Solution Manual for Surgical Technology for the Surgical Technologist 6th Edition by Association of by welldoneassistant

SOLUTIONS MANUAL Surgical Technology for the Surgical Technologist: A Positive Care Approach 6th Edition Association of Surgical Technologists

TABLE OF CONTENTS Chapter 1: Introduction to Surgical Technology Chapter 2: Legal Concepts, Risk Management, and Ethical Issues Chapter 3: The Surgical Patient Chapter 4: Physical Environment and Safety Standards Chapter 5: Technological Science Concepts Chapter 6: Principles of Microbiology Chapter 7: Surgical Asepsis and Sterility: Best Practices and Techniques Chapter 8: Emergency Situations and All-Hazards Preparation Chapter 9: Surgical Pharmacology and Anesthesia\ Chapter 10: Instrumentation, Equipment, and Supplies Chapter 11: Hemostasis, Wound Healing, and Wound Closure Chapter 12: Preoperative Surgical Case Management

Chapter 13: Intraoperative and Postoperative Surgical Case Management Chapter 14: Diagnostic Procedures Chapter 15: Minimally Invasive Applications Chapter 16: General Surgery Chapter 17: Obstetric and Gynecologic Surgery Chapter 18: Ophthalmic Surgery Chapter 19: Otorhinolaryngologic Surgery Chapter 20: Oral and Maxillofacial Surgery Chapter 21: Plastic and Reconstructive Surgery Chapter 22: Genitourinary Surgery Chapter 23: Orthopedic Surgery Chapter 24: Cardiothoracic Surgery Chapter 25: Peripheral Vascular Surgery Chapter 26: Neurosurgery

AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

Solution and Answer Guide AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; CHAPTER 1: Introduction to Surgical Technology

TABLE OF CONTENTS Opening Case Study.................................................................................................................................... 1 Closing Case Study ..................................................................................................................................... 2 Questions For Further Study ..................................................................................................................... 3

OPENING CASE STUDY A patient has been scheduled for a diagnostic laparoscopy to confirm the pathology that may be causing chronic pelvic pain. While in the preoperative holding area, a registered nurse (RN) performs the nursing evaluation, including checking the patient’s documentation, confirming allergies and special needs, and providing emotional support. The anesthesia care provider reviews the preanesthesia assessment and starts an intravenous (IV) line. The RN and patient care technician transport the patient into the operating room (OR). The patient notices a person in the OR wearing a surgical gown, mask, gloves, hair cover, and protective eyewear. This person sets up surgical instruments, equipment, and supplies on a large table draped in blue material. The person steps back from the table, turns to the patient, and says, “Good morning, my name is Emma. I’m a Certified Surgical Technologist(CST), and I’ll be assisting Dr. 1. In what nursing role is the RN functioning? ANS: The nurse is functioning in the role of circulator. The circulating role is a licensed professional whose scope of practice is inclusive of patient care, patient identification, patient documentation, and patient advocacy. As part of the surgical team, the circulator will remain as the nonsterile professional capable of providing the sterile surgical team with needed supplies during a surgical procedure. 2. In what surgical technologist role is Emma functioning? ANS: Emma is the surgical technologist in the first scrub role. Within their scope of practice, the responsibility of a surgical technologist is to provide optimal patient care, advocate for the patient, demonstrate therapeutic support, and assist the surgical team by helping the patient return to their best possible state of wellbeing. 3. What organization is responsible for accrediting the program Emma attended?

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

ANS: CAAHEP establishes standards for education of surgical technology program and grants accreditation to surgical technology programs. This will only take place upon the recommendation of ARCSTSA, which verifies and clarifies that programs are adhering to AST Core Curriculum developed by AST. 4. What is the preferred educational background for Emma, as established by the organization that accredits programs? ANS: Since Emma introduced herself as a CST, she had to have attended an accredited program. There are two recognized accreditation organizations, ARCSTSA and ABHES, which, under the umbrella of CAAHEP, are responsible for ensuring that education background is adhered to. 5. What organization offers the Certified Surgical Technologist (CST) examination that Emma successfully passed? ANS: The NBSTSA offers the Certified Surgical Technologist (CST) exam. Graduates of programs that have been granted accreditation status qualify to take the NBSTSA exam, which awards and owns the trademark of the CST and CFA credentials.

