A nurse is preparing a client for an arthroscopy of the knee. Which nursing intervention is most appropriate during the pre-procedure preparation?
1Administer a Fleet enema to cleanse the bowel
2Apply ice packs to the knee for 30 minutes before the procedure
3Ensure the client has signed informed consent and verify NPO status✓ 정답
4Position the client in Trendelenburg position for optimal visualization
해설
Pre-procedure preparation for arthroscopy requires standard surgical preparation protocols including informed consent verification and NPO status confirmation to prevent aspiration during anesthesia.
Arthroscopy is a minimally invasive surgical procedure that requires proper preoperative preparation to ensure patient safety and optimal outcomes. The most important nursing interventions before arthroscopy are consent verification and confirmation of NPO (nothing by mouth) status.
Informed consent is a legally and ethically necessary requirement before any surgical procedure. The nurse must verify that the patient has received sufficient information about the procedure, including risks, benefits, alternatives, and expected outcomes. The consent form must be signed by the patient or legal representative before administering sedatives or anesthetics.
NPO status is essential because arthroscopy typically requires sedation or general anesthesia. Having food or liquid in the stomach increases the risk of aspiration pneumonia if the patient vomits during the procedure. Standard NPO guidelines usually require no food for 8 hours and no clear liquids for 2 hours before the procedure, though this may vary according to institutional policies.
Additional preoperative preparations include baseline vital sign assessment, allergy verification, medication adjustments, and confirmation of correct surgical site marking. The nurse should also assess the patient's understanding of postoperative care and discharge instructions.
Post-arthroscopy care generally includes monitoring for complications such as infection, bleeding, and neurovascular injury. Patients are typically discharged the same day and receive instructions on activity restrictions, wound care, and follow-up appointments.
Understanding the Procedure
An arthroscopy is a minimally invasive surgical procedure that allows direct visualization of the internal structures of a joint, most commonly the knee. Although it is often performed as a same-day surgery with a relatively short recovery time, it is still an invasive procedure that requires anesthesia (local, regional, or general) and a controlled, sterile environment. From a nursing perspective, preparing a client for knee arthroscopy involves the same rigorous safety checks and education required for any surgical intervention.
Why Option 3 is the Most Appropriate Intervention
The most critical nursing actions before any invasive procedure are verifying that informed consent has been obtained and confirming the client's NPO (nothing by mouth) status. These are non-negotiable patient safety requirements.
- Informed Consent: The nurse must ensure the consent form is signed, dated, and witnessed, and that the client can verbalize an understanding of the procedure, its risks, and benefits. This is a legal and ethical imperative that protects the client's autonomy.
- NPO Status: Confirming NPO status is essential to reduce the risk of pulmonary aspiration of gastric contents during anesthesia. The standard preoperative fasting guideline for clear liquids is typically 2 hours, and for a light meal, it is 6 hours or more, depending on institutional policy. Research on preoperative fasting practices, such as the secondary analysis of the Thirst study, highlights that prolonged fasting for liquids remains a widespread issue despite clear guideline recommendations [3]. As a nurse, you must verify the exact duration of fasting and advocate for adherence to evidence-based guidelines to prevent unnecessary patient discomfort and dehydration while maintaining safety.
Why the Other Options are Incorrect
- Option 1: Administer a Fleet enema to cleanse the bowel. Bowel preparation is not indicated for a knee arthroscopy. The surgical site is an extremity joint, not the abdominal or pelvic cavity. Administering an unnecessary enema is an example of a low-value, non-evidence-based intervention that can cause patient discomfort and is not part of the standard preoperative protocol for this procedure. This aligns with the principles of de-implementing low-value preoperative testing and interventions, which are often driven by habit rather than evidence .
