Midterm 2 - Lecture 7b (Lung Transplants)

Question 1

describe the history of lung transplants

Answer 1

Question 2

candidates - general indicaition for lung transplants

Answer 2

Question 3

candidates - absolute contraindications for lung transplants

Answer 3

Question 4

candidates - relative contraindications for lung transplants

Answer 4

Question 5

describe the evaluation process for lung transplants

Answer 5

Question 6

describe what the initial Pt assessment does

Answer 6

File opening

Explanations of the LT/HLT process from physio perspective (pre, post, out-patient)

Information about current and past levels of physical activity limitations

Assessment

Oxygen needs

Education+++

Clinical impression of patient’s candidature

Question 7

what are the factors affecting the wait times for lungs?

Answer 7

Question 8

what would allow a pt to go on the emergency transplant list?

Answer 8

Question 9

what is the organ donor per million people died in canada compared to other countries?

Answer 9

Question 10

what are top causes of death of donor organs and reasons of refusal

Answer 10

Question 11

describe the PHYSIOTHERAPY FOLLOW-UP DURING WAITING TIME

Answer 11

Question 12

describe the surgery - frequency and duration

Answer 12

Question 13

describe the lung transplant

Answer 13

Question 14

describe the heart-lung transplant

Answer 14

Question 15

scars from transplants

Answer 15

Question 16

intensive care - how long do you stay there, PT intervention, extubation

Answer 16

Question 17

what is the post-op meds like?

Answer 17

Question 18

what are specific post-op complications for lung transplants?

Answer 18

Question 19

what are other complications for lung transplants?

Answer 19

Question 20

Pt interventions:

what are the sectors, what is the frequency, duration, and intensity?

Answer 20

Question 21

describe physio in intensive care

Answer 21

• From medical stabilization
• Without a prescription
• Discussion with the medical team in doubt
• Fields of treatment (Ventilation, Secretions, Mobility)
• Pt on mechanical ventilation (VS or VAC mode) (Deep breathing)
• Once extubated:
  ¤ Incentive inspirometer (5 min/hour)
  ¤ Coughing with splinting
  ¤ Active mobilisations UE’s and LE’s
  ¤ Sitting in bed -> on the edge of the bed -> in the chair

¤ Walking with rolling walker (Equipment management)

Question 22

describe when the pt transfers to the transplant unit from intensive care

Answer 22

Question 23

describe transplant unit interventions

Answer 23

• Increase walking endurance
• Progressive weaning of walking aid ̈ Stationary bike and/or treadmill
• Weight training LE’s and UE’s
• Stretching UE’s / neck / trunk
• Stairs training
• *** Focus on self-management ***
• Communication with team

Question 24

describe the discharge preparation process

Answer 24

Question 25

what are physical restrictions for pts? (as part of the discharge planning)

Answer 25

Question 26

look over the long temr medication list

Answer 26

_Bone density_ ¤ Vitamine D ¤ Calcium ¤ Biphosphonate (Actonel, Fosamax) ¤ Bone formation agent (Fortéo) _Miscellaneous_ ¤ Anti-Nausea (Gravol) ¤ Pain killers (Tylenol, Dilaudid, Empracet, MS Contin, Fentanyl patch) ¤ Gastric (Motilium, Pantoloc) ¤ Constipation (Lactulose, Senekot, Colace, glycerine) ¤ Diarrhea (Imodium) ¤ Diuretics (Lasix) ¤ Insulin

Question 27

describe pt follow-up immediately after hospital discharge

Answer 27

Question 28

describe the out pt PT follow-up (frequency, goals)

Answer 28

Question 29

what is the long-term surgical mortality rate?

Answer 29

Question 30

describe the progression of the lung and heart-lung transplant waiting list

Answer 30

Question 31

what are the 2016 stats on average age, length of hospital stay, and waiting time? (urgent and all)

Answer 31

Question 32

what are main causes of death after transplant?

Answer 32

Question 33

describe the relationship btw bronchiolitis obliterans and years lived with new lungs

Answer 33

Question 34

what are reasons for rehospitalization?

Answer 34

Question 35

describe rehospitalization physio follow-up

Answer 35

Question 36

describe the exvivo system

Answer 36

System from Sweden (Dr Stig Steen) More portable than the one in Toronto 2 system purchased by the CHUM (1 research, 1 at Notre-Dame for the patients) Operational since march 2014 2 transplants done in 2014 with the EVLP \*helps surgeon make call - can watch the lung on this machine to see how it does then make decision whether to use or not

Question 37

conclusion to lung transplant lecture

Answer 37