Geriatrics Flashcards
(48 cards)
How does minute ventilation change in the elderly?
Increases (increased dead space > increased minute vent to maintain CO2)
How does lung compliance change in the elderly?
Increase (think COPD esque) ~ easier to inflate the lungs
Increase in a given volume for a given pressure
How does lung elasticity change in the elderly?
Decreases.
Elastic recoil is lost ~ this promotes small airway collapse.
>increased dead space
>Decrease alveolar surface area
>V/Q mismatch
> increased A-a gradient!
> reduced PaO2
How is chest wall compliance changed with age?
Decreased chest wall compliance.
Chest wall is stiffer and less tendency to expand.
>calcification of joints
>diaphragmatic flattening
>A:P diameter
>decreased intervertebral disc height.
>decreased muscle strength
How does old age alter the response to hypercarbia and hypoxia?
Chemoreceptors are less sensitive
> risk of Hypoventilation
>risk of apnea
> risk of resp failure
***consider bipap and cpap
How does old age affect protective airway reflexes?
Reduced efficacy of cough and swallowing.
> increased risk of aspiration
How does old age affect airway tone?
Decreased muscle strength
> risk of resp failure
> risk of upper airway obstruction
What lung components are INCREASED in old age?
FRC
Residual volume
Closing capacity
What lung components are decreased in old age?
Viral capacity
Inspiratory reserve volume
Expiratory reserve volume
FEV & FEV1
At what age does closing capacity surpass FRC in the supine position?
~ 45 years
At what age does closing capacity surpass FRC in the standing position?
~65
How does old age affect TLC?
Not much
* increase in Residual volume reduces viral capacity
What are the 4 most prevalent cardiac diseases in the elderly?
HTN
CHF
CAD
And MI
What are the best indicators of cardiac reserve?
Exercise tolerance and the ability to perform daily living activities
What is the most common cause of death for the elderly in the postoperative period?
MI
How does the arterial system change with age?
Loss of elastin and increased collagen
> ^SVR
> ^ pulse pressure
> ^ myocardial wall tension
> ^ LV thickness (concentric hypertrophy)
How does the venous system change with age?
Decreased
Loss of elastin and increased collagen
>capacitance fx is diminished
Changes in blood volume cause HUGE changes in pressure
How does myocardial compliance change with age?
Decreased
Impaired relaxation > diastolic dysfunction
>greater pressure to fill
>filling pressure > volume
> ^HR reduces filling time
What is so important in a non-compliant ventricle?
Atrial kick
**increased pressure in that atria can cause Afib (leads to a lack of priming)
How is myocardial hypertrophy?
Increased
Concentric hypertrophy (reduces compliance and impairs relaxation)
How does cardiac conduction change with age?
Decreased
Fibrosis of the conduction system
***loss of SA node tissue
(Increased likelihood of dysrhythmias)
What is Virchow’s triad?
Venous stasis
Hypercoagulability
Endothelial dysfunction
What is PRESERVED in the geriatric heart?
Systolic function
What is increased in the geriatric heart?
SVR
pulse pressure
Prolonged circulation time
