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S2 Movement Science > Heart and Lung Transplants/Rehab > Flashcards

Heart and Lung Transplants/Rehab Flashcards

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1
Q

most common organ waiting lists

A 
kidney
-81%
liver
-11.4
heart
-3
lung
-1
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2
Q

organ transplant process

A

deceased donors –> organ procurement organization –> UNOS computer system –> transplant center –> candidates

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3
Q

to avoid conflict of interest, what is the rule

A

neither the physician of the donor nor the physician that pronounced the death may participate in the organ transplantation

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4
Q

transplant center has how long after it is offered a donor organ

A

1 hour

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5
Q

organs may be matched by…

A

tissue match
blood type
length of time on the waiting list
immune status/antigens
distance between the potential recipient and the donor
degree of medical urgency (for heart, liver, lung and intestines)

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6
Q

brain death requirements

A

coma/unresponsive
absence of motor responses to pain in all extremities
absence of brain stem reflexes
apnea

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7
Q

organ type and waiting times

A 
heart
-230 days
lung
-1068 days
heart lung
-if heart available, lung will go with it
liver
-796 days
kidney
-1121 days
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8
Q

survival rates at 1 year

  • heart
  • lung
  • liver
  • kindney
A 
heart
-87%
lung
-100%
liver
-90%
kidney
-95%
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9
Q

survival rates at 5 years

  • heart
  • lung
  • liver
  • kidney
A 
heart
-73%
lung
-51%
liver
-77%
kidney
-81%
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10
Q

what else do you need to be a donor apart from having it on your driver’s license

A

in a will

sign up with the national registry

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11
Q

ethical considerations of transplants

A 
utility
-maximize benefit to all
-consider survival and QOL
justice/equity
-fair distribution
-medical benefits (sicker 1st)
respect for persons
-right not to donate
-transparency
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12
Q

which is more important for transplants, justice/equity or respect for persons

A

justice/equity

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13
Q

psychosocial aspect or receiving an organ transplant

-two traumatic events that can affect their patient’s thoughts

A

sense of imminent death

trauma of dealing with the transplant surgery and afternath

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14
Q

end stage diseases that may require a heart transplant

-most to least common

A 
cardiomyopathy (46%)
CAD/ishcemic heart disease (45%)
restrictive valve disease
retransplant or graft failure
congenital disease
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15
Q

heart transplant recipient criteria

A 
terminal heart disease
no renal/hepatic dysfunctiion
no acute infections
no recurrent pulmonary infections
psychosocial stability
no alcohol, tobacco, drug use
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16
Q

heart transplant donor criteria

A 
normal echocardiogram
(-) HIV and hepatitis
brain death declared
age <45 years (some exceptions)
no pre-existent heart disease
few coronary artery disease risk factors
no heart trauma
no malignancy
no infection
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17
Q

liver transplant recipient criteria

A

no liver transplant for people who suffer from liver damage due to

  • current alcohol or substance abuse
  • cancer that has spread to other organs
  • advanced heart and lung diseases, a condition of sepsis
  • HIV patients
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18
Q

cardiac rehab pre-transplant

-what vitals are monitored

A

physician/therapist guided program designed to maximize a candidate’s strength and endurance to activity
closely monitored vitals
-HR, BP, O2 sat, dyspnea

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19
Q

early complications seen in patients post-heart transplant

A 
donor organ dysfunction
acute rejections
renal failure
arrhythmias
bleeding
infection due to immunosuppression
denervated heart physiology
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20
Q

denervated heart physiology

A

the drive through the SA node to increase HR during exercise will be altered in these people
HR response will be slower after transplant

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21
Q

chronic complications post-heart transplant

A

prone to infection due to immunosuppression
accelerated coronary atherosclerosis
chronic rejection (greatest risk in the 1st year post-transplant
hypertension

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22
Q

heart rejection

  • due to…
  • what is done to prevent this
A

cells have antigens on their surfaces. the immune system recognizes the cells as foreign and attacks them
an organ that is not matched can trigger a transplant rejection
patients are “typed.” the more similar the antigens are between the donor and recipient, the less likely that the organ will rejected

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23
Q

acute rejection Sx

A

organ’s function may start to decrease
general discomfort, uneasiness, or feeling unwell
pain or swelling in the area of the organ (rare)
fever
flu-like symptoms, including chills, body aches, nausea, cough, and SOB

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24
Q

immunosuppression

  • result
  • caregivers must…
  • ______ for life
  • what type of drugs do they take?
  • side effects
A

patient is more susceptible to infections
caregivers wear a mask
anti-rejection meds for life
immunosuppression with glucocorticoids e.g. prednisone and solumedrol to suppress body’s natural immune system
cocktail is specific to match time post transplant, type of transplant
side effects
-nausea
-weakness

