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S4- Acute Care > Week 6- Oncology and Organ Transplant > Flashcards

Week 6- Oncology and Organ Transplant Flashcards

1
Q

Neoplasm is classified by what?

A
  • cell type
  • growth pattern
  • anatomic location
  • degree of dysplasia
  • tissue of origin
  • ability to spread or remain in the original location
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2
Q

What is the difference between a benign tumor and a malignant tumor?

A
  • Benign tumor: differentiated cells that reproduce at a higher rate than normal and are often encapsulated, allowing expansion, but DO NOT spread to other tissues
  • Malignant tumor: undifferentiated cells, are uncapsulated, and grow uncontrollably, invading normal tissues and causing destruction to surrounding tissues and organs; MAY spread to distant sites of the body
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3
Q

What is the difference between a primary and secondary tumor?

A
  • Primary: original tumor in original locaton

- Secondary: metastases that have moved from the primary site

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4
Q

Terminology:

  • _________ = “New growth” pertaining to an abnormal mass of tissue that is excessive, persistent, and unregulated by physiological stimuli.
  • _______ = Common medical language for a neoplasm.
  • ________ = A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Malignant tumors are referred to as cancers.
A
  • Neoplasm
  • Tumor
  • Cancer
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5
Q

Terminology:

  • __________ = Variability of cell size and shape with an increased rate of cell division (mitosis).
  • _________ = Replacement of one mature cell type by a different mature cell type, resulting from certain stimuli such as cigarette smoking.
  • __________ = An increasednumberof cells resulting in an enlarged tissue mass. It may be a mechanism to compensate for increased demands, or it may be pathological when there is a hormonal imbalance.
  • _________ = The extent to which a cell resembles mature morphology and function. A cell that is well differentiated is physiological and functions as intended. A poorly differentiated cell does not resemble a mature cell in both morphology and function.
A
  • Dysplasia
  • Metaplasia
  • Hyperplasia
  • Differentiation
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6
Q

What are the common S/Sx of Cancer?

A
  • Unusual bleeding or discharge
  • Unexplained weight loss (10lbs or more)
  • Fever
  • Fatigue
  • Pain
  • Persistent cough or hoarseness without cause
  • Skin changes
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7
Q

Wat are the 2 main hallmarks of cancer?

A
  • Unexplained weight loss

- Unexplained pain (no explained onset, wakes patient up)

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8
Q

What are some ways cancer is diagnosed?

A
  • Medical imaging
  • Blood tests for cancer markers
  • Biopsy (definitive test to ID cancer type)
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9
Q

When it comes to cancer prevention, what are the 3 stages of disease prevention and what do each involve?

A

Primary
-Taking steps to prevent getting disease in the first place. (using sun block)

Secondary
-Involves using screening tools for early identification of cancer. (biopsy, stool guaiac, pap smear, sputum cytology, sigmoidoscopy, colonoscopy, etc…)

Tertiary
-Involves reducing symptoms and improving QOL in presence of disease.

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10
Q

Cancer ______ Describes the location and size of the primary site of the tumor, the extent of lymph node involvement, and the presence or absence of metastasis. This helps to determine treatment options, predict life expectancy, and determine prognosis for complete resolution

A

Staging

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11
Q

Cancer staging measures what 3 things?

A

TNM System

  • T: extent (size and/or number) of tumor
  • N: lymph node involvement
  • M: presence/absence of metastasis
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12
Q
  • The _____ system is commonly used to stage cancer.

- Generally the ______ the number, the more advanced.

A
  • TNM

- higher

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13
Q

Cancer _______ reports the degree of dysplasia, or differentiation from the original cell type.

A

Grading

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14
Q
  • Lower grade tumors: ______ differentiated cells that more closely resemble original cells
  • Higher grade tumors: _____ differentiated (i.e., undifferentiated) cells that are less like original cells
  • ______ grade tumors are more aggressive.
  • Differentiation is a _____ thing.
A
  • highly
  • less
  • higher
  • good
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15
Q

With tumor grading, is G1 better or worse prognosis than G4?

