Question

Mr. P. is a 35-year-old man with a history of cystic fibrosis. He is married and has a young son. His chronic illness has been medically managed at a tertiary center 150 miles from his home. However, his pulmonary status has progressively deteriorated over the past 3 months, and he now requires continuous oxygen therapy along with his standard medical management. Being placed on the transplant list is one option proposed to Mr. P. and his wife. Questions 1. Because Mr. P. has been successfully managed for treatment of the cystic fibrosis, Mr. and Mrs. P. weigh the pros and cons of placing him on the transplant list. Why might they be concerned about a lung transplant for Mr. P.? 2. What is the lung allocation score used in evaluating candidates? Why is this score helpful in determining who gets priority for a transplant? 3. Mr. and Mrs. P. agree to his being placed on the transplant list as his condition is progressively worsening. Shortly thereafter, Mr. P. is hospitalized in the tertiary care center, and mechanical ventilation is imminent if a transplant is not performed. Organs become available; however, they are positive for cytomegalovirus (CMV). Given the criteria for donors, why are CMV-positive lungs being considered? 4. Mr. P. agrees to the transplant and undergoes successful surgery. He is extubated within 12 hours of surgery. What are some important postoperative nursing interventions after extubation?

Answer 1

Answer :

• Many people with cystic fibrosis face the possibility of lung transplant .
• Lung transplantation can extent and improve the quality of life ,but it involves an extensive evaluation process and a commitment to living the lifestyle required to keep new lungs healthy.
• Lung allocation score is a calculated score derived for each patient over the age of 12 years which is utilised to predict wait list survival probability with and without a lung transplant .
• Patient with cystic fibrosis had documented higher wait list mortality compared to other lung diseases .
• The creation of the lung allocation score was intended to facilitate allocation of short supply of available donor lungs to individuals with more urgent need .
• The over all median time for lung transplantation is less than 6 months .
• Candidates with LAS more than 50 have a median wait time of 1 month .the LAS more than 50 May have short wait time .
• Mr. P is suffering with cystic fibrosis and his condition is progressively worsening ,so he need to have lung transplantation for survival of Mr. P .
• Lung transplantation will increase the survival rate of Mr. P and he can able to lead happy life for some years .
• According to Canadian CF patients 67% of patients were still alive nine years of a lung transplant .
• People with cystic fibrosis who have been infected by cytomegalo virus are more likely to experience faster disease progression and reach end stage lung disease compared to those who have not been infected.

Some post operative interventions :

• Monitor vital signs such as ECG , ABG values , urine output ,02 level analysis and chest tube drainage .
• Lung sounds are auscultated .
• Pain control is important to allow deep breathing and coughing with chest physiotherapy .
• Fluids are restricted.
• Serum electrolytes ,CBC obtained daily .
• Isolation is important
• Monitor the patient for clinical manifestation of infection such as change in vital signs , fever ,local infection, change in respiratory status ,excessive secretion,tachypnea and dyspnea.
• Check for bleeding .