- Option 2: Apply ice packs to the knee for 30 minutes before the procedure. Ice packs are a common postoperative intervention used to reduce pain, swelling, and inflammation after arthroscopic procedures, such as the Arthroscopic Cartilage Regeneration Facilitating Procedure (ACRFP) . Applying ice preoperatively is not a standard practice and would not be the priority during the immediate pre-procedure preparation phase. The focus at this stage is on safety verification, not symptom management.
- Option 4: Position the client in Trendelenburg position for optimal visualization. The Trendelenburg position, where the head is lower than the feet, is used for procedures in the lower abdomen and pelvis to shift abdominal contents upward or for treating hypotension. It has no role in a knee arthroscopy. The client is typically positioned supine with the knee placed in a positioning device that allows the surgeon to manipulate and access the joint.
Connecting Preoperative Care to Patient Experience
A systematic review of patients' experiences with day surgery reveals that the preoperative phase is often marked by anxiety related to the unknown, including the procedure itself and the anesthesia . Your role in verifying the signed consent form provides a crucial opportunity to assess the client's understanding, answer last-minute questions, and offer reassurance. By confirming that the client has followed the NPO instructions, you are directly preventing a potential cancellation of the surgery. These actions, while seemingly administrative, are fundamental nursing interventions that anchor patient safety and create a foundation of trust before the client enters the operating room. The drive to reduce low-value care, such as unnecessary testing before low-risk procedures, emphasizes that every preoperative action must be purposeful and evidence-based . Ensuring a signed consent and verified NPO status are high-value, evidence-based actions that are the cornerstone of safe, patient-centered preoperative nursing care.
References (research sources)
[3]
True Preoperative Liquid Fasting in Romania-A Secondary Analysis of the Thirst Study.Research articleMoisa E, Negoita SI, Camilleri Podesta AM, Ionescu D, Tomescu DR, Mirea LE, Droc G, Grigorescu BL, Petrisor C, Drăgoescu AN, Novac MB, Ristescu AI, Blaj M, Orban C, Bedreag O, Tănase NV, Dutu M, Vintila BI, Tuculeanu G, Bilotta F, Corneci D, On Behalf Of The Romanian Thirst Study Group. (2026) · DOI: 10.3390/nu18111714
Clinical Pre-Procedure Checklist
Before a client undergoes knee arthroscopy, the nurse must prioritize safety by completing the following critical tasks:
Verify Informed Consent: Confirm the form is signed, dated, and witnessed. Assess the client's understanding of the procedure, including its purpose, risks, and benefits. If the client has questions or appears confused, notify the provider before proceeding.
Confirm NPO Status: Explicitly ask the client when they last had anything to eat or drink. Document the exact time. Follow institutional fasting guidelines (typically 2 hours for clear liquids, 6 hours for a light meal). If NPO status is not maintained, immediately inform the anesthesia provider.
Complete a Preoperative Assessment: Record baseline vital signs, allergies, and medical history. Verify the correct surgical site with the client and mark it per facility protocol.
Ensure Safe Positioning: The client will be positioned supine on the operating table. Do not place the client in Trendelenburg position, as this is not indicated for knee arthroscopy.
Remove Prohibited Items: Have the client remove jewelry, dentures, and nail polish. Ensure the operative leg is free of any restrictive clothing.
Nursing Rationale
These interventions are non-negotiable patient safety requirements. Verifying informed consent protects the client's autonomy and legal rights. Confirming NPO status directly prevents the life-threatening complication of pulmonary aspiration during anesthesia. Skipping these steps constitutes a serious breach of the standard of care.
Arthroscopy — A minimally invasive surgical procedure using a fiber-optic camera to visualize, diagnose, and treat problems inside a joint.
Informed Consent — A legal and ethical process ensuring a patient understands the risks, benefits, and alternatives to a procedure before agreeing to it.
NPO — Nil Per Os (nothing by mouth); a preoperative fasting status required to minimize the risk of pulmonary aspiration during anesthesia.
Pulmonary Aspiration — The inhalation of gastric contents into the lungs, a serious anesthetic complication prevented by maintaining NPO status.