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S2 Movement Science > Heart and Lung Transplants/Rehab > Flashcards

Heart and Lung Transplants/Rehab Flashcards

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1
Q

most common organ waiting lists

A 
kidney
-81%
liver
-11.4
heart
-3
lung
-1
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2
Q

organ transplant process

A

deceased donors –> organ procurement organization –> UNOS computer system –> transplant center –> candidates

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3
Q

to avoid conflict of interest, what is the rule

A

neither the physician of the donor nor the physician that pronounced the death may participate in the organ transplantation

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4
Q

transplant center has how long after it is offered a donor organ

A

1 hour

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5
Q

organs may be matched by…

A

tissue match
blood type
length of time on the waiting list
immune status/antigens
distance between the potential recipient and the donor
degree of medical urgency (for heart, liver, lung and intestines)

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6
Q

brain death requirements

A

coma/unresponsive
absence of motor responses to pain in all extremities
absence of brain stem reflexes
apnea

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7
Q

organ type and waiting times

A 
heart
-230 days
lung
-1068 days
heart lung
-if heart available, lung will go with it
liver
-796 days
kidney
-1121 days
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8
Q

survival rates at 1 year

  • heart
  • lung
  • liver
  • kindney
A 
heart
-87%
lung
-100%
liver
-90%
kidney
-95%
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9
Q

survival rates at 5 years

  • heart
  • lung
  • liver
  • kidney
A 
heart
-73%
lung
-51%
liver
-77%
kidney
-81%
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10
Q

what else do you need to be a donor apart from having it on your driver’s license

A

in a will

sign up with the national registry

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11
Q

ethical considerations of transplants

A 
utility
-maximize benefit to all
-consider survival and QOL
justice/equity
-fair distribution
-medical benefits (sicker 1st)
respect for persons
-right not to donate
-transparency
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12
Q

which is more important for transplants, justice/equity or respect for persons

A

justice/equity

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13
Q

psychosocial aspect or receiving an organ transplant

-two traumatic events that can affect their patient’s thoughts

A

sense of imminent death

trauma of dealing with the transplant surgery and afternath

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14
Q

end stage diseases that may require a heart transplant

-most to least common

A 
cardiomyopathy (46%)
CAD/ishcemic heart disease (45%)
restrictive valve disease
retransplant or graft failure
congenital disease
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15
Q

heart transplant recipient criteria

A 
terminal heart disease
no renal/hepatic dysfunctiion
no acute infections
no recurrent pulmonary infections
psychosocial stability
no alcohol, tobacco, drug use
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16
Q

heart transplant donor criteria

A 
normal echocardiogram
(-) HIV and hepatitis
brain death declared
age <45 years (some exceptions)
no pre-existent heart disease
few coronary artery disease risk factors
no heart trauma
no malignancy
no infection
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17
Q

liver transplant recipient criteria

A

no liver transplant for people who suffer from liver damage due to

  • current alcohol or substance abuse
  • cancer that has spread to other organs
  • advanced heart and lung diseases, a condition of sepsis
  • HIV patients
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18
Q

cardiac rehab pre-transplant

-what vitals are monitored

A

physician/therapist guided program designed to maximize a candidate’s strength and endurance to activity
closely monitored vitals
-HR, BP, O2 sat, dyspnea

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19
Q

early complications seen in patients post-heart transplant

A 
donor organ dysfunction
acute rejections
renal failure
arrhythmias
bleeding
infection due to immunosuppression
denervated heart physiology
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20
Q

denervated heart physiology

A

the drive through the SA node to increase HR during exercise will be altered in these people
HR response will be slower after transplant

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21
Q

chronic complications post-heart transplant

A

prone to infection due to immunosuppression
accelerated coronary atherosclerosis
chronic rejection (greatest risk in the 1st year post-transplant
hypertension

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22
Q

heart rejection

  • due to…
  • what is done to prevent this
A

cells have antigens on their surfaces. the immune system recognizes the cells as foreign and attacks them
an organ that is not matched can trigger a transplant rejection
patients are “typed.” the more similar the antigens are between the donor and recipient, the less likely that the organ will rejected

