Question

Discussion (7) 1. Advance directives are very important so that an easy death as described by the patient's wishes can be accomplished. It is not uncommon for a patient to have a DNR/DNI order. Describe what should happen when there is a death in the OR during a procedure. (2) 2. Describe the difference between DCD (donation after cardiac death) and whole-brain death for organ transplantation. (2) 3. Describe Maslow's hierarchy of needs. Which stage is addressed during surgery? (3) 1. Describe the special considerations that must be made in the plan of care when completing pediatric surgery. () 2. Describe special considerations that must be made in the plan of care for the obese patient in surgery. (3) 3. Describe special considerations that must be made in the plan of care for the trauma patient. (4)

Answer 1

1. It is a coroner's Case

In which a patient death that requires investigation by the corner, as well as an autopsy on the deceased; death in OR or ER, unwitnessed death, after admission from another facility, criminal activity is suspected, suicide, of an incarcerated individual, *as a result of an infectious disease that might pose a public health risk.

2. DBD:

- This is where a patient has entered a state of complete brain death due to trauma, cerebrovascular damage, or anoxic event

- Clinical exam, nuclear flow studies and MRI will show no signs of neuro function/no brain activity)

- Transplant team is never involved in the original care of the DBD pt. The patient will be pronounced brain dead by hospital physician and only then will the transplant team (OPO = organ procurement organization) be contacted.

- Organs that can be procured: heart, lungs, intestines, liver, pancreas, and kidneys.

DCD:

- This is a situation where the patient is still technically alive, but it is determined that the patient has no chance of recovery from brain damage & cannot survive without a ventilator, and the family has decided to withdraw life support (thus the patient will experience cardiac death)

- Transplant team is kept outside of OR until the patient actually experiences cardiac death (~60min). OPO is involved in discussions with the family and takes over patient's care/pays for patients fees incurred after this point.

- Organs that can be procured: lungs, pancreas, liver & kidneys.

- If patient does not die within 2 hours of removal of life support, they are no longer eligible for organ donation (returned to unit to die there).

3. Maslow's heirarchy of needs is one of the theory which describes about the various ascending needs of an individual beaded on priority and importance .

Steps are :-

- physiological needs

- security needs

- affiliation needs

- self esteem needs

- self actualization needs

The stage which is addressed during surgery is the physiological needs basically maintaining the life by mechanically ventilating the patient .