Surgical Count Procedures

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Questions and Answers

What is the primary purpose of the closing count during surgery?

To prepare the surgical site for the final dressing

To ensure all surgical items are accounted for before skin closure (correct)

To assess the effectiveness of anesthesia during the procedure

To confirm the patient’s identity before closing

Who is responsible for documenting the surgical count on the count sheet?

The surgeon performing the procedure

The circulating nurse (correct)

The anesthesiologist

The patient’s family member

What is the primary purpose of conducting surgical counts?

To ensure no surgical items are left inside the patient after closure (correct)

To track the time taken for the surgical procedure

To keep an inventory of instruments used during surgery

To document the experience level of the surgical team

Which of the following categories does NOT fall under the items counted during surgical procedures?

Intravenous fluids Signup and view all the answers

What should happen when a surgical count is found to be incorrect?

The surgical team should document the error and complete an incident report Signup and view all the answers

Which sequence is recommended for the final surgical counts?

Sterile Field → Mayo Stand → Back Table → Items removed from sterile field Signup and view all the answers

In what stage of a surgical procedure should the initial count be performed?

Before the surgical incision is made Signup and view all the answers

Who must be present during surgical counts to ensure accuracy?

Two perioperative nurses, with one being a Registered Nurse Signup and view all the answers

What should be done with laundry and garbage during the surgical counting process?

They should remain in the room until the final count is complete Signup and view all the answers

What is included in the documentation of the surgical counts?

Results of initial, closing, final, and additional counts Signup and view all the answers

Which of the following best describes the term 'radiopaque' in the context of surgical items?

Items that can be detected by X-ray imaging Signup and view all the answers

What must the circulating nurse do after completing the final count?

Verbalize the count results to the surgeon for acknowledgment Signup and view all the answers

What is the outcome if the surgical count does not match during the closing procedure?

The operation may need to be delayed or extended to resolve the discrepancy Signup and view all the answers

Which standard governs the variations in institutional policies related to surgical counts?

ORNAC Standards Signup and view all the answers

Which of the following statements about the count sheet is true?

The count sheet is kept in the patient’s health record Signup and view all the answers

During which count are surgical items allowed to be added or removed as the operation progresses?

Changeover count Signup and view all the answers

When is a minor count completed during a surgical procedure?

During initial, closing, and final counts if no risk of entry is present. Signup and view all the answers

What type of count is always performed for the final count?

Minor count. Signup and view all the answers

In which scenario is a major count required for the initial count?

When there is confirmed entry into a large cavity. Signup and view all the answers

What is a characteristic of minimally-invasive surgical counts?

Count requirements depend on the length of the incisions. Signup and view all the answers

What determines whether a procedure requires a minor or major count during initial and closing counts?

The risk of entering a body cavity and the size of the incision. Signup and view all the answers

Which procedure would require a major count for the closing count?

Laparotomy for bowel resection. Signup and view all the answers

In an inguinal hernia repair, when is a major count required?

For the initial count regardless of cavity entry. Signup and view all the answers

What is a defining feature of a major count?

Counts sharps, miscellaneous items, and instruments. Signup and view all the answers

What is the first action a perioperative nurse should take if an initial surgical count is not completed?

Notify the surgical team. Signup and view all the answers

What should be documented if an initial count is not completed before surgery?

The reason for the incomplete count and actions taken. Signup and view all the answers

If an incorrect count is discovered during the procedure, what is the first step that should be taken?

Suspense the wound closure to search for missing items. Signup and view all the answers

Which of the following actions is NOT required after an incorrect count is identified?

Immediately disclose the count to the patient. Signup and view all the answers

What is a key preventative measure to avoid incorrect counts during surgery?

Avoid disruptions during surgical counts. Signup and view all the answers

If a surgeon refuses an X-ray after a procedure due to an incomplete count, what should be done?

Document the refusal according to healthcare institution policies. Signup and view all the answers

What should the scrub nurse do if an incorrect count is identified?

Conduct a search of the surgical site and setup. Signup and view all the answers

What is an important aspect of communication among the OR team to prevent incorrect counts?

Being aware of all surgical items used during the procedure. Signup and view all the answers

When is the initial surgical count performed?

Before the procedure begins Signup and view all the answers

What is counted during the closing count when the cavity is opened greater than 10mm?

Major count items are counted Signup and view all the answers

Which scenario requires a minor count during the initial count?

No confirmed or potential cavity entry Signup and view all the answers

What is a factor that influences the closing count?

The size of the incision and cavity entry Signup and view all the answers

In which type of procedure is a minor count performed during the closing count if the cavity is opened less than 10mm?

Minimally-invasive procedures such as laparoscopy Signup and view all the answers

What is the purpose of the final count during the surgical procedure?

To account for remaining items during skin closure Signup and view all the answers

What type of count is typically performed during the initial count for a bronchoscopy?

Minor count as there is no cavity entry Signup and view all the answers

Which statement accurately describes the factors influencing the initial count?

It varies based on the risk of cavity entry Signup and view all the answers

Study Notes

Surgical Counts Overview

Surgical counts are essential to prevent the retention of sponges, sharps, and instruments inside a patient post-surgery.
Institutional policies guide what items are counted, based on ORNAC Standards.

Counting Procedures

The first layer approximated during a laparotomy is the peritoneum.
Closing and final counts follow the sequence: Sterile Field → Mayo Stand → Back Table → Items removed from sterile field.
Closing counts occur after items are no longer in use; documentation is critical.

Count Documentation and Personnel Responsibilities

Final counts total all surgical items, recorded in designated columns on the count sheet.
Two perioperative nurses, one being an RN, conduct counts audibly and visibly.
If a scrub nurse is absent, a surgeon can count with an RN as per institutional policy, with documentation required.

Types of Counts

Initial Count: Conducted before procedures, determining if a major or minor count is needed based on potential cavity entry.
Closing Count: Takes place during the first layer of wound closure, varies by cavity entry size.
Final Count: Always includes a minor count, done during skin closure.

Major vs. Minor Counts

Major Count: Involves counting sponges, sharps, miscellaneous items, and instruments, performed for open procedures with significant incisions (greater than 10mm).
Minor Count: Required for minor surgeries where no cavity entry is confirmed, can also be used for small incisions in minimally invasive procedures.

Special Considerations

Minimally Invasive Procedures: The count protocols differ based on incision size; initial counts may be waived for urgent procedures.
Incomplete counts must be documented; actions such as notifying surgical teams, consulting for postoperative X-rays, and completing incident reports are necessary.

Handling Count Discrepancies

If a discrepancy arises, the circulating nurse informs the surgeon, and wound searches commence immediately.
An incident report is generated, and the patient's documentation must reflect the actions taken.

Best Practices

Preventative actions against incorrect counts include avoiding disruptions, timely documentation, ensuring legible records, and fostering communication among OR team members.

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Description

This quiz covers critical actions to be taken if an initial surgical count is not performed. It emphasizes the importance of notifying the surgical team, documenting the incomplete count, and consulting with the surgeon for further actions. Perfect for perioperative nurses seeking to reinforce their knowledge on surgical protocols.

Surgical Count Procedures - Module 6

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