Lung Transplant Evaluation

Lung Transplant Evaluation

Patient Information:

Name:

Date of Birth:

Gender:

Medical Record Number:

Referring Physician:

Introduction

The purpose of this form is to provide a means for evaluating the level of preparation that has taken place before a lung transplant procedure and also to assess the outcome or result of the procedure once it has been executed.

Overview of Evaluation

This evaluation provides a well-organized assessment where we thoroughly examine and evaluate the health of the patient before and after the transplant procedure. Furthermore, it also enables us to determine the success rate of the transplant procedure.

Evaluation Criteria

Criteria for this evaluation include the patient's health status pre- and post-transplant, surgical procedure effectiveness, post-operation recovery, and lung function. Each criterion is articulated & assessed in detail in the evaluation table.

Criteria

Description

Rating

(1-5)

Pre-Transplant Health Status

Evaluate the overall health condition of the patient before the lung transplant procedure.

Surgical Procedure Effectiveness

Assess the efficacy of the transplant procedure.

Post-Operation Recovery

Evaluate the patient's health and recovery progress after the operation.

Post-Transplant Lung Function

Assessment of the functionality of the transplanted lung, post-operation.

Immunosuppressive Medication Management

Assess how effectively the patient is managing and responding to immunosuppressive medications post-transplant.

Incidence of Rejection

Evaluate the occurrence and severity of rejection episodes post-transplant.

Infection Control

Assess the patient's susceptibility to infections and their ability to manage and prevent them post-transplant.

Quality of Life

Measure the patient's subjective perception of their quality of life post-transplant.

Cardiovascular Health

Evaluate the impact of the transplant on the patient's cardiovascular system.

Pulmonary Rehabilitation Participation

Assess the patient's engagement in pulmonary rehabilitation programs post-transplant.

Psychological Support

Evaluate the provision and effectiveness of psychological support services for the patient and their caregivers.

Nutritional Status

Assess the patient's nutritional intake, absorption, and overall nutritional status post-transplant.

Pulmonary Function Tests

Regularly conduct pulmonary function tests to objectively measure lung function parameters post-transplant.

Long-Term Complications

Monitor and assess the development of long-term complications associated with lung transplantation.

Rating Scale

1 - Poor
2 - Below Average
3 - Average
4 - Above Average
5 - Excellent

Additional comments and notes:

Comments

Evaluation Templates @ Template.net