Free Lung Transplant Evaluation Template
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.
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Criteria |
Description |
Rating (1-5) |
|---|---|---|
|
Pre-Transplant Health Status |
Evaluate the overall health condition of the patient before the lung transplant procedure. |
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Surgical Procedure Effectiveness |
Assess the efficacy of the transplant procedure. |
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Post-Operation Recovery |
Evaluate the patient's health and recovery progress after the operation. |
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Post-Transplant Lung Function |
Assessment of the functionality of the transplanted lung, post-operation. |
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|
Immunosuppressive Medication Management |
Assess how effectively the patient is managing and responding to immunosuppressive medications post-transplant. |
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Incidence of Rejection |
Evaluate the occurrence and severity of rejection episodes post-transplant. |
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Infection Control |
Assess the patient's susceptibility to infections and their ability to manage and prevent them post-transplant. |
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Quality of Life |
Measure the patient's subjective perception of their quality of life post-transplant. |
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Cardiovascular Health |
Evaluate the impact of the transplant on the patient's cardiovascular system. |
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Pulmonary Rehabilitation Participation |
Assess the patient's engagement in pulmonary rehabilitation programs post-transplant. |
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Psychological Support |
Evaluate the provision and effectiveness of psychological support services for the patient and their caregivers. |
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Nutritional Status |
Assess the patient's nutritional intake, absorption, and overall nutritional status post-transplant. |
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Pulmonary Function Tests |
Regularly conduct pulmonary function tests to objectively measure lung function parameters post-transplant. |
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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:
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Comments |
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