A

Better

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16
Q

What are the 3 approaches to cancer treatment?

A
  • Cure (adjuvent and neoadjuvent)
  • Control (reduce new cancer growth)
  • Palliation (cure not possible, make patient as comfortable as possible)
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17
Q

Difference between adjuvent therapy and neoadjuvent therapy

A
  • Neoadjuvant therapies are delivered before the main treatment, to help reduce the size of a tumor or kill cancer cells that have spread.
  • Adjuvant therapies are delivered after the primary treatment, to destroy remaining cancer cells
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18
Q

What are the 4 main cancer treatment options?

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Biotherapy
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19
Q

Indications for Surgical Management:

  • Removal of __________ lesions or of organs at high risk for cancer.
  • Establishing a diagnosis by _______.
  • Assisting in staging by sampling _____ _____.
  • Definitive treatment by removing the ______ tumor.
  • Reconstruction of a limb or organ with or without skin grafting.
  • __________ care such as decompressive or bypass procedures.
A
  • precancerous
  • biopsy
  • lymph nodes
  • primary
  • palliative
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20
Q

__________ primary objective is to eradicate tumor cells, either benign or malignant, while minimizing damage to healthy tissue.

A

Radiation

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21
Q

Indications for Radiation:

  • Definitive treatment with the intent to cure.
  • __________ treatment to improve chances of successful surgical resection.
  • _________ treatment to improve local control of cancer growth after chemotherapy or surgery.
  • __________ treatment to prevent growth of cancer in asymptomatic, yet high-risk areas for metastasis.
  • Control to limit growth of existing cancer cells.
  • Palliation to relieve pain, prevent fracture, and enhance mobility when cure is not possible.
A
  • Neoadjuvant
  • Adjuvant
  • Prophylactic
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22
Q

What are the general side effects of radiation?

A
  • skin reactions
  • fatigue
  • N/V/D
  • weight loss
  • myelosuppression
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23
Q
  • Radiation can also case site-specific _________ such as limb edema, visual disturbances, pneumonitis, cystitis, and cardiomyopathy.
  • ________ are often prescribed.
A
  • toxicities

- antiemetics

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24
Q

With patients on radiation, we want to be careful of fragile _____.

A

skin

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25
Q

_________ purpose it to inhibit various signaling pathways that control cancer cell proliferation, invasion, metastasis, angiogenesis, and cell death.

A

Chemotherapy

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26
Q

What are the typical side effects of chemotherapy?

A
  • N/V
  • “cancer pain”
  • loss of hair and other fast-growing cells, including platelets, red blood cells, and white blood cells
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27
Q
  • What is the mode of delivery for chemotherapy?

- Is chemotherapy a primary, neoadjuvant, or adjuvant therapy?

A
  • IV/central line, injection to tumor site

- It can be any of the 3.

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28
Q
  • Chemotherapeutic drugs are often given in cycles, __-__ cycles every ___ weeks.
  • Are chemotherapeutic drugs given in combination with other chemo-therapeutic agents?
A
  • 6-8 cycles every 3 weeks

- Yes

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29
Q

Chemotherapy and PT considerations:

  • __/__ may limit rehab participation.
  • _________ status decreased nutrient absorption and can thus affect strength/conditioning.
  • ______ plays a major role in modification of activities.
  • Monitor ______ signs.
A
  • N/V
  • nutritional
  • fatigue
  • vital
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30
Q
  • Chemotherapy targets ALL cells that are dividing, what does this mean?
  • What are the most common effects directly related to this?
A
  • Can affect important cells such as bone marrow, GI tract and buccal mucosa, reproductive organs, and hair follicles.
  • myelosuppression, NVD, stomatitis, reproductive dysfunction, hair loss
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31
Q
  • What is Nadir?

