Navigating The Preop Visit In Primary Care

Sep 9

The preoperative exam— every patient having surgery needs to have a visit with a healthcare provider before their surgery in order to assess their health and verify that it is relatively safe to proceed with surgery. So nerve-wracking!

You're being asked to evaluate a patient before surgery—but what exactly are you responsible for? Are you supposed to “clear” the patient? Which patients need additional cardiac evaluation? And which preoperative labs, ECGs, or imaging do you actually need to order?

A preoperative evaluation isn't about declaring that surgery is completely safe. It's about identifying and assessing the patient's perioperative risk, looking for conditions that may need further evaluation or optimization before surgery, and communicating those findings to the surgical team.

In this episode, we walk through a practical approach to the preoperative evaluation in primary care, including surgical risk, cardiovascular risk assessment, functional capacity, preoperative testing, and when further evaluation may be needed.

2026 Update: This is a Real World NP classic, originally recorded in 2019. The foundational approach to evaluating a patient before surgery is still relevant and is one I continue to teach today. Since this episode was recorded, guidelines have evolved around perioperative cardiovascular risk assessment and when preoperative testing is indicated. We're currently working on an updated version of this episode; in the meantime, you'll find our current recommendations in the Preoperative Evaluation Cheat Sheet in the Digital NP Binder.

Listen

Watch

What I Cover in This Episode:

What a preoperative evaluation is—and why we don't really “clear” patients for surgery
How the type and risk of surgery affect your evaluation
Assessing and optimizing chronic medical conditions before surgery
Evaluating cardiovascular and pulmonary risk
Using functional capacity/METs as part of cardiovascular risk assessment
When you may need additional evaluation or specialist input
What to consider when ordering preoperative labs, ECGs, and imaging
Important history to gather, including previous surgeries/anesthesia complications, medications, smoking, and alcohol use

Key Takeaways

A Preop Visit Isn't About “Clearing” the Patient

No surgery is risk-free. Your role is to assess the patient's current health and perioperative risk, identify conditions that may need further evaluation or optimization, and communicate your assessment and recommendations to the surgical team.

Start With the Procedure + the Patient

Clarify the planned procedure, its risk, and the patient's relevant medical history and current clinical status before deciding what additional evaluation or testing is needed.

Don't Order Routine Preoperative Testing Just Because Surgery Is Planned

CBCs, metabolic testing, coagulation studies, ECGs, chest X-rays, and other tests should be ordered when indicated by the patient, procedure, medications, or clinical findings—not automatically for every preoperative patient.

Cardiovascular Assessment Is Stepwise

Assess for active or unstable cardiovascular conditions first, then consider surgical risk, estimated perioperative cardiovascular risk, functional capacity, and whether additional testing would change management.

Document Risk—Not “Clearance”

Document your assessment of perioperative risk, relevant findings, conditions that have been optimized or still need attention, and recommendations for the surgical/anesthesia team.

Resources mentioned in this episode:

The Preoperative Evaluation Cheat Sheet walks you through surgical risk, cardiovascular risk, functional capacity, preop testing, and documentation—so you can quickly work through what your patient needs before surgery. Get the Cheat Sheet inside the Digital NP Binder.

If you liked this post, also check out:

