Final - Heart/Lung Transplant Flashcards
Diagnosis for Heart transplant
- End-stage congestive heart failure
- Ischemic cardiomyopathy
- Dilated cardiomyopathy
- Congenital heart disease for which no conventional therapy exists or that conventional therapy has failed
- Ejection fraction less than 20%
- Intractable angina or malignant cardiac arrhythmias for which conventional therapy has been exhausted
- Patient requires mechanical circulatory support or dependent on inotropes
- Patients have exhausted all other medical options for treatment of heart condition
diagnosis for lung transplant
- Alpha-1 Antitrypsin Deficiency
- Bronchiectasis
- Cystic Fibrosis
- COPD/Emphysema
- Lymphangioleiomyomatosis
- Pulmonary Fibrosis
- Pulmonary Hypertension
- Sarcoidosis
listing process for transplant
- Deplete all other medical options
- Meet requirements for transplant
▫ Consultations and evaluations are a series of
tests conducted in order to ensure that the
patient is a viable candidate for organ
transplantation - The patient is entered into the national
computerized waiting list, which is maintained
by UNOS
matching system
Donor organs are matched to potential
recipients according to objective medical data
▫ blood type
▫ tissue type
▫ size of the organ
▫ medical urgency of the patient
▫ time already spent on the waiting list
▫ geographical distance between donor and
recipient
patient selection and limitations
- An active, uncorrectable infection throughout the body
- HIV or AIDS
- Active cancer outside the organ
- Active alcoholism or substance abuse
- Irreversible, severe brain damage
- Severe uncorrectable diseases of other organs
- Inability or refusal to comply with medical direction
- Comprehension
- Psychological consideration
- Age
surgical complications for lung transplant
- Infection
- Phrenic nerve injury
- Reintubation
- Rehabilitation
- Tracheostomy
- Death
- Bleeding
- Blood transfusions
- Reperfusion injury
- Rejection
- Airway complications
- Fluid imbalance
long term complications of lung transplant
- Hypertension
- Kidney dysfunction or failure
- Phrenic nerve injury/damage
- Diabetes
- Cancer
- High cholesterol
- Osteoporosis
- Chronic rejection
- Recurrent infection
role of PT post transplant
- To evaluate the patients needs
- Educate patient on precautions
- Assist in improving functional mobility and
endurance - Allow for return to prior level of function or
greater
lung transplant education
- Native lung(s) was/were connected to the brain via Vagus nerve (CN X)
- Transplanted lung(s) is/are not connected and CN X may or may not regenerate
- Gas exchange will occur without CN X connection
- Pt will feel secretions in the lung(s) but will not be able to respond innately
- Frequent voluntary coughing will become routine for transplant patients
- Frequent positional changes allows gravity to assist in moving secretions
heart transplant education
- Native heart was connected to the brain via the
Vagus nerve (CN X)
▫ Transplanted heart is not connected by nerves,
vagus nerve will not regenerate - Pt will not feel heart discomfort or pain (angina) in the event of a myocardial infarction
- Transplanted heart will respond to activity based solely on hormonal changes in the blood
what do heart transplant changes mean?
▫ Resting HR will be faster than with native heart
▫ HR will be increased with activity but at a slower rate than with native heart
▫ HR will never go as high on exertion as with native heart
▫ HR will take longer to decrease to resting rate following exertion than with native heart
▫ Warm-up and cool-down become more important as these will cause hormonal changes in blood and therefore signal heart to respond appropriately
post transplant precautions
▫ All patients must wear a surgical mask prior to exiting their room.
▫ Reverse isolation precautions may be indicated
▫ Use antibacterial wipes on all equipment brought into patient room (walker, gait belt)
intubated/sedated patients
▫ Primarily bed activity/PROM if pt remain sedated.
▫ Mobility is initiated once sedation is weaned and pt can follow commands.
— Use of cardiac chair, dangling EOB, and bed to chair transfers are performed when appropriate
swan ganz catheter what is it
Allows measurement of pressures in
the right atrium, right ventricle, pulmonary artery, and the filling pressure (“wedge” pressure) of the left atrium
Internal jugular and femoral swan ganz catheter limitations
IJ: limit cervical rotation/side bending
femoral: usually on bedrest
