NLE Perioperative & Pain Nursing — Preoperative and Intraoperative NursingConcept Map

Concept

Preoperative Phase

Sub Concepts

• Surgical Classification (urgency, purpose, risk)
• Preoperative Assessment and Surgical Risk Factors
• Informed Consent Process
• NPO Status Management
• Preoperative Checklist
• Preoperative Teaching and Psychological Preparation

Relationship To Central

First phase of perioperative care; focuses on patient preparation and risk reduction

Concept

Intraoperative Phase

Sub Concepts

• Types of Anesthesia (general, regional, local, moderate sedation)
• Surgical Safety Measures
• Surgical Counts and Retained Object Prevention
• Patient Positioning and Alignment
• Surgical Asepsis and Operating Suite Zones
• Operating Room Team Roles

Relationship To Central

Second phase of perioperative care; focuses on safety during surgical procedure

Concept

Risk Assessment and Management

Sub Concepts

• Age-related risks
• Obesity and malnutrition
• Chronic disease complications
• Medication interactions and holds
• Coagulation and fluid-electrolyte abnormalities
• Baseline diagnostic testing

Relationship To Central

Critical element across both phases; identifies modifiable and non-modifiable risk factors

Concept

Patient Safety Standards

Sub Concepts

• Correct-site surgery verification
• Surgical time-out protocol
• Two-identifier patient verification
• Surgical site marking
• Sterile field maintenance
• Latex-free environment preparation

Relationship To Central

Foundational to all perioperative nursing practice; prevents never events

Concept

Nursing Interventions and Responsibilities

Sub Concepts

• Preoperative assessment and preparation
• Consent witnessing and verification
• Patient advocacy and communication
• Equipment preparation and maintenance
• Intraoperative monitoring and documentation
• Complications recognition and reporting

Relationship To Central

Core nursing actions aligned with RA 9173 professional standards

To

Preoperative Preparation

From

Surgical Risk Assessment

Strength

strong

Relationship

Risk factors identified during assessment guide the type and extent of preparation needed; higher-risk patients may require additional interventions, testing, or medication adjustments

To

Patient Autonomy and Legal Protection

From

Informed Consent

Strength

strong

Relationship

Consent protects both the patient's right to self-determination and the healthcare provider from liability; fundamental ethical and legal principle in RA 9173 professional practice

To

Aspiration Prevention

From

NPO Status

Strength

strong

Relationship

NPO (nothing by mouth) protocols directly reduce the risk of aspiration of gastric contents under general anesthesia, a potentially life-threatening intraoperative complication

To

Postoperative Complications

From

Preoperative Teaching

Strength

strong

Relationship

Effective teaching on deep breathing, incentive spirometry, splinting, and leg exercises prevents postoperative complications such as atelectasis, pneumonia, and deep vein thrombosis

To

Patient Monitoring

From

Anesthesia Selection

Strength

strong

Relationship

Type of anesthesia determines specific intraoperative monitoring parameters needed; general anesthesia requires airway management and continuous cardiovascular monitoring, while regional anesthesia requires different monitoring foci

To

Preoperative Assessment

From

Malignant Hyperthermia Screening

Strength

strong

Relationship

Family history of malignant hyperthermia must be identified during preoperative assessment to enable dantrolene preparation and alternative anesthetic agent selection

To

Correct-Site Surgery Prevention

From

Surgical Time-Out

Strength

strong

Relationship

Time-out protocol with whole team verification is the final safety check before incision to confirm correct patient, procedure, and site—critical for preventing never events

To

Retained Foreign Object Prevention

From

Surgical Counts

Strength

strong

Relationship

Three-point counting protocol (before procedure, before cavity closure, at final skin closure) is the primary mechanism to prevent retained sponges, instruments, or sharps

To

Pressure Injury and Nerve Damage Prevention

From

Patient Positioning

Strength

strong

Relationship

Proper positioning with bony prominence padding and correct alignment protects the anesthetized patient who cannot self-protect from pressure-related injuries and nerve compression

To

Surgical Site Infection Prevention

From

Surgical Asepsis

Strength

strong

Relationship

Strict aseptic technique and maintenance of sterile fields reduce contamination and lower surgical site infection rates, a key quality and safety metric

To

Patient Safety Culture

From

Operating Room Team Roles

Strength

moderate

Relationship

Clear role definition (surgeon, anesthesia provider, scrub nurse, circulating nurse) ensures coordinated care, communication, and advocacy for the unconscious patient's safety

To

Patient Identification Error Prevention

From

Two-Identifier Verification

Strength

strong

Relationship

Use of two identifiers (name and hospital ID, or name and DOB) at multiple checkpoints prevents wrong-patient surgery and medication administration errors

To

Correct-Site Surgery

From

Surgical Site Marking

Strength

strong

Relationship

Preoperative surgical site marking by the surgeon/proceduralist identifies the intended operative site and provides visual verification during time-out

To

Infection Prevention

From

Hair Clipping

Strength

moderate

Relationship

Clipping (not shaving) hair the day of surgery removes hair without creating micro-abrasions that increase infection risk; shaving is contraindicated

To

Oxygenation Assessment

From

Nail Polish Removal

Strength

moderate

Relationship

Nail polish must be removed to allow visual assessment of capillary refill and nail bed color as indicators of oxygenation status during and after anesthesia

To

Post-Dural Puncture Headache

From

Spinal Anesthesia

Strength

moderate

Relationship

Spinal anesthesia carries risk of post-dural puncture headache (PDPH) postoperatively; managed with flat positioning, fluids, and monitoring for severity

To

Anxiety Reduction and Induction Facilitation

From

Preoperative Medication Administration

Strength

moderate

Relationship

Preoperative sedatives, antiemetics, and antibiotic prophylaxis reduce anxiety, prevent nausea/vomiting, and facilitate smooth anesthetic induction

To

Risk Stratification

From

Baseline Diagnostic Testing

Strength

moderate

Relationship

Baseline labs (CBC, BMP, coagulation studies) and imaging establish normal parameters against which intraoperative changes can be evaluated and post-surgical complications detected early

To

Medication Reconciliation

From

Chronic Disease Management

Strength

strong

Relationship

Patients with chronic diseases often take multiple medications; careful reconciliation determines which are held (anticoagulants, oral hypoglycemics) and which continue (cardiac drugs) perioperatively

To

Anaphylaxis Prevention

From

Latex Allergy Screening

Strength

strong

Relationship

Identifying latex allergies during preoperative assessment enables preparation of a latex-free operating environment to prevent intraoperative anaphylaxis