WEBVTT
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Hey there, welcome to the Real World NP podcast.
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I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
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company for nurse practitioners in primary care.
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confident, capable, and take the best care of their patients.
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the right place.
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Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
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slash podcast.
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Well, hey there, it's Liz Rohr from Real World NP, and you're watching NP Practice
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Made Simple, the weekly videos to help save you time, frustration, and help you
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learn faster so you can take the best care of your patients.
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So today I'm going to be talking about preoperative exams.
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It's kind of a big topic, but I'm going to do my very best to kind of give you
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an overview of guidance of how I conduct my exams and how I recommend you do based
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on the available guidelines.
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A couple of disclaimers I want to make from the beginning is that if you are
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an algorithm-loving, tool-loving kind of girl like I am, or boy, that you
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might be a little bit disappointed for pre-op exams because they're a little
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bit complicated.
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So really, one of the take-homes I want you to take away from this is that
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each pre-op exam is for that patient at that time with those chronic
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conditions for that type of surgery, unfortunately.
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So it's really hyper-individualized, and that's a very good reason is
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because there's a lot to think about.
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So with that in mind, I think it's really important that you, I really want
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to stress that you ask questions whenever you're not sure, right?
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So there's a spectrum of the different types of pre-ops we're seeing, right?
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There's healthy patients undergoing low-risk surgeries all the way through
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very complicated, multiple chronic comorbidities, very ill patients
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trying to undergo high-risk surgeries or asking for your clearance.
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And so I'm going to be talking a little bit more towards the kind of
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second one I mentioned just because that's kind of come up as a lot,
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as a question a lot.
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But one other kind of like disclaimer I want to add is that I'm
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a family nurse practitioner and I've been doing this for four years.
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However, the patients that I'm seeing are generally on the healthier side
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or are having lower-risk surgeries if they have some chronic comorbidities.
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So I'm actually, I think that's actually a benefit for making this video,
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though, because if I were to switch over to that type of practice
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in internal medicine, doing those kind of higher-risk patients,
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this is what I would do.
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So just one other thing to say before we start is that you kind of
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want to have a discussion with your supervisor.
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I'm going to be going over kind of like the steps that I recommend
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that I would take if I was kind of transitioning into that practice
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of a more intense internal medicine position in terms of doing,
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I mean, my job is intense, but it's just not doing that intense skill.
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This is kind of like the approach that I would take,
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but I would also present this to my collaborating physician
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and my supervisor and talk about, here's my approach.
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And is this something that you recommend?
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Do you have other protocols in the clinic?
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Do you have other forms of patients fill out like things like that?
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Just having that kind of discussion first.
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Now that those disclaimers are all out of the way,
