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Flashcards in transplant pt 2 Deck (41):
1

heart transplant post op

pt w/ chest tube, arterial line, pulm A catheter
keep HOB up to 30 deg and turn pt q 1-2 hrs
HR maintained 90-110 bmp
systolic 90 mmHg

2

sternotomy precautions

no pushing, pulling, or lifting >10 lbs

3

heart transplant signs of rejection

hypotension
pericardial friction rub
ventricular S3 gallop
decreased CO
peripheral edema
pulm crackles
jugular vein distension
new cardiac arrhythmias

4

heart transplant - isolation

positive pressure flow
mask, handwashing

5

phase I cardiac rehab

usually 2-3 days post op
stable hemodynamically
active supine ex w/out resistance --> amb --> stationery bike
vitals and stomps are pre, during, post ex
EKG monitored for changes w/ acitivity

6

donor heart denervated

higher than normal resting HR
no symp/parasymp regulation
Hr does not vary w/ respiration, position, temp

7

donor heart and exercise

warmup/cool down w/ ex 5-10 mins
HR increase w/ ex w/ 3-5 min delay
HR remains elevated longer after ex

8

peak HR in transplant pts

lower than same age pts

9

borg scale, heart pts

RPE
aim for 11-13

10

heart - monitor BP

pre, during, post-activity
recipients are higher than normal
systolic: 80-150
diastolic <90

11

orthostatic hypotension

lacks reflex compensation
enc slow position changes

12

assess c/o angina or sternal pressure

instead monitor dyspnea, lt headedness, increase RPE, arrhythmias
pain from incision or sx manipulation

13

heart - monitor daily

changes and c/o w/ ex
fatigue is a sign or rejection and ischemia, so note significant changes and alert using ASAP

14

single lung

most common
indicated w/ all end-stage conditions except cystic fibrosis and bronchiectasis
anterolateral or posterolateral thoracotomy
utilizes cadaveric organ

15

double lung

bilateral anterior thoracotomy at 4th and 5th intercostal space w/ possible transverse sternotomy

16

indications for double lung

cystic fibrosis
bronchiectasis
pulm HTN

17

living donor lobar

bilateral lower lobes received from two compatible donors
donor lungs are enough to fill hemithorax

18

lung transplant post op

retrain cough and deep breathing - lungs are denervated

aggressive bronchopulmonary hygiene
after extubation
PT, RN, Nsg all take part

19

post op infection risk highest w/

lung transplant

20

lung transplant care

postural drainage
suctioning
vibration
gentle pervussion
diaphragmatic breathing
coughing
incentive spirometer

21

lung transplant therapy

check w/ nursing re: suctioning
sleep in reverse trendelenburg if pt is hemodynamically stable for postural drainage
turn double lung recipients every 1-2 hrs during first 24 hr period
decreased secretion retention
turn 20-30 deg and progress to 90 as tolerated

focus PT on increase LE strength and endurance

22

single lung its should lie

on non sx side

23

lung transplant - schedule Rx w/ regard to

bronchopulm hygiene, nebulizer use, pain meds

24

thoracotomy precautions

10 lbs lifting restriction
partial WB UE
use pillow to splint for incisional pain

25

respiratory isolation

gown, mask, gloves in room
amb in hallway w/ mask

26

lung - O2 sat

monitor w/ activity
>90% needed

27

bone marrow transplant

always from living donor

harvested from post/ant iliac crest or sternum

28

allogeneic bone marrow transplant

harvested from matching donor
donor does not have to be related
given immediately to pt after cytoredduction therapy

29

syngeneic bone marrow transplant

harvested from identical twin

30

autologous bone marrow transplant

harvested from pt when healthy
marrow is frozen and stored

31

peripheral blood stem cell harvest

allogenic or autologous
leukapheresis
may need three to seven harvests
may be from umbilical cord blood
received after high dose chemo and radiation
faster recovery of immune system and blood count
may cause fluid overload to lungs in recipient
hematological recovery takes 10-12 days

32

common symptoms after rein fusion - bone marrow transplant

fever
chills
nausea
HA
flushing

33

reverse protective isolation

neutrophil count <1,000/mm3

34

thrombocytopenic precautions - platelet count <50,000/mm3

may cause spontaneous bleeding

35

thrombocytopenic precautions - platelet count <50,000/mm3

exercise okay if asymptomatic

36

thrombocytopenic precautions - platelet count 20,000-30,000

light AROM w. NO resistance, amb as tolerated

37

PT concerns regarding transplant pts

coordinate therapy time w/ nursing
check labs daily
supine ex when applicable and cleared
encourage early amb as able

38

LE edema

typical after transplant sx
may be initially painful
shorter walks
assess need for AD

monitor vitals w/ activities

39

avoid restive UE ex w/ heart and lung pts

~6 weeks/ cleared by MD

40

HEP

educate re: warm up, cool down, monitoring symptoms, vitas

41

transplants and contact sports

no contact sports for life