Geriatrics Flashcards
(150 cards)
1
Q
________ is a greater determinant of posts complications than anesthetic management
A
preop co-morbid diseases
2
Q
the most commonly occurring post op complications in the elderly are
A
cardiac
Pulmonary
neuro
3
Q
thoracic, major vascular, and interperitneal sx in the elderly can increase what 3 complications
A
increased bleeding
Increased risk of post op vent
Increased VAP
4
Q
aging is associated with a progressive loss of functional reserve in what organ systems
A
all
5
Q
a ____% decline in organ function occurs after the age of 30
A
1%
ex a 70 yo has a 40% decline in general function
6
Q
the elderly generally maintain homeostasis but become increasingly less able to restore it when subjected to what?
A
trauma
stress
disease
drugs
7
Q
what happens to their muscle mass?
A
decreased
8
Q
what happens to their Fat
A
increased
9
Q
What happens to the H20 levels
A
decreased
10
Q
so what happens to hydrophilic drugs
A
decreased Vd (less H20)
11
Q
So what happens to lipophilic drugs
A
increased Vd (more fat)
12
Q
what happens to thermoregulation
A
it becomes impaired
Body heat preservation is a must
13
Q
younger pts shiver at 36.1 C, pts over 80 don’t shiver until what temp
A
35 C
14
Q
Shivering increasing O2 consumption by how much? and leads to hypoxia, acidosis, and CV compromise
A
400%
15
Q
____ and ____ of the elderly to requires special attention b/c of fragile skin, decreased SQ fat, and poor skin turgor
A
positioning
padding
16
Q
Common age related systemic anatomic and physiologic changes: what happens to
organ function
A
decreased
17
Q
Common age related systemic anatomic and physiologic changes: what happens to
blood volume
A
decreased
18
Q
Common age related systemic anatomic and physiologic changes: what happens to
protective reflexes
A
decreased
19
Q
Common age related systemic anatomic and physiologic changes: what happens to
ability to retain heat
A
decreased
20
Q
Common age related systemic anatomic and physiologic changes: what happens to
lean body mass
A
decreased
21
Q
Common age related systemic anatomic and physiologic changes: what happens to
skin elasticity and collagen
A
decreased
22
Q
Common age related systemic anatomic and physiologic changes: what happens to
intracellular water
A
decreased
23
Q
Common age related systemic anatomic and physiologic changes: what happens to
body fat
A
increased
24
Q
Common age related systemic anatomic and physiologic changes: what is a complication related to loss of protective reflexes
A
aspiration pneumonia
25
d/t the progressive loss of function in ALL organs what are 2 complications
increased risk for breakdown
| decreased ability to repair
26
state what causes the altered CV physiology:
| Increased LV wall thickness
increase in the size and Number of individual muscle fibers and adipocytes (fat cells)
27
state what causes the altered CV physiology:
| Increased LV hypertrophy
chronic increases in afterload
28
state what causes the altered CV physiology:
| Increased LV wall tension
chronic increases in after load
29
state what causes the altered CV physiology:
| Increased afterload
decreased arterial compliance
30
state what causes the altered CV physiology:
| Increased cardiac workload
reduction in arterial compliance results in increased after load, increased systolic bp, and LV hypertrophy
31
state what causes the altered CV physiology:
| Increased Systolic Bp
reduced arterial compliance
32
state what causes the altered CV physiology:
| Increased peripheral vascular resistance
reduction in arterial compliance caused primarily by fibrosis of the tunica media (middle layer)
33
state what causes the altered CV physiology:
| increased circulation time
reduced myocardial pump fun leads to reduced CO which prolongs circulation time
34
what does the Decreased circulation time mean with IV induction
slower induction
35
what does Decreased circulation time mean with VAA's inhalation induction?
