The pаtient is а 40-yeаr-оld female with Dоwn syndrоme who was admitted to the hospital for a repeat penetrating keratoplasty (corneal transplant). The patient lives 120 miles away from the hospital with elderly parents and, because of the distance to be traveled, was being admitted instead of having an outpatient procedure. The patient had a penetrating keratoplasty on the left eye in the past. She developed a corneal ulcer and perforation, requiring a repeat penetrating keratoplasty via percutaneous approach in the left eye. The patient did understand the procedure and agreed to it, but the consent form was signed by her father. At the time of the corneal transplant, it was noted again that her eye was soft and appeared to be perforated, with a flat anterior chamber. The donor cornea was prepared. The previous donor cornea was removed from the patient’s eye. Four interrupted 10-0 nylon cardinal sutures were placed to secure the new donor tissue to the host, and a symmetrical rhomboid crease on the donor was noted. A total of 12 more interrupted 10-0 nylon sutures were placed equally distant from each other to secure the donor to the host, and the chamber was intermittently formed. The wound was checked for leaks, and none were seen. Subtenon injections of 80 mg Depo-Medrol and 40 mg gentamicin were administered as part of the procedure. Vigamox eye drops were placed in the eye. A bandage contact lens was placed in the eye with a shield on top. The patient was awakened and transferred to the recovery room. She stayed in the hospital overnight for pain control and management. She was examined the next morning by the ophthalmic surgeon and discharged to the care of her adult brother and parents to be driven home. Principal Diagnosis: Secondary Diagnosis: Hint: This is a Z code to show the patient's corneal transplant status. Add'l Diagnosis: Principal Procedure: Secondary Procedure: HINT: There are no extra blanks.
Nоаh dоesn’t seem tо know whаt to expect from his mother, so he is feаrful, easily upset, and confused. The world does not make a lot of sense to him. What type of attachment does Noah probably have with his mother?