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A 59-year-old male was admitted to the hospital 7 days ago because of worsening congestive heart failure (CHF). The patient was initially managed medically with diuretics and positive inotropes but ultimately required left ventricular assist device (LVAD) implantation to achieve hemodynamic stability. During this hospital admission, the patient was placed on the heart transplant list as Status 1B. You are consulted one day status/post LVAD placement for progressive mobility and assistance with discharge planning. The patient's past medical history consists of CHF, hypertension (HTN), Type 2 diabetes mellitus (DM), coronary artery disease (CAD), and asthma. He is married and lives in a single-story home with four steps to enter. His three adult children live nearby and are supportive.

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What are the examination priorities?

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Based on his health condition, what do you anticipate may be the contributors to activity limitations?

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What are possible complications interfering with physical therapy?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy examination and/or interventions?

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Describe a physical therapy plan of care based on each stage of the health condition.

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  • CONGESTIVE HEART FAILURE (CHF): Inability of the left ventricle to effectively pump blood to meet the metabolic demands of the body; as a result, blood pools in the pulmonary vasculature causing congestion and shortness of breath
  • HEART TRANSPLANT: Replacement of a chronically diseased heart with a donated heart from a recently deceased individual
  • STATUS 1B: One of several designations defined by the United Network of Organ Sharing, a national nonprofit organ sharing system established by federal United States law in 1984 to classify patients based on different priorities for organ transplantation; patients classified as Status 1B are second in priority for an organ transplant (behind patients classified as Status 1A), have a life expectancy of more than 7 days without heart transplantation, and may have a VAD for more than 30 days or receive continuous intravenous inotropes in a nonintensive care setting
  • VENTRICULAR ASSIST DEVICE (VAD): Mechanical device that assists the left, right, or both ventricles to improve cardiac output; the pump mechanism of the VAD may be outside or inside the body

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  1. Describe the indications for LVAD implantation.

  2. Understand the mechanisms involved with the mechanical circulatory assist provided by LVAD.

  3. Identify adverse drug reactions (ADRs) of common heart medications that may affect physical therapy examination and/or interventions.

  4. List potential complications for a patient who is status/post LVAD implantation.

  5. Outline the physical therapy examination for this patient population.

  6. Design a plan of care for the individual with mechanical circulatory support.

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PT considerations during management of the individual status/post LVAD implantation:

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  • General physical therapy plan of care/goals: Prevent or minimize loss of range of motion (ROM), ...

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