faster induction
36
state what causes the altered CV physiology:
| Increased conduction fibrosis
conduction system fibrosis and loss of SA node cells will increase the incidence of dysrhythemias
37
state what causes the altered CV physiology:
| Increased incidence of dysrhytmias
conduction fibrosis of SA node
38
state what causes the altered CV physiology:
| Increased vagal tone
a decrease in sensitivity of adrenergic receptors leads to a decrease in HR
39
what 5 factors r/t the CV system are unchanged in the geriatric population
```
Diastolic BP (main one)
resting systolic function
excitation-contraction coupling
Ionized Ca++ levels
Contractile proteins
```
40
state what causes the altered CV physiology:
| Decreased Cardiac reserve
exagerated drops in bp adversely affecting the compensatory mechanism of the pt
41
state what causes the altered CV physiology:
| Decreased Cardiac Output
aging process and increased Afterload
42
state what causes the altered CV physiology:
| Decreased resting HR
increase in vagal tone (normal declining HR is loss of 1 BPM for each year over 50
43
state what causes the altered CV physiology:
| Decreased Left Ventricular compiance
stiffer (less complaint) myocardial muscle fibers
44
state what causes the altered CV physiology:
| Decreased Stroke volume
decreased myocardial pump function
45
state what causes the altered CV physiology:
| Decreased Perfusion to vital organs
organs atrophy
46
state what causes the altered CV physiology:
| Decreased CHRONOTROPIC and INOTROPIC responses
decreases in adrenergic receptor quality
47
state what causes the altered CV physiology:
| Decreased baroreceptor function
decreased sensitivity of stretch receptors owing to normal aging process
48
state what causes the altered CV physiology:
| Decreased adrenergic sensitivity
decrease in quality of receptors
49
state what causes the altered respiratory physiology:
| Increased vocal cord stimulation for closure
the stimulus needed for vocal cord closure (protection) is markedly elevated (need increased stimulus to close vocal cords)
50
state what causes the altered respiratory physiology:
| Increased airway obstruction
aging decreases the sensitivity of the need to clear secretions.
51
state what causes the altered respiratory physiology:
| Increased risk of aspiration
d/t vocal cord stimulation being elevated, thus putting the pt at a higher risk for aspiration.
aslo chest wall rigidity increases and the ability to cough is also decreased
52
state what causes the altered respiratory physiology:
| Increased pulmonary complications
decrease in protective laryngeal reflexes and decreased ability to cough
53
state what causes the altered respiratory physiology:
| Increased physiological deadspace
the breakdown of alveolar septa reduces total alveolar surface area, increasing both anatomic and physiologic headspace. these changes disrupt the normal matching of ventilation and perfusion within the lungs, increasing both shunting and deadspace.
54
state what causes the altered respiratory physiology:
| Increased work of breathing
skeletal calcification and increased airway resistance
55
state what causes the altered respiratory physiology:
| Increased POTENTIAL FOR HYPOXIA
decreased elasticity of lung
reduction in alveolar surface area
decrease efficiency of gas exchange
airway collapse
56
```
state what causes the altered respiratory physiology:
Increased FRC (modest)
```
30% of the alveolar wall tissue is lost b/y age 20-80, diminishing elastic recoil and parenchymal traction that maintains airway patency. this produces increased residual volume, closing volume, and FRC
57
state what causes the altered respiratory physiology:
| Increased closing volume and closing capacity (dramatic)
caused by airway collaps and distribution of TV to areas of the lung that are less perfused
58
state what causes the altered respiratory physiology:
| Increased alveolar compliance
absorption of connective tissue and this results in a loss id protective netting to restrict or limit the expansion of the alveoli
59
state what causes the altered respiratory physiology:
| Decreased elastin fibers ( reduced elasticty)
normal aging process
60
state what causes the altered respiratory physiology:
| Decreased Tissue elasticity
muscles replaced with adipose tissue
61
state what causes the altered respiratory physiology:
| Decreased Lung recoil
chest wall less compliant (stiffer) if the chest wall does not expand upward or outward, the lung will not expand fully, nor recoil fully
62
state what causes the altered respiratory physiology:
| Decreased alveolar surface area
alveolar wall tissue is decreased
63
state what causes the altered respiratory physiology:
| Decreased ability to cough
decreased muscle strength
64
state what causes the altered respiratory physiology:
| Decreased chest wall compliance
cartilage and connective tissue become stiffer
65
what type of lung disease is displayed by the geriatric population d/t decreased chest wall compliance
restrictive (like the obese)
66
state what causes the altered respiratory physiology:
| Decreased VC, ERV, IRV
as residual volumes increase, there is a decrease in VC, ERV, IRV
67
state what causes the altered respiratory physiology:
| Decreased protective responses
laryngeal respones blunted
68
state what causes the altered respiratory physiology:
| Decreased ease of mask ventilation
often edentulous
69
what happens to the lung volume and capacity in the elderly:
RV
increases
70
what happens to the lung volume and capacity in the elderly:
ERV
decreases
71
what happens to the lung volume and capacity in the elderly: FRC
INcreases
72
what happens to the lung volume and capacity in the elderly:
CC
increased
73
what happens to the lung volume and capacity in the elderly:
IC
decreases
74
what happens to the lung volume and capacity in the elderly:
VC
decreases
75
what happens to the lung volume and capacity in the elderly:
TLC
no change
76
Nervous system:
| what happens to Duration of spinal action
increases
77
Nervous system:
| what happens to SENSORY block with spinals
increases
78
Nervous system:
| what happens to epidural volume cephalic spread?
