Test #2 Aging PPt-Josh Flashcards Preview

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Flashcards in Test #2 Aging PPt-Josh Deck (103):
1

what is a rogressive process w/ diminishing ability to adapt to stressful events?

 

aging

2

what age is considered elderly?

65 and up

3

there is a __% decline in organ fxn per year after age 30!!

1%

4

Surgical Morbidity & Mortality:

elderly have a higher iincidence of certain co-existing diseases, what are some of those common diseases?

  • DM
  • Ischemic heart disease
  • Malnutrition
  • Renal impairment
  • Cerebralvascular disease
  • Lung disease

5

Surgical Morbidity & Mortality:

what are some common surgical complications

  • MI
  • Dysrhythmias
  • Cardiac arrest
  • reintubation

6

Surgical Morbidity & Mortality:

the 30 day mortality rates increase every decade after age ___?

30

7

Cellular Effects of Aging:

there is a limited number of human _____!

Structural framwork for tissues

8

Effects of aging on Body Composition:

you have a loss of _____ muscle

Skeletal muscle (lean body mass)

9

Effects of aging on Body Composition:

there is an increased % of ______ fat, and a decreased _____ fat!!

body

SQ

10

Effects of aging on Body Composition:

they have a decreased skin ________

elasticity

11

Effects of aging on Body Composition:

there is reduced _____ and _____ tissue perfusion

skin

soft tissue

12

Effects of aging on Body Composition:

they have poor skin _____

 

turgor

13

Anesthestic Implications: Body changes

you must have careful positioning b/c what 3 main reasons

  1. fragile skin
  2. Poor skin turgor
  3. Decreased SQ fat

14

Anesthestic Implications: Body changes

you want to be cautious w/ adhesives d/t what 2 reasons?

  1. collagen loss
  2. decreased elasticity of skin

15

Anesthestic Implications: Body changes

why must u prevent hypothermia?

3 reasons

  • low basal metabolic rate
  • Hypothyroidism
  • Hihgh BSA

16

Anesthestic Implications: Body changes

what are the 4 main effects of post op shivering

  • increase O2 consumption 400%
  • Hypoxia
  • Acidosis
  • Cardiopulmonary compromise

17

CV System:

Cardiac fnx declines by ____% btw the age of 20 & 80

 

50%

18

CV System: Peripheral Vascular changes

what happens to wall thickness and diameter

  • increased

19

CV System: Peripheral Vascular changes

what happens to Aorta and large ateries?

Stiffiening

20

CV System: Peripheral Vascular changes

WHat occurs to vasodilation

decreased

21

CV System: Peripheral Vascular changes

they have systemic HTN form what?

decreased baroreceptor sensitivity

22

CV System: Myocardial changes

What happens to thickness of LV wall

thickens

23

CV System: Myocardial changes

what happens to compliance

decreased

24

CV System: Myocardial changes

what happens to Aortic valve cusps?

thickening

25

CV System: Myocardial changes

the increased LV wall thickness leads to what?

LVH

26

CV System: CV changes

what happens to the myocardial pump

Impaired pumping

27

CV System: CV changes

what happens to CO

Decreased

28

CV System: CV changes

what happens to circulation time

prolonged

29

CV System: CV changes

there is a greater reliance on _____ and ___ ____

LVEDV

&

Atrial Kick

30

CV System: CV changes

increased incidence of _____ ( a disease)

CAD

31

CV System: CV changes

WHat happens to their maximum HR

 

Lower

32

CV System: CV changes

what happens to their response to Catecholamines

Decreased response

33

Anesthesia: CV

what is the best predictor of postoperative functional status

preoperative functional status

34

Anesthesia: CV

does routine testing improve outcomes?

Nope

35

Anesthesia: CV

prop testing should be reserved for what pts?

High risk sx

< METS 4

3 or more risk factors for CAD

36

Changes in ANS:

what happens to PNS

DIminished

37

Changes in ANS:

what happens to SNS

 

 

Increased

38

Changes in ANS:

what happens to their response to Beta stimulation

Reduced

39

Changes in ANS:

the changes are manifested in what 3 main ways

  1. Compromised thermoregulatin
  2. Decreased Baroreceptor sensitivity
  3. Dehydration

40

Respiratory changes: Alveolar Level

there is a ___% reduction in alveolar surface area available for gas exchange by age 70

15%

41

Respiratory changes: Alveolar Level

the 15% reduction in alveolar surface area available for gas exchange is due to what 2 things?

  1. reduction of elastic tissue
  2. Increased Collagen

42

Respiratory changes: Alveolar Level

there is an _______ alveolocapillary membrane thickness

increased

43

Respiratory changes: Alveolar Level

the increased alveolocapillary membrane thickness means what?

a decline on PaO2

 

PaO2 90mmHg @ 20ys and 70 mmHg @ 80 yrs

44

Respiratory changes: Alveolar Level

what is teh equation for PaO2?

PaO2= 100-(0.4 x age)

45

Respiratory changes: Alveolar Level

what happens to alveolar compliance?

Decreased

46

Respiratory changes: Alveolar Level

why is there a decreased in alveolar compliance (3)

  1. V/Q mismatch
  2. Increased physiological shunt
  3. Decreased efficiency of O2 exchange

47

Respiratory changes: Function

what happens to FEV1 & FVC

decreased

48

Respiratory changes: Function

what happens to closing volumes

Increased

49

Respiratory changes: Function

there is a __% decrease in TLC by age 70

10 %

50

Respiratory changes: Function

there is a diminished response to CNS response to ___ and ____

hypoxia and

Hypercarbia

51

Airway changes:

what happens to their larygeal and pharyngeal responses?

diminished

52

Airway changes:

the diminished laryngeal and pharyngeal responses mean what 3 things?

