Living with lung transplant Flashcards
How many people will give up smoking when asked
Only 1% of patients will give up smoking when asked- need to reduce other lifestyle factors
What is important when prescribing medications
Think about whether they will interact or not- think about allergies
What should you look at when looking at family history
Any significant conditions in first degree relatives
Describe how social history is important in disease
Occupations, drinking, smoking, any social barriers that will prevent their adherement to a management plan
Consider psychosocial health
Describe the sweat test
Used to diagnose CF- prognosis of CF has improved dramatically
The sweat test measures the amount of chloride (a component of salt) in the sweat
Describe airway clearance in patients with cystic fibrosis
2x daily, end of disease process
5 or 6 hours daily
What is the final treatment option for patients with cystic fibrosis
Lung transplant
Describe the psychosocial care for cystic fibrosis
Important to hear about its potential impacts on jobs and social relationships
May require physiotherapy
What is the life expectancy for someone with a lung transplant
Less than 3 years
Describe the burden associated with lung transplant
Long inpatient stay- can’t be too underweight or too overweight- otherwise the outcomes are poor
Burden is the large number of medications that you have to take- see transplant centre two times a week, only 5 in country- may have to travel long distances
Patient compliance is essential (immune suppressants)
What is key in any transplant
Balance between infection and rejection
What is the diet like for patients with a lung transplant
it is akin to being pregnant
What medications to patients with CF require
Medications to help digest food
Due to sinus infections
Eating can make breathlessness worse
Describe the emotional burden associated with CF
Large emotional burden for family to deal with children with CF
Survivor’s guilt can have an impact on mental health
What is the purpose of the consultation
Diagnosis
Management plan
Lifestyle modification
Describe the patient complaint
Brief
Patients own words
Describe the history presenting complaint
Mixture of open ended & closed questions
Tailored questions to rule in/out diagnoses
Details of previous episodes with similar complaint
Describe past medical history
Medical
surgical
Describe medications and allergy
Dose and duration
OTC, alternative therapie
Describe family history
1st degree relatives
Describe social history
Occupation Smoking/ alcohol/ recreational drugs Living situation Social support ADL Pets
Describe cystic fibrosis
Multi system disease Mutation in CFTR gene Autosomal recessive Diagnosis usually in childhood: Presence of 2 CFTR mutations Positive sweat test >60mmol/L Clinical features Median survival ~40 years, newborn >50y
cycle of infection, inflammation, lung damage and colonisation
Describe the respiratory management of cystic fibrosis
Antibiotics Port-A-Cath/ IVAD Airway clearance Recombinant DNase/ Inhaled mannitol Hypertonic saline Macrolides (Azithromycin) Ivacaftor (G551Dm, 5%) Oxygen, nocturnal NIV Lung transplant
Describe other things you need to consider in the management of cystic fibrosis
High calorie high protein diet
Enteral tube feeding
Fat soluble Vitamins A/E/K/D
What are the co morbidities of cystic fibrosis
Diabetes GORD DIOS Osteoporosis Chronic rhinosinusitis Subfertility Psychosocial
Who needs a transplant
FEV1<30% of predicted
PaO2<7.3 kPa
PaCO2>6.7 kPa
Increasing frequent of pulmonary exacerbations
Recurrent/ refractory pneumothoraces
Recurrent hemoptysis despite bronchial artery embolization
Progressive chronic end stage respiratory disease
Life expectancy
2-3 years
What is the criteria for those who can have a transplant
No renal, heart or liver disease No osteoporosis BMI >17 or <30 No untreatable psychiatric condition No history of cancer within 5 years Reliable social support Good adherence to medication and appointments
List some transplantable respiratory conditions
COPD Interstitial lung disease Cystic fibrosis Bronchiectasis Idiopathic pulmonary arterial hypertension
Describe some post transplant complications
Infection
Immunosuppression
Viral, bacterial, fungal
Rejection
Cellular (acute)
Antibody mediated (chronic)
Describe life after a transplant
Lifestyle adaptation
Diet, travel, appointments
Medications and their side effects
Frequent appointments and admissions
Antibiotics
Steroids
Bronchoscopy + Biopsy
List some history patient complaints
Current symptoms Cough Dyspnoea tightness/ wheeze haemoptysis Sputum Fevers Fatigue weight loss anorexia Unwell contacts Spirometry/ FEV1 Number of illnesses in last year Need for admission
Describe the past medical history that may present with cystic fibrosis
GORD Diabetes GI Renal Sinusitis surgery
Describe the medications that the patient may be on
Inc PT/ nebs/ Ivs/ O2/NIV
Describe the family history associated with CF
1st degree relative with CF
Describe the social history in patients with CF
Impact on ADL/ work
Physical activity
Occupation
Smoking/ alcohol/ drugs