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actually, this is one more kind of disclaimer,
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is that people talk about pre-op clearance.
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It's not clearance. Don't say clearance.
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I don't say clearance anymore.
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It's really like you can never erase the risk somebody has
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of having a surgery, but what you're doing is you're optimizing the surgery
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so that optimizing their health so that the surgery is as low risk as possible.
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And you're talking about the risks and benefits and alternatives
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and deciding if the risks outweigh the benefits, right?
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Because there is always the option of not clearing somebody, right?
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They're not recommending them to have surgery,
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but optimizing is the kind of buzzword to use in perioperative medicine, it sounds like.
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So I first kind of start my assessment with this,
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is it a low-risk surgery, moderate or high-risk surgery?
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And that kind of frames the workup and the history questions
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and all the stuff that I'm doing, right?
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So a low-risk surgery, for example, is like a cataract surgery.
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Not a whole lot that you have to do to kind of clear them for surgery, right?
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To optimize them for surgery because the biggest risk for complication
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is for having an uncontrolled high blood pressure.
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Whereas, you know, if you have some sort of GI surgery or brain surgery,
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things like that, those have different risks, right?
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And so the risk is based on how long the surgery is,
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how much blood loss there is and the fluid shifts.
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And unfortunately, there's no comprehensive list that I've found.
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I found a pretty solid one.
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And actually, I should have mentioned that I have a handout down below this video
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kind of with a cheat sheet of the information I'm going to be giving you in this video.
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So talking about the risks and the risks of the different types of surgeries is on there.
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If you find that there's a surgery that's not listed, this is again,
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if I was in your shoes, I would discuss with one of my collaborating providers
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and I would say, you know, are you familiar with the surgery,
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how long it is, how involved it is,
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and would you assess it to be a low, moderate or high risk?
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And again, I kind of also like as another kind of direction pointer,
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you can kind of search and see if there's specific information
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for the evaluation, pre-op evaluation for cataract surgery, for example,
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or pre-op evaluation for cholecystectomy or something like that.
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They may or may not exist, but that's like another kind of path to go down.
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So once I've kind of determined if it's low, moderate or high,
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kind of like if it's a low-risk cataract surgery,
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I'm not necessarily going to get into the full thing necessarily, right?
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But if I've determined it's kind of like a moderate to high risk,
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I'm going to kind of go down this, this is the typical path that I would go down.
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And so I'm going to kind of, the framework is that I'm assessing their chronic conditions,
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I'm assessing their cardiac and pulmonary risk scores, risk factors,
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and kind of taking it from there as well as like recapping their medications,
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getting an accurate social history during the full physical exam
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and then deciding what testing to do.
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So the main risks of having a surgery are death,
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cardiac complications and pulmonary complications.
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There's others, of course, but those are kind of like the main ones
