Transplant Quiz 4 Flashcards
What is the criteria for an organ transplant?
End-stage disease in transplantable organ
Failure of conventional therapy
Absence of untreatable malignancy or irreversible infection
Absence of disease that would attack new organ
What other qualities must a transplant candidate demonstrate in order to receive an organ?
Emotional and psychological stability
Adequate support system
Willing to comply with lifelong immunosuppressive therapy
Age limits and drug and alcohol abuse are specific to transplant facility
Who all is on the team of health care professionals to evaluate candidates?
Transplant surgeon Transplant nurse coordinator Infectious disease physician Psychiatrists Social Worker Nutritionists Sometimes a PT
What are the types of donors?
Cadaveric - (dead by neurological criteria, death must happen at a place where cardiopulm support is available)
Living- Get to have greater evaluation of organs)
What is the average length of stay in the hospital after donating an organ?
1-2 days for kidneys
8 days for simultaneous pancrease-kidney (SPK)
How soon are patients ambulating after surgery?
Postop day 1
What are some complications after a transplant?
Surgical - vascular (thrombosis, stenosis, leakage at anastomotic sites, and bleeding)
Medical - Fluid overload or dehydration, electrolyte imbalance, hypo/hypertension
Rejection
Infection
What are the most common side effects of immunosupressants?
Hypertension Bone marrow suppression Electrolyte disturbances Decrease bone density Renal dysfunction Hepatotoxicity
What are the 3 approaches to posttransplant immnosupression?
Induction immunosuppression (high dose to prevent acute rejection) Maintenance (long term) Antirejection (managing any specific acute rejection at any point)
What are the types of rejection?
Hyperacute - within 48 hours, ischemia and necrosis of the graft (general malaise and high fever). Unresponsive to treatment
Acute - within first 3 months to year. Treatable
Chronic - After first few months and is gradual and progressive deterioration of the graft
What types of infection are most common with transplants?
Bacterial, Viral, Fungal
What is the most common cause of hospitalization, morbidity/mortality after transplant?
Infection
What are some general SxS of infection?
Temperature greater than 100.5 Fatigue Shaking, chills, body aches Sweating Diarrhea lasting longer than 2 days Dyspnea Cough or sore throat
Where is a kidney transplant placed?
Extraperitoneally in the iliac fossa through an obliue lower abdominal incision
What is considered excellent renal function?
Urine output of 800-1000 ml per hour
Declining levels of BUN and serum creatinine
(Dialysis may be needed directly after transplant until levels normalize)
What are the most common signs of rejection with a kidney transplant?
Increase BUN and serum creatinine levels Decrease urine output Increase BP Weight gain greater than 1 kg in 24 hours Ankle edema
What parameters do you want to monitor with kidney transplant patients?
Intake/output Daily weights Inspection of neck veins, Skin tugor Mucous membranes for dehydration Extremities for edema Auscultation (crackles can be sign of excess volume)
What are some therapy considerations for kidney transplant patients?
Assist in adhering to fluid recommendations (2-3 liters)
BP needs to be maintained to ensure adequate perfusion (systolic needs to be above 110 mmHg)
Consistent BP needs to be monitored over the lifespan because many patients develop hypertension overtime.
What’s the goal for preoperative physical therapy for liver transplants?
Aerobic conditioning Strength training Posteral education Maximize functional mobility with focus on education regarding postop follow-up Fall prevention Home exercise program Lifestyle modification
What are the types of Liver transplant?
Orthotopic Cadaveric - (removal of diseased liver and new one put in place)
Cadaveric Split - (Divide adult cadaveric liver in situ into 2 functional allografts)
Living Adult Donor
What are some indications of liver function after transplant?
Bile production (thick dark-green bile drainage)
Coagulation factors (PT, PTT, INR)
Hypokalemia
Normal to sightly elevated blood glucose levels
How long are the tubes left in after liver transplant?
JP suction drains - 1 week
T Tube in bile duct - 12 weeks
What is the typical length of stay in the hospital after liver transplant?
1-3 weeks
What are some PT considerations after liver transplant?
Deep breathing exercises (prone to atelectasis and pneumonia)
Increased lower extremity edema and abdominal girth can throw off balance and can cause low back pain
