transplant pt 2

Question 1

heart transplant post op

Answer 1

pt w/ chest tube, arterial line, pulm A catheter
keep HOB up to 30 deg and turn pt q 1-2 hrs
HR maintained 90-110 bmp
systolic 90 mmHg

Question 2

sternotomy precautions

Answer 2

no pushing, pulling, or lifting >10 lbs

Question 3

heart transplant signs of rejection

Answer 3

hypotension
pericardial friction rub
ventricular S3 gallop
decreased CO
peripheral edema
pulm crackles
jugular vein distension
new cardiac arrhythmias

Question 4

heart transplant - isolation

Answer 4

positive pressure flow

mask, handwashing

Question 5

phase I cardiac rehab

Answer 5

usually 2-3 days post op
stable hemodynamically
active supine ex w/out resistance –> amb –> stationery bike
vitals and stomps are pre, during, post ex
EKG monitored for changes w/ acitivity

Question 6

donor heart denervated

Answer 6

higher than normal resting HR
no symp/parasymp regulation
Hr does not vary w/ respiration, position, temp

Question 7

donor heart and exercise

Answer 7

warmup/cool down w/ ex 5-10 mins
HR increase w/ ex w/ 3-5 min delay
HR remains elevated longer after ex

Question 8

peak HR in transplant pts

Answer 8

lower than same age pts

Question 9

borg scale, heart pts

Answer 9

RPE

aim for 11-13

Question 10

heart - monitor BP

Answer 10

pre, during, post-activity
recipients are higher than normal
systolic: 80-150
diastolic <90

Question 11

orthostatic hypotension

Answer 11

lacks reflex compensation

enc slow position changes

Question 12

assess c/o angina or sternal pressure

Answer 12

instead monitor dyspnea, lt headedness, increase RPE, arrhythmias
pain from incision or sx manipulation

Question 13

heart - monitor daily

Answer 13

changes and c/o w/ ex

fatigue is a sign or rejection and ischemia, so note significant changes and alert using ASAP

Question 14

single lung

Answer 14

most common
indicated w/ all end-stage conditions except cystic fibrosis and bronchiectasis
anterolateral or posterolateral thoracotomy
utilizes cadaveric organ

Question 15

double lung

Answer 15

bilateral anterior thoracotomy at 4th and 5th intercostal space w/ possible transverse sternotomy

Question 16

indications for double lung

Answer 16

cystic fibrosis
bronchiectasis
pulm HTN

Question 17

living donor lobar

Answer 17

bilateral lower lobes received from two compatible donors

donor lungs are enough to fill hemithorax

Question 18

lung transplant post op

Answer 18

retrain cough and deep breathing - lungs are denervated

aggressive bronchopulmonary hygiene
after extubation
PT, RN, Nsg all take part

Question 19

post op infection risk highest w/

Answer 19

lung transplant

Question 20

lung transplant care

Answer 20

postural drainage
suctioning
vibration
gentle pervussion
diaphragmatic breathing
coughing
incentive spirometer

Question 21

lung transplant therapy

Answer 21

check w/ nursing re: suctioning
sleep in reverse trendelenburg if pt is hemodynamically stable for postural drainage
turn double lung recipients every 1-2 hrs during first 24 hr period
decreased secretion retention
turn 20-30 deg and progress to 90 as tolerated

focus PT on increase LE strength and endurance

Question 22

single lung its should lie

Answer 22

on non sx side

Question 23

lung transplant - schedule Rx w/ regard to

Answer 23

bronchopulm hygiene, nebulizer use, pain meds

Question 24

thoracotomy precautions

Answer 24

10 lbs lifting restriction
partial WB UE
use pillow to splint for incisional pain

Question 25

respiratory isolation

Answer 25

gown, mask, gloves in room | amb in hallway w/ mask

Question 26

lung - O2 sat

Answer 26

monitor w/ activity | >90% needed

Question 27

bone marrow transplant

Answer 27

always from living donor harvested from post/ant iliac crest or sternum

Question 28

allogeneic bone marrow transplant

Answer 28

harvested from matching donor donor does not have to be related given immediately to pt after cytoredduction therapy

Question 29

syngeneic bone marrow transplant

Answer 29

harvested from identical twin

Question 30

autologous bone marrow transplant

Answer 30

harvested from pt when healthy | marrow is frozen and stored

Question 31

peripheral blood stem cell harvest

Answer 31

allogenic or autologous leukapheresis may need three to seven harvests may be from umbilical cord blood received after high dose chemo and radiation faster recovery of immune system and blood count may cause fluid overload to lungs in recipient hematological recovery takes 10-12 days

Question 32

common symptoms after rein fusion - bone marrow transplant

Answer 32

``` fever chills nausea HA flushing ```

Question 33

reverse protective isolation

Answer 33

neutrophil count <1,000/mm3

Question 34

thrombocytopenic precautions - platelet count <50,000/mm3

Answer 34

may cause spontaneous bleeding

Question 35

thrombocytopenic precautions - platelet count <50,000/mm3

Answer 35

exercise okay if asymptomatic

Question 36

thrombocytopenic precautions - platelet count 20,000-30,000

Answer 36

light AROM w. NO resistance, amb as tolerated

Question 37

PT concerns regarding transplant pts

Answer 37

coordinate therapy time w/ nursing check labs daily supine ex when applicable and cleared encourage early amb as able

Question 38

LE edema

Answer 38

typical after transplant sx may be initially painful shorter walks assess need for AD monitor vitals w/ activities

Question 39

avoid restive UE ex w/ heart and lung pts

Answer 39

~6 weeks/ cleared by MD

Question 40

HEP

Answer 40

educate re: warm up, cool down, monitoring symptoms, vitas

Question 41

transplants and contact sports

Answer 41

no contact sports for life