I'm posting some answers to the past year exam questions for all to review. Do comment should you notice any discrepancy or have anything to add. Also note that i have expanded on the explaination so i can squeeze in as much details as possible.
(A) Write short notes on the counts of sponges, sharps and instruments during surgery.
Importance :
Loss in any of the above mentioned will result in harm to the patient
Loss in any of the above mentioned will result in harm to the patient
Who to count :
Scrub nurse + Circulating nurse
When to count :
(i) Before Surgery
(ii) Before closure of body cavity
(iii) Before closure of skin
Scrub nurse + Circulating nurse
When to count :
(i) Before Surgery
(ii) Before closure of body cavity
(iii) Before closure of skin
How to count :
(According to standards of practice of the institution)
* Count concurrently, audibly with the circulating nurse (or qualified staff) and use of Count Chart accurately
(According to standards of practice of the institution)
* Count concurrently, audibly with the circulating nurse (or qualified staff) and use of Count Chart accurately
(i) Preop
- Loosen bundles of swabs lightly
- Pick up 1 swab at a time
- Loosen bundles of swabs lightly
- Pick up 1 swab at a time
- Show radio-opaque thread/ intact loop of penny towel to circ nurse
- Recount if interrupted or in doubt
- Recount if interrupted or in doubt
- Remove/discard bundle in event of discrepancy
- Ensure circ nurse records immediately + initials on Count Chart
(ii) Intra Op
- Keep count of swabs at op site
- Maintain 2 swabs at op field at any 1 time
- Maintain 2 swabs at op field at any 1 time
- Use abdominal packs/penny towels/swab sticks for large/deep wounds
- Do not remove any swabs from OT til op is over
- Pass out soiled/wet swabs to circ nurse
- Count, bag up and place aside in sets of 5s/10s (according to protocol)
- Document -> strike out bundle and initial name
- Count all swabs before closure of cavity and skin
(floor count, trolley count and op field counts)
(floor count, trolley count and op field counts)
(iii) Sutures / Sharps
- Conduct preliminary/initial count
- Give 1 at a time
- Recieve intact needle
- Suture packs to tally with needles
- Additional supplies to be obtained from circ nurse
- Needles passed out are to be accounted in Count Chart
(iv) Instruments
- Conduct prelimary checks for intactness
- Account for broken/missing parts
- Observe for intactness
- Account for additional supplies in Count Chart
* The surgical team must be informed immediately of any discrepancy, and a thorough search + xray in OT + incident report must be done.
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(B) You are an OT circulating nurse. Give a brief account on how you would handle the specimens recieved from the Scrub nurse during surgery.
* Principles revolve around :
(i) Deal promptly
(ii) Confirm nature of specimen + correct type of examination
(iii) Correct labelling + Preservation + Despatch
(iii) Correct labelling + Preservation + Despatch
Interventions include :
- Use appropriate container
- Do not mix specimens
- Correct + sufficient preservatives
(Eg . fully immerse specimen in 4% Formaldenhyde)
- Multi specimens -> label in numerical order using seperate containers
(Eg . fully immerse specimen in 4% Formaldenhyde)
- Multi specimens -> label in numerical order using seperate containers
- Avoid traumatizing specimen
- Double bag item prn (must be biohazard bag)
- No preservatives for specimen if C&S or frozen section
- Ensure correct patient details + type of exam required + nature of specimen
- Despatch to respective labs with correct forms STAT
- Implants/ FBs/ Stones/ Teeth are to be returned to ward nurse/pt/family
- Amputated limbs sent to mortuary for burial/disposal
