Preoperative Exams in Primary Care: A Guide for Nurse Practitioners

You're seeing a patient for a preoperative evaluation before an upcoming surgery. The surgeon has requested some testing and documentation—but how do you determine what your patient actually needs before their procedure?

Which patients need additional cardiovascular evaluation? When should you use RCRI or DASI? Do you need to order an ECG, chest X-ray, or routine labs? And how do you document your assessment without saying the patient is "cleared" for surgery?

In this updated episode of Real World NP, we're walking through a practical approach to the preoperative evaluation for noncardiac surgery in primary care, including updated cardiovascular risk assessment recommendations and how to apply them during an actual patient visit.

What You'll Learn:

• What your role is during a preoperative evaluation
• How to assess surgical risk and identify reasons to pause before surgery
• Using RCRI, ACS NSQIP, and DASI to assess cardiovascular risk and functional capacity
• What to include in the preoperative history and physical exam
• Assessing chronic conditions and pulmonary risk before surgery
• When preoperative labs, ECGs, and imaging are indicated
• Medication considerations before surgery, including anticoagulants, diabetes medications, and SGLT2 inhibitors
• What to document and communicate to the surgical and anesthesia teams

Timestamps

00:00 – Introduction

01:32 – Your role in the preoperative evaluation

02:13 – Assessing surgical risk

03:04 – Reasons to pause before surgery

03:58 – Cardiovascular risk assessment: RCRI and ACS NSQIP

04:45 – Functional capacity and DASI

05:24 – Preoperative history and chronic conditions

06:56 – Pulmonary risk assessment

07:25 – Physical exam and selective testing

08:25 – Perioperative medication considerations

09:37 – Documenting the preoperative evaluation

Resources Mentioned:

Preoperative Evaluation Cheat Sheet: A quick-reference guide to surgical risk, cardiovascular assessment, functional capacity, testing, and documentation. Get your copy at www.realworldnp.com/binder

For a full transcript and conversation chapters, visit the blog: https://www.realworldnp.com/blog/preop-exam-nurse-practitioner

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