Organ Transplants

Question 1

Selection of recipients is if they have a _______ __-___ disease

Answer 1

progressive end stage

Question 2

6 selection criteria for transplant pts ?

Answer 2

1. age
2. no alcohol or tabacco dependency
3. no CI’s to immunosuppression
4. otherwise healthy
5. social support
6. psychological factors

Question 3

Best transplant pt survival rate?

Answer 3

liver and heart

Question 4

Worst transplant pt survival rate ?

Answer 4

lungs

Question 5

4 transplant complications?

Answer 5

1. rejection
2. immunosuppresion
3. infection
4. graft failure

Question 6

3 times transplants can be rejected?

Answer 6

1. hyper acute
2. acute
3. chronic

Question 7

Chronic transplant rejection is most common in _____ transplants

Answer 7

lung

Question 8

5 common s/s of transplant rejection?

Answer 8

1. pain at site
2. fever/feeling unwell
3. weight change
4. swelling
5. decreased urine output

Question 9

Immunosuppressive drugs increase likelihood of CAD (T/F)

Answer 9

TRUE

Question 10

What are 3 ways infection is avoided post transplant?

Answer 10

1. D/C invasive lines
2. early ambulation
3. prophylactic antibiotics

Question 11

Early post transplant failure = high risk of ______

Answer 11

mortality

Question 12

There is a constant low risk of _____ failure once pt is out of early phase

Answer 12

graft

Question 13

After heart transplant, pt will have no ______ due to denervated heart

Answer 13

angina

Question 14

Peak HR reaches ___% of normal post transplant

Answer 14

80

Question 15

Donor ___ node determines HR

Answer 15

SA

Question 16

There are 2 __ waves seen post heart transplant

Answer 16

2

Question 17

The first P wave in an ECG of someone with a heart transplant is followed by a QRS complex (T/F)

Answer 17

FALSE

Question 18

There is no ______ innervation to control transplanted heart, so there is a resting tachycardia

Answer 18

autonomic

Question 19

Normally heart is usually more influenced by the ___ via _____ nerve

Answer 19

PNS; vagus

Question 20

What is the normal resting HR post transplant ?

Answer 20

90-110

Question 21

Higher HR post transplant allows normal CO despite lower ___ ____ and ______ _____ fraction

Answer 21

stroke volume; ventricular ejection

Question 22

No sympathetic stimulation to denervated heart = unable to respond quickly to situations that require _____ HR or _____ contractility to maintain CO

Answer 22

increased x2

Question 23

______ ______ can be problematic post heart transplant due to no sympathetic stimulation

Answer 23

orthostatic hypotension

Question 24

No parasympathetic control post heart transplant = longer _____ _____ needed post exercise (to avoid big drop in CO as there is a dec in venous return)

Answer 24

cool down

Question 25

Watch for _______ post heart transplant, due to ______ imbalance and irritation from surgery / handling

Answer 25

arrhythmias; electrolyte

Question 26

Denervation post lung transplant causes a V-Q imbalance until recovery of _______ function occurs

Answer 26

autonomic

Question 27

Decreased _______ clearance post lung transplant

Answer 27

mucociliary

Question 28

Cough may be ineffective due to lack of sensation when there is irritation below _____ ______ line

Answer 28

tracheal suture

Question 29

Need care post lung transplant suctioning past _____ line due to danger of _______

Answer 29

suture; dehiscence

Question 30

There is abnormally thick _______ post lung transplant

Answer 30

mucus

Question 31

There is increase in extravascular ______ post lung transplant from disrupted pulmonary ______

Answer 31

water; lymphatics

Question 32

Increased reliance on ______ metabolism post lung transplant

Answer 32

anaerobic

Question 33

Regular chest clearance techniques required as pt not usually able to clear effectively without assistance (T/F)

Answer 33

TRUE

Question 34

Limited _____ suction post lung transplant

Answer 34

deep

Question 35

Use mechanical ______- | ______ machine for feedback for diaphragm PT rx

Answer 35

insufflation - exsufflation

Question 36

May need to rehab ______ post lung transplant

Answer 36

diaphragm

Question 37

Most complications from liver transplant are due to pre op end stage liver disease (T/F)

Answer 37

TRUE

Question 38

4 liver transplant considerations pre op?

Answer 38

1. hemorrhage 2. muscle weakness + tremor 3. confusion/decrease LOC 4. fluid retention (low albumin)

Question 39

2 post op issues liver transplant?

Answer 39

1. CV instability and tachycardia | 2. LBP

Question 40

PT management pre - transplant?

Answer 40

1. exercise testing 2. exercise training 3. muscle strength 4. resp assessment and treatment 5. educate

Question 41

PT management post transplant?

Answer 41

1. secretion removal and long reexpansion 2. early ambulation 3. ROM/mobility/strength 4. rehab programs with self management teaching 5. ongoing yearly monitoring of function

Question 42

5 outcome measures to monitor pts?

Answer 42

1. borg scale / perceived exertion scale 2. talk test 3. BP 4. HR 5. O2 sat

Question 43

VO2 max post heart transplant ?

Answer 43

70% age predicted max

Question 44

VO2 max post lung transplant ?

Answer 44

4-60% age predicted max

Question 45

VO2 max post kidney and liver transplants ?

Answer 45

normal exercise capacity

Question 46

Recommended exercise prescription guideline for Canada?

Answer 46

150 minutes of mod intensity a week

Question 47

Mod intensity programs (__-__ RPE) recommended for organ transplant pts, can build up to hight intensity

Answer 47

3-5

Question 48

Need longer _____ __ / ____ ____ when exercising with post organ transplant pts

Answer 48

warm up / cool down

Question 49

Precautions when working with transplant pts?

Answer 49

infection control; wiping down equipment; avoiding unwell populations; be aware of psychological considerations

Question 50

4 long term PT goals post organ transplant ?

Answer 50

1. aerobic conditioning 2. prevent steroid induced mm atrophy 3. optimize secretion clearance and breathing 4. lessen OP effects secondary to diuretics and steroids