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
2
Q
diagnosis for lung transplant
A
- alpha 1 antitrypsin deficiency
- bronchiectasis
- cystic fibrosis
- COPD/emphysema
- lymphangioleiomyomatosis
- pulmonary fibrosis
- pulmonary hypertension
- sarcoidosis
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
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
5
Q
UNOS status classifications for heart allocation
A
look at notes
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
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
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
9
Q
procurement
A
- requires careful coordination of several surgical teams
- preservation and packing of organs for transplant
10
Q
order of organ removal
A
liver = 8-12 hours
kidney = 24-36 hours
heart = 4-6 hours
lung = 4-6 hours
11
Q
surgical complications
A
bleeding, blood transfusions, reperfusion injury, rejection, airway complications, fluid imbalance, infection, phrenic nerve injury, reintubation, rehab, tracheostomy, death
12
Q
long term complication
A
hypertension, kidney dysfunction or failure, phrenic nerve injury/damage, diabetes, cancer, high cholesterol, osteoporosis, chronic rejection, recurrent infection
13
Q
early ICU care
A
- hemodynamic management
- renal function
- pulmonary function
- immunosuppression
- prevention of rejection/infection
- early mobilization
14
Q
immunosuppressant meds
A
- calcineurin inhibitors (cyclosporin, tacrolimus)
- corticosteroids (prednisone)
- anti-proliferative agents (azathioprine, mycophelolate mofetil)
15
Q
cyclosporine (neoral)
A
- one of the most effective immunosuppressant meds
- inhibits calcineurin
16
Q
tacrolimus (prograf)
A
- 10 to 100 times more potent than cyclosporine
- inhibits calcineurin
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
heart transplant education
patient will not feet heart discomfort or pain due to loss of vagus nerve innervation to heart
26
heart transplant changes
- 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
post transplant precautions
- 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
swan ganz catheter
- 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
intra-aortic balloon pump (IABP)
- mechanical device that is used to decrease myocardial oxygen demand and increase CO
30
intra-aortic balloon pump (IABP) mobility restrictions
- ipsilateral hip flexion limited to <30 deg
- knee immobilizer in place for most patients
- femoral vs subclavian IABP
31
arterial line
- 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
arterial line locations
- radial: limit active wrist extension
- femoral: limit active hip flexion
- dorsalis pedis: no DF, no weightbearing on that foot
33
chest tubes
inserted to drain blood, fluid, or air and to allow lungs to fully expand; tube is placed between ribs and pleural space
34
single lung transplant incision
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
double lung transplant incision
clamshell incision- an incision is then made from under the patients armpit, around to the sternum, and then back towards the other armpit
36
heart transplant incision
sternotomy- incision that bisects the sternum, once surgery is finished the sternum is laced back together with wiring
37
thoracotomy/sternotomy precautions
- 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
exercises for sternotomy/thorcotomy
- 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
RPE scale
- most transplant patients during ADLs fall in the range of 6-10
- exercise and exertion should remain in the range of 11-13
40
UE general conditioning exercises
- shoulder shrugs, flexion, adduction, bicep curls, and side bends/reaches
41
LE general conditioning exercises
ankle pumps, knee extension/flexion, hip flexion, extension, abduction, and gluteal sets
42
cardiac rehab phase 1
- 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