- Are chemo drugs held at this time?

A
  • Period where WBC is at its lowest (10-28 days after).

- Yes, high risk for infection.

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32
Q

What are some (5) specific chemo considerations?

A
  • Neutropenia- may occur at specific points in chemo cycle, infection prevention key
  • Lymphedema- lymph fluid doesn’t drain, often arm, leg; slow development (even years later)
  • Memory problems- “chemo brain,” during or after treatment
  • Peripheral neuropathy- may damage sensory, motor or autonomic nerves
  • Pain- may be severe and difficult to control
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33
Q

PT Implications for Patients on Chemo:

  • Will side effects prevent patient from participating in PT?
  • Consider treatment ____________
  • _______ issues
A
  • modifications

- safety

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34
Q

Effects of Exercise on Chemo:
-Research shows that exercise has __________ effects during chemo, but will require _________ exercise prescriptions due to variability of cancer demands.

A
  • positive

- customized

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35
Q

When do we withhold exercise at rest?

  • HR >____
  • ________
  • low ________ BP
A
  • HR > 100bpm
  • dyspnea
  • low diastolic BP
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36
Q

When do we stop exercise?

A
  • abnormal BP response
  • abnormal fatigue
  • dizziness
  • nausea
  • pallor
  • excessive sweating
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37
Q
  • _________ therapy, also referred to as immunotherapy, uses a patient’s native host defense system as mechanisms to treat cancer.
  • It is highly targeted while minimizing ___.
A
  • Biological (Biotherapy)

- AE

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38
Q

List of Cancer Related Impairments.

A
  • Cancer Related Fatigue
  • Pain
  • Cognitive Function
  • Lymphedema
  • Range of Motion
  • Muscle Strength
  • Muscle Endurance
  • Cardiovascular and Respiratory
  • Hearing and Vestibular
  • Sensory
  • Balance, Gait, and Sensory Integration
  • Distress, Anxiety, Depression
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39
Q

Cancer Related Fatigue:

  • Cancer related fatigue- extreme persistent fatigue that remains after periods of rest, is disruptive to activities of daily living (ADLs), is unremitting
  • ___% to ____% of people with cancer
  • 90% of patients with radiation therapy
  • 80% of patients with chemotherapy
  • May already be present in __% of patients at time of diagnosis, prior to treatment
  • Can it persist years after cancer treatment ends?
A
  • 70-100%
  • 40%
  • Yes
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40
Q

Pain:

  • May be due to malignancy, side effects or after effects of treatment.
  • One of most common issues addressed by rehabilitation professionals.
  • __-__% patients undergoing acute cancer treatment experience pain.
  • __% patients with metastatic disease experience pain.
  • Chronic pain relatively common in cancer survivors.
  • Pain is a ______ risk for cancer patients!
  • _____ of pain may cause functional limitations as much as pain itself.
  • Although there are no specific pain scales for cancer, what are some outcome measures that can be used?
A
  • 30-50%
  • 70%
  • fall
  • Fear
  • Brief Pain Scale, Pain Treatment Satisfaction Scale, VAS, Numeric Pain Scale
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41
Q

Cognitive Function:

  • What 6 cognitive domains are affected?
  • Same cognitive domains are often used in mobility and gait, and if impaired can contribute to _____ risk.
  • Can they persist after treatment?
  • __________ function decline is associated with increased falls while __________ is not.
A
  • Visual memory, Spatial function, Executive function, Attention, Memory, Concentration
  • fall risk
  • yes
  • inverse
  • executive function, orientation
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42
Q

List some cognitive outcome measures used.

