Acute Care Final Exam with Complete
Solutions
Adverse side effects to immunosuppressive drugs Correct Ans--prone to infection/cancers
-elevated blood sugar (DM)
-decreased bone density/osteoporosis
-elevated BP (fluid retention)
-easy bruising
-muscle loss/weakness
-delayed wound healing
Types of exercise programs important for pt post-transplant Correct Ans-aerobic and WB
exercises, also balance to reduce fracture and plyometrics
3 types of lung transplants Correct Ans--single lung
-double lung
-lobar
Primary indications for lung transplant Correct Ans--COPD with FEV1 < 20%
-CF with FEV1 < 30%
-bronchiectasis
-primary pulmonary htn
-idiopathic pulmonary fibrosis
,-alpha 1 anti trypsin deficiency (genetic cause for emphysema)
Criteria to be eligible for lung transplant Correct Ans--smoking cessation
-no infection
-no cancer
-adequate social support
-adequate mental function
-no history of medical non-compliance
-no other severe organ involvement
-age <65 yo
-6 MWT (need to be able to walk 600 feet in 6 min)
Procedure for lung transplant Correct Ans-bypass with open thoracotomy
Side effect after lung transplant Correct Ans-confusion
Pre lung transplant PT Correct Ans--6MWT
-WB
-endurance
-strength training
-spinal position, protection, and stabilization
,Post lung transplant impairments Correct Ans--decreased secretion clearance
-incisional pain
-decreased ROM in the UE
-limited LE strength
-decreased functional mobility
-decreased exercise tolerance
Post lung transplant PT interventions Correct Ans--bilateral shoulder ROM
-WB activities
-facilitation of normal diaphragmatic breathing
-endurance activities
-balance activities
-posture activities
-pt education (ex. plyometrics to maintain bone density)
Indications for cardiac transplant Correct Ans--cardiomyopathy
-EF < 20%
-valvular disease
-inoperable CAD/ischemic heart disease
-cardiac tumors w no evidence of spread
-congenital heart disease (peds)
-absence of reversible or surgically amenable heart disease
, -NYHA class III - IV symptoms despite optimal medical mgmt
-max oxygen consumption < 14 ml/kg/min
-estimated 1 year survival without transplant < 50%
Criteria for cardiac transplant Correct Ans--no active infection
-no irreversible liver, kidney, lung disease
-no malignancy
-no symptomatic PAD, CVD
-age < 65 yo
-no active substance abuse
3 types of cardiac transplant patient (class) Correct Ans-IA (sickest)
IB
2
Procedure for heart transplant Correct Ans--heart lung bypass
-old heart removed
-new heart vasculature anastamosed to great vessels
-removed from bypass
Post surgical concerns for heart transplant Correct Ans--denervation of vagus nerve (lose
sympathetic input)
Solutions
Adverse side effects to immunosuppressive drugs Correct Ans--prone to infection/cancers
-elevated blood sugar (DM)
-decreased bone density/osteoporosis
-elevated BP (fluid retention)
-easy bruising
-muscle loss/weakness
-delayed wound healing
Types of exercise programs important for pt post-transplant Correct Ans-aerobic and WB
exercises, also balance to reduce fracture and plyometrics
3 types of lung transplants Correct Ans--single lung
-double lung
-lobar
Primary indications for lung transplant Correct Ans--COPD with FEV1 < 20%
-CF with FEV1 < 30%
-bronchiectasis
-primary pulmonary htn
-idiopathic pulmonary fibrosis
,-alpha 1 anti trypsin deficiency (genetic cause for emphysema)
Criteria to be eligible for lung transplant Correct Ans--smoking cessation
-no infection
-no cancer
-adequate social support
-adequate mental function
-no history of medical non-compliance
-no other severe organ involvement
-age <65 yo
-6 MWT (need to be able to walk 600 feet in 6 min)
Procedure for lung transplant Correct Ans-bypass with open thoracotomy
Side effect after lung transplant Correct Ans-confusion
Pre lung transplant PT Correct Ans--6MWT
-WB
-endurance
-strength training
-spinal position, protection, and stabilization
,Post lung transplant impairments Correct Ans--decreased secretion clearance
-incisional pain
-decreased ROM in the UE
-limited LE strength
-decreased functional mobility
-decreased exercise tolerance
Post lung transplant PT interventions Correct Ans--bilateral shoulder ROM
-WB activities
-facilitation of normal diaphragmatic breathing
-endurance activities
-balance activities
-posture activities
-pt education (ex. plyometrics to maintain bone density)
Indications for cardiac transplant Correct Ans--cardiomyopathy
-EF < 20%
-valvular disease
-inoperable CAD/ischemic heart disease
-cardiac tumors w no evidence of spread
-congenital heart disease (peds)
-absence of reversible or surgically amenable heart disease
, -NYHA class III - IV symptoms despite optimal medical mgmt
-max oxygen consumption < 14 ml/kg/min
-estimated 1 year survival without transplant < 50%
Criteria for cardiac transplant Correct Ans--no active infection
-no irreversible liver, kidney, lung disease
-no malignancy
-no symptomatic PAD, CVD
-age < 65 yo
-no active substance abuse
3 types of cardiac transplant patient (class) Correct Ans-IA (sickest)
IB
2
Procedure for heart transplant Correct Ans--heart lung bypass
-old heart removed
-new heart vasculature anastamosed to great vessels
-removed from bypass
Post surgical concerns for heart transplant Correct Ans--denervation of vagus nerve (lose
sympathetic input)
