NUR 426 EXAM 1
diagnosis 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 - answer what are triggers for a
referral for a lung transplant?
to 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 - answer what is the goal of a lung
transplant?
true – answer 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 - answerif a CF pt receives a lung transplant, will their disease still
remain?what may happen?
a patients status where they are sick enough to need a transplant but they are well
enough to survive the surgery - answerwhat does a transplant window refer to?
too sick, too healthy (may have frequent visits to see if pt condition declines over time),
obesity, malnutrition, lack of social support, lack of determination, evidence of cancer,
multi-system organ failure (exception is dual organ transplant) - answerwhat are some
CI for lung transplant?
when a patients QOL is not acceptable, when they are emotionally ready, when they are
consistently hypercapnic, inc frequency of hospitalizations, rising pulm art pressure, life
threatning hemopytsis, rapid decline in lung function and high o2 demand with little
reserve - answerwhen is the right time to get placed on the transplant list?
excellent at managing complex med schedules, accustom to sinus rinses and airway
clearance, typically have a support system, well managed pre transplant, those who are
good at self care and are involved in their care have best outcomes - answerwhy are CF
patients typically good transplant pt?
united network of organ sharing-- blood type, size and lung allocation score 0-100
(higher number is a sicker patient) - answerthis organization matches donors with
potential recipients-- what are the requirements for matching?
false - answerT/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 - answerduring post op recovery from a lung transplant, what kind of
nursing care may be required?
pain medication can impair respiratory rate so manage pain with a 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 - answerwhat is important pt
teaching post transplant?
this organ is the only organ directly exposed to the outside world - answerwhy do lung
transplants typically have the worst pt outcomes?
infection and cancer (especially skin) - answertransplant 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 - answerwhat are the 3 immunosuppressive drugs that
transplant pt are put on?
infection-- get immunizations every year-- new onset diabetes due to chronic steroid use
and hyperglycemia-- alter diet, monitor BS and obtain insulin - answerwhat are some
post transplant complications that may arise?
nausea - answerwhat is the leading 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 - answerwhat is the discharge
teaching for transplant pt?
rejection - answerthis 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 decrease in lung function
admin o2, obtain blood cultures, admin atbx/ steroids, perform bronchoscopy, assess
nutrition, get lab work - answerA 34 year old female with CF status post bilateral lung
transplant presents to UED with general complaints of not feeling well. Upon
assessment, the nurse finds that her weight is down 12 pounds from her previous
measurement one month prior. Her O2 saturation is 89% on room air. The physician
, orders a PFT and the results show a drop in FEV1 from 68% to 55%. The nurse can
expect several treatment plans. Let's prioritize them:
palliative care - answerthis type of care is specialized medical care for people with
serious illness and can follow a pt through diagnosis, tx and end of life-- it is a
multidisciplinary approach that focuses on providing pt with relief from symptoms and
stress- main goal is to improve quality of life for both the patient and family-- can be
concurrent with curative treatment-- can be seen as outpatient visits or inpatient units
hospice care - answerthis type of care 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 multidisciplinary approach to treating symptoms of
disease at the end of life-- it is paid by medicare and most insurance-- appropriate
medical equipment is covered by the company-- assists with spiritual needs and
bereavement-- covers a home care aide to help with ADLs-- has respite care options--
medications are covered-- covers inpatient care if pt rapidly declines and has severe
symptoms that cannot be managed in the home
home health - answerthis type of care is based on insurance coverage and a signed
order of medical necessity is required-- assists in management of social, economic and
emotional factors by obtaining community resources, counseling and education, long
term planning and crisis intervention-- chaplain in not available, a home care aide is
covered if it is part time or intermittent, medications are covered by the patient or
insurance company, continuous care is not available, bereavement care is not available,
inpatient care is not covered by company, medical supplies are covered as ordered by
the physician, pt must be homebound***
home health nursing - answerthis type of care is community based nursing that is
important for post-hospital care following an acute illness episode or exacerbation of a
chronic illness-- this serves a population that is moving towards health restoration and
full functionality-- a case manager oversees the total health care plan for this patient
and ensures a holistic and interdisciplinary approach in the care received-- covered by
medicare, medicaid, private insurance and direct pt payment-- documentation is used in
OASIS format to provide outcome based care and to identify factors that led to
rehospitalization--- telehealth is also used in this type of nursing to exchange
information such as vitals and blood sugar
home health - answerthis type of nursing care includes skilled assessment of the
patient's physical, psychological, social, and environmental status. Nursing interventions
may include intravenous (IV) therapy and injections, parenteral nutrition, venipuncture,
catheter insertion, pressure ulcer treatment, wound care, ostomy care, and patient and
family teaching-- medication management and reconciliation is a huge role in this type
of nursing
diagnosis 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 - answer what are triggers for a
referral for a lung transplant?