A
  • Functional Assessment of Cancer Therapy-Cognitive Function (FACT-COG)
  • Perceived Cognition Questionnaire
  • Mini-Mental State Examination- simple screening tool for screening mental functions
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43
Q

Lymphedema:

  • Lymphedema- extremity swelling resulting from disruption of the lymphatics due to obstruction from a tumor or lymph node dissection.
  • 15-30% prevalence of lymphedema in patients with _______ cancer.
  • Lymphedema exists after surgery for non–breast-cancer-related malignancies, but data documenting this occurrence are less common.
  • Lymphedema associated with decreased _______.
  • _____, ______ garments, and _______ lifting have been shown to be beneficial.
  • What are 2 ways to assess lymphedema?
A
  • breast cancer
  • QOL
  • MLD, compression garments, weight lifting
  • limb circumference, water displacement
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44
Q

Range of Motion:
-Deficits in ROM may arise from what 3 things?
-Can ROM loss extend beyond the immediately radiated joint?
Loss of ROM may impact patient’s function and ability to maintain _________.
-How do we assess ROM?

A
  • scar formation following surgery, disuse of a joint following chemo or surgery, fibrosis caused by irradiation
  • Yes
  • balance
  • Goniometry
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45
Q

Muscle Strength:
Deficits in muscle strength may arise from any of the following:
-Tumor-produced inflammatory intermediates that are ________.
-Surgical interventions/radiation/chemotherapy may damage muscle groups and ___________ nerves.
-Corticosteroids preferentially damage __________ limb muscles.
-Pain, fear, and fatigue lead to inactivity, causing further loss of muscle strength.

-__________ leads to muscle weakness that is linked to poor balance and falls.

A
  • catabolic
  • peripheral
  • proximal

-Sarcopenia

46
Q

Muscle Endurance:

  • Muscular endurance- ability to sustain a force over time in order to complete an activity.
  • Muscular endurance deficits are documented ______ cancer treatment.
  • Decreased endurance can lead to decreased ability to complete _______ related tasks.
  • Is it often assessed in a clinical setting? Why or why not?
A
  • after
  • balance
  • No, there is a lack of established reliable and valid methods to test and no normative data.
47
Q

CV and Respiratory:

  • List some ways we assess cardiac and respiratory function?
  • What are some outcome measures used for it?
A
  • vital signs, response to exercise, dyspnea scale, Borg RPE

- Graded exercise test, 2MWT or 6MWT

48
Q

Hearing and Vestibular Function:

  • Hearing impairments may require a _______ if detected.
  • Vestibular schwannoma, a relatively rare benign tumor, can impair vestibular function.
  • ________, a chemotherapy drug, has been associated with both vestibular toxicity and ototoxicity.
  • What are some ways to assess for hearing/vestibular dysfunction?
A
  • referral
  • schwannoma
  • cisplatin
  • finger rub test, balance assessment, VOR testing, visual acuity test
49
Q

Sensory:

  • Most common cause of sensory impairment is chemotherapy induced ________ _________.
  • What is it characterized by?
  • What is another common cause.
  • Are these patients at increased risk for postural control impairments, falls, and gait alterations?
A
  • peripheral neuropathy
  • paresthesias, dysethesias, decreased touch pressure thresholds, decreased vibration thresholds, decreased proprioception, reduced deep tendon reflexes
  • compression secondary to tumor
  • Yes
50
Q
  • What are some ways we assess sensory function?

- What are some outcome measures used?

A
  • Sensation testing (light and sharp touch)
  • Vibratory testing
  • Monofilament testing
  • Reflexes
  • Thermal stimuli
  • Touch pressure threshold testing
  • Modified Total Neuropathy Score
  • Functional Assessment of Cancer Therapy-Neurotoxicity
51
Q

Balance, Gait, and Sensory Integration:

  • Adults unable to balance on 1 limb for __ seconds had 2.1x risk of fall w/ injury. Is there normative data for this?
  • Limitations in full tandem stance found to be a predictor of falls in older cancer survivors.
  • Cancer or cancer treatments can alter gait characteristics; assessments include _______ analysis and ______ speed measurements
  • Cancer survivors have difficulty integrating _______ information from different sources (Modified Clinical Test of Sensory Interaction in Balance)
A
  • 5 seconds, no normative data for cancer patients
  • kinematic analysis and gait speed measurements
  • sensory
52
Q

Distress, Anxiety, Depression:

  • _______ disability is a leading cause of emotional distress in cancer survivors.
  • ________ is more strongly related to level of disability than to the cancer diagnosis itself.
  • ________ linked to decreased stress, depression, and anxiety levels.
A
  • pysical
  • distress
  • exercise
53
Q

What are some outcome measures to assess distress, anxiety, and depression?