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you want to think about in terms of framing your pre-op exam.
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So for assessing the cardiac risk, I'm just going to kind of go through that.
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There's the most to talk about with that one.
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So the kind of two scenarios that we're talking about are
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somebody who has established cardiovascular disease,
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aortic stenosis, AFib, history of an MI.
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Those patients, me personally, this is a recommendation that I'm going to make
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is that they go see their cardiologist
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to have their input on the preoperative optimization.
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Are they optimized from their cardiologist perspective
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or at the very least get them on the phone, right?
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And say like, what are your kind of thoughts about this?
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Once I've kind of gathered all of my information,
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so I can present the case, right?
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Which I talk about in how to ask questions the right way
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if you haven't seen that video yet.
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Kind of getting all your stuff together before you're asking all the questions
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and asking very specific questions, especially of a specialist.
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And then you have the other patient who's coming in
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that you're kind of the detective and you're deciding,
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is there an underlying cardiovascular disease that we haven't discovered yet
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and that if we don't discover it is going to put them at risk
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for cardiovascular complications around their surgery or risk for death, right?
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Which is like, ooh.
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So here's the advice that I recommend.
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So you're kind of asking a history, right?
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So you're talking about, do you have any obvious signs, right?
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Of angina, shortness of breath, dyspnea and exertion, edema, things like that.
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Do they have a story of something that's coming
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that we haven't really assessed yet?
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And also, we're going to look at functional capacity.
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So that's talking about like, what are they capable of doing
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in their day-to-day lives?
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Are they able to go grocery shopping, go up the stairs,
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walk around the block without any of those symptoms, right?
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Or are they not?
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And there's a couple of tools you can use.
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One is called the MET score, M-E-T-S.
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So these are where the scoring tools come in,
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make your job a little bit easier.
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The MET score and that kind of,
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you can just ask them the questions and then fill that out
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and that gives them a score.
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And so if it's four or more,
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they're less likely to have cardiovascular complications.
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And so for those patients, you know,
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depending on the history and what your assessment is,
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plus the functional capacity of that MET score,
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you can decide, are they at risk for cardiovascular complications or not?
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Are they at risk for an underlying CAD or something like that?
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That's kind of what we're getting at here.
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But that's kind of like what I would do.
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There's another one called the,
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the next thing is aside from assessing the functional capacity
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of the cardiovascular risk specifically in a surgery.
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And there's a couple of tools for that.
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The NESQIP is one of them, N-S-Q-I-P.
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And then the revised cardiac risk index,
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I believe is the other one.
