Pulmonary - Lung transplant

Question 1

Who qualifies for a lung transplant?

Answer 1

• if they have progressive terminal cardiopulm diseease and will die soon
• with emphysema

Question 2

What are the indicators for lung transplant?

Answer 2

COPD
idiopathic pulmonary fibrosis
CF
idiopathic pulmonary arterial HTN
Sarcoidosis

Question 3

What is the survical rate post 1 year transplant?

Answer 3

greater than 80%

Question 4

What is the survival rate after 5 years?

Answer 4

~ 50%

Question 5

What is the % of being able to perform physical activity?

Answer 5

80% with minimal limitations

Question 6

What is the evaluation needed for lung transplant?

Answer 6

• needed to be on the list
• medical compliance with social support
• consider styles of coping with stressors
• caregiver stress

Question 7

What is the pre-operative rehab?

A picture

Answer 7

Question 8

What is a major-long term complication of lung transplant?

Answer 8

brochiolitis obliterans syndrome (BOS) = fibrosing of the terminal bronchioles

Question 9

What are the sx of BOS?

Answer 9

• dyspnea
• limited exercise tolerance
• productive cough with sputum

Question 10

What are the clinical presentation of BOS?

Answer 10

decreased breath sounds
crackles and rales
pulmonary HTN

Question 11

What is the treatment for BOS?

Answer 11

prevention through maintenance of immunosuppression drug regimen
quickly intervening to treat infections or rejections

Question 12

What are the problems present in the early stages of lung transplant?

Answer 12

• decreased mucus clearance
• ineffective cough

due to denervation

Question 13

What are the initial PT management goals?

Answer 13

improve functional abilities, self-care and mobility
- bronchial hygiene
- positioning
- enhance cough effort
- mobility

Question 14

Activity levels for inpatient PT

Answer 14

Question 15

Guidelines for determining appropriateness of exercise and progression

Answer 15

Question 16

What is the process of lung volume reduction surgery?

Answer 16

20-30% of volume of each lung is removed

Question 17

What is the goal of lung volume reduction surgery?

Answer 17

improve thoracic distention and chest wall mechanism

Question 18

What is lung-volume reduction surgery common for?

Answer 18

Severe COPD
emphysema

Question 19

What is the mechanism of non-invasive ventilation or BiPAP

Answer 19

A mask that deliever positive airway pressure during inhalation/exhalation

Question 20

BiPAP is used due to the indication of what?

Answer 20

With respiratory failure and not responding to max meds/O2 therapy

Question 21

What is BiPAP commonly used for?

Answer 21

for severe COPD
- because of increased sx at night = cyclic pattern of no sleep -> daytime fatigue

Question 22

What can BiPAP also be used for?

Answer 22

For emergent flare-ups to reduce load off breathing and heart