A
  • Profile of Mood States
  • Distress Thermometer
  • Hospital Anxiety and Depression Scale
  • 2-Item Depression Questionnaire
  • General Anxiety Disorder 2-Item
54
Q

Do patients with cancer have similar goals to other patients?

  • optimize __________ mobility
  • minimize or prevent ______-______ ______ (CRF)
  • prevent joint __________ and skin breakdown
  • prevent or reduce limb ________
  • prevent postoperative _________ complications
A

Yes, but the timeframes will be a little longer.

  • optimize functional mobility
  • minimize or prevent cancer-related fatigue (CRF)
  • prevent joint contracture and skin breakdown
  • prevent or reduce limb edema
  • prevent postoperative pulmonary complications
55
Q

Knowing the ______ and _______ of cancer can help the physical therapist modify a patient’s treatment parameters and establish realistic goals and intervention.

A

stage and grade

56
Q

What 3 things can be done postop or during cancer treatment to help with bed rest deconditioning?

A
  • deep breathing exercises (pulmonary)
  • frequent position changes (decubitus ulcers)
  • bed exercise programs (muscle atrophy)
57
Q

When should we use care with manual secretion clearance techniques and resistive exercise programs?

A

When there is metastatic cancer, especially bone to bone increasing the risk of fracture.

58
Q

Minimizing Cancer Related Fatigue:

  • Do aerobic or resistive exercise programs help minimize complications of CRF?
  • When do we begin an exercise program?
  • Before exercise sessions, evaluate the patient to rule out ________/________ in medical status.
  • Monitor ________ before, during, and after.
  • Emphasize the importance of an exercise _____ to help monitor progress and promote adherence.
A
  • Both
  • When treatment starts
  • instability/decline
  • vitals
  • diary
59
Q

Minimizing Cancer Related Fatigue:
-Patient/caregiver _________ is important for safety management, energy conservation, postural awareness, and body mechanics during ADLs.
If on ________ precautions: place exercise equipment in room, such as stationary bicycles or upper-extremity ergometers (after being thoroughly cleaned or disinfected with facility-approved solutions).
When performing mobility or exercise treatments, care should be taken to avoid bruising or bleeding into joint spaces when patients have low ________ counts.

A
  • education
  • isolation
  • platelet
60
Q

Minimizing Cancer Related Fatigue:

  • _________ support for both the patient and family is at times the most appreciated and effective method in helping to accomplish the physical therapy goals.
  • Timely communication with the entire health care team is essential for safe and effective care (include functional status, goal progress, and factors interfering with prognosis).
  • Lab values, especially ____/____, _____ count, ______ count, and _____ should be monitored daily.
A
  • emotional

- Hgb/HCt, WBC count, platelet count, and INR

61
Q

Fall risk factors unique to oncology patients?:

  • Treatment with __________ agents
  • Advanced cancer ______
  • Presence of ____________ (Brain metastases, Depression, Fatigue)
  • Falls might be __________ by healthcare providers
  • Decreased ________ with fall risk precautions
A
  • chemotherapeutic
  • stage
  • comorbidities
  • overlooked
  • compliance
62
Q

Breast Cancer:

  • What are the surgical options for breast cancer?
  • When can total-skin-sparing mastectomy be done?
  • What are the common post-op issues?
  • What are the mobility concerns?
A
  • lumpectomy, total mastectomy, total skin-sparing mastectomy, and bilateral mastectomy
  • Patients receiving immediate breast reconstruction after.
  • Pain, lymphedema (post-op drains often used), nerve damage.
  • Do not displace drain, use abdominal support during coughing, use log-roll in/out of bed.
63
Q

