Lung & Heart Transplant Flashcards by Stacey Marti

Contraindications for Transplant (9)

Irreversible renal function
Systemic disease
Psychosocial/Cognitive instability
Absence of support
Active Infection
Hx of non-compliance
Active substance abuse
Morbid obesity
Lack of financial coverage

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Recommended Criteria for Heart Transplant (5)

CAD
Cardiomyopathy
Hear valve disease w/CHF
Severe congenital heart disease
Poor QoL

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Recommended Criteria for Lung Transplant (5)

COPD/Emphysema
IPF
Cystic Fibrosis
Idiopathic pulmonary HTN
Sarcoidosis

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UNOS

United Network of Organ Sharing

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Components of PT Eval (9)

Appearance
Edema
Vitals
Pain
Posture
ROM(general)
Strength(LE b/c sternal precautions)
CardioPulm assessment
Exercise tolerance

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Prehab PT Goals(4)

Pt/family education
CV endurance training
Strength/Flexibility
Breathing training

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Donor Selection Considerations (4)

ABO blood compatibility
Histocompatibility
Brain death
Age

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Level IA Recipient

Mechanical circulatory support
Mechanical ventilation
Continuous medication
Can’t leave the hospital, maybe on biVAD

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Level IB Recipient

Left or Right VAD needed

Continuous infusion

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T/F: When a patient has an LVAD placed, the are permanently take off the transplant list.

False. They are temporarily taken off for 6 wks b/c can’t get another surgery and then put back on the transplant list.

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Orthotropic Cardiac procedure

More common
Requires replacement w/donor heart
Must be done w/in 4-5 hrs
Pt on bypass

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Hetertropic Cardiac procedure

Rare.
Leaves recipient heart in place.
Connects donor heart to right side of chest.

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Lung Transplant Procedure (5)

probably not that important

Open chest.
Separate pulm veins &amp; artery
Remove lung
Reconnect bronchus of donor lung
Reattach pulm artery, veins &amp; other vessels

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Medications for Transplants (6)

Immunosuppressants
Anti-inflammatories
Anti-viral
Antibiotics
Mycostatins
Gastric motility agents

*initiated in ICU and continued life long

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Sternal Precautions

No pushing, pulling or lifting
6-8 wks

*document if pt not following precautions

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Focuses of Acute IP PT (5)

Education
Fan'l abilities for self-care
Mobility
Transfers
Ambulation

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Acute IP PT Treatments (6)

Pulmonary hygiene
Chest wall mechanics
Strength/ROM (LEs mostly)
Exercises, MET levels 1-3
ADLs
Education on precautions

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Documentation: Exercise tolerance (3)

Response of vitals
RPE
SOB

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T/F: Warm up and cool down are unimportant in cardiac patients.

False. They will require longer time for both.

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Length of OP PT Treatment

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Hospital d/c to 8-12 wks post

Goals of OP PT (5)

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Strength
Aerobic conditioning
Independence w/HEP
Education/Self-monitoring
Musculoskeletal problem solving

Symptoms of Heart Transplant Rejection (4)

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Flu-like symptoms
Fever
Muscle aches
Dysarrhythmia

Symptoms of Lung Transplant Rejection (2)

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SOB

Desaturation

Long Term Complications (6)

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Steroid myopathy
Osteoporosis
CAD
Cancer
Wound healing
Infection

Alternatives to Transplant (3)

VADs Pharmacological mgmt Cardiomyopathy

What is an LVAD? (4)

Device that pumps blood from LV to aorta. Implanted below heart Advanced failure (bridge to transplant) End Stage failure (extends life 5-10 years)

LVAD Precautions (3)

Sternal: Post 6 wks or more No chest compressions Fall risk w/increased bleeding risk

LVAD Treatment (5)

``` Bed mobility Transfers Gait training Balance/Safety Functional Endurance ```

Alternatives to Lung Transplant (2)

Lung Volume Reduction Surgery (LVRS) | Pressure release ventilation or BiPAP

T/F: Normal activities should not be resumed after transplant.

False. Normal activities can be resumed after consulting w/physician. Avoid vigorous activity.

Central Venous Pressure

Pressure of blood in thoracic vena cava near R. atrium

Pulmonary Artery Pressure (PAP)

Pressure to pump blood from heart to lungs | Normal: 14 mmHg

Pulmonary HTN

PAP of 25-30 mmHg

Normal MAP

70-110 mmHg

Intra-aortic Balloon Counter Pulsation (IABP) (3)

Balloon located in descending aorta. Inflated at onset of diastole Deflated at onset of systole

Uses of IABP (4)

Wean from bypass Heart failure Cariogenic shock MI

Conditions for Ventilation

Respiratory depression Inspiratory muscle fatigue Inspiratory muscle weakness Severe hypoxemia/Lung parenchymal disease

Modes of Positive Air Pressure

``` Intermittent Mandatory Ventilation (IMV) Pressure Support Ventilation (PSV) Positive End Expiratory Pressure (PEEP) Constant Positive Airway Pressure (CPAP) Inspiratory hold ```

What is proper FiO2?

21%, higher if sicker

Term: IMV

Regular breaths scheduled | Adjusted to pt need

Term: PSV

Pt initiates breath and ventilator delivers preset value support

Term: PEEP

Pressure support during inspiration to keep alveoli from collapsing Higher = more ill

Term: CPAP

Helps keep airway open so they don't collapse | Use for vent weaning

Indications for Ventilation (4)

Pulmonary atelectasis Inability to clear secretions Hypoventilation Failure of MDI/Nebulizer

Term: Tracheostomy

Artificial opening into the trachea for tube insertion

Term: Tracheotomy

Incision into trachea through skin to create tracheostomy

Indications for Tracheostomy

Temporary for operation (protect airway from swelling) Post-laryngectomy Provide airway access when on ventilator Post Facial trauma

Indications for Intubation

Need for positive pressure ventilation Protect against aspiration of GI contents Neuromuscular paralysis Surgical for head, thorax, abdomen

Lung & Heart Transplant Flashcards

(48 cards)