transplant pt 2 Flashcards
heart transplant post op
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
sternotomy precautions
no pushing, pulling, or lifting >10 lbs
heart transplant signs of rejection
hypotension pericardial friction rub ventricular S3 gallop decreased CO peripheral edema pulm crackles jugular vein distension new cardiac arrhythmias
heart transplant - isolation
positive pressure flow
mask, handwashing
phase I cardiac rehab
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
donor heart denervated
higher than normal resting HR
no symp/parasymp regulation
Hr does not vary w/ respiration, position, temp
donor heart and exercise
warmup/cool down w/ ex 5-10 mins
HR increase w/ ex w/ 3-5 min delay
HR remains elevated longer after ex
peak HR in transplant pts
lower than same age pts
borg scale, heart pts
RPE
aim for 11-13
heart - monitor BP
pre, during, post-activity
recipients are higher than normal
systolic: 80-150
diastolic <90
orthostatic hypotension
lacks reflex compensation
enc slow position changes
assess c/o angina or sternal pressure
instead monitor dyspnea, lt headedness, increase RPE, arrhythmias
pain from incision or sx manipulation
heart - monitor daily
changes and c/o w/ ex
fatigue is a sign or rejection and ischemia, so note significant changes and alert using ASAP
single lung
most common
indicated w/ all end-stage conditions except cystic fibrosis and bronchiectasis
anterolateral or posterolateral thoracotomy
utilizes cadaveric organ
double lung
bilateral anterior thoracotomy at 4th and 5th intercostal space w/ possible transverse sternotomy
indications for double lung
cystic fibrosis
bronchiectasis
pulm HTN
living donor lobar
bilateral lower lobes received from two compatible donors
donor lungs are enough to fill hemithorax
lung transplant post op
retrain cough and deep breathing - lungs are denervated
aggressive bronchopulmonary hygiene
after extubation
PT, RN, Nsg all take part
post op infection risk highest w/
lung transplant
lung transplant care
postural drainage suctioning vibration gentle pervussion diaphragmatic breathing coughing incentive spirometer
lung transplant therapy
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
single lung its should lie
on non sx side
lung transplant - schedule Rx w/ regard to
bronchopulm hygiene, nebulizer use, pain meds
thoracotomy precautions
10 lbs lifting restriction
partial WB UE
use pillow to splint for incisional pain
respiratory isolation
gown, mask, gloves in room
amb in hallway w/ mask
lung - O2 sat
monitor w/ activity
>90% needed
bone marrow transplant
always from living donor
harvested from post/ant iliac crest or sternum
allogeneic bone marrow transplant
harvested from matching donor
donor does not have to be related
given immediately to pt after cytoredduction therapy
syngeneic bone marrow transplant
harvested from identical twin
autologous bone marrow transplant
harvested from pt when healthy
marrow is frozen and stored
peripheral blood stem cell harvest
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
common symptoms after rein fusion - bone marrow transplant
fever chills nausea HA flushing
reverse protective isolation
neutrophil count <1,000/mm3
thrombocytopenic precautions - platelet count <50,000/mm3
may cause spontaneous bleeding
thrombocytopenic precautions - platelet count <50,000/mm3
exercise okay if asymptomatic
thrombocytopenic precautions - platelet count 20,000-30,000
light AROM w. NO resistance, amb as tolerated
PT concerns regarding transplant pts
coordinate therapy time w/ nursing
check labs daily
supine ex when applicable and cleared
encourage early amb as able
LE edema
typical after transplant sx
may be initially painful
shorter walks
assess need for AD
monitor vitals w/ activities
avoid restive UE ex w/ heart and lung pts
~6 weeks/ cleared by MD
HEP
educate re: warm up, cool down, monitoring symptoms, vitas
transplants and contact sports
no contact sports for life
