Geriatrics Flashcards Preview

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Flashcards in Geriatrics Deck (150)
1

________ is a greater determinant of posts complications than anesthetic management

preop co-morbid diseases

2

the most commonly occurring post op complications in the elderly are

cardiac
Pulmonary
neuro

3

thoracic, major vascular, and interperitneal sx in the elderly can increase what 3 complications

increased bleeding
Increased risk of post op vent
Increased VAP

4

aging is associated with a progressive loss of functional reserve in what organ systems

all

5

a ____% decline in organ function occurs after the age of 30

1%
(ex a 70 yo has a 40% decline in general function)

6

the elderly generally maintain homeostasis but become increasingly less able to restore it when subjected to what?

trauma
stress
disease
drugs

7

what happens to their muscle mass?

decreased

8

what happens to their Fat

increased

9

What happens to the H20 levels

decreased

10

so what happens to hydrophilic drugs

decreased Vd (less H20)

11

So what happens to lipophilic drugs

increased Vd (more fat)

12

what happens to thermoregulation

it becomes impaired
Body heat preservation is a must

13

younger pts shiver at 36.1 C, pts over 80 don't shiver until what temp

35 C

14

Shivering increasing O2 consumption by how much? and leads to hypoxia, acidosis, and CV compromise

400%

15

____ and ____ of the elderly to requires special attention b/c of fragile skin, decreased SQ fat, and poor skin turgor

positioning
padding

16

Common age related systemic anatomic and physiologic changes: what happens to
organ function

decreased

17

Common age related systemic anatomic and physiologic changes: what happens to
blood volume

decreased

18

Common age related systemic anatomic and physiologic changes: what happens to
protective reflexes

decreased

19

Common age related systemic anatomic and physiologic changes: what happens to
ability to retain heat

decreased

20

Common age related systemic anatomic and physiologic changes: what happens to
lean body mass

decreased

21

Common age related systemic anatomic and physiologic changes: what happens to
skin elasticity and collagen

decreased

22

Common age related systemic anatomic and physiologic changes: what happens to
intracellular water

decreased

23

Common age related systemic anatomic and physiologic changes: what happens to
body fat

increased

24

Common age related systemic anatomic and physiologic changes: what is a complication related to loss of protective reflexes

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

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