Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

cardiopulm > heart & lung transplant > Flashcards

heart & lung transplant Flashcards

1
Q

diagnosis for heart transplant

A
  • end stage congestive HF
  • ischemic cardiomyopathy
  • dilated cardiomyopathy
  • congenital heart disease for which no therapy will help
  • ejection fraction less than 20%
  • intractable angina or malignant cardiac arrhythmias for which no therapy will help
  • patient requires mechanical circulatory support or dependent on inotropes
  • patients have exhausted all other medical options
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

diagnosis for lung transplant

A
  • alpha 1 antitrypsin deficiency
  • bronchiectasis
  • cystic fibrosis
  • COPD/emphysema
  • lymphangioleiomyomatosis
  • pulmonary fibrosis
  • pulmonary hypertension
  • sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

listing process for transplant

A
  • deplete all other medical options
  • meet requirements for transplant
  • patient is entered into national computerized waiting list, which is maintained by UNOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

matching system based on

A
  • blood type
  • tissue type
  • size of organ
  • medical urgency of patient
  • time already spent on waiting list
  • geographical distance between donor and recipient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

UNOS status classifications for heart allocation

A

look at notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

lung allocation score

A
  • score from 0 to 100 for each transplant candidate age 12 and older
  • estimates the severity of each candidates illness and his or her chance of success following a lung transplant using medical info
  • lung allocation score determines waitlist order in addition to blood type and distance between candidate and hospital where organ is located
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

patient selection and limitations

A
  • 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 disease of other organs
  • inability or refusal to comply with medical direction
  • comprehension
  • psychological consideration
  • age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

donor evaluation

A
  • brain death/hemodynamically stable
  • blood/antibody type
  • size
  • drug abuse
  • no malignancies (except brain)
  • no infections
  • medical history
  • cause of death
  • first person consent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

procurement

A
  • requires careful coordination of several surgical teams
  • preservation and packing of organs for transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

order of organ removal

A

liver = 8-12 hours
kidney = 24-36 hours
heart = 4-6 hours
lung = 4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

surgical complications

A

bleeding, blood transfusions, reperfusion injury, rejection, airway complications, fluid imbalance, infection, phrenic nerve injury, reintubation, rehab, tracheostomy, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

long term complication

A

hypertension, kidney dysfunction or failure, phrenic nerve injury/damage, diabetes, cancer, high cholesterol, osteoporosis, chronic rejection, recurrent infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

early ICU care

A
  • hemodynamic management
  • renal function
  • pulmonary function
  • immunosuppression
  • prevention of rejection/infection
  • early mobilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

immunosuppressant meds

A
  • calcineurin inhibitors (cyclosporin, tacrolimus)
  • corticosteroids (prednisone)
  • anti-proliferative agents (azathioprine, mycophelolate mofetil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cyclosporine (neoral)

A
  • one of the most effective immunosuppressant meds
  • inhibits calcineurin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

tacrolimus (prograf)

A
  • 10 to 100 times more potent than cyclosporine
  • inhibits calcineurin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

corticosteroids

A
  • inhibit hypersensitivity reactions
18
Q

azathioprine (imuran)

A

appears to interfere with DNA synthesis in cells mediating the immune response

19
Q

mycophenolate mofetil (cellcept)

A

inhibits synthesis of DNA precursor of T and B lymphocytes which decrease immune response

20
Q

psychological issues

A

fear, acceptance of new organ, drug effects, appearance, potential prolonged hospital stay, lifelong commitment

21
Q

preparation for transplantation

A
  • transplant team
  • pre-admission courses at hospital
22
Q

post op changes

A

changes in strength or ROM, endurance or tolerance of activities, ability to perform self care tasks, ability to walk independently

23
Q

role of PT

A
  • evaluate patients needs
  • educate patient on precautions
  • assist in improving functional mobility and endurance
  • allow for return to prior level of function or greater
24
Q

lung transplant education on coughing

A

patient will need to voluntarily cough due to loss of vagus nerve connection to lung

25
Q

heart transplant education

A

patient will not feet heart discomfort or pain due to loss of vagus nerve innervation to heart

26
Q

heart transplant changes

A
  • resting HR faster
  • HR will be increased with activity but at a slower rate
  • HR will never go as high on exertion
  • HR will take longer to decrease to resting
  • warm up and cool down become very important
27
Q

post transplant precautions

A
  • patients must wear surgical mask prior to exiting room
  • reverse isolation precautions may be indicated
  • use antibacterial wipes on all equipment brought into patent room
28
Q

swan ganz catheter

A
  • allows measurement of pressures in right atrium, right ventricle, pulmonary artery, and filling pressure of left atrium
  • internal jugular vein: limit cervical rotation/side bending
    -femoral: usually on bedrest
29
Q

intra-aortic balloon pump (IABP)

A
  • mechanical device that is used to decrease myocardial oxygen demand and increase CO
30
Q

intra-aortic balloon pump (IABP) mobility restrictions

A
  • ipsilateral hip flexion limited to <30 deg
  • knee immobilizer in place for most patients
  • femoral vs subclavian IABP
31
Q

arterial line

A
  • thin catheter inserted into an artery to monitor blood pressure continuously and to obtain samples for arterial blood gas measurements
  • position transducer so that is it level with the heart or phlebostatic axis (4th intercostal space mid axillary line)
32
Q

arterial line locations

A
  • radial: limit active wrist extension
  • femoral: limit active hip flexion
  • dorsalis pedis: no DF, no weightbearing on that foot
33
Q

chest tubes

A

inserted to drain blood, fluid, or air and to allow lungs to fully expand; tube is placed between ribs and pleural space

34
Q

single lung transplant incision

A

thoracotomy- incision along side wall of chest, under the shoulder blade around the chest, ending near the sternum. an alternate method involves an incision under the breastbone

35
Q

double lung transplant incision

A

clamshell incision- an incision is then made from under the patients armpit, around to the sternum, and then back towards the other armpit

36
Q

heart transplant incision

A

sternotomy- incision that bisects the sternum, once surgery is finished the sternum is laced back together with wiring

37
Q

thoracotomy/sternotomy precautions

A
  • no resistive exercises to affected UE, however full AROM is encouraged
  • no heavy pushing, pulling, lifting more than 10 pounds
  • log rolling when transferring in and out of bed to avoid strong abdominal contraction
  • avoid excessive UE leverage during sit to stand transfers
  • no driving or sitting in a passenger seat where an airbag can be deployed
38
Q

exercises for sternotomy/thorcotomy

A
  • aimed to reduce development of scar tissue at the incision
  • gentle stretches
  • breathing with movement
  • shoulder shrugs, circles and flexion, cervical rotation, trunk rotation and sidebending
39
Q

RPE scale

A
  • most transplant patients during ADLs fall in the range of 6-10
  • exercise and exertion should remain in the range of 11-13
40
Q

UE general conditioning exercises

A
  • shoulder shrugs, flexion, adduction, bicep curls, and side bends/reaches
41
Q

LE general conditioning exercises

A

ankle pumps, knee extension/flexion, hip flexion, extension, abduction, and gluteal sets

42
Q

cardiac rehab phase 1

A
  • progress from initial supportive and self-care activities to regular daily walking
  • 3-5 days inpatient, including transition to home-based activities
  • goals: increase appetite and strength, increase aerobic capacity

cardiopulm (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions