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NUR 426 EXAM 1 QUESTIONS AND CORRECT ANSWERS
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NUR 426 EXAM 1 QUESTIONS AND CORRECT ANSWERSDiagnosis of interstitial lung disease, FEV1 less than 30%, frequent of recurrent
hemoptysis, (typical end stage CF pt), rapid decline in functional ability, rapid drop in
FEV1 even if it isnt less than 30 despite optimal therapy
What are triggers for a referral for a lung transplant?
improve quality of life and have pt set goals and improve respiratory function-- gradual
increase/ improvement of FEV1, decreased respiratory exacerbations, no more
continuous oxygen and increase in activity
What is the goal of a lung transplant?
true
T/F: transplant is not a cure, its a treatment
yes-- their donor lungs could get the disease and they may need a re-transplant-- the
body will still have other CF manifestations such as pancreatic insufficiency, absorption
issues and sinusitis
if a CF pt receives a lung transplant, will their disease still remain? what may happen??
a patient's status where they are sick enough to need a transplant but they are well
enough to survive the surgery
what is a transplant window?
too sick, too healthy pt. may have to come in frequently to check if their condition
worsens over time, obesity, malnutrition, lack of social support, lack of motivation,
presence of cancer, multi-system organ failure except for dual organ transplant
what are some CIs for lung transplant?
when a patient's QOL is not acceptable, when they are emotionally ready, when they are
consistently hypercapnic, increasing frequency of hospitalisations, rising pulmonary
arterial pressure, life-threatening hempotysis, rapid decline in lung function and high O2
requirements with little in reserve
,When is the appropriate time to get placed on to the transplant list?
excellent managing complex med schedules, accustom to sinus rinses and airway
clearance, usually have a support system, well managed pre transplant, those that are
good at self care and are involved in their care have best outcomes
why are CF patients typical good transplant pt?
united network of organ sharing-- blood type, size and lung allocation score 0-100
(higher number is a sicker patient)
this organization matches donors with potential recipients-- what are the requirements
for matching?
T/F: if a CF patient receives a transplant, they can receive a single lobe or one lung
monitoring PA pressure with a swans gans catheter, monitor central venous pressure,
intake and output and pertinent lab work-- monitor for dysrhythmias, perform vent
maintenance, care for chest tubes, foleys, CVL's and arterial lines, and pain
management
During postoperative recovery from lung transplantation, what type of nursing care
might be required?
Pain medication can depress respiratory rate so manage pain with variety of methods,
early ambulation leads to better outcomes and shorter hospital stay, adequate nutrition
will promote wound healing and prevent muscular atrophy and proper breathing
techniques need to be learned as well as how to use incentive spirometry and effectively
clear the airway, increase exercise as tolerated
What is important PT teaching post transplant?
,this organ is the only organ directly exposed to the outside world
why do lung transplants typically have the worst pt outcomes?
infection and cancer (especially skin)
transplant patients will be on immunosuppressive therapy for life to reduce the chance
of rejection. what does this put them at risk for?
prograf, prednisone and cellcept
what are the 3 immunosuppressive drugs that transplant pt are put on?
infection-- vaccinations yearly-- new onset diabetes secondary to chronic use of steroid
and hyperglycemia-- dietary changes, BS monitoring, and insulin
what are some post transplant complications that may occur?
nausea
what is the most common symptom of rejection in transplants?
medication compliance, signs and symptoms of rejection and when to report, avoid sick
contacts, no raw meat or shellfish allowed in diet, monitor BP and blood sugar, avoid
animals like cats and birds, wear sunscreen and protective outerwear and their is an
increase risk of infection so take proper precautions
what is the discharge teaching for transplant pt.?
rejection
This is an immune response to a donor organ. During the first year, medication can be
, tweaked to pull out of this state. TX with ATBX, IV steroids or plasmapheresis. Long term
complications include bronchiolitis obliterans syndrome which causes a decline in lung
function.
Admin O2, obtain blood cultures, admin ATBX/steroids, perform bronchoscopy, assess
nutrition, get lab work
A 34-year-old female with CF, s/p bilateral lung transplant presents to the UED with
generalized complaints of not feeling well. On assessment, the nurse notes she is down
12 pounds from the previous month. Her O2 saturation is 89% on room air. The
physician orders a PFT and the results indicate a drop in FEV1 from 68% to 55%. The
nurse can expect several plans of treatment. Let's outline them in priority order:
Palliative care
this is specialized medical care for persons with serious illness and may accompany a pt
through diagnosis, tx, and end of life; it is a multidisciplinary approach that focuses on
the pt and providing them with relief from symptoms and stress. The main goal is to
improve the quality of life for the pts. and their families. Can be provided concurrently
with curative treatment; may occur as an outpatient visit or inpatient units
Hospice care
This is specialized care for serious illness at the end of life. It is available to anyone who
is no longer receiving aggressive curative treatment. An MD must certify that a patient is
6 months away from dying if the disease runs its normal course. It is a multidiscipline
approach to treatment of symptoms of disease at the end of life. It is paid by medicare
and most insurances. Company covers appropriate medical equipment. Assists with
spiritual needs and bereavement. Covers a home care aide to assist with ADLs. Has
options for respite care. Medications are covered. Covers inpatient care if pt rapidly
declines and has severe symptoms that cannot be managed in the home.
home health
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