How to Call Approval Process From Flow in Salesforce

To call an approval process from Flow in Salesforce, add the Submit for Approval core action to your flow, set Record ID to the record and Approval Process Name Or ID to the approval process’s API name, and optionally add a submission comment. In a record-triggered flow this submits records automatically, so users no longer have to click Submit for Approval.

I built a real approval process and a record-triggered flow in a Salesforce Developer Edition org that submits every opportunity of 100,000 or more, tested it on create and on update, and tried submitting a record twice. Below are the settings, the approval requests that arrived, and the error you get when a record is already in approval.