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 evaluationHow to assess surgical risk and identify reasons to pause before surgeryUsing RCRI, ACS NSQIP, and DASI to assess cardiovascular risk and functional capacityWhat to include in the preoperative history and physical examAssessing chronic conditions and pulmonary risk before surgeryWhen preoperative labs, ECGs, and imaging are indicatedMedication considerations before surgery, including anticoagulants, diabetes medications, and SGLT2 inhibitorsWhat to document and communicate to the surgical and anesthesia teamsTimestamps00:00 – Introduction01:32 – Your role in the preoperative evaluation02:13 – Assessing surgical risk03:04 – Reasons to pause before surgery03:58 – Cardiovascular risk assessment: RCRI and ACS NSQIP04:45 – Functional capacity and DASI05:24 – Preoperative history and chronic conditions06:56 – Pulmonary risk assessment07:25 – Physical exam and selective testing08:25 – Perioperative medication considerations09:37 – Documenting the preoperative evaluationResources 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 ______________________________© 2026 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.