1a. Geriatrics

Question 1

Frailty

Answer 1

slowness, grip weakness, weight loss, exhaustion, decrease in physical activity

Question 2

why are older adults at risk of airway obstruction?

Answer 2

decrease in laryngeal and pharyngeal support

Question 3

why are older adults at increased risk of pulmonary aspiration?

Answer 3

decreased protective airway reflexes

Question 4

how does HTN contribute to perioperative risk?

Answer 4

perioperative risk doubles for every 20-mm Hg systolic/10-mm Hg diastolic increase in blood pressure

Question 5

effects of aging in geriatrics: pulse pressure … why?

Answer 5

widens d/t greater/disproportionate % increase in SBP

Question 6

what happens to the regulation of Ca2+ in the elderly patient?

Answer 6

impaired Ca2+ homeostasis. leads to myocardium generating force over a longer period after excitation (AKA reduced LV relaxation) and contributes to diastolic dysfunction.

Question 7

what causes stiffening of arteries in geriatric patients?

Answer 7

loss of elastin and increased collagen

Question 8

stiff arteries leads to …

Answer 8

systolic HTN
myocardial hypertrophy
impaired diastolic relaxation

Question 9

what are the anesthetic consequences of stiffening arteries in geriatric patients?

Answer 9

labile BP, diastolic dysfunction, and sensitivity to volume status

Question 10

what is the most common conduction abnormality in geriatric patients and what is the mechanism?

Answer 10

atrial fibrillation
calcification of pacemaker and His-bundle cells

Question 11

failure of the geriatric patient to maintain preload l/t to what?
what is the pt dependent on as a result? hint: HR

Answer 11

an exaggerated decrease in CO; the geriatric patient is dependent on NSR and low-normal HR

Question 12

effects of aging in geriatrics: lung compliance

(parenchyma)

Answer 12

INCERASES

Question 13

effects of aging in geriatrics: chest wall compliance

Answer 13

DECREASES

Question 14

effects of aging in geriatrics: physiologic shunt

Answer 14

INCREASES

Question 15

effects of aging in geriatrics: oxygen exchange

inc/dec at what level?

Answer 15

decreases at the alveolar level

Question 16

increased compliance causes…

what happens to the small airways?

Answer 16

small airway diameter to narrow, eventually increasing CLOSING VOLUME

Question 17

closing volume exceeds FRC at approximately what ages according to position?

Answer 17

SUPINE: 45 years
STANDING: 65 years

Question 18

effects of aging in geriatrics: vital capacity

Answer 18

DECREASES

Question 19

what lung volumes are increased in geriatrics?

Answer 19

residual volume
FRC
closing volume

Question 20

effects of aging in geriatrics: total lung capacity

Answer 20

unchanged

Question 21

effects of aging in geriatrics: FVC

Answer 21

decreased

Question 22

effects of aging in geriatrics: FEV1

Answer 22

decreased

Question 23

effects of aging in geriatrics: gas exchange

what happens to PaO2?

Answer 23

impaired

(Mean PaO2 on room air decreases from 95 mm Hg at age 20 to less than 70 mm Hg at age 80)

Question 24

what occurs as a result of stiff chest wall (decreased compliance)?

Answer 24

increased WOB and impaired gas exchange

Question 25

increased WOB, impaired gas exchange, and increased V/Q mismatch increases the risk of what in the geriatric patient?

Answer 25

respiratory failure

Question 26

what occurs as a result of increased lung compliance?

Answer 26

increased V/Q mismatch (and impaired gas exchange)

Question 27

increased small airway closure in the geriatric patient contributes to what? what should the CRNA consider as a result?

Answer 27

increased anatomic dead space alveolar recruitment maneuvers

Question 28

effects of aging in geriatrics: liver size

Answer 28

decreases in mass 20-40%

Question 29

how does the change in liver mass affect the pharmacokinetics of drugs?

Answer 29

decreased drug metabolism, prolonged half-life, and increased or decreased distribution of medications

Question 30

effects of aging in geriatrics: albumin

Answer 30

decreased

Question 31

what is the affect of decreased albumin levels in older adults?

Question 32

effects of aging in geriatrics: alpha1-acid glycoprotein (AAG)

Answer 32

increased

Question 33

what is the affect of increased AAG levels in older adults?

Question 34

effects of aging in geriatrics: endocrine

Answer 34

decline in # and function of pancreatic islet beta cells leading to decreased insulin secretion and insulin resistance

Question 35

effects of aging in geriatrics: thermoregulation

Answer 35

impaired (d/t decreased hypothalamic function)

Question 36

effects of aging in geriatrics: basal metabolic rate

Answer 36

decreased

Question 37

what is the main anesthetic implication of impaired thermoregulation in older adults?

Answer 37

slowed anesthetic elimination

Question 38

effects of aging in geriatrics: peripheral vasoconstriction in response to cold

Answer 38

decreased

Question 39

strategies to prevent intraoperative hypothermia in geriatric patients

Answer 39

fluid warmer, thermal mattress, forced air warmer

Question 40

effects of aging in geriatrics: GFR and effects

Answer 40

decreased; decreased renal drug clearance

Question 41

effects of aging in geriatrics: renin and aldosterone

Answer 41

decreased

Question 42

effects of aging in geriatrics: Na+ conservation

Answer 42

impaired

Question 43

what renal effects contribute to dehydration in the geriatric patient?

Answer 43

kidneys do not respond to nonrenal loss of water

Question 44

why is serum creatinine not a reliable test of kidney function in the older adult?

Answer 44

often remains unchanged

Question 45

what are the effects of decreased renal function in geriatrics?

Answer 45

accumulation of metabolites and drugs excreted by the kidneys electrolyte imbalances

Question 46

effects of aging in geriatrics: sensitivity to anesthetic agents

Answer 46

increased; decrease dose of induction agents and avoid benzodiazepines

Question 47

effects of aging in geriatrics: BBB

Answer 47

more permeable

Question 48

POCD

Answer 48

cognitive impairments i.e. memory deficits and delayed psychomotor (pts may or may not recover)

Question 49

risk factors for POCD

Answer 49

high alcohol intake or alcohol abuse, increasing age, high ASA, hx of CVA, cardiac surgery, postoperative delirium

Question 50

beneficience

Answer 50

to do good obligation or responsibility to help the patient

Question 51

nonmaleficence

Answer 51

do no harm to not intentionally harm the patient