Term
| What does heterotopic transplantation mean? |
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Definition
| 2 hearts in the body at the same time |
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Term
| What does orthotopic transplantation mean? |
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Definition
| Take the bad heart out and put the good/new one in |
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Term
| What is the primary indication for a thoracic organ transplantation? |
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Definition
| Progressive terminal cardiopulmonary dz with limited life expectancy |
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Term
| Name the top 3 reasons in which the majority of heart transplants are performed. |
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Definition
1. CAD
2. Myocardial damage
3. Cardiomyopathy |
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Term
| The majority of lung transplants are performed in patients with what? |
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Definition
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Term
| This is an indication for heart and lung repeat transplantation |
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Definition
| Failure of transplanted organ |
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Term
| What all has to be done for a person to be a candidate for a transplantation |
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Definition
1. an evaluation must occur for acceptance onto the transplant list
2. candidate must be able to comply with a complicated medical regimen and have sufficient social support
3. style of coping with stressors inherent in waiting period may predict aspects of QOL
4. caregiver stress
5. results of eval is compiled by a transplantation coordinator |
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Term
| What kinds of factors affect the ranking in which the person is placed on the transplant list? |
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Definition
Tissue Match
Blood Type
Length of time on list
Immune status
Distance between recipient and donor |
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Term
| The priority of lung transplantation list in maintained by who? |
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Definition
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Term
| Recipient of what age or younger are ranked first by ABO blood status? |
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Definition
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Term
| What type of score are the pts provided with that determines their priority on the transplant list? |
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Definition
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Term
| List the 5 parts to the PT eval related to lung transplant |
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Definition
1. Similar to any cardiopulmonary medical or surgical pt
2. Lung transplantation candidate - need to assess efficacy of airway clearance techniques
3. Assessment of aerobic capacity / endurance with exercise and activity using maximal test
4. Test results serve as basis for prescribing a program and provide useful info to the transplantation team
5. Exercise may be contraindicated in pts with primary pulmonary hypertension |
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Term
| Most lung centers require participation of candidates in what? |
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Definition
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Term
| Recommendation of _ rehab is made on an individual basis |
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Definition
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Term
| Name some components of the preoperative rehab |
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Definition
Pt/family education
cardiovascular endurance training
musculoskeletal strength |
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Term
| What is the goal of preoperative rehab? |
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Definition
| Improve or prevent deterioration of candidate's physical condition |
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Term
| In preoperative rehab, typically the level of participation in endurance activities will be limited to minimal levels of what? |
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Definition
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Term
| This device is used to bridge the pt |
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Definition
LVAD
Left Ventricular Assistive Device |
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Term
| How often are most pts able to participate in exercise in the preoperative rehabilitation? |
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Definition
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Term
| Name 4 factors related to transplant unsuitability |
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Definition
1. Pt did not meet criteria for organ system failure
2. Presence of contraindications limits potential for success
3. Decreased overall benefits for the pt from transplantation
5. Pt opted for more conservative surgical or medical management |
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Term
| With lung volume reduction surgery, how much of the lung is removed? |
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Definition
| 20-30% of volume of each lung |
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Term
| What is the goal of lung volume reduction surgery? |
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Definition
| To improve thoracic distention and chest wall mechanics |
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Term
| What do the results of the national emphysema treatment trial depend on? |
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Definition
| exercise capacity and what lobe is involved |
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Term
| Name the 4 categories for the national emphysema treatment trial |
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Definition
1. Low ex capacity / Upper lobes
2. High ex capacity / Upper lobes
3. Low ex capacity / Lower lobes
4. High ex capacity / Lower lobes |
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Term
| This results in a lower mortality rate with LVRS |
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Definition
| Low ex capacity / upper lobes |
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Term
| This shows no difference in mortality, but better outcomes |
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Definition
| High ex capacity / upper lobes |
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Term
| This results in a similar mortality rate |
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Definition
| Low ex capacity / lower lobes |
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Term
| This results in a higher mortality with LVRS |
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Definition
| High ex capacity / lower lobes |
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Term
| A tightly fitting nasal mask to deliver positive airway pressure during inspiration and exhalation. Indicated for pts with signs of respiratory failure despite maximal drug and O2 therapy |
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Definition
| Noninvasive ventilation or BiPAP |
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Term
| Pt with this tend to deteriorate in medical status quickly |
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Definition
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Term
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Definition
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Term
| Implantable electrically power device that provides permanent support of systemic circulation. Pt typically is able to resume ADLs and exercise program |
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Definition
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Term
| Destination VAD - patients who have __ year life expectancy, not a candidate for tranplantation |
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Definition
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Term
| Fatigue-resistance skeletal ms is wrapped around the pts heart and stimulated electrically |
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Definition
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Term
| Also known as piggyback. This is where the native heart is not removed. The donor heart is connected to the native heart via right/left atria |
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Definition
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Term
| The complete excision of the recipient atria with complete atrioventricular transplantation, bicaval and pulmonary venous anastomoses |
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Definition
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Term
| Biatrial anastomoses whereby donor and recipient atrial cuffs are sewn together |
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Definition
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Term
| This leaves the recipient SA node intact, which remains functional; donor heart SA is denervated. Two separate P waves are seen on ECG |
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Definition
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Term
| With a heart transplant, the pts nerves are denervated so they can no longer feel chest pain. What can they do to be aware of chest pain or discomfort in the future? |