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And so that kind of, they don't overlap.
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So it's kind of you pick one or the other,
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they don't really compare to each other.
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And again, just depends on your conversation
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you've had with your supervisor of like,
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should we be using the NESQIP?
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Do you use this, et cetera, et cetera?
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And using that kind of with a grain of salt, right?
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Because that's not perfect.
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I mean, the METS isn't perfect either,
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but the NESQIP, again, which is like a tool
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where you input the type of surgery they have,
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their age, their risk factors,
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the medications, like things like that.
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It's a whole online thing.
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Again, it's in that handout.
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And you can kind of use that to inform your clinical judgment.
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And I think the main drawback for that
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is they don't have every surgery and it's not perfect, right?
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You can't just look at that and be like,
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okay, you're done.
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It's really like more complex than that.
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But it's helpful in terms of gathering a tool
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if that's something that your supervisor recommends.
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So that's like the main thing for cardiovascular.
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And what your kind of conclusion about that is,
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is do they have a less than 1% risk of death
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or complications or greater than 1%.
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And if it's greater than 1%,
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then they need cardiovascular evaluation.
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And so what does that look like?
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Personally, I really recommend you send them to cardiology
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because it's one thing to know to order a stress test,
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but it's another thing to be able to order the correct one
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and interpret it correctly.
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And then to follow up and decide whether you need more testing
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because it's a false negative or something like that.
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You can do it if you want to,
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but never feel yourself pressured to do so.
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Because I feel like I just hear that,
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and this is maybe a soapbox moment,
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but I just feel like I hear from so many new grads
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who put that pressure on themselves.
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I'm like, I have to know it.
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I know to order stress tests, I'm going to do it.
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But then again, you have to just be really careful
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with the things that you get back.
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And maybe there's another test
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that they would recommend instead.
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Again, that's my own personal opinion
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just to save yourself a little bit of sanity.
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And it's a right thing to do.
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Both of them are right,
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00:10:08.790 --> 00:10:11.970
but it's okay to send them to cardiology,
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and that's what I recommend.
224
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And then pulmonology, pulmonary,
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that's kind of the cardiac risk assessment.
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So the pulmonology risk assessment
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is a little bit less algorithmic.
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I don't like it as much, less guideline-based,
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but same moral of the story here goes
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is that do they have an established COPD,
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asthma, et cetera, et cetera,
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I keep forgetting about sleep apnea.
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00:10:33.290 --> 00:10:35.030
