Pre-Operative Assessment for Elective Shoulder Surgery
This reflection paper examines pre-operative assessment and post-operative care in elective shoulder surgery, drawing on Akhtar, MacFarlane, and Waseem's 2013 article in The Open Orthopaedics Journal. The author, a nurse practitioner student in a pre-surgical testing unit, applies the article's framework to an actual patient evaluation prior to shoulder surgery resulting from a sports injury. Key assessment elements discussed include patient history, medication review, lifestyle factors such as smoking and alcohol use, and the selective ordering of diagnostic tests. The paper also briefly addresses post-operative care priorities, including monitoring, pain management, and sepsis control, connecting evidence-based clinical guidelines to real-world nursing practice.
- Introduction: Context for pre-operative assessment and patient case
- Patient History and Clinical Examination: Reviewing medications, lifestyle, and surgical history
- Selective Diagnostic Testing: Justifying inclusion or exclusion of specific tests
- Post-Operative Care Considerations: Monitoring, pain control, and sepsis management
- Conclusion: Connecting evidence-based theory to clinical practice
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What makes this paper effective
- The paper consistently bridges academic source material with a concrete clinical encounter, demonstrating applied learning rather than abstract summary.
- It appropriately justifies the exclusion of certain diagnostic tests (e.g., ECG, coagulation screening) based on the patient's age and health status, showing critical clinical reasoning.
- Direct quotations from Akhtar et al. are well-integrated and used to validate each step of the assessment process, giving the reflection an evidence-based foundation.
Key academic technique demonstrated
The paper demonstrates theory-to-practice application — a core reflective technique in health sciences education. Rather than simply summarizing the source article, the author maps each clinical guideline onto a real patient scenario, explaining how and why each assessment decision was made. This approach illustrates the student's ability to critically evaluate which interventions are appropriate for a specific patient profile.
Structure breakdown
The paper opens by introducing the guiding article and the clinical context, then moves through patient history-taking, medication and lifestyle review, selective test ordering, and finally post-operative care. Each section corresponds to a stage in the pre-operative assessment process, creating a logical, chronological structure that mirrors actual clinical workflow. The conclusion briefly synthesizes the value of connecting research to practice.
Introduction
The relevance of pre-operative assessment cannot be overstated when it comes to the clearance of patients for elective surgeries — particularly in the enhancement of both patient safety and care. The article "Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery," by Akhtar, MacFarlane, and Waseem, elaborates on "pre-operative assessment in elective orthopedic surgery and shoulder surgery" and reviews "the essentials of peri- and post-operative care" (p. 316). From the outset, the authors point out that pre-operative assessment helps not only in enhancing patient safety, but also in averting complications arising from surgical procedures deemed inappropriate.
As a nurse practitioner student in a pre-surgical testing unit, I assessed a patient who was scheduled to undergo shoulder surgery. The patient, referred to herein as Patient X, was a young, healthy adult. Akhtar, MacFarlane, and Waseem note that, as far as pre-operative assessment is concerned, "detailed history and clinical examination must be conducted, and additional tests and investigations be requested which are specific to the needs of an individual" (p. 321). The authors support their assertion with relevant evidence. In my assessment of Patient X — who was to undergo shoulder surgery due to an injury sustained during a sporting event — I conducted the relevant clinical examinations and investigations.
Patient History and Clinical Examination
One of the most important points to consider in a patient's history is whether they have any conditions that could adversely affect the planned surgery. Regarding Patient X, I focused on whether he had any undesirable reactions to agents to be used in the forthcoming surgery or related care thereafter. I also reviewed his surgical history and inquired whether he was taking any medications. It is important to note that some medications — particularly certain anti-inflammatory drugs such as naproxen and ibuprofen — could increase bleeding at the time of surgery.
An inventory of the patient's lifestyle, specifically regarding drinking patterns and smoking history, was also taken. In the words of Akhtar, MacFarlane, and Waseem, taking a patient's smoking history is of great relevance given that "smokers are difficult to anaesthetize," while alcohol documentation is important "as induction of liver enzymes by alcohol may shorten the action of anesthetic drugs…" (p. 316).
Selective Diagnostic Testing
According to the authors, several conditions could adversely affect peri-operative care. These include, in their words, "ischaemic heart disease, diabetes mellitus and liver or renal dysfunction" (p. 316). In this case, no order was made for tests such as an electrocardiogram (ECG) or biochemistry panel. These were unnecessary given the age and health status of Patient X.
It is, however, important to note that had Patient X been older or presented health concerns, tests that might have been ordered include a biochemistry panel (to minimize the risk of cardiac arrest by detecting serum potassium concentration deficits), a full blood count, and an electrocardiogram (to investigate underlying ischaemic heart disease). Coagulation testing was also deemed unnecessary, as the assessment of Patient X revealed no history of a bleeding disorder. The exclusion of tests that do not add clinical value is supported by Akhtar, MacFarlane, and Waseem, who note that the absence of tests such as pre-operative chest radiographs "has not been shown to be associated with an increase in post-operative morbidity or mortality" (p. 317).
Conclusion
Overall, the article by Akhtar, MacFarlane, and Waseem was both informative and highly relevant in connecting theory to practice. By applying its framework to a real patient encounter, this reflection demonstrates the value of evidence-based pre-operative assessment in supporting patient safety and optimizing surgical outcomes.
References
Akhtar, A., MacFarlane, R. J., & Waseem, M. (2013). Pre-operative assessment and post-operative care in elective shoulder surgery. The Open Orthopaedics Journal, 7(3), 316–322.
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