A nurse is assisting with a surgical procedure that requires a large number of instruments and supplies. Which of the following strategies should the nurse use to facilitate counting and prevent foreign body retention? (Select all that apply.)

Choice A reason:

This is incorrect because the Trendelenburg position does not improve blood pressure or blood flow to the brain. In fact, it may increase intracranial pressure and reduce cerebral perfusion.

Choice B reason:

This is incorrect because the Trendelenburg position does not reduce the risk of bleeding or infection in the lower abdomen or pelvis. It may increase the risk of aspiration, respiratory compromise, and venous congestion.

Choice C reason:

This is incorrect because the Trendelenburg position does not prevent pressure ulcers or nerve damage in the back and legs. It may cause nerve injury due to stretching of the brachial plexus and pressure on the peroneal nerve.

Choice D reason:

This is correct because the Trendelenburg position helps to increase the space and visibility in the upper abdomen or chest by displacing the abdominal organs downward. This may facilitate surgical procedures such as cholecystectomy, hiatal hernia repair, or thoracic surgery.

Choice A reason:

Using a standardized counting method and sequence for each procedure helps to ensure consistency and accuracy in the counting process. It also reduces the risk of confusion or miscommunication among the surgical team members. This is a recommended standard of practice by the Association of Surgical Technologists (AST)

Choice B reason:

Separating sponges into groups of five or ten and counting them as one unit helps to facilitate counting and prevent foreign body retention. It also allows for easier identification of missing sponges in case of an incorrect count. This is another recommended standard of practice by the AST.

Choice C reason:

Keeping instruments and supplies on separate trays according to their function does not necessarily facilitate counting or prevent foreign body retention. It may help to organize the surgical field, but it does not address the issue of counting or documenting the items used during the procedure. Therefore, this is not a correct answer.

Choice D reason:

Using a white board or paper to record the counts and update them as needed helps to facilitate counting and prevent foreign body retention. It provides a visual reference for the surgical team members and allows for easy verification of the counts at any time during the procedure. It also helps to document any discrepancies or changes in the counts. This is another recommended standard of practice by the AST.

Choice E reason:

Discarding any unused items before the final count does not facilitate counting or prevent foreign body retention. It may actually increase the risk of losing track of the items used during the procedure or leaving some items inside the patient. Therefore, this is not a correct answer.