Chapter 3 Flashcards
the Surgical Patient
primary role of STSR
give care to patient during procedure
-establish + protect sterile field
-care of instruments
-assist surgeon
maslows hierarchy
physiological
safety
love/ belonging
esteem
self actualization
what causes ethical dilemmas in modern medicine
multi culture and religion
4 basic components of needs
physical
psychological
social
spiritual
3 categories of psychologic needs
fear
loss of security
family issues
2 categories of social needs
relationship with peers
support system
4 categories of spiritual needs
supporting religious beliefs
recognize faith
visit with clergy
right to refuse treatment
when would you give surgery
last resort and a last offer of hope
two broad factors that apply
adaptation + stress
environment is what conditions
ALL that effect us
roy adaptation model is based on
family support
culture
intelligence
personalities
what is the roy adaptation model
viewing the patient as a biopyschosocial individual
stress definition
nonspecific response of the body to a demand
factors of stress
type/ severity of illness
previous medical history
age
environment
family role
economic
religious
4 coping mechanisms for stress
denial
rationalization
regression (reverting to young)
repression (don’t think, won’t happen)
death and dying treatment
goes from maintaining/ buying time (palliative) to comfort care
medically accepted definition of death
cardiac
higher brain death
- low Brain stem continues to provide w/o assistance of respirator
whole brain death
- current law as to what defines death in most he world
Roman Catholic death
anoint the sick
catholic/ protestant death
offer last rights
muslim death
turned east to face Mecca after death
jewish death
dying patient never left alone
don’t touch body until rabbi
buddhist death
reincarnation, last thought determines
hindus
cremation, helps soul begin journey
5 stages of grief
denial
anger
bargaining
depression
acceptance
not in order and not always all
causes of death
accidental
terminal - progressive
prolonged/ chronic
sudden/ no warning
forms of treatment
palliative
therapeutic
palliative treatment
symptom relief
improves quality of life
doesn’t alter progression of disease
theraputic disease
treat/ manage disease
elective (pacemaker, novasure)
non- elective (transplant)
examples of life support
feeding tubes, bypass machine, dialysis
forms of treatment
ordinary + extraordinary
ordinary care
care given to prolong life
physician morally obligated to provide
no additional burden to patient
extraordinary care
burden on patient
may be costly
no obligation to accept treatment
surgeon not morally obligated to provide
euthenasia
passive- patient refuses life saving efforts (DNR)
active- actions to speed up death process (morphine)
active euthanasia
voluntary- patient initiates
involuntary- patients rights violated
AHA patent care partnership + patient self detrimiation act
- allows patient right to refuse treatment
- must inform pt of right to choose care type
- provide pt with info concerning wills
STSR- AHA patient care partnership role
- refrain from imposing value system on pt
- honor ALL patients requests
advanced directives
speaks for the pt
handles medical interventions
sustain or not life
power of attorney
DNR + DNI differences
DNI: breathing
DNR: heart
broad guidelines for death in OR
notifiers supervisor
postmortem care
notify family
notify religious leaders
preserve evidence, body to coroner
what do you do when you debrief death in the OR
hospital has counselors
remember HIPPA
move on
organ transplants
protocols by medicare and medicaid
family is consulted- can include clergy
declaration of death - whole brain
DCD
donation after cardiac death
only if predicted the heart would cease to function after 90 minutes once life support removed
organ trasplant pt 2
next of kin must consent to donate blood
- not in utah
facility’s procurement coordinator (gift of life coordinator) determines the pt sustainability for organ donation, organize process + seek family consent
what kind of doctor can give transplants
transplant doctor can not be end of life doctor or declaration of death doctor
how much time do you have after you take out the heart to transplant
4-6 hours
much time do you have after you take out the lungs to transplant
4-6 hours
much time do you have after you take out pancreases to transplant
12-24 hours
much time do you have after you take out the liver to transplant
24 hours
much time do you have after you take out kidney to transplant
48-72 hours
how much time do you have after you take out the cornea to transplant
5-7 days
how much time do you have after you take out heart valves, skin, bone, veins to transplant
3-10 years (freeze)