CLOSING CASE STUDY Ian is a CST with several years of experience working at a large urban hospital. They have just finished assisting the circulating RN and anesthesia care provider in positioning the patient and have been asked if they will perform the skin prep on the patient. 1. What role is Ian performing? ANS: Ian is performing the role of STCR (surgical technologist in the circulating role) since they are assisting the circulating registered nurse. The training provided by an accredited surgical technologist program incorporates performing some of the functions of circulator in an operating room. 2. Is the role a nonsterile or sterile role? ANS: The team member is functioning in the role of a circulator, which is a nonsterile role. Perioperative case management consists of the preoperative, intraoperative, and postoperative phases. During each of these phases, there are team members who perform tasks which require them to be sterile, and others may complete tasks which are nonsterile. When prepping the patient, the prepping solution and/or prep stick come in a sterile package, and the appropriate process is to don sterile gloves using open-glove technique. 3. What are the roles of the other OR team members?

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

ANS: Non-Sterile team members: Anesthesia care provider: responsible for monitoring patients’ vital signs Anesthesiology resident or a CRNA (certified registered nurse anesthetist): assists the anesthesia care provider Operating Room Attendants (patient care techs, transporters): assist with moving the patient from one place to another Nursing students Sterile team members: CST (certified surgical technologists): assists team with the procedure CFA (certified first assist): assists the surgeon with performing the procedure Surgical Residents: there to learn from the surgeons how to accomplish the procedure Medical Students (typically fourth-year students): students getting ready to select their specialization in medicine Surgical Technology students Surgeon

QUESTIONS FOR FURTHER STUDY 1. What is the difference between a job description and a role description? ANS: Role descriptions, by their very nature, are broad in scope, describing a typical or common set of activities and responsibilities. Job descriptions, however, are produced and approved by the institution for which one works. Depending on the type of job, they may be written fairly broadly, but they are usually quite specific regarding the surgical technologist’s responsibilities. Because (as of this writing) surgical technologists are subject to licensure in certain states, there may not be a directly related statute that applies to the surgical technologist’s job description for your state. (Examples of states requiring licensure or registration include: Colorado, Washington, District of Columbia, Texas, etc.) The job description is typically the work and property of the given institution in which the surgical technologist works. The surgical technologist should be familiar with the job description in the institution of employment in order to define his or her scope of practice for the institution. Job descriptions provide a job title and definition, specific requirements for the job, duties and tasks to be performed, and designation of one’s immediate supervisor to whom one is accountable. Job descriptions are placed within the context of an institution’s mission and a department’s role in accomplishing that mission. Surgical technologists have traditionally been assigned to the nursing department when employed by a facility such as a hospital or ambulatory surgical center. With the increased use of private surgical technologists and the “traveling” surgical technologist, the employer may be a physician, a physicians’ group, or an agency. In some locales, a surgical technologist who is employed outside the institution but will be assisting in the facility is required to seek permission to function through the medical credentials committee at the hospital. No matter the employment situation, the surgical technologist must be aware of the conditions of employment, the nature of the

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

job, required tasks, and specified limitations. The job description may establish the criteria by which the surgical technologist will be judged in a case concerning alleged negligence or malpractice. 2. How does health care financing affect the services that healthcare professionals provide? ANS: Health care financing may affect the type of surgeries performed, the schedule, and personnel ratios; the salary that the health care professional receives; the amount, type, and quality of equipment, supplies, and additional resources that are available for patient care; and many other variables. These variables, when combined, create the overall environment in which health care professionals work. 3. List several reasons why a surgical technologist might need to communicate with the diagnostic imaging department, medical laboratory department, or a medical-surgical floor nurse. ANS: The surgical technologist may be responsible for arranging patient transportation, obtaining patient records, or coordinating preoperative, intraoperative, and postoperative events. Communication between departments and specific individuals responsible for patient care is imperative. Minimally invasive procedures have also increased the amount of cooperation between departments. 4. Describe the “typical” workday for the surgical technologist. ANS: The surgical technologist functions in a sterile capacity during surgical procedures, but also performs many nonsterile duties throughout the course of the workday. Other roles include assistant circulator, second scrub, second assistant (providing exposure as a camera driver or handheld held retraction), or other duties as assigned. Some of the scrub role duties of the surgical technologist in each phase of surgical case management include: Preoperative Case Management • Donning OR attire and personal protective equipment • Surgical site verification • Preparing the OR • Gathering necessary equipment and supplies • Creating and maintaining the sterile field • Scrubbing and donning sterile gown and gloves • Organizing the sterile field for use • Counting necessary items • Assisting team members during entry of the sterile field • Placing sterile drapes to expose the operative site • Correct patient verification, e.g., “time out” Intraoperative Case Management • Maintaining the sterile field, including establishing neutral zone • Passing instrumentation, equipment, and sup• plies to the surgeon and surgical assistant as needed • Assessing and predicting (anticipating) the

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

• • • • • • •

needs of the patient and surgeon and providing the necessary items in order of need Preparing irrigation fluids Preparing and handling medications Counting necessary items Caring for the specimen Clearing residual blood and skin prep solutions from patient’s skin Preparing and applying the dressing

Postoperative Case Management • Maintaining the sterile field until the patient is transported from the OR • Disassembling the sterile field • Removing used instruments, equipment, and supplies from the OR • Caring for and maintaining instruments, equipment, and supplies following use • Preparing the OR for the next patient 5. Define the term competency as it relates to the role of the surgical technologist. ANS: The term competency means that one is well qualified and has the knowledge and/or skills to perform in a particular area. For the surgical technologist, skill assessments and the certification exam are often used to determine competency. 6. In addition to the traditional role of the surgical technologist in the surgical setting, list at least two other related employment options. ANS: Most surgical technologists are employed in hospital surgery departments, obstetric departments, and ambulatory care centers. However, because of the broad educational background combined with a specialized focus, the following options are also available to the surgical technologist: • Specialization in an area of interest such as cardiac, orthopedic, or pediatric surgery • Employment as a traveling Certified Surgical Technologist • Advancement to the role of surgical assistant • Employment by a veterinary surgeon or animal care facility • Employment by a medical corporation to represent its products • Research and product development • Employment in the material management or central supply areas • Assumption of supervisory responsibilities • Surgical technology educator • Military service • Volunteer opportunities (such as the Peace Corps) • Technical writing, illustration, and photography • Employment as a consultant Note: Some of these positions require experience and further education.

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

Solution and Answer Guide AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; CHAPTER 2: Legal Concepts, Risk Management, and Ethical Issues

TABLE OF CONTENTS Opening Case Study.................................................................................................................................... 6 Closing Case Study ..................................................................................................................................... 6 Questions For Further Study ..................................................................................................................... 7

OPENING CASE STUDY Bret is a CST working with Dr. Jones on an open cholecystectomy procedure. Dr. Jones has both hands engaged and asks Bret to inject a contrast medium into the cystic duct under their direct supervision. 1. Is this act different from injecting medication into an IV line, and if so, how? ANS: As a Certified Surgical Technologist (CST) it is outside of the accepted scope of practice, whether under the supervision of a licensed professional or not, to administer any type of pharmaceutical substance to a patient. A CST is nationally certified but not a licensed healthcare provider. 2. What do you think that Bret should do in this situation? ANS: Having been trained as a CST and having graduated from an accredited program, Bret knows that he should remind the surgeon that he is not permitted to administer any medication to any patient at any time. If Bret were to follow the surgeon’s direction, and the patient subsequently sustained injury, Bret would be liable, as would the surgeon, for going outside his scope of practice. 3. How can Bret know what the best course of action would be in this situation? ANS: Since the scenario states that both of the surgeon’s hands are occupied, Bret could always inform the surgeon that he would gladly retract and/or suction for them, so the surgeon could then administer the contrast media. This solution would prevent a potential negligent act to take place which could easily lead to a civil malpractice lawsuit.