increases
79
Nervous system:
| what happens to CSF according to stolting
increases
80
Nervous system:
| what happens to epidural motor block?
decreases
81
Nervous system:
| epidural segment dosing
decreases
82
Nervous system:
| what happens to dose of general anesthestics
decreases
83
Nervous system:
| what happens to CSF according to Nagehout, M&M, and Miller
decreases
84
Nervous system:
| what is the most common neurological complication
postop delerium (15-53%)
85
Nervous system:
| postop delerium is characterized by what?
```
disruption of perception
Disruption of thinking and memory
Disruption in psychomotor behavior
disruption in sleep wake cycle
disruption in attention
disruption in conciousness
```
86
Nervous system:
| what are risk factors for post delerium
```
old age
male
dementia
ETOH abuse
Depression
duration of anesthesia
poor functional status
abnormal electrolytes
parkinsons dz
CV disease
dehydration
metabolic dz
intraop anticholinesterases
ICU admission
surgery type
```
87
Nervous system:
| post op delirium is most common in what 2 surgeries
```
orthopedic (28-60%)- femur
CV surgery (32-47%)
```
88
Nervous system:
| what is not the same as post of delirium, has a subtle onset and may not present for weeks to months after sx
POCD
| post operative cognitive dysfunction
89
Nervous system: POCD
| characterized by what?
memory deficits
difficulty concentrating
impaired comprehension
delayed psychomotor speed
90
Nervous system: POCD
there are no universally accepted diagnostic activity, no definition, no known cause, no cure, and no proven effective stratigies
just for knowledge
91
Nervous system: POCD
| what are recommendations for prevention
keep anesthesia short
use short acting and rapidly metabolized drugs
pts at risk, use inhalation drugs
92
what is the most common comorbidity in the elderly
HTN
| followed by CAD
93
Endocrine:
| what happens to insulin resistance?
Increased Insulin resistance
94
Endocrine:
| what happens to heat loss
increased heat loss
95
Endocrine:
| what happens to basal O2 consumption
decreased
96
Endocrine:
| what happens to Heat Production
decreased
97
Endocrine:
| what happens to liver mass, hepatic blood flow, and liver metabolism
decreased
98
Endocrine:
| why does basal and metabolic O2 consumption decline as one ages
d/t general loss of lean body mass
99
Endocrine:
the combo of Heat production decrease, heat loss increase, and hypothalamic temperature regulating centers reseting to a lower level all predispose the patient to what?
hypothermia
100
Endocrine:
| why does DM increase in the elderly
d/t the decline in pancreatic function
101
Endocrine:
| what are 2 mechanisms responsible for elevated blood sugars
sluggish insulin response to hyperglycemia
| Resistance to effects of insulin at peripheral receptors
102
Gastrointestinal & hepatobiliary system:
| what happens to liver mass
decreases
103
Gastrointestinal & hepatobiliary system:
| what happens to hepatic blood flow
decreases
104
Gastrointestinal & hepatobiliary system:
| what happens to Liver function
decreases
105
Gastrointestinal & hepatobiliary system:
| what happens to albumin production
decreases
106
Gastrointestinal & hepatobiliary system:
| what happens to Gastric pH
increases
107
Gastrointestinal & hepatobiliary system:
| what happens to gastric emptying
decreases
108
Gastrointestinal & hepatobiliary system:
| what happens to Plasma cholinesterase levels in men
decreases
109
Gastrointestinal & hepatobiliary system:
| why is there a concern for a full stomach in the elderly
Gastric pH rises (more alk), gastric emptying prolonged
110
Gastrointestinal & hepatobiliary system:
| hepatic blood flow decreases but what happens to hepatocellular function?