But do they have those established already?
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Do they see a pulmonologist already?
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I'm going to have a conversation
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with a pulmonologist
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00:10:38.610 --> 00:10:39.770
or have them see the pulmonologist
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to get their opinion about
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if this is a high-risk surgery
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or is it appropriate risk for them.
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00:10:46.590 --> 00:10:48.050
Otherwise, are you assessing somebody
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who has an underlying lung disease
243
00:10:49.130 --> 00:10:50.110
that hasn't been uncovered yet?
244
00:10:50.450 --> 00:10:52.230
So do they have some risk factors for sleep apnea?
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00:10:52.290 --> 00:10:54.350
There's that stopping scoring,
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00:10:54.370 --> 00:10:55.930
which again, I'll put in the handout,
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which you can kind of guide
248
00:10:58.110 --> 00:10:59.150
and see if you have sleep apnea.
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None necessarily that's going to bar you
250
00:11:00.470 --> 00:11:01.350
from having surgery,
251
00:11:01.410 --> 00:11:03.270
but it's just another factor to think about.
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00:11:03.610 --> 00:11:05.330
Again, when you get all this data
253
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and this information,
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00:11:06.110 --> 00:11:07.290
what I personally would do
255
00:11:07.290 --> 00:11:08.710
if I was in that situation
256
00:11:08.710 --> 00:11:10.110
was that I would get all the information,
257
00:11:10.370 --> 00:11:11.830
do all the physical exam,
258
00:11:11.850 --> 00:11:13.110
the history, all that stuff,
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00:11:13.430 --> 00:11:15.830
present it to my supervising physician
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00:11:15.830 --> 00:11:17.050
or collaborator,
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00:11:17.470 --> 00:11:18.870
and then ask what they think.
262
00:11:20.030 --> 00:11:22.390
So again, do they have a long-term smoking history?
263
00:11:22.490 --> 00:11:24.590
Do they have dyspnea that hasn't been diagnosed yet?
264
00:11:24.610 --> 00:11:25.910
Do they have a cough that's not diagnosed yet?
265
00:11:25.990 --> 00:11:26.730
Things like that.
266
00:11:26.790 --> 00:11:28.790
Let's just make sure that that's optimized first.
267
00:11:28.790 --> 00:11:30.370
So maybe you need to delay the surgery
268
00:11:30.370 --> 00:11:31.390
until they see pulmonology.
269
00:11:31.450 --> 00:11:33.390
Again, you could consider doing a chest x-ray
270
00:11:33.390 --> 00:11:35.510
versus pulmonary function tests,
271
00:11:37.450 --> 00:11:39.090
but again, do you feel confident
272
00:11:39.090 --> 00:11:40.570
with your PFT interpretation?
273
00:11:40.630 --> 00:11:41.570
I'm just going to be real right now
274
00:11:41.570 --> 00:11:44.310
that I don't feel that confident with PFTs.
275
00:11:44.470 --> 00:11:45.590
It's something that I'm working on,
276
00:11:45.690 --> 00:11:46.770
but again, I'm not a pulmonologist
277
00:11:46.770 --> 00:11:48.750
in terms of there are certain things
278
00:11:48.750 --> 00:11:49.750
that I understand about it,
279
00:11:49.790 --> 00:11:51.630
but do I feel confident differentiating
280
00:11:51.630 --> 00:11:53.570
between COPD versus interstitial lung disease
281
00:11:53.570 --> 00:11:55.630
versus other things that are going on?
282
00:11:56.390 --> 00:11:58.310
It's not just as simple as asthma and COPD.
283
00:11:58.850 --> 00:12:01.030
That's why there's pulmonary as a specialist.
284
00:12:01.630 --> 00:12:02.650
So anyway, I'm being on a soapbox,
285
00:12:02.710 --> 00:12:03.810
but it's for your benefit
286
00:12:03.810 --> 00:12:05.430
because I don't want you to feel that pressure
287
00:12:05.430 --> 00:12:06.810
of having to do all the things
288
00:12:06.810 --> 00:12:08.090
and be all the things at all at once
289
00:12:08.090 --> 00:12:10.030
because I hear that over and over again,
290
00:12:10.030 --> 00:12:11.170
and I felt that myself too.
291
00:12:13.190 --> 00:12:15.750
So cardiac risk, so low, medium, or high risk,
292
00:12:15.830 --> 00:12:18.650
cardiac risk assessment, pulmonology risk assessment.
293
00:12:18.650 --> 00:12:20.070
There's no tools that I'm aware of,
294
00:12:20.170 --> 00:12:22.090
deciding what testing they need to do,
295
00:12:22.170 --> 00:12:23.350
if they need to do anything.
296
00:12:23.530 --> 00:12:24.730
And then the next thing is like,
297
00:12:24.730 --> 00:12:26.210
once you kind of like met those things
298
00:12:26.210 --> 00:12:27.490
is thinking about like,
299
00:12:27.490 --> 00:12:28.610
what are their chronic conditions, right?
300
00:12:28.610 --> 00:12:29.870
So you're kind of optimizing those, right?
301
00:12:29.870 --> 00:12:30.570
So they have diabetes.
302
00:12:30.690 --> 00:12:33.170
I'm just doing a recap in the history of like,
303
00:12:33.170 --> 00:12:37.350
diabetes A1C in October 2019 was 6.8.
304
00:12:37.430 --> 00:12:39.390
They take myformin twice a day.
305
00:12:39.810 --> 00:12:41.150
Blood sugars have been this and this,
306
00:12:41.490 --> 00:12:43.750
nothing less than 70, greater than 300.
307
00:12:44.190 --> 00:12:46.190
Here are the symptoms, they are asymptomatic.
308
00:12:47.050 --> 00:12:47.770
Same thing for hypertension,
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00:12:47.870 --> 00:12:49.610
just like a recap of like their chronic conditions.
310