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23
Q

acute rejection Sx

A

organ’s function may start to decrease
general discomfort, uneasiness, or feeling unwell
pain or swelling in the area of the organ (rare)
fever
flu-like symptoms, including chills, body aches, nausea, cough, and SOB

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24
Q

immunosuppression

  • result
  • caregivers must…
  • ______ for life
  • what type of drugs do they take?
  • side effects
A

patient is more susceptible to infections
caregivers wear a mask
anti-rejection meds for life
immunosuppression with glucocorticoids e.g. prednisone and solumedrol to suppress body’s natural immune system
cocktail is specific to match time post transplant, type of transplant
side effects
-nausea
-weakness

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25
Q

post-heart transplant rehab: acute phase

  • focus on…
  • precautions
  • exercise guidelines…
  • be aware of…
A

multiple lines and tubes immediately post-transplant
focus on functional mobility - bed mobility, transfers and ambulation
sternal precautions
phase 1 cardiac exercise guidelines
be aware of abnormal HR responses

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26
Q

post-heart transplant: after discharge from hospital

-what is the cardiac rehab program

A

3x/week program designed to increase candidate’s endurance to activity, strength, balance and overall QOL
closely regulated vital signs during exercise

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27
Q

special considerations with exercise post-heart transplant

A

denervation
-loss of vagal tone, lack of sympathetic stimulation
patient may not have chest pain during exercise secondary to denervation of the heart
patient will have a higher resting HR which may not increase with exertion (>100)
altered baroreceptor response: HR increases slowly with exercise and then remains elevated for increased time post-exercise
-signals from the aortic baroreceptors normally travel through the vagus nerve

28
Q

ventricular assist device

  • used with what patients
  • bridges gap between…
  • types
A

used in patients with non-reversible left ventricular failure at imminent risk for death
bridges the gap between terminal heart disease and cardiac transplantation
LVAD
RVAD
BiVAD

29
Q

comparison of survival rates for the heart transplant patient vs. LVAD

A

similar rates

30
Q

RVAD and LVAD

  • implantation location
  • motor connects to…
  • what is a driveline
A

implanted in the left upper quadrant of abdomen
motor connects to external control and power components via a percutaneous tube
cable called a driveline extends from the pump, out through the skin, and connects the pump to a controller and power sources worn outside the body

31
Q

therapy considerations in a patient with a VAD

A

patient’s VAD is hooked up to a controller when at rest
battery unit can be utilized
when ambulating have 2 extra batteries

32
Q

early mobilization of LVAD recipients

A

PT initiated in ICU that focused on early mobilization and ambulation of the patient resulted in improved functional mobility upon time of DC from hospital
physician usually sets rehab parameters based on the flow rate reading
-4.0 and above is considered good

33
Q

rehab for patients post-VAD implant

-goals

A

prevent

  • muscular atrophy
  • respiratory compromise
  • decreased skin integrity
34
Q

rehab for patients post-VAD implant

-plan

A

progress on POD (post-op day) #1 to bed mobility, transfers
ambulation by POD #2
by POD 10-30, begin progressive aerobic exercise at RPE 11-13 on Borg Scale
light resistance training

35
Q

lung disease diagnosis groups

-how many groups

A

group A
group B
group C
group D

36
Q

group A diseases

A

obstructive

  • COPD
  • emphysema
37
Q

group B diseases

A

pulmonary vascular disease

pulmonary hypertension

38
Q

group C diseases

A

cystic fibrosis

39
Q

group D diseases

A

restrictive diseases

  • IPF (idiopathic pulmonary fibrosis)
  • sarcoidosis
40
Q

indications for lung transplant

A

untreatable end-stage pulmonary, parenchymal, and/or vascular disease
absence of other major medical illnesses
substantial limitation of daily activities
-projected life expectancy <2 years
-rehab potential
-satisfactory psychosocial profile and emotional support system
-acceptable nutritional status
-disease-specific mortality exceeding transplant-specific mortality over 1-2 years

41
Q

relative contraindications for lung transplant

A 
tobacco use within past 6 months
age
->65 for single lung
->60 for bilateral
->55 for heart-lung
psychosocial instability
prednisone use >20-40 mg/day
42
Q

single lung transplant

  • indication
  • which is replaced
  • better for…
A

non-septic lung disease
poorest functioning lung replaced
better for older people

