- Preoperative phase. Nursing assessment, informed consent, and patient teaching.
- Intraoperative phase. Surgical safety checklists (Time Out), sterile technique, and anesthesia monitoring.
- Postoperative phase (PACU). Airway management, pain control, wound care, and identifying complications such as hemorrhage or dehiscence.
The Three Perioperative Phases
Perioperative care runs across three phases, and the WHO Surgical Safety Checklist anchors safety checks to each one: Sign In before anesthesia, Time Out before skin incision, and Sign Out before the patient leaves the operating room (World Health Organization). AORN's Comprehensive Surgical Checklist combines those WHO checks with The Joint Commission Universal Protocol for preventing wrong site, wrong procedure, and wrong person surgery (AORN; The Joint Commission).
In the preoperative phase, the nurse confirms identity, verifies informed consent, reviews allergies and airway risk, and completes patient teaching. In the intraoperative phase, the nurse maintains sterile technique, leads the surgical Time Out, and monitors the patient under anesthesia. In the postoperative phase, PACU nursing focuses on airway and circulation, pain control, wound assessment, and early recognition of complications such as hemorrhage, dehiscence, or infection.
Frequently Asked Questions
What are the three phases of perioperative nursing? The preoperative phase (before surgery), the intraoperative phase (during surgery), and the postoperative phase (recovery, often beginning in the PACU). Each has its own nursing priorities and safety checks.
What is the surgical Time Out? The Time Out is a pause taken just before skin incision in which the whole surgical team verbally confirms the correct patient, correct procedure, and correct site. It is a core step of the WHO Surgical Safety Checklist and The Joint Commission Universal Protocol (World Health Organization; The Joint Commission).
What is the nurse's role in informed consent? The surgeon obtains informed consent, but the perioperative nurse confirms the signed consent is on the chart, that it matches the planned procedure and site, and that the patient understands and has no new questions before proceeding.
What are common postoperative complications nurses monitor for? Airway compromise, hemorrhage, hypotension, infection, wound dehiscence or evisceration, deep vein thrombosis, and uncontrolled pain. Early detection in the PACU is a frequent NCLEX focus.
What is wound dehiscence? Dehiscence is the partial or complete separation of a surgical wound's edges. If abdominal organs protrude through the opening, it becomes evisceration, a surgical emergency requiring the nurse to cover the site with sterile saline-soaked gauze and notify the surgeon immediately.
Why do these topics matter for the NCLEX? Perioperative questions test clinical judgment under standardized safety protocols, so the exam rewards knowing the checklist steps, consent verification, sterile technique, and the priority assessments for each phase.