Breast Cancer Lymphedema:
-Incidence ranges from __% with lumpectomy to up to __% with mastectomy.
How do we measure girth?
Treatment options: retrograde massage, elevation, compression wrapping, elastic garments, compression pumps

A
  • 3%, 70%

- circumferential or water displacement

64
Q

With breast cancer, don’t overlook __________ consequences of altered body image and sexuality, effects of terminal disease diagnosis.

A

psychological

65
Q

What are the 3 basic types of skin cancer?

A
  • Melanoma
  • Basal cell carcinoma
  • Squamous cell carcinoma
66
Q
  • ________ has 15% of cases being fatal and comes from sun exposure.
  • ___________ is a noduloulcerative lesion from sun exposure to head/ears.
  • __________ has a variable presentation of pink lesions to scaly plaques.
A
  • Melanoma
  • Basal cell carcinoma
  • Squamous cell cancer
67
Q

What are the ABCDE rules of skin cancer?

A 
A = asymmetry
B = border-irregular
C = color-varied
D = diameter (>6mm)
E = evolving (appearance changes)
68
Q

Respiratory (Lung) Cancer:

  • What are the 2 main categories? Which one makes up 85% of cases?
  • What are the symptoms?
  • What are common sites of metastases?
  • Staging goes from ___ to ____.
A
  • non-small-cell lung cancer (NSCLC) (85%), small cell lung cancer (SCLC)
  • chronic cough, dyspnea, hoarseness, chest pain, and hemoptysis
  • bone, adrenal glands, liver, intraabdominal lymph nodes, brain and spinal cord, and skin
  • Ia to IV
69
Q
  • Stage I and II lung cancer is treated via ____________ (gold standard).
  • Does a thoracic surgery cause pain?
A
  • lobectomy

- VERY painful incision

70
Q

Post-op Thoracic Surgery Considerations:

  • Surgical procedure will cause lung _________
  • Chest tube placement
  • High level of pain
  • ______________ exercises
  • Monitor ______ (some patients may require supplemental O2)
A
  • deflation
  • deep breathing exercises
  • O2sat
71
Q

ORGAN TRANSPLANTATION

A

ORGAN TRANSPLATATION

72
Q
  • What are the 3 most common transplants?
  • What is the reason for a transplant usually?
  • __-__ year life expectancy without transplant.
A
  • kidney, liver, and heart
  • They have exhausted all other medical options.
  • 1-3 years
73
Q

Basic Criteria for Transplantation:

  • The presence of ____-stage disease in a transplantable organ.
  • The ________ of conventional therapy to treat the condition successfully.
  • The absence of untreatable ________ or irreversible __________.
  • The absence of disease that would attack the ________ _______/_______.
A
  • end-stage
  • failure
  • malignancy, infection
  • transplanted organ/tissue
74
Q

What are the 5 steps to getting on the organ transplant waiting list?

A
  • get referral
  • Gather information
  • Select a transplant center
  • Schedule an evaluation appointment
  • Get listed
75
Q

Organ Transplant Candidates Must:
-Demonstrate _________ and _________ stability.
Have an adequate ________ system.
Be willing to comply with lifelong _____________ drug therapy.

A
  • emotional and psychological
  • support
  • immunosuppressive
76
Q

Where do the organs come from?

A
  • Cadaveric Donors

- Living Donors

77
Q
  • With cadaveric donors, __________ support/mechanical vent is required to maintain viability of organ.
  • “Best fit” is someone of similar ______/_______.
A
  • cardiopulmonary

- height/weight

78
Q

The ___________________ administers all organ procurement and distribution in the US. It sets standards for transplant centers and teams, tissue typing labs, and organ procurement organizations.