nothing (very little changes)
111
Gastrointestinal & hepatobiliary system:
| what 2 things impairs the livers ability to metabolize anesthetics and NDMR
reduced hepatic blood flow
| potential reduction in P450 enzyme
112
Gastrointestinal & hepatobiliary system:
| what 2 things are responsible for inadequate perioperative hepatic function
reduced liver tissue mass
| reduced blood flow
113
Gastrointestinal & hepatobiliary system:
| levels of what are reduced in elderly men
plasma cholinesterase
114
Renal Function:
| what happens to BUN
increases
115
Renal Function:
| what happens to ability to develop hypo and hyperkalemia
increases
116
Renal Function:
| what happens to kidney mass
decreases
117
Renal Function:
| what happens to renal blood flow and plasma flow
decreases
118
Renal Function:
| what happens to GFR
decreases
119
Renal Function:
| what happens to renal function
decreases
120
Renal Function:
| what happens to creatinine production
decreases
121
Renal Function:
what happens to
respons to ADH
decreases
122
Renal Function:
| what happens to response to Aldosterone
decrease
123
Renal Function:
| what happens to concentrating ability
decreases
124
Renal Function:
| renal blood flow decreases 50% about ____% per decade
10%
125
Renal Function:
| why does renal blood flow decrease?
d/t decrease in CO and decreases in renal vascular bed
126
Renal Function:
| the reduction of renal plasma flow leads to what?
decreased renal function
127
Renal Function:
| GFR decreases about ___ to ___% per decade
6-8%
128
Renal Function:
| what is the most sensitive indicator of renal function in the elderly
creatinine clearance
129
Renal Function:
| the combination of decreased renal function and reduced cardiac function makes the geriatric patients prone to what
fluid overload
130
Renal Function:
| elderly release large amounts of what in response to hypertonic saline loads
ADH
131
Renal Function:
| what happens to the bodies response to ADH an daldosterone
decreasd
132
Renal Function:
| as renal function declines so does the ability to do what
excrete drugs
133
Renal Function:
| what are 5 common age related renal anatomic and physiologic changes
```
decreased renal blood flow
Decreased GFR
Decreased ability to concentrate urine
decreased ability to conserve water
decreased elimination of drugs
```
134
Pharmacology:
| what happens to circulation time
increases (takes longer to circulate)
135
Pharmacology:
| what happens to body fat
increases
136
Pharmacology:
| what happens to Vd for lipid soluble drugs
increases
137
Pharmacology:
| what happens to recovery from VAA's
increases (takes longer()
138
Pharmacology:
| what happens to muscle mass
decreases
139
Pharmacology:
| what happens to Body heat production
decreases
140
Pharmacology:
| what happens to core body temp
decreases
141
Pharmacology:
| what happens to basal metabolic requirments
decrease
142
Pharmacology:
| what happens to MAC requirements
decreases
143
Pharmacology:
| what happens to total body water
decreases
144
Pharmacology:
| what happens to Vd for water soluble drugs
decreases
145
Pharmacology:
| what happens to dosing of barbs, bento, opioids
decreases
146
Pharmacology:
| what causes the decrease in Total body water
decrease in muscle mass
| increase in body fat
147
Pharmacology:
| why is there more af a drug that can cross the BBB
reduced plasma protein binding
| Increased free drug
148
Pharmacology:
| MAC is reduced ___to __ % per decade over the age of 40
4-6%
149
Pharmacology:
| why may recovery from VAAs be prolonged?
increased Vd (increased body fat), decreased hepatic function, and decreases pulmonary exchange
150
Pharmacology:
| what happens to the response of all muscle relaxants
unaltered