00:12:49.650 --> 00:12:50.690
And you don't necessarily have to do
311
00:12:50.690 --> 00:12:51.910
like the full laundry list.
312
00:12:52.010 --> 00:12:53.250
I mean, it really depends, again,
313
00:12:53.450 --> 00:12:54.410
conversation with your supervisor,
314
00:12:54.450 --> 00:12:56.330
but if they've got like seven chronic conditions,
315
00:12:56.330 --> 00:12:59.310
if you can do your best to do a very quick recap
316
00:12:59.310 --> 00:13:00.150
of all that stuff,
317
00:13:00.230 --> 00:13:01.790
like that can be really helpful for the surgeon
318
00:13:02.430 --> 00:13:04.010
and the medical team that's taking care of it
319
00:13:04.010 --> 00:13:05.670
because they don't know the baseline like you do, right?
320
00:13:06.770 --> 00:13:08.530
And then in terms of the R.O.S.
321
00:13:08.550 --> 00:13:09.910
and the physical exam, those are really,
322
00:13:09.990 --> 00:13:12.210
the main thing is like respiratory and cardiovascular.
323
00:13:12.970 --> 00:13:14.470
So like cough, shortness of breath,
324
00:13:14.630 --> 00:13:16.890
dyspnea exertion, chest pain,
325
00:13:17.170 --> 00:13:18.730
syncope, near syncope, edema,
326
00:13:19.130 --> 00:13:21.070
but then also relevant to the type of surgery
327
00:13:21.070 --> 00:13:21.690
they're having, right?
328
00:13:21.690 --> 00:13:22.490
Are they having eye surgery?
329
00:13:22.570 --> 00:13:23.970
Maybe do an eye R.O.S., right?
330
00:13:25.730 --> 00:13:27.750
But like the full physical exam,
331
00:13:28.050 --> 00:13:30.830
I just, that's my default because, you know,
332
00:13:31.010 --> 00:13:34.090
again, there's a lot of complex moving parts
333
00:13:34.090 --> 00:13:35.790
and if they've got something cardiac or respiratory,
334
00:13:35.790 --> 00:13:37.190
they could have something, you know,
335
00:13:37.350 --> 00:13:39.190
in their abdomen like they could have distended at,
336
00:13:39.470 --> 00:13:41.410
like just, I just do the full thing.
337
00:13:41.450 --> 00:13:42.490
And maybe you do something different
338
00:13:42.490 --> 00:13:43.530
and maybe your supervisor tells you
339
00:13:43.530 --> 00:13:44.110
to do something different,
340
00:13:44.110 --> 00:13:45.550
in which case do that, right?
341
00:13:45.550 --> 00:13:47.110
But that's what I'm gonna start with.
342
00:13:47.370 --> 00:13:48.530
I'm gonna get all that information,
343
00:13:48.750 --> 00:13:50.730
do my exam, present it.
344
00:13:50.930 --> 00:13:52.470
The other history questions you wanna think about
345
00:13:52.470 --> 00:13:53.850
are really good social history.
346
00:13:53.850 --> 00:13:55.510
Are they drinking alcohol?
347
00:13:56.150 --> 00:13:56.910
How much?
348
00:13:56.950 --> 00:13:57.690
How often?
349
00:13:57.770 --> 00:13:58.310
Things like that,
350
00:13:58.310 --> 00:13:59.410
because they could go into alcohol withdrawal,
351
00:13:59.450 --> 00:14:00.250
like that's pretty serious.
352
00:14:00.310 --> 00:14:01.290
How much do they smoke?
353
00:14:02.190 --> 00:14:04.310
Again, like nicotine withdrawal, things like that.
354
00:14:04.890 --> 00:14:06.690
And then, do they have any history
355
00:14:06.690 --> 00:14:08.490
of like malignant hyperthermia?
356
00:14:08.850 --> 00:14:10.250
Having had surgery before?
357
00:14:10.390 --> 00:14:11.710
Have they ever had surgery before?
358
00:14:11.990 --> 00:14:12.690
And then the medications,
359
00:14:12.830 --> 00:14:13.710
like what are they taking for meds?
360
00:14:14.370 --> 00:14:16.290
That's actually like a whole discussion in and of itself.
361
00:14:16.570 --> 00:14:18.190
So I don't really have like good rules for that,
362
00:14:18.190 --> 00:14:20.110
but that really is case by case dependent
363
00:14:20.110 --> 00:14:21.030
and surgery dependent,
364
00:14:21.110 --> 00:14:22.550
whether or not they continue aspirin
365
00:14:22.550 --> 00:14:23.350
or stop aspirin,
366
00:14:24.870 --> 00:14:26.630
continue autoblockers, et cetera, et cetera.
367
00:14:27.070 --> 00:14:29.690
So again, I'd either talk with a surgeon
368
00:14:29.690 --> 00:14:30.910
or collaborate with my physician,
369
00:14:31.070 --> 00:14:32.150
depending on the case, right?
370
00:14:32.510 --> 00:14:34.350
So I think that's it.
371
00:14:34.750 --> 00:14:36.170
And you know, I didn't really touch a ton
372
00:14:36.170 --> 00:14:38.110
on like the healthy patient
373
00:14:38.110 --> 00:14:39.630
with a low-risk surgery very much,
374
00:14:39.650 --> 00:14:42.010
but I wanna keep this short and sweet if I can.
375
00:14:42.250 --> 00:14:43.570
There's a list of history questions
376
00:14:43.570 --> 00:14:45.210
that are included in the handout down below
377
00:14:45.210 --> 00:14:47.610
that I kind of have my students,
378
00:14:47.630 --> 00:14:48.510
I kind of give to my students
379
00:14:48.510 --> 00:14:51.450
to do a pre-op exam on somebody that's on a healthier.
380
00:14:52.010 --> 00:14:53.710
Again, just like elicits any history
381
00:14:53.710 --> 00:14:55.770
of cardiovascular disease or liver disease
382
00:14:55.770 --> 00:14:57.050
or stuff like that.
383
00:14:57.290 --> 00:14:58.450
You're just trying to uncover
384
00:14:58.450 --> 00:15:00.610
what else is going on under there, right?
385
00:15:00.610 --> 00:15:01.750
So you don't have any surprises
386
00:15:01.750 --> 00:15:03.690
around the time of having that surgery.
387
00:15:04.070 --> 00:15:05.710
You know, one other thing actually I wanna add
388
00:15:05.710 --> 00:15:06.950
is about the testing.
389
00:15:07.930 --> 00:15:11.890
So one quick thing before I wrap up
390
00:15:11.890 --> 00:15:15.090
is that for testing what we over test
391
00:15:15.090 --> 00:15:18.070
in the United States for preoperative exams,
392
00:15:18.510 --> 00:15:20.450
there aren't for the healthy adult
393
00:15:20.450 --> 00:15:21.410
with a low-risk surgery,
394
00:15:21.750 --> 00:15:23.950
there really isn't very much that's recommended at all.
395
00:15:24.110 --> 00:15:26.270
Again, please look at your case-by-case situation,
396
00:15:26.690 --> 00:15:29.410