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25
post-heart transplant rehab: acute phase - focus on... - precautions - exercise guidelines... - be aware of...
multiple lines and tubes immediately post-transplant focus on functional mobility - bed mobility, transfers and ambulation sternal precautions phase 1 cardiac exercise guidelines be aware of abnormal HR responses
26
post-heart transplant: after discharge from hospital | -what is the cardiac rehab program
3x/week program designed to increase candidate's endurance to activity, strength, balance and overall QOL closely regulated vital signs during exercise
27
special considerations with exercise post-heart transplant
denervation -loss of vagal tone, lack of sympathetic stimulation patient may not have chest pain during exercise secondary to denervation of the heart patient will have a higher resting HR which may not increase with exertion (>100) altered baroreceptor response: HR increases slowly with exercise and then remains elevated for increased time post-exercise -signals from the aortic baroreceptors normally travel through the vagus nerve
28
ventricular assist device - used with what patients - bridges gap between... - types
used in patients with non-reversible left ventricular failure at imminent risk for death bridges the gap between terminal heart disease and cardiac transplantation LVAD RVAD BiVAD
29
comparison of survival rates for the heart transplant patient vs. LVAD
similar rates
30
RVAD and LVAD - implantation location - motor connects to... - what is a driveline
implanted in the left upper quadrant of abdomen motor connects to external control and power components via a percutaneous tube cable called a driveline extends from the pump, out through the skin, and connects the pump to a controller and power sources worn outside the body
31
therapy considerations in a patient with a VAD
patient's VAD is hooked up to a controller when at rest battery unit can be utilized when ambulating have 2 extra batteries
32
early mobilization of LVAD recipients
PT initiated in ICU that focused on early mobilization and ambulation of the patient resulted in improved functional mobility upon time of DC from hospital physician usually sets rehab parameters based on the flow rate reading -4.0 and above is considered good
33
rehab for patients post-VAD implant | -goals
prevent - muscular atrophy - respiratory compromise - decreased skin integrity
34
rehab for patients post-VAD implant | -plan
progress on POD (post-op day) #1 to bed mobility, transfers ambulation by POD #2 by POD 10-30, begin progressive aerobic exercise at RPE 11-13 on Borg Scale light resistance training
35
lung disease diagnosis groups | -how many groups
group A group B group C group D
36
group A diseases
obstructive - COPD - emphysema
37
group B diseases
pulmonary vascular disease | pulmonary hypertension
38
group C diseases
cystic fibrosis
39
group D diseases
restrictive diseases - IPF (idiopathic pulmonary fibrosis) - sarcoidosis
40
indications for lung transplant
untreatable end-stage pulmonary, parenchymal, and/or vascular disease absence of other major medical illnesses substantial limitation of daily activities -projected life expectancy <2 years -rehab potential -satisfactory psychosocial profile and emotional support system -acceptable nutritional status -disease-specific mortality exceeding transplant-specific mortality over 1-2 years
41
relative contraindications for lung transplant
``` tobacco use within past 6 months age ->65 for single lung ->60 for bilateral ->55 for heart-lung psychosocial instability prednisone use >20-40 mg/day ```
42
single lung transplant - indication - which is replaced - better for...
non-septic lung disease poorest functioning lung replaced better for older people
43
bilateral lung | -indication
septic lung disease, cystic fibrosis | pulmonary HTN
44
living-donor lobar transplant - best for... - donation associated with... - need lobes from _____ donors to form...
best for children donation associated with 15% decrease in lung volume without change in functional capacity need lobes from 2 donors to form entire lung for recipient
45
donor selection
absence of infection of airways or parenchyma acceptable gas exchange <60 years old <20-30 pack years
46
lung transplant allocation
limited supply | patients are ranked according to severity of disease
47
lung pre-transplant workup
intense battery of tests to determine if suitable for transplant must maintain adequate nutrition and conditioning pre-transplant exercise training may be most important
48
lung pre-transplant rehab
``` conditioning - bike or walk respiratory muscle training -spirometry lower extremity muscle training -quads, hamstrings core strengthening UE and trunk ROM back extension strengthening -prevent loss of bone mass -energy conservation ```
49
lung transplant acute complciations
``` hyperacute rejection reimplantation response (reperfusion injury) acute graft dysfunction airway complications infection ```
50
lung transplant acute considerations
``` lines and tubes -chest tubes, ventilator, IVs, foley need to mobilize early full AROM of UEs by discharge from hospital ambulation without assistive device home exercise program self-monitoring of SaO2 ```
51
lung transplant complications
acute rejection - most have at least one episode
52
lung transplant acute rejection - when does it happen - how it is diagnosed - symptoms - Tx
``` 3-6 months spirometry - drop of 10-15% on spirometry indicates rejection diagnosed with biopsy symptomatic -fever, cough, dyspnea, failure to thrive asymptomatic -identified by regular biopsies Tx -immunosuppressive medications ```
53
lung transplant chronic complications
chronic rejection
54
chronic lung rejection - when - what - prevalence - CMV... - Tx
6 months to 1 year obliterative bronchiolitis present in 40% at 1 year, 60-70% at five years CMV unknown etiology, but possibly linked to acute rejection treat with immunosuppressive medications
55
what is CMV
cytomegalovirus
56
immunosuppressive complications
osteoporosis muscle weakness infections malignancy
57
common types of malignancy
Non Hodgkins Lymphoma squamous cell carcinoma of skin and lip Kaposi's sarcoma
58
osteoporosis - criteria - prevalence after 1 year on corticosteroids
bone density 2 SDs below age-matched norms | 10-37% develop a fracture in 1st year
59
chronic corticosteroid and muscle weakness
chronic corticosteroid use causes proximal-limb muscle weakness and type II fiber atrophy cyclosporine impairs mitochondrial function, decreasing muscle ability to utilize oxygen poor pre-transplant activity and post-transplant bedrest may cause atrophy and alter metabolic capacity, especially in lower limb early fatigue reduced muscle mass, muscle atrophy
60
lung transplant and infection
rate of infection is higher than other organ transplant recipients constant exposure to external environment -recipients wear respiratory masks in public for life
61
QOL post-lung transplant
``` improved -mobility -energy -sleep -dyspnea -ability to accomplish ADLs many patients return to work post-transplant ```
62
exercise limitations in lung transplant
``` 3 months -SLT 46% predicted -DLT 50% predicted 1 year -same VO2 -improvement in lung function -return to daily activities ```
63
aerobic exercise training after heart transplant | -how effective
achieve 95% age predicted max
64
resistance training after transplant | -functions
prevents vertebral osteoporosis | increases muscle strength (counteracts steroid myopathy)
65
_____ therapy speeds muscle atrophy
corticosteroid therapy

S2 Movement Science (13 decks)

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