A

United Network for Organ Sharing

79
Q

What are the (6) factors in decision to allocate organs?

A
  1. ) ABO blood typing
  2. ) Tissue (histocompatibility) typing
  3. ) Size
  4. ) Waiting time
  5. ) Severity of illness/degree of medical urgency
  6. ) Geographic location
80
Q

How Long Are Organs Viable:

  • Heart = __-__
  • Lungs = __-__
  • Pancreas = __-__
  • Liver = __-__
  • Kidneys = __-__
A
  • Heart = 4-6 hours
  • Lungs = 4-6 hours
  • Pancreas = 24 hours
  • Liver = 24-30 hours
  • Kidneys = 48-72 hours
81
Q

What are some pre-op patient issues with organ transplant recipients?

A
  • Weakness
  • Possibly prolonged hospitalization
  • Fatigue
  • Extended confinement to bed or home
  • Poor functional mobility including gait
  • Poor breathing mechanics
  • Poor airway clearance
82
Q

Pre-Transplant Hospitalization Issues:
-Liver failure: hepatic __________
Kidney failure: dehydration, ____ complications
Pancreatic failure: complication from _____
Intestinal failure: bowel obstructions, symptom of ______ failure
Heart failure: _______ and ___-_______ causes
Lungs: infection, ______ exacerbation

A
  • infections
  • DM
  • DM
  • liver
  • ischemic, non-ischemic
  • COPD
83
Q

Can PTs begin before transplantation?

A

Yes, used to address deficits caused by failing organs such as dyspnea, weakness, fatigue, pain, edema, fall risk, mobility patients.

84
Q
  • Are PTs involved with organ donors?
  • On average, the duration of donor hospitalization may range from __-__ days for a kidney donor to ___ days for a simultaneous pancreas-kidney (SPK) donor
A
  • Not usually, only if there are complications. Usually they are out of bed day 1.
  • 1-2, 8
85
Q

-What 4 things does post-op care of the transplant recipient focus on?

A
  • Allograft function
  • Rejection
  • Infection
  • AE of immunosuppressive drugs
86
Q
  • _________ is the leading problem of organ transplant.
  • Requires _________ immunosuppressive drugs.
  • Delicate between suppressing organ rejection and life-threatening suppression of ________ function.
A
  • rejection
  • LIFELONG
  • immune function
87
Q

What are the 3 drug approaches to post-transplant management?

A
  • Induction immunosuppression
  • Maintenance immunosuppression
  • Antirejection immunosuppression
88
Q

What is induction immunosuppression?

A

High dose meds to prevent acute rejection immediately after transplantation (30d).

89
Q

What is maintenance immunosuppression?

A

Any long-term drugs used for immunosuppression.

90
Q

What is antirejection immunosuppression?

A

All immunosuppressive meds given to manage specific acute rejection episodes post transplantation.

91
Q
  • _______ system control and suppression is critical to success of transplant and prevention of rejection.
  • The drugs used put the patient at risk for _______.
A
  • immune

- infection

92
Q

What are some of the serious adverse affects associated with immunosuppressive agents used?

A
  • systemic symptoms: N/V, fever, chills
  • liver/kidney toxicity
  • mental status change
93
Q

What are the 3 general types of graft rejections?

A
  • Hyperacute Rejection
  • Acute Rejection
  • Chronic Rejection
94
Q

Hyperacute Rejection:

  • Occurs within ___h of transplant surgery.
  • Usually due to ____ ______ group or human leukocyte antigen (HLA).
  • Usually ________ to treatment.
  • Does it involve removal of the transplant?
A
  • 48h
  • ABO blood group
  • unresponsive
  • Yes, and subsequent retransplantation
95
Q

Acute Rejection:

  • May occur __-__ months post-op.
  • Treatable but requires _______ intervention and __________ drugs.
  • Verifying _____ compatibility and “crossmatching” between donor and recipient decrease likelihood.
  • ____ matching significantly improves success rate.
A
  • 3-12 months
  • early intervention and antirejection drugs
  • ABO
  • HLA
96
Q

Chronic Rejection:

  • Usually occurs within a few ________ post-op.
  • Gradual and __________ deterioration of graft.
  • Eventual ___________ required.