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Definition
| Look for other signs and symptoms such as diaphoresis, SOB, or dyspnea on exertion |
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Term
| Name 3 ways to harvest donor lungs |
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Definition
1. Pulmonary veins are detached from heart with cuff of left atrium
2. Pulmonary arteries are transected
3. Lungs removed en bloc, divided into separate right and left lungs |
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Term
| What is the preferred procedure for lung transplantation? |
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Definition
| Use of mainstem bronchial anastomoses, bilateral anterior throacotomies or transsternal bilateral thoracotomy (clanshell) |
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Term
| What type of thoracotomy is done for a single lung transplant? |
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Definition
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Term
| If the heart is denervated, how will the heart know when to increase because the pt is exercising? |
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Definition
| Catecholamine circulation. This is why cool down is very important and needs to be done longer because you should give your body enough time to realize it is done exercising and decrease the catecholamines |
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Term
| The majority of medications consist of ___ agents and drugs targeting side effects of these agents |
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Definition
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Term
| This regimen in necessary to prevent rejection of the donor organ. |
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Definition
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Term
| Induction therapy is where you get a strong dose of immunosuppressives. What are some advantages of this? |
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Definition
| Reduce rejection, decrease risk of briochiolitis obliterans (which is a long term complication of transplants) |
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Term
| Induction therapy is where you get a strong dose of immunosuppressives. What are some advantages of this? |
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Definition
| Reduce rejection, decrease risk of briochiolitis obliterans (which is a long term complication of transplants) |
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Term
| What are some disadvantages of induction therapy? |
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Definition
| Increase incidence of malignancy and infection; increase the cost of transplantation |
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Term
| Name 3 things to watch for as the pt responds to activity postoperatively. |
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Definition
1. Note pt had undergone a major change in cardiovascular physiology
2. Understanding the change in physiology allows for proper application of precautions
3. Common changes include improvements in hemodynamic function |
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Term
| This initially occurs following heart transplant; infrequent with isolated lung transplant |
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Definition
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Term
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Definition
| Donor heart responds in the same manner as the denervated heart; native heart is still innervated, but attention should be on the donor hearts response |
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Term
| After transplantation, why is there a delayed reaction of the denervated heart? |
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Definition
| it requires an adequate warm-up and cool down (catecholamine) |
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Term
| After a heart transplant, HR monitoring no longer an an accurate measure of exercise intensity, so what is? |
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Definition
| RPE (want it between 12 and 14 |
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Term
| After a heart transplant, what is the importance of monitoring BP during exercise? |
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Definition
| HTN is a concern due to likelihood of developing ischemia |
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Term
| Does HTN occur after lung transplant? |
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Definition
| Yes, but lower incidence than heart transplant |
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Term
| After __ transplant, maximum O2 uptake and exercise capacity improve significantly, but still remain below predicted values |
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Definition
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Term
| After transplant, exercise will be limited mainly due to what 6 things? |
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Definition
HTN
Ms atrophy
Pretransplant changes
Suboptimal nutrition
deconditioning |
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Term
| PT evaluation is initiated in ICU how soon after sx? |
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Definition
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Term
| Why is protective isolation done after sx? |
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Definition
| Immunosuppression (see these pts first and do not see them if you are sick) |
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Term
| __ pts are initially intubated and mechanically ventilated. They are on multiple medications, multiple IV lines, chest drainage tubes, endocardial pacemaker wires, urinary catheter, and multiple monitoring lines |
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Definition
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Term
| What are the PT goals in the post operative inpatient phase? |
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Definition
Improve function and QOL
Specifically functional abilities in self-care and mobility |
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Term
| In ICU after a heart transplant, name 5 things the PT will examine and focus on |
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Definition
1. Impaired gas exchange
2. Airway clearance
3. Effects of prolonged static positioning during sx
4. Pain
5. Mobility restrictions |
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Term
| In ICU, after a heart transplantation, how is exercise started? |
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Definition
| Supine, then progress to sit-to-stand |
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Term
| What are 2 major education topics the PT will focus on in ICU setting after heart transplant? |
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Definition
Safety
Correct performance of exercise |
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Term
| Name 3 possible complications in acute phase after heart transplant. |
|
Definition
1. Bacterial infections
2. Nonspecific graft failure
3. Acute rejection |
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Term
| Lung transplantation typically begins 1st day post-op in ICU. PT will look at cardiopulmonary conditioning, and the problems and goals are similar to the heart transplant ones. PT will make sure to pay attention to changes in the lungs caused by what? |
|
Definition
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|
Term
| Name 4 main focuses of the PT on lung transplant in ICU setting |
|
Definition
Pulmonary hygiene
Optimal positioning
Mobilization
Cough effort |
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Term
| After the pt leaves ICU, that is the PT focusing on? |
|
Definition
-Ventilation and Airway clearance for optimal oxygen transport
-Thoracic mobility
-Breathing exercises |
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Term
| Name the discharge goals after a lung transplantation |
|
Definition
| Independence in self-care, secretion clearance, increased thoracic mobility, general strength and endurance, ability to participate in HEP |
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|
Term
| Name some possible complications following lung transplantation. |
|
Definition
-Infection
-Ischemia-reperfusion injury
-Acute graft failure
-Acute rejection
-Symptomatically, infection and acute rejection are noted to have low-grade fever and leukocytosis
- |
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Term
| This phase begins following hospital discharge and continues until discharge from formal rehab program - typically 6 weeks |
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Definition
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Term
| What are the discharge goals from the post-operative outpatient phase? |
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Definition
-Functional capacity improved to allow return to normal activities (work/school)
-Achieve goals - competent with self-monitoring and independent in HEP |
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|
Term
| What test is typically used to determine the exercise prescription for the post-operative outpatient phase? |
|
Definition
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|
Term
| What are 7 S&S of Acute Rejection |
|
Definition
Low grade fever
Increase in resting BP
Hypotension w/activity
Myalgia
Fatigue
Decreased exercise tolerance
Ventricular dysrhythmias |
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