but the main testing I want you to think about
397
00:15:29.410 --> 00:15:30.850
is if they have any cardiac risk factor,
398
00:15:30.990 --> 00:15:32.530
hypertension, high cholesterol,
399
00:15:32.850 --> 00:15:34.230
other cardiac abnormalities,
400
00:15:34.490 --> 00:15:36.530
consider doing an EKG,
401
00:15:36.610 --> 00:15:39.030
also considering that in diabetes and CKD.
402
00:15:39.350 --> 00:15:40.710
The rationale for that being like
403
00:15:40.710 --> 00:15:41.390
you're getting a baseline
404
00:15:41.390 --> 00:15:44.430
because they're at higher risk for complications,
405
00:15:44.690 --> 00:15:47.310
but also you can help detect anything that's abnormal
406
00:15:47.310 --> 00:15:48.410
that they need to have investigated
407
00:15:48.410 --> 00:15:49.690
before their surgery, right?
408
00:15:49.690 --> 00:15:52.330
Chest X-rays, one to consider maybe.
409
00:15:53.130 --> 00:15:53.950
Case-by-case dependent,
410
00:15:54.110 --> 00:15:55.190
if they're a long-term smoker,
411
00:15:55.310 --> 00:15:56.310
things like that.
412
00:15:56.450 --> 00:15:57.710
If they have an older age,
413
00:15:57.730 --> 00:15:59.670
things like that, higher-risk surgery.
414
00:16:01.030 --> 00:16:02.890
Hemoglobin is recommended for adults
415
00:16:02.890 --> 00:16:05.750
over the age of 65, like a CBC,
416
00:16:06.110 --> 00:16:07.670
or people who are under 65
417
00:16:07.670 --> 00:16:09.550
if they have a higher risk,
418
00:16:09.790 --> 00:16:11.090
higher blood loss surgery.
419
00:16:11.810 --> 00:16:13.630
And then again, like it depends on the surgery, right?
420
00:16:13.630 --> 00:16:14.710
Are they having a GU surgery?
421
00:16:14.750 --> 00:16:16.750
They should probably have a urinalysis, right?
422
00:16:16.770 --> 00:16:18.370
But like urinalysis for everybody,
423
00:16:18.370 --> 00:16:20.590
there isn't really enough evidence to recommend that.
424
00:16:21.470 --> 00:16:23.330
So again, always collaborate,
425
00:16:23.410 --> 00:16:24.310
always ask questions,
426
00:16:24.390 --> 00:16:25.390
case-by-case dependent,
427
00:16:25.710 --> 00:16:27.070
but those are kind of like
428
00:16:27.070 --> 00:16:28.030
the main ones to think about.
429
00:16:28.110 --> 00:16:29.730
I think the most important is the EKG
430
00:16:29.730 --> 00:16:31.190
for people who have cardiac risk factors
431
00:16:31.190 --> 00:16:32.610
because again, you're just digging to find
432
00:16:32.610 --> 00:16:34.130
if there are any cardiac abnormalities,
433
00:16:34.150 --> 00:16:35.130
and if you have any question
434
00:16:35.130 --> 00:16:36.430
about somebody with pulmonary abnormalities
435
00:16:36.430 --> 00:16:37.270
and you're not quite sure,
436
00:16:37.570 --> 00:16:38.330
do a chest X-ray,
437
00:16:38.370 --> 00:16:39.490
do they have any abnormalities,
438
00:16:41.250 --> 00:16:42.290
feel free to send them to PUM.
439
00:16:42.530 --> 00:16:43.130
So that's it.
440
00:16:43.130 --> 00:16:44.490
I'm sorry that was so much information.
441
00:16:44.490 --> 00:16:46.130
I tried to keep it as short and sweet as possible.
442
00:16:46.170 --> 00:16:47.470
Hopefully it was more helpful
443
00:16:47.470 --> 00:16:48.410
than it was confusing.
444
00:16:48.690 --> 00:16:50.010
And I hope that there were some helpful tips
445
00:16:50.010 --> 00:16:51.290
you can take away into your practice
446
00:16:51.290 --> 00:16:52.350
because again,
447
00:16:52.930 --> 00:16:54.310
it's such case-by-case dependent
448
00:16:54.310 --> 00:16:56.690
that you just have to be as careful as you can
449
00:16:56.690 --> 00:16:58.110
and then just ask for help when you need it.
450
00:16:58.110 --> 00:16:59.670
And just don't push yourself too hard
451
00:16:59.670 --> 00:17:02.150
because it's okay to ask for help
452
00:17:02.150 --> 00:17:03.770
and it's okay to refer out when you need to.
453
00:17:03.770 --> 00:17:04.650
And I say this a lot,
454
00:17:04.650 --> 00:17:05.750
but I just gotta keep saying it
455
00:17:05.750 --> 00:17:07.490
because I keep hearing it over and over again.
456
00:17:07.650 --> 00:17:10.109
So I hope that makes you feel a little bit better.
457
00:17:10.310 --> 00:17:11.470
Definitely leave a comment below.
458
00:17:11.690 --> 00:17:12.650
If this video was helpful,
459
00:17:12.670 --> 00:17:13.750
I'd love to hear from you.
460
00:17:13.930 --> 00:17:15.369
Also, if you have a difference of opinion
461
00:17:15.369 --> 00:17:16.930
about what testing we should be doing,
462
00:17:16.930 --> 00:17:18.089
definitely let me know.
463
00:17:18.089 --> 00:17:19.290
Maybe that's a little controversial.
464
00:17:19.510 --> 00:17:20.510
Hopefully it's not.
465
00:17:20.910 --> 00:17:22.270
Hopefully it's reassuring.
466
00:17:22.990 --> 00:17:25.569
And yeah, any other screening tools you use
467
00:17:25.569 --> 00:17:27.210
or other suggestions that you have
468
00:17:27.210 --> 00:17:28.470
or recommendations, things like that.
469
00:17:28.510 --> 00:17:29.670
And hopefully there's nothing I left out.
470
00:17:29.730 --> 00:17:31.490
Don't forget to grab your copy
471
00:17:31.490 --> 00:17:32.670
of the Ultimate Resource Guide
472
00:17:32.670 --> 00:17:35.070
from the new NP over at realworldnp.com
473
00:17:35.070 --> 00:17:36.350
if you haven't grabbed one already.
474
00:17:36.510 --> 00:17:38.590
And you'll get these videos
475
00:17:38.590 --> 00:17:40.410
that straight to your inbox with notes from me,
476
00:17:41.190 --> 00:17:43.170
bonus content that I just don't share anywhere else.
477
00:17:43.170 --> 00:17:44.790
So thank you so much for watching.
478
00:17:44.790 --> 00:17:46.890
Hang in there and I'll see you next time.
479
00:18:16.910 --> 00:18:19.250
With notes from me, patient stories,
480
00:18:19.530 --> 00:18:20.450
and extra bonuses,
481
00:18:20.690 --> 00:18:22.590
I really just don't share anywhere else.
482
00:18:23.030 --> 00:18:24.550
Thank you so much again for listening.
483
00:18:24.710 --> 00:18:25.950
Take care and talk soon.

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Liz Rohr