Manifests differently in each organ:

  • ______: bronchiolitis obliterans
  • ______: cardiac transplant vasculopathy
  • ______: transplant nephropathy/transplant glomerulopathy
  • ________: ductopenic rejection/vanishing bile duct syndrome
A
  • months
  • progressive
  • transplantation
  • Lungs: bronchiolitis obliterans
  • Heart: cardiac transplant vasculopathy
  • Kidney: transplant nephropathy/transplant glomerulopathy
  • Liver: ductopenic rejection/vanishing bile duct syndrome
97
Q
  • Graft-versus-Host Disease can be _____ or ______.
  • When does it occur?
  • What 3 areas does it mainly affect?
A
  • acute or chronic
  • When the transplanted organ recognizes the patient’s body as foreign and mounts an immunological reaction. (reverse of transplant rejection)
  • liver, skin, gut
98
Q

Acute GVHD:

  • Causes tissue destruction via ______ response.
  • Contributes to post-transplant _________ in 15-40% of patients.
  • Symptoms: hepatitis, dermatitis, and GI issues
  • ________ storm.
A
  • immune
  • mortality
  • cytokine
99
Q

Chronic GVHD:

  • _______ organ toxicity.
  • Develops in 15 to 50% of patients who survive __ months post-transplant.
  • Involves Integumentary, Ocular, GI, and a range of other organ dysfunction.
A
  • multiple

- 3 months

100
Q

Short vs. Long term effects of corticosteroids

A

1

101
Q

What are the general S/Sx of infection?

A
  • Temperature greater than 38° C (100.5° F)
  • Fatigue
  • Shaking, chills, body aches
  • Sweating
  • Diarrhea lasting longer than 2 days
  • Dyspnea
  • Cough or sore throat
102
Q
  • What is the typical LOS post transplant?

- Which transplant is the shortest, which is the longest LOS?

A
  • 3-16 days

- kidney shortest, SPK longest

103
Q

What are the effects of transplant recipients being deconditioned/in poor health going into surgery?

A
  • Recovery time lengthened by pre-op deficits
  • Extreme weakness and fatigue with liver transplants
  • Decreased O2 capacity in heart and lung transplants
  • Generalized weakness from disease processes
104
Q

Is PT safe post-op?

A

Yes, as long as the pt is stable.

105
Q

Be aware of GVHD S/Sx. What are they?

A
  • Abdominal pain, N/V/D
  • Often accompanied by skin rash
  • Specific to organ
106
Q

Be aware of organ rejection S/Sx. What are they?

A
  • Flu-like symptoms
  • Fever >101 degrees
  • Pain over transplant
  • Fatigue
  • Specific to organ
107
Q

When is the best time to treat patients?

A

After pain meds and when they are not as fatigued.

108
Q

MAP >__-__mmHg to ensure adequate perfusion to organs.

A

60-70

109
Q

What are interventions post-op transplant geared towards?

A
  • Focus on impaired gas exchange
  • Airway clearance
  • Positioning
  • Therex
  • Transfer training
  • Gait training
110
Q

PT with these patients involves _______ control, __________, and ________ of activity when appropriate.

A

-infection control, mobilization, and modification of activity

111
Q
  • Can immunosuppressive agents delay wound healing?

- Can they cause osteoporosis?

A
  • Yes

- Yes

112
Q

Transplant Patient Education:

  • Patients receive education pre-op about expectations.
  • Customized _____.
  • Strenuous exercise that puts stress on incision site should be avoided for about ____ months post-op.
  • How long should contact sports be avoided?
A
  • HEP
  • 2 months
  • lifetime

S4- Acute Care (15 decks)

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