CNOR: Preoperative Assessment

When a patient breaches NPO guidelines, the nurse must objectively document the exact intake specifics, including the type and volume of fluid and the exact time it was consumed. The nurse must then notify the anesthesia provider, who is responsible for assessing the aspiration risk and deciding whether to delay or cancel the case. Option D correctly identifies the documentation requirement and the appropriate collaborative action. Options A and B are incorrect because the nurse does not unilaterally cancel or proceed with surgery following an NPO breach. Option C is irrelevant, as an NPO breach does not invalidate the surgical consent.

Patients with gastroparesis have significantly delayed gastric emptying, making the standard six-hour fasting rule for a light meal insufficient. Option B is best because consulting anesthesia allows for a tailored plan, such as rapid sequence induction or further delay. Option A ignores the heightened aspiration risk associated with the patient's comorbidities. Option C is incorrect because while sodium citrate neutralizes acid, it does not reduce gastric volume or address the delayed emptying of solid food. Option D is an overreaction, as the anesthesia team may choose to proceed using specialized airway management rather than outright cancellation.

A patient with a history of neck radiation presenting with inspiratory stridor likely has severe upper airway obstruction or fixed subglottic stenosis. The perioperative nurse must anticipate a potential "cannot intubate, cannot ventilate" crisis and ensure a surgical airway kit (tracheostomy or cricothyrotomy) is immediately available as the definitive rescue plan. Option B is useful for certain types of obstructions, but it does not bypass a fixed subglottic stricture as reliably as a surgical airway. Option C is a postoperative recovery position that helps maintain a patent airway in a spontaneously breathing patient, but it does not assist with the induction crisis. Option D is contraindicated because a supraglottic device sits above the vocal cords and will not bypass the suspected subglottic obstruction.

Carbohydrate loading is generally contraindicated in patients with delayed gastric emptying, such as those with diabetic gastroparesis, due to a significantly increased aspiration risk. Option A is correct because the nurse must intervene to prevent aspiration and collaborate with anesthesia. Options B and C are incorrect because any volume of liquid poses a danger when the stomach cannot empty properly within the standard two-hour window. Option D is incorrect; while carbohydrate loading does reduce postoperative insulin resistance in appropriate candidates, it is unsafe for this specific patient profile.

If a patient states they have an advance directive but the physical document is unavailable, the perioperative nurse should engage the patient in a direct discussion to determine their current wishes. A competent patient's verbalized preferences always take precedence over a written document, especially when they are present and able to communicate effectively. Option D is correct because the nurse can document these verbal wishes directly in the medical record and allow the elective surgery to proceed safely. Option A is incorrect because assuming full resuscitation ignores the patient's explicit statement that they have specific directives in place. Option B and Option C are incorrect because an elective procedure does not need to be canceled or delayed solely to retrieve a piece of paper when the competent patient can immediately and directly communicate their healthcare decisions to the team.