Organ Transplants Flashcards
Selection of recipients is if they have a _______ __-___ disease
progressive end stage
6 selection criteria for transplant pts ?
- age
- no alcohol or tabacco dependency
- no CI’s to immunosuppression
- otherwise healthy
- social support
- psychological factors
Best transplant pt survival rate?
liver and heart
Worst transplant pt survival rate ?
lungs
4 transplant complications?
- rejection
- immunosuppresion
- infection
- graft failure
3 times transplants can be rejected?
- hyper acute
- acute
- chronic
Chronic transplant rejection is most common in _____ transplants
lung
5 common s/s of transplant rejection?
- pain at site
- fever/feeling unwell
- weight change
- swelling
- decreased urine output
Immunosuppressive drugs increase likelihood of CAD (T/F)
TRUE
What are 3 ways infection is avoided post transplant?
- D/C invasive lines
- early ambulation
- prophylactic antibiotics
Early post transplant failure = high risk of ______
mortality
There is a constant low risk of _____ failure once pt is out of early phase
graft
After heart transplant, pt will have no ______ due to denervated heart
angina
Peak HR reaches ___% of normal post transplant
80
Donor ___ node determines HR
SA
There are 2 __ waves seen post heart transplant
2
The first P wave in an ECG of someone with a heart transplant is followed by a QRS complex (T/F)
FALSE
There is no ______ innervation to control transplanted heart, so there is a resting tachycardia
autonomic
Normally heart is usually more influenced by the ___ via _____ nerve
PNS; vagus
What is the normal resting HR post transplant ?
90-110
Higher HR post transplant allows normal CO despite lower ___ ____ and ______ _____ fraction
stroke volume; ventricular ejection
No sympathetic stimulation to denervated heart = unable to respond quickly to situations that require _____ HR or _____ contractility to maintain CO
increased x2
______ ______ can be problematic post heart transplant due to no sympathetic stimulation
orthostatic hypotension
No parasympathetic control post heart transplant = longer _____ _____ needed post exercise (to avoid big drop in CO as there is a dec in venous return)
cool down
Watch for _______ post heart transplant, due to ______ imbalance and irritation from surgery / handling
arrhythmias; electrolyte
Denervation post lung transplant causes a V-Q imbalance until recovery of _______ function occurs
autonomic
Decreased _______ clearance post lung transplant
mucociliary
Cough may be ineffective due to lack of sensation when there is irritation below _____ ______ line
tracheal suture
Need care post lung transplant suctioning past _____ line due to danger of _______
suture; dehiscence
There is abnormally thick _______ post lung transplant
mucus
There is increase in extravascular ______ post lung transplant from disrupted pulmonary ______
water; lymphatics
Increased reliance on ______ metabolism post lung transplant
anaerobic
Regular chest clearance techniques required as pt not usually able to clear effectively without assistance (T/F)
TRUE
Limited _____ suction post lung transplant
deep
Use mechanical ______-
______ machine for feedback for diaphragm PT rx
insufflation - exsufflation
May need to rehab ______ post lung transplant
diaphragm
Most complications from liver transplant are due to pre op end stage liver disease (T/F)
TRUE
4 liver transplant considerations pre op?
- hemorrhage
- muscle weakness + tremor
- confusion/decrease LOC
- fluid retention (low albumin)
2 post op issues liver transplant?
- CV instability and tachycardia
2. LBP
PT management pre - transplant?
- exercise testing
- exercise training
- muscle strength
- resp assessment and treatment
- educate
PT management post transplant?
- secretion removal and long reexpansion
- early ambulation
- ROM/mobility/strength
- rehab programs with self management teaching
- ongoing yearly monitoring of function
5 outcome measures to monitor pts?
- borg scale / perceived exertion scale
- talk test
- BP
- HR
- O2 sat
VO2 max post heart transplant ?
70% age predicted max
VO2 max post lung transplant ?
4-60% age predicted max
VO2 max post kidney and liver transplants ?
normal exercise capacity
Recommended exercise prescription guideline for Canada?
150 minutes of mod intensity a week
Mod intensity programs (__-__ RPE) recommended for organ transplant pts, can build up to hight intensity
3-5
Need longer _____ __ / ____ ____ when exercising with post organ transplant pts
warm up / cool down
Precautions when working with transplant pts?
infection control; wiping down equipment; avoiding unwell populations; be aware of psychological considerations
4 long term PT goals post organ transplant ?
- aerobic conditioning
- prevent steroid induced mm atrophy
- optimize secretion clearance and breathing
- lessen OP effects secondary to diuretics and steroids
