can build a defensible surgical plan before incision: risk stratification, consent, optimization, prophylaxis, and team briefing. The RNFA contributes nursing assessment and surgical knowledge, but does not replace the surgeon’s evaluation or anesthesia’s clearance.
Core rules and concepts
- Focused history: prior reactions to anesthesia, latex, chlorhexidine, iodine, adhesives; bleeding and bruising; OSA; renal and hepatic function; current anticoagulants and antiplatelets, including herbal supplements.
- Risk indices: cardiac risk (RCRI), VTE (Caprini), frailty, glycemic control (HbA1c), malnutrition, tobacco, and colonization with MRSA or resistant organisms when policy requires decolonization.
- Medication plan: continue beta blockers and most chronic meds with a sip of water; hold or bridge anticoagulants per protocol; manage insulin and SGLT2 inhibitors to avoid euglycemic ketoacidosis.
- Prophylaxis: antibiotic within 60 minutes before incision (120 for vancomycin or fluoroquinolone), weight-based dosing, redosing for long cases; normothermia and glucose control.
- Consent and site: verify procedure, laterality, implants, blood consent, advance directives, and mark the site with the patient awake when required.
Worked example
An elective hernia patient on warfarin for atrial fibrillation has an INR of 2.6. The RNFA does not simply cancel or stop warfarin. The team calculates thromboembolic risk, plans perioperative bridging per cardiology protocol, confirms timing of the last dose, and documents the plan. The case proceeds only when INR and anesthesia criteria are met.
Traps
Assuming NPO means all medications; missing OSA and difficult airway; accepting a stated allergy without mechanism; treating an INR as a surrogate for all bleeding risk; and letting consent omit laterality or implant details.