  1. decreased airway clearance (cough/ swallowing)
  2. decreased Gag reflex
  3. Predisposition to aspiration

53

Airway changes:

what happens to their airway passages?

Narrows

54

Airway changes:

the narrowed airway passages mean what 3 things?

 

  1. more turbulant flow
  2. Increased work of breathing
  3. Difficult ventilation

55

Airway changes:

what 3 complications can occur form being endentulous

  1. poor mask seal
  2. loss of upper airway muscle tone
  3. difficult mask ventilation

56

Airway changes:

they develop cervical arthritis and OA, what 2 complication occur d/t this?

  1. limites extension & flexion
  2. Difficult intubation

57

Renal changes:

renal atrophy results in approx ___% reduction in the number of functioning nephrons by age 80

 

50%

58

Renal changes:

ther is a __-__% per year decline in glomerular filtration rate

1-1.5%

59

Renal changes:

RBF decreases __-__% per year after age 25

1-2%

60

Renal changes:

By age 65, RBF decreases __-__%

40-50%

61

Renal changes:

they have a inability to concentrate urine and preserve H2O and Sodium, this can lead to what 3 complications?

  1. electrolyte abnormalities
  2. Hypovolemia
  3. Dehydration

62

Renal changes:

ARF contributes to __ in 5 postop deaths

1 in 5

63

Hepatic System:

what happens to tissue mass

decreased

64

Hepatic System:

is there a lot of changes in hepatocellular fxn?

No there is only a few

65

Hepatic System:

what happens to hepatc blood flow?

Decreased

66

What happens to filtration rate?

Decreased

67

Hepatic System:

what happens to excretatory capacity

reduced

68

Malnutrition:

w/ malnutrition the serumm albumin is what?

< 3 g/dL

69

GI changes:

what happens to Gastric residual volume?

 

 

Increased

70

cGI changes:

what happens to the sphincters? and one inparticular?

Dysfuntion occurs

mainly LES

71

GI changes:

what are some anesthestic implications?

RSI?

Avoid LMA?

Prophylactic antacids

72

Endocrine fxn:

atrophy of endocrine glands cause a reduced production of what hormones ( 5 main)

 

  1. insulin
  2. Throxine
  3. Growth
  4. Renin
  5. Aldosterone

73

Endocrine fxn:

what happens to postprandial BGLs?

Increased

74

Endocrine fxn:

what 2 complications occur from increased postprandial BGLs?

  • Decreased liberation of insulin in response to hyperglycemia
  • resistance to effects of insulin

75

Endocrine fxn:

DM is an independent predictor of long term decreases in quality of life following sx.  what are 5 complications r/t  DM

  • increased risk of Aspiration
  • Poor wound healing
  • Infection
  • Cardiac and cerebralvascular event
  • Autonomic dysfunction

76

Endocrine fxn:

you want to ensure adequate conrol of glucose b4 surgery!! in reality several weeks b4 if possible, you want to ensure the BGL is b/t what?

120-180

77

Hemotological Changes:

what happens to Bone marrow fnx?

Diminished

78

Hemotological Changes:

what happens to hematopoiesis?

decreased

79

Oncologic and immune fxn changes:

compromised cellular immunity can lead to what 2 d/o

Leukopenia

lymphopenia

80

Oncologic and immune fxn changes:

what is the most significant risk factor for the development of Cancer?

Age

81

CNS changes:

what happens to brain mass?

decreased 30% by age 80

82

CNS changes:

what happens to Neuronal density/ CMRO2 and CBF?

all decreased

83

CNS changes:

what happens to neurotransmitter receptor sites

decreased

84

CNS changes:

what happens to the fibers in the spinal cord tract

decreased

85

CNS changes:

are the structurl changes in the CNS automatically associtaed w/ decline in cognitive fxn?

nope

86

CNS changes:

what is the transient and flunctuating disturbance of conciousness that occurs shortly after sx

Post op delerium

87

CNS changes:

what is teh persistant change in cognative performance diagnosed by neuropsychological tests

postop cognitive dysfunction

88

CNS changes:

out of the last 2 which one has th ehighest association w/ the elderly

post op delerium

89

Postoperative Delerium:

the Sx manifest how many days postop?

1-3

90

Postoperative Delerium:

what are risk factors

  • > 70 y/o
  • Dementia
  • ETOH abuse
  • Prior PD
  • Visual disturbances
  • Prior ilness
  • certain injuries (HIP)
  • elevated BUN

91

Postoperative Delerium:

what are perioperative risk factors

  • Large blood loss
  • Blood products
  • Inadequate analgesia
  • narcotics/Benzos
  • Postop HCT < 30%

92

Postoperative Delerium:

do most pt's experience complete recovery?

Yes

93

Postoperative Delerium:

what are 3 ways to help prevent it?

  • Stimulate cognition
  • nutrition/fluid intake
  • Exercise

94

Postoperative Delerium:

what is treatment

Haldol for agitation

95

Postoperative Delerium:

what 2 main drugs do u want to avoid

  • Chlorpromazine
  • Benzo

96

Delerium:

whata re factors that precipitate delerium

  • D- drug use
  • E- electrolytes
  • L- lack of drugs (withdrