Question

CASE STUDIES 1. Read the following scenario and answer the questions that follow. A surgical technologist who is new on the lob is assigned to work in the outpatient clinic for minor procedures. Her role is to assist the circulator during the morning's work. The first patient arrives to have a skin lesion removed. The circulator tells the surgical technologist to collect the equipment and forms necessary to take the patient's vital signs during the case. The ST looks for a digital blood pressure cuff. Not finding one that is working, she obtains a manual sphygmomanometer and stethoscope. She cannot find a form for documenting the vital signs, so she takes a blank paper from the printer. The case is about to begin. The ST explains to the patient that she will be taking the vital signs every 15 minutes. The case begins with local infiltration of the lesion using lidocaine with epinephrine 1:200,000. After the infiltration, the ST begins to take the blood pressure reading. She cannot find the pulse at first because it is thready and weak. Finally she thinks she has located it and takes the reading. She records 145/95 on her paper. She records the pulse at 120 and respiration at 19. She knows that epinephrine can increase the pulse rate, so she is not concerned with the reading. The patient is slightly overweight, so the blood pressure reading also makes sense. The ST continues to take the patient's vital signs over a 45-minute period. She skips the last reading because the skin incision has been closed. The patient is moved to a waiting area. The circulating nurse asks the ST for her documentation. When she sees it, she asks why the ST didn't use the appropriate form. The ST replies that she could not find one. The ST has recorded the vital signs as follows: 1 - 145/95 pulse - 120 resp 19 2- 150/95 pulse - 120 resp 20 3- 135/90 pulse - 110 resp 12 She tells the circulator that the blood pressure changed as the anesthetic began to "wear off." The circulator is somewhat disturbed at the scrub's explanations and documenta- on of the patient's vital sians. She asks the scrub why she did not record the middle blood pressure reading. The ST states that she didn't know it was required a. List all the errors made by the new ST in her new role.

Answer 1

The following are the errors made by the new ST in her new role:

• She didn't collect the appropriate equipment and forms, as she was told, to take the patient's vital signs during the case. Instead of obtaining a digital BP cuff she obtains a manual one, and instead of a form, she gets a paper from the printer. She could have asked someone for the above requirements if she couldn't find one herself.
• The patient has a pulse rate of 120, but the ST couldn't locate it at first, which could be due to her inexperience.
• She skipped the last reading.
• She is unaware of the fact that epinephrine changes the pulse rate. This is evident from her conversation with the circulator, she tells the circulator that the blood pressure changed as the anesthetic began to wear off.