Before Surgery: Fasting, Medication Instructions, Skin Preparation, and Safety Planning
Teach the client to follow the written fasting instructions exactly; the usual standard is no solid food for 6 to 8 hours and clear liquids until 2 hours before anesthesia. Blood thinners, some diabetes medications, and herbal supplements are stopped only as the surgeon or anesthesia provider instructs. Arrange a ride home and a responsible adult to stay with the client for 24 hours after anesthesia.
Who needs this teaching
Adults scheduled for surgery with general anesthesia, regional anesthesia, or procedural sedation, and the person who takes them home. Preoperative teaching reduces anxiety, surgical delays, and the risk of pulmonary aspiration, bleeding, and surgical site infection.
The priority teaching points
- Fasting. Follow the written instructions exactly. The standard for healthy adults is to stop fried or fatty foods and meat 8 hours before, a light meal 6 hours before, and clear liquids 2 hours before anesthesia. Clear liquids include water, pulp-free juice, black coffee, and clear tea. Milk is not a clear liquid. Fasting prevents pulmonary aspiration of gastric contents. Report any fasting violation honestly.
- Medications. Bring a complete medication list, including nonprescription drugs, vitamins, and herbal supplements. Stop medications only as the surgeon or anesthesia provider instructs. Anticoagulant and antiplatelet drugs increase bleeding risk; the prescriber sets the stop date and any bridging plan. SGLT2 inhibitors are stopped at least 3 days before surgery (4 days for ertugliflozin) to prevent euglycemic ketoacidosis. Insulin and other diabetes medications need adjusted doses. Ginkgo, garlic, and ginseng supplements increase bleeding risk.
- Skin preparation. Shower or bathe with soap or an antiseptic agent such as chlorhexidine as instructed, at least the night before surgery. Do not shave the surgical site. Shaving causes microabrasions that increase the risk of surgical site infection. Staff remove hair with clippers when needed.
- Smoking cessation. Stop smoking and vaping as early as possible. Stopping at least 4 weeks before surgery reduces wound and pulmonary complications.
- After anesthesia. Arrange a ride home and a responsible adult to stay for the first 24 hours. Anesthesia and sedation impair judgment and reaction time. Do not drive, operate machinery, drink alcohol, or sign legal documents for 24 hours.
- Day of surgery. Remove jewelry, including body piercings, and makeup. Remove nail polish or artificial nails as instructed, because they interfere with pulse oximetry. Bring glasses, hearing aids, and dentures in labeled cases, and the CPAP device when prescribed.
- Information to report. Tell the team about allergies, including latex, medications, and adhesives; prior reactions to anesthesia and a family history of malignant hyperthermia; loose teeth or dentures; obstructive sleep apnea; and possible pregnancy. Loose teeth risk dislodgement and aspiration during intubation. Obstructive sleep apnea increases the risk of airway obstruction and opioid-induced respiratory depression.
- Change in health. Report fever, a cold, cough, vomiting, diarrhea, or a rash or skin break near the surgical site before surgery. These conditions increase anesthesia and infection risk.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Fever, cold, cough, or sore throat before surgery | Chest pain or pressure |
| A rash, cut, or skin infection near the surgical site | Sudden shortness of breath |
| Vomiting, diarrhea, or a possible pregnancy | Sudden facial droop, arm weakness, or speech difficulty |
| Uncertainty about which medications to stop or take | Bleeding that does not stop with firm pressure |
Teach-back questions
- "What time will you stop eating, and what time will you stop clear liquids?"
- "Which medicines will you stop, and on what day?"
- "How will you wash your skin before surgery?"
- "Who will drive you home and stay with you?"
- "Which health changes will you report before surgery?"
Teaching tips
- Write the exact food and liquid stop times on the handout.
- Reconcile the medication list with the surgeon's written instructions.
- Confirm fasting times with teach-back, because fasting errors delay or cancel surgery.
Read more on NCLEXPace
- Perioperative Nursing: Safety Across the Surgical Journey
- Nursing Care Before and After Common Procedures
- Informed Consent, Advance Directives, and Who Can Sign
Sources
- American Society of Anesthesiologists Committee on Standards and Practice Parameters. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-393.
- Berrios-Torres SI, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-791.
- Douketis JD, et al. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2022;162(5):e207-e243.
- Dapagliflozin, Empagliflozin, Canagliflozin, and Ertugliflozin Tablets: FDA prescribing information (DailyMed).
Why this matters for the NCLEX
Teaching is effective when the client states, "I will follow the fasting times on my instruction sheet exactly," and "My sister will drive me home and stay with me for 24 hours." Statements requiring further teaching include, "I will shave my knee the night before surgery," "I will keep taking my ginkgo because it is natural," and "I will have coffee with milk on the way to the hospital."
Frequently asked questions
Why does the client not shave the surgical site?
Shaving causes microabrasions that allow bacteria to enter the skin. This increases the risk of surgical site infection.
Is milk a clear liquid?
No. Milk and juice with pulp are not clear liquids. Milk follows the 6-hour light-meal rule.
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