to 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 - answer what is the goal of a lung
transplant?
true – answer 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 - answerif a CF pt receives a lung transplant, will their disease still
remain?what may happen?
a patients status where they are sick enough to need a transplant but they are well
enough to survive the surgery - answerwhat does a transplant window refer to?
too sick, too healthy (may have frequent visits to see if pt condition declines over time),
obesity, malnutrition, lack of social support, lack of determination, evidence of cancer,
multi-system organ failure (exception is dual organ transplant) - answerwhat are some
CI for lung transplant?
when a patients QOL is not acceptable, when they are emotionally ready, when they are
consistently hypercapnic, inc frequency of hospitalizations, rising pulm art pressure, life
threatning hemopytsis, rapid decline in lung function and high o2 demand with little
reserve - answerwhen is the right time to get placed on the transplant list?
excellent at managing complex med schedules, accustom to sinus rinses and airway
clearance, typically have a support system, well managed pre transplant, those who are
good at self care and are involved in their care have best outcomes - answerwhy are CF
patients typically good transplant pt?
united network of organ sharing-- blood type, size and lung allocation score 0-100
(higher number is a sicker patient) - answerthis organization matches donors with
potential recipients-- what are the requirements for matching?
false - answerT/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 - answerduring post op recovery from a lung transplant, what kind of
nursing care may be required?
pain medication can impair respiratory rate so manage pain with a 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 - answerwhat is important pt
teaching post transplant?
this organ is the only organ directly exposed to the outside world - answerwhy do lung
transplants typically have the worst pt outcomes?
infection and cancer (especially skin) - answertransplant 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 - answerwhat are the 3 immunosuppressive drugs that
transplant pt are put on?
infection-- get immunizations every year-- new onset diabetes due to chronic steroid use
and hyperglycemia-- alter diet, monitor BS and obtain insulin - answerwhat are some
post transplant complications that may arise?
nausea - answerwhat is the leading 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 - answerwhat is the discharge
teaching for transplant pt?
rejection - answerthis 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 decrease in lung function
admin o2, obtain blood cultures, admin atbx/ steroids, perform bronchoscopy, assess
nutrition, get lab work - answerA 34 year old female with CF status post bilateral lung
transplant presents to UED with general complaints of not feeling well. Upon
assessment, the nurse finds that her weight is down 12 pounds from her previous
measurement one month prior. Her O2 saturation is 89% on room air. The physician
, orders a PFT and the results show a drop in FEV1 from 68% to 55%. The nurse can
expect several treatment plans. Let's prioritize them:
palliative care - answerthis type of care is specialized medical care for people with
serious illness and can follow a pt through diagnosis, tx and end of life-- it is a
multidisciplinary approach that focuses on providing pt with relief from symptoms and
stress- main goal is to improve quality of life for both the patient and family-- can be
concurrent with curative treatment-- can be seen as outpatient visits or inpatient units
hospice care - answerthis type of care 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 multidisciplinary approach to treating symptoms of
disease at the end of life-- it is paid by medicare and most insurance-- appropriate
medical equipment is covered by the company-- assists with spiritual needs and
bereavement-- covers a home care aide to help with ADLs-- has respite care options--
medications are covered-- covers inpatient care if pt rapidly declines and has severe
symptoms that cannot be managed in the home
home health - answerthis type of care is based on insurance coverage and a signed
order of medical necessity is required-- assists in management of social, economic and
emotional factors by obtaining community resources, counseling and education, long
term planning and crisis intervention-- chaplain in not available, a home care aide is
covered if it is part time or intermittent, medications are covered by the patient or
insurance company, continuous care is not available, bereavement care is not available,
inpatient care is not covered by company, medical supplies are covered as ordered by
the physician, pt must be homebound***
home health nursing - answerthis type of care is community based nursing that is
important for post-hospital care following an acute illness episode or exacerbation of a
chronic illness-- this serves a population that is moving towards health restoration and
full functionality-- a case manager oversees the total health care plan for this patient
and ensures a holistic and interdisciplinary approach in the care received-- covered by
medicare, medicaid, private insurance and direct pt payment-- documentation is used in
OASIS format to provide outcome based care and to identify factors that led to
rehospitalization--- telehealth is also used in this type of nursing to exchange
information such as vitals and blood sugar
home health - answerthis type of nursing care includes skilled assessment of the
patient's physical, psychological, social, and environmental status. Nursing interventions
may include intravenous (IV) therapy and injections, parenteral nutrition, venipuncture,
catheter insertion, pressure ulcer treatment, wound care, ostomy care, and patient and
family teaching-- medication management and reconciliation is a huge role in this type
of nursing
