Preparing For Surgery: Pre-Procedure Interview Questions
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Pre-Procedure Interview Questions

Reviewing Your Health History

This page is intended to provided patients with an understanding of the questions they can expect during the pre-procedure interview process.

The following questions will help our surgical team best meet your individual needs during your surgery. Please take a few minutes to answer these questions truthfully. Most of the questions require a simple "yes" or "no" response. If you aren’t sure, please respond "don’t know."

Questions will be posed on the following topics:

Anesthesia

• Have you had an acute respiratory illness this past year (pneumonia, bronchitis)?
• Do you have asthma or wheezing?
• Have you had tuberculosis or a positive skin test for tuberculosis?
• Have you been in contact with anyone with tuberculosis?
• Do you have emphysema, shortness of breath?
• Do you use oxygen?
• Have you been diagnosed with or shown symptoms of sleep apnea?
• Do you use a C-Pap machine? If so, what is the setting?
• Have you or a family member had an unusual reaction to anesthesia?

Cardiovascular

• Do you have heart valve disease mitral valve prolapse?
• Do you have high blood pressure?
• Do you have chest pain or have you ever had chest pain?
• Have you had a heart attack(s)?
• Have you had a cardiac angiogram, angioplasty or coronary artery bypass graft?
• Have you had a stroke? If yes, residual effects? 
• Do you have an irregular or fast heartbeat?
• Have you had congestive heart failure?
• Have you had a stress test or echocardiogram within the past two years?
• Do you see a cardiologist?
• What is your cardiologist's name?
• What is your cardiologist's phone number?
• Please note:  If you see a cardiologist, we recommend that you notify him or her about your scheduled procedure.
• Have you had a previous EKG?  If so, what was the date, location and reason?
• Are you able to walk one block or climb two flights or stairs without chest pain or shortness or breath?

Metabolic / Endocrine

• Are you diabetic? If so, how is it controlled: Diet? Oral medications? Insulin?
• Do you have thyroid trouble?
• Have you been diagnosed with cancer in the past year? If so, what site location?
• Have you had radiation therapy in the last year?
• Have you had chemotherapy in the last six months?

Hepatic / Renal / Hematology

• Have you had any liver trouble, jaundice or hepatitis? If so, please specify.
• Do you have renal disease or insufficiency?
• Do you require hemo or peritoneal dialysis?
• Do you have anemia?
• Do you have sickle cell disease?
• Do you have any prolonged bleeding or bruise easily?
• Have you had a blood transfusion within the past three months?
• Have you used aspirin or NSAIDs (non-steroidal anti-inflammatory drugs, such as Motrin, Ibuprophin, Naproxyn) in the past two weeks?
  Recommendation: Stop using aspirin or NSAIDs prior to your procedure or contact your surgeon for instructions.
• Are you taking herbal or dietary supplements?
  Recommendation: Stop taking herbal or dietary supplements prior to your procedure or contact your surgeon for instructions.

Neurological

• Have you had polio, paralysis or meningitis?
• Have you had any seizures?
• Have you had a head injury with loss of consciousness within the last six months?
• Have you had a stroke?
• Do you have any psychological problems?

Cultural / Social

• Do you have any history of drug or alcohol dependency?
• Do you drink alcohol?
• How often do you drink alcohol?
• How much alcohol do you drink?
• Do you use any street drugs?
• Which drugs have you used?
• When were they used last?

Pain Management

• Are you being treated by a physician for chronic pain? If so, what is the source of your pain?

Musculoskeletal

• Have you had any back pain, injury or nerve damage?
• Do you have arthritis?
• Do you have any difficulty with neck extension?
• Do you have any difficulty opening your mouth wide or having your jaw lock?
• Do you use any assistive devices: cane, crutches, walker, wheel chair, brace, prosthesis?

Gastrointestinal

• Do you have any ulcers, reflux or heartburn?

Nutritional Assessment

• What is your stated height and weight?

Obstetrics

• Have you been pregnant in the past three months?
• Are you possibly pregnant?

Pediatrics – for Patients Age 12 and younger

• Was the child born premature or full-term? How many weeks gestation?
• Has the child ever used an apnea monitor?
• Are immunizations up to date?
• Has the child had rheumatic fever?
• Has the child had a recent exposure to a contagious disease?
• Has the child had a recent fever and/or upper respiratory infection in the past two weeks?
• Does the child have any mental or physical disabilities?

Communication

• Are you deaf, hard-of-hearing or use a hearing aid?
• If you use a hearing aid: right ear, left ear or both?
• Do you use glasses or contacts?
• Do you have impaired vision? If so, right or left eye?
• Do you have any objections to messages left or given regarding this procedure?
• Should we exclude anyone from your care decisions or access to your information?

Physician and Related Information

• Who is your primary physician (first and last name)?
• What is your primary physician’s phone number?
• Are you supposed to see your primary care physician for pre-operative evaluation?
• Name of physician you will see for pre-op evaluation if other than your PCP physician.
• When is the date of your appointment for evaluation?
• Do you authorize your nurse to obtain medial records from an outside source pertaining to your procedure?

Discharge Planning

• Who will drive you home from the hospital?
• Who will stay with you overnight (after an outpatient procedure)?
• Who will assist you after discharge from the hospital?

Advance Directives

• Do you have an advance directive, living will or healthcare power of attorney?
• Are you willing to bring a copy to Central DuPage Hospital for your admission?

Latex / Infection Alerts

• Do you have any latex allergy or sensitivity?
• Have you had an antibiotic resistant infection?

Miscellaneous

• What medications are you currently taking?
• At what dosage? How frequently?
• Do you have any allergies, intolerances or side effects (such as drugs, food, environment, latex, rubber)?
• Have you had any previous surgeries or hospitalizations?
• If yes, when (date), what type of surgery or procedure, at which hospital (hospital name and city/state)?
• Do you smoke? Have you ever smoked? When did you quit?
• How many packs do you/did you smoke per day?
• How many years were you a smoker?
• Would you like smoking cessation information?