[The surgeon allows his surgical assistant to leave prior to closure of the incision and asks the scrub nurse to assist (retract and cut sutures) while she is doing the closure count. As the scrub nurse, you would:
inform the surgeon that you are still counting but will assist as soon as your count is completed
assist the surgeon and count after the closure of the abdomen is complete
assist the surgeon while counting as a scrub nurse is supposed to multitask
inform him that retracting is not your job]
I would go with the first answer. It's bad practice to count after the abdomen closure is complete because if there is something missing and still inside the patient then they would have to reopen which is time consuming and the scrub would probably cop the blame for it anyway.
I would not count and assist at the same time because I want to be focused on my count and not distracted. And to count and retract at the same time would be bad because you'd be twisting your body around a lot which is very bad for your back.
[You are asked to scrub for an emergency cesarian section (C/S). You know that you usually perform this many counts for a C/S (think about how many body cavities are entered to deliver the baby):
2-initial count and skin closure count
3-initial count, abdominal cavity closure count, and skin closure count
4-initial count, uterus closure count, abdominal cavity count, and skin closure count.
5-initial count, uterus closure count, peritoneum closure count, fascia closure count, and skin closure count]
Have never scrubbed for a c-section because we don't do them where i work so i'm going by what i do for a hysterectomy.
I would have to go with number answer 4.
[The patient is rushed into the OR just as you are just beginning to receive supplies from the circulating nurse. You are not yet set up and have not even started your initial count and the surgeon has scrubbed and is beginning to prep. Best practice dictates that you would:
insist that an initial count be done prior to the start of the surgery
notify the appropriate management that an initial count was not done
forget about counting because of the emergency status of the procedure and then follow incorrect count policy at the end of the case
only count items used in the procedure]
This is a tough one. I would have to go with the last one and go with an incorrect count policy as well and have the patient x-rayed afterwards.
Hope this helps