Flashcards in Lung and Heart Transplants Deck (33):
What are contraindications for heart and lung transplants?
Irreversible renal failure
Psychosocial or cognitive instability
Absence of support
History of non compliance
Active substance use
Lack of adequate financial coverage
What is recommended criteria for heart or lung transplant?
Heart: CAD, cardiomyopathy (virus), heart valve disease with CHF, severe congenital heart disease, poor quality of life (intractable angina and life threatening arrhythmias)
Lung: 44% COPD/emphysems, 17% IPF, 15% CF, 9% other (idiopathic pulmonary hypertension, sarcoidosis)
What are additional considerations for evaluations of lung transplant?
Air flow obstruction
What are medical aspects of the evaluation before transplant?
Medical assessment: lab tests, cardiopulm assessment, other tests
Team evaluation: physician and medical staff, PT, dietitian, social worker, psychologist/psychiatrist
What are parts of PT eval for transplant pts?
General: Appearance, edema, vitals, pain, posture, ROM, strength, bed mobility, transfers, gait, ADLs
Cardiopulm assessment: breathing and vent function, airway clearance, auscultation
Exercise tolerance: maximal stress test, sub max treadmill or cycle, 6MW, oxygen saturation/gas exchange
What is goal and aspects of preoperate PT for transplants?
Improve or prevent deterioration of physical conditions before surgery
Pt and family education, cardiovascular endurance training, strength and flexibility training, breathing training, follow guidelines
What are considerations for donor selection?
ABO blood compatible
Age less than 34-40
Weight and thoracic dimensions match
What are the levels of recipient classification?
1A: mechanical circulatory support or medical evidence of significant device related complications, mechanical vent, continuous meds, BVAD
1B: left or right LVAD
II: everyone else
Based on disease level, need for mechanical support, and meds
Determines how quickly patient gets transplant
What is the surgical procedure for heart transplants?
Orthotopic: replacing bad heart with donor heart
Heterotopic: leaving recipients heart in place and connecting donor heart to right side of chest, rare to see this
What is surgical procedure for lung transplants?
During a lung transplant, the chest is opened to reveal the heart, lungs, and major blood vessels (A). Inferior and superior pulmonary veins and pulmonary artery are separated, and lung is removed (B). The bronchus of the donor lung is connected to the patient's existing bronchus (C). The pulmonary artery is attached (D), and the pulmonary vein and other blood vessels are also connected (E).
What medications are people put on after transplants?
Gastric motility agents
Initiated in intensive care and continued life long
what is post op treatment for acute inpatient?
Education, functional abilities in self care, mobility, transfers, ambulation, pulmonary hygiene and chest wall mechanics, strength and ROM, exercises (ADLs, MET levels 1-3, breathing), education on precautions
What are sternal precautions?
Sternal precautions: not allowed to push, pull, or lift more than 5-10 pounds for 6-8 weeks
Document if they are not following precautions
What are treatment considerations for post op treatment for acute inpatient?
Patients need longer warm up and cool down period
Monitor exercise tolerance using vitals and RPE scale
What is outpatient post op treatment?
From hospital discharge up to 8-12 weeks post
Similar to phase 2 cardiac rehab
Goals: strength, aerobic conditioning, independence with HEP, education and self monitoring, musculoskeletal problem solving
Changes in cardiovascular and pulmonary status following lung transplation
What should we be monitoring for during OP rehab?
Signs and symptoms of rejection
Heart: flu like symptoms, fever, muscle aches, dysarrhythmias
Lung: shortness of breath, desaturation
What are long term complications for transplants?
What are alternatives to heart transplant?
Ventricular assistive devices or systems
What is LVAD?
Device that receives blood from left ventricle and delivers to aorta
Assists to pump blood through body
Implanted below the heart, attaches at apex
Used to treat advanced heart failure
Who are candidates for LVAD?
Bridge to transplant: patients with non reversible left heart failure, CHF, cardiomyopathy, imminent risk of death, candidate for cardiac transplant
Destination therapy: long term support for patients who are not candidates for heart transplant with end stage heart failure, can extend life 5-10 years
What are LVAD precautions?
Post implantation for 6 weeks or longer
Batteries/power: watch cables, check battery charge
No chest compressions
Gait belt placement: want it higher
What are LVAD vitals and treatment?
HR: use manual or Doppler
SpO2: unreliable due to diminished pulse pressure
BP: manual or Doppler
Monitor for s/s of dizziness and SOB
Treatment: bed mobility, transfers, gait training, functional endurance, balance and safety, education on precautions
What are alternatives to lung transplants?
Lung volume reduction surgery (LVRS)
Pressure release ventilation or biphasic positive airway pressure (BiPAP)
What are future trends in transplantation
Prolongs the life
80% of heart transplants are alive 2 yrs after operation
If rejection can be controlled then survival can be increased up to 10 years or more
Immunosuppressive drugs must be taken indefinitely
Relatively normal activities can resume as soon as patient feels well enough and after consulting with his or her doctor
Vigorous physical activity should be avoided
What are the different pressures assessed with hemodynamic monitoring?
Right arterial pressure or central venous pressure
Pulmonary artery pressure
Impending or established respiratory failure
Inadequate ventilation and/or oxygenation
Inspiratory muscle fatigue
Inspiratory muscle weakness
Severe hypoxemia/lung parenchymal disease
What are principles of mechanical ventilation?
Delivering stream of compressed air via a face mask and hose
Splinting the airway (keeping it open under air pressure)
Ventilators can take sole charge of a patient's ventilation
Assist patients with their own breaths
What are different modes of mechanical vent?
Intermittent mandatory vent or synchronized intermittent mandatory vent
Pressure support vent
Positive end expiratory pressure: higher is more ill, pressure in lungs higher, support during inspiration
Constant positive airway pressure: helps keep airway open
What are indications for ventilation?
Inability to clear secretions
Need for short term vent support for patients who are hypo ventilating
Medication delivery device: when MDI/nebulizer failed
What is tracheostomy and tracheotomy?
Tracheostomy: artificial opening into trachea, through which a tube can be inserted
Tracheotomy: incision into trachea through the skin to create tracheostomy
What are indications for tracheostomy?
Temporarily during some operations to protect the airway from inspiration and swelling
Permanently after laryngectomy
Provide airway access for some patients on vents
After facial trauma
What are indications for intubation?
Need to deliver positive pressure ventilation
Protection of respiratory tract from aspiration of gastric contents
Almost all situations involving neuromuscular paralysis
Surgical procedures involving the cranium, thorax, or abdomen