Organ donation

School of Health and Human Sciences Student Name: Student ID: Unit Name: Unit Code: Unit assessor/lecturer: _____________________________ Assignment title: _____________________________ Assignment No: Due date:__________ I have read and understood the rules relating to the Awards (Rule 3.17) as contained in the University Handbook. I understand the penalties that apply for plagiarism and agree to be bound by these rules. The work I am submitting attached to this declaration is entirely my own work. Signature Date Markers comments Introduction Brain damage and death in patients gives medical professionals the reference point for organ donation. Brain death results from brain damage that may result from factors such as cardiac arrest that affects blood vessels in the heart. Another condition that affects blood vessels is berry aneurysm, which affects the artery walls in the brain. Berry aneurysm is commonly referred to as saccular brain aneurysm. The artery in the brain is composed of two muscle layers and one elastic layer. Berry aneurysm results when the sac like or berry like enlargements form on the two muscle tissues and the elastic tissue on the wall of the arteries in the brain and then rapture (Vajkoczy & Hartmann, 2002). Provide a brief pathophysiology of berry aneurysm and how rupture can lead to brain death These berry-like enlargements commonly form at congenitally weak spots in a ring of arteries at the base of the brain or the circle of Willis (Vajkoczy & Hartmann, 2002). The circle of wills receives blood from all the major arteries in the brain and circulates to other areas of the brain. This leads to intracranial hemorrhage and raptured berry aneurysms are common in people 40 to 60 years old. Intracranial hemorrhage presents where the artery raptures and the leaking blood cause a hematoma which applies pressure on the brain tissue. Further bleeding causes increased hematoma which further compresses the brain tissue. This shares the axons connections which are responsible for sending impulses between neurons in the brain tissue resulting in brain death (Naidech, 2011). Berry aneurysm can be acquired, hereditary or congenital. Some people are born with defects on their artery wall. Others have an inherited disease of the weak connective tissues that contribute to the weakening of the artery wall. Others acquire the condition from injury and unhealthy habits such as smoking and heavy cocaine use. Systemic hypertension is another cause because of the pressure it creates on the artery wall (Khurana & Spetzler, 2012). Other artery walls in the body have two elastic layers while the walls of the artery comprise of one elastic layer and two muscle layers to ensure its strength and elasticity. There are certain points in the layers that predispose the brain artery to aneurysm. For instance, the smooth muscle layer is thinned out or non-existent at the points where the artery branches out. Excessive pressure at this point which may be because of high blood pressure or atherosclerosis may result in ballooning and consequently berry aneurysm. In addition, the elastic layer has natural perforations and any damage at these points may expose the artery to aneurysm. Prior to their rapture, small amounts of blood may leak from the aneurysms for hours and even days. The symptoms of the leaks may include stiffness of the neck, headaches and nausea although it is reported that 90 per cent of the cases have no symptoms until rapture occurs. When rapture of the major brain arteries occurs, the circle of Willis does not receive blood. The circle of Willis circulates blood to other parts of the brain that controls functions such as movement, sight, feeling and thinking. It causes an excruciating headache accompanied by nausea and vomiting which may be followed by temporary loss of consciousness, coma and death (Applbaum, Tilburt, Collins, & David, 2008). Death results from the irreversible brain damage or death which results from the fact that brain parts fail to receive oxygen due to limited blood supply and circulation (Zamula, 2002). Demonstrate knowledge of the nursing care that is required for this patient Brain death is irreversible cessation of the functioning of all the parts of the brain. This is a widely accepted reason for pronouncing death of a human being. When the parts of the brain cease functioning, some of the human tissues may continue functioning and brain dead people may survive for some time. Upon brain death diagnosis, life-sustaining treatment is withdrawn but may be continued to preserve organs such as the liver or kidneys (Lee & Grisez, 2012). However, it is generally considered unethical and futile to continue to support vital organ function once a diagnosis of brain death is made (Lane, et al., 2004). Once a person has been declared brain dead, physiological changes that follow may jeopardize potentially transplantable organs. Some of the changes occur in the cardiovascular system, endocrine and metabolic disturbances and disruption of internal homeostasis. Brain death also triggers pro-inflammatory molecules release. It is thus necessary to deliver nursing care to normalize the physiology of brain dead persons with the intention improving organ procurement and enhance graft survival. Nurses most often intervene to prevent cardiac arrest and to preserve the possibility of organ donation rather than to save the patient’s life. In case the nurses overlook the possibility of organ donation, they continue focusing on the brain injury and the patient dies in a way that precludes organ donation. When patients are severely brain damaged there is no purpose in instituting resuscitative efforts. Nurses observe the patient on the mechanical ventilation in an intensive care unit. They also assist the physicians to perform a series of clinical tests for neurological function. During diagnosis, brain dead patients are in a coma and demonstrate no response to battery tests repeated in six to twelve hours to assess brain stem function. The most common test is the apnea test where the ventilator is removed from the patient to determine whether the patient has any capacity to breath. Once the findings persist and they rule out other probable causes for absence of neurological function such as drug intoxication, shock or hypoxia the patient is pronounced dead. If the patient is a suitable donor, nurses observe that the heart is perfusing the patient’s organs (Troug, 2007). Nurses ensure clearance of secretions for patients receiving mechanical ventilation using the closed suction system. It consists of a suction catheter which is enclosed in a plastic film sleeve that ensures uninterrupted oxygen supply. It maintains a patient’s airway for effective ventilation and reduces chances of tracheal suction which include high airway pressures, adventitious breath sounds and reduction in oxygenation saturation levels. Nurses provide nutritional support in accordance to the patient’s activity levels. For patients with functional gastrointestinal tracts, entereal nutrition is the preferred method of feeding. This is because it maintains mucosal integrity and increases blood flow to the gut and minimizes septic complications. This decreases instigation of gastrointestinal problems. The nurse assesses the patient’s response to feeding by aspirating the nasogastric tube every four hours to assess food tolerance. They may consider peripheral feeding for those with feeding intolerance to enteral feeding (Newmarch, 2006). Nurses also provide oral hygiene because the presence of an oral cuffed endotracheal tube may cause hyper salivation or a dry mouth in some patients. They provide routine care such as bathing the brain dead person. Nurses also play a significant role in the operating room where patients are taken for organ retrieval (Zielinski, 2011). Nurses ensure safety of the mechanically ventilated patients by observing them at all times. This particularly applies when moving the patient and positioning the ventilator tubing. Nurses conduct safety checks on equipment in the bed space, alarm limits on monitoring equipment and ventilator alarm. These require being available at all times and connected to the oxygen supply. The high vacuum suction equipment also requires being in full working condition to maintain airway patency. Overall, the nurs...