CLOSING CASE STUDY A nineteen-year-old female patient is scheduled to have an elective abortion in the OR. It is legal in your state for this procedure to be performed on this patient. © 2024 Cengage Learning, Inc. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

1. How does AST’s motto of Aeger Primo apply in this case? ANS: Aeger Primo is Latin for “patient first.” As healthcare professionals, a Certified Surgical Technologist has the ethical obligation to provide optimal patient care to all patients who arrive in an operating room. This mindset should include no judgment based on gender, culture, or religious beliefs. It is imperative that a CST remember their obligation is to the patient, who in this case, is the nineteenyear-old female. </question type="essay"> 2. How does AST’s Code of Ethics for Surgical Technologists apply to this case? ANS: There are ten statements in the AST Code of Ethics that a CST abides by, and in this case, the CST must maintain the highest standards of professional conduct and patient care. They are to respect the patient’s beliefs, protect their moral rights, and always adhere to the Code of Ethics. 3. What are the differences between morals and ethics? ANS: Ethics define what is good for individuals and society. It is a system of moral principles and rules that become standard for professional conduct. Morals are guides for ethical decisions, such as when we teach our children to trust, to be honest, and to care. Moral principles may be thought of as personal ethics; therefore, they may differ among varied cultures and religions. Morals incorporate an acknowledgement and respect for an individual human being’s autonomy. 4. Would you treat this patient any differently than you treat other patients? ANS: A CST has an obligation, responsibility, and expectation to provide the same level of care to all patients having surgery. The CST’s Scope of Practice clearly defines CSTs as health care providers who provide services for which they are accountable and responsible based on their education, experience, and national credentialing. The CST agrees to an unspoken oath to adhere to the principles of asepsis in each patient they encounter

QUESTIONS FOR FURTHER STUDY 1. Discuss how the two concepts of intraoperative counts and res ipsa loquitur intersect. ANS: Res ipsa loquitur – “The thing speaks for itself; harm obviously came from a given act or thing of which the defendant had sole control. Foreign bodies left in patients secondary to incorrect sponge, sharps, and instrument counts – the circulator and certified surgical technologist must count all items specified by hospital policy for counting before the procedure begins, at the time that wound closure begins and again during skin closure. If an item is left within the patient an x-ray or surgical removal of the item is proof that the item was left during surgery.

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AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; C HAPTER 1: Introduction to Surgical Technology

2. Explain the fundamental change the Patient Care Partnership introduced as related to the patient. ANS: American Hospital Association’s (AHA) Patient Care Partnership reflect values that the patient is an autonomous individual who is in need of a serves that he or she cannot provide. Patient Care Partnership informs the patient about what he or she should expect and that the patient must be involved in his or her health care and ask questions. There are six expectations, including high-quality clean and safe environment, involvement in own care, help when leaving the hospital, and help with bill and insurance claims. The patient has the right to make decisions about and be involved in his or her care. 3. Discuss the differences between morals and ethics. Give as many examples of each as you can think of. ANS: Ethics is the system of moral principles and rules that become standards for professional conduct and should not be confused with morals. Morals dictate codes of conduct, which are put forward by a society and used as a guide to behavior by the members of that society. Moral principles are guides for ethical decisions making include the principles of benevolence, trustworthiness, honest, basic justice prevention of harm and the refusal to take unfair advantage, Ethics includes rules of conduct and standards of behavior principles such as impartiality, objectivity, duty of care, confidentiality, and full disclosure. Ethical principles include being trustworthy and honest. In simplest terms, it has been identified as the moral obligations that one person owes another TJC defines ethics as “the branch of philosophy that deals with systematic approaches to moral issues, such as the distinction between right and wrong and the moral consequences of human actions. Ethics involves a system of behaviors, expectations and morals composing of standards of conduct for the profession. 4. In a conversation with a CST fellow-worker, he relates a story about a recent case. You soon realize that the patient in question was one of your close family members. What do you do? ANS: The fellow-worker has committed an invasion of privacy. The Health Insurance Portability and Accountability Act (HIPAA) has been violated. Consumers may file a formal complaint regarding the privacy practices of a covered health plan or provider. You can also discuss the importance of this act with your fellow workers. This is an ethical plight, do you report them, do you discuss it with your fellow coworker or do you do nothing. HIPAA laws are to protect the privacy of the individual. Our ultimate responsibility is to the patient.

Solution and Answer Guide AST, Surgical Technology for the Surgical Technologist, 6e, ISBN: 9780357625736; CHAPTER 3: The Surgical Patient

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