43
Q

bilateral lung

-indication

A

septic lung disease, cystic fibrosis

pulmonary HTN

44
Q

living-donor lobar transplant

  • best for…
  • donation associated with…
  • need lobes from _____ donors to form…
A

best for children
donation associated with 15% decrease in lung volume without change in functional capacity
need lobes from 2 donors to form entire lung for recipient

45
Q

donor selection

A

absence of infection of airways or parenchyma
acceptable gas exchange
<60 years old
<20-30 pack years

46
Q

lung transplant allocation

A

limited supply

patients are ranked according to severity of disease

47
Q

lung pre-transplant workup

A

intense battery of tests to determine if suitable for transplant
must maintain adequate nutrition and conditioning
pre-transplant exercise training may be most important

48
Q

lung pre-transplant rehab

A 
conditioning - bike or walk
respiratory muscle training
-spirometry
lower extremity muscle training
-quads, hamstrings
core strengthening
UE and trunk ROM
back extension strengthening
-prevent loss of bone mass
-energy conservation
49
Q

lung transplant acute complciations

A 
hyperacute rejection
reimplantation response (reperfusion injury)
acute graft dysfunction
airway complications
infection
50
Q

lung transplant acute considerations

A 
lines and tubes
-chest tubes, ventilator, IVs, foley
need to mobilize early
full AROM of UEs by discharge from hospital
ambulation without assistive device
home exercise program
self-monitoring of SaO2
51
Q

lung transplant complications

A

acute rejection - most have at least one episode

52
Q

lung transplant acute rejection

  • when does it happen
  • how it is diagnosed
  • symptoms
  • Tx
A 
3-6 months
spirometry - drop of 10-15% on spirometry indicates rejection
diagnosed with biopsy
symptomatic
-fever, cough, dyspnea, failure to thrive
asymptomatic
-identified by regular biopsies
Tx
-immunosuppressive medications
53
Q

lung transplant chronic complications

A

chronic rejection

54
Q

chronic lung rejection

  • when
  • what
  • prevalence
  • CMV…
  • Tx
A

6 months to 1 year
obliterative bronchiolitis
present in 40% at 1 year, 60-70% at five years
CMV unknown etiology, but possibly linked to acute rejection
treat with immunosuppressive medications

55
Q

what is CMV

A

cytomegalovirus

56
Q

immunosuppressive complications

A

osteoporosis
muscle weakness
infections
malignancy

57
Q

common types of malignancy

A

Non Hodgkins Lymphoma
squamous cell carcinoma of skin and lip
Kaposi’s sarcoma

58
Q

osteoporosis

  • criteria
  • prevalence after 1 year on corticosteroids
A

bone density 2 SDs below age-matched norms

10-37% develop a fracture in 1st year

59
Q

chronic corticosteroid and muscle weakness

A

chronic corticosteroid use causes proximal-limb muscle weakness and type II fiber atrophy
cyclosporine impairs mitochondrial function, decreasing muscle ability to utilize oxygen
poor pre-transplant activity and post-transplant bedrest may cause atrophy and alter metabolic capacity, especially in lower limb
early fatigue
reduced muscle mass, muscle atrophy

60
Q

lung transplant and infection

A

rate of infection is higher than other organ transplant recipients
constant exposure to external environment
-recipients wear respiratory masks in public for life

61
Q

QOL post-lung transplant

A 
improved
-mobility
-energy
-sleep
-dyspnea
-ability to accomplish ADLs
many patients return to work post-transplant
62
Q

exercise limitations in lung transplant

A 
3 months
-SLT 46% predicted
-DLT 50% predicted
1 year
-same VO2
-improvement in lung function
-return to daily activities
63
Q

aerobic exercise training after heart transplant

-how effective

A

achieve 95% age predicted max

64
Q

resistance training after transplant

-functions

A

prevents vertebral osteoporosis

increases muscle strength (counteracts steroid myopathy)

65
Q

_____ therapy speeds muscle atrophy

A

corticosteroid therapy

S2 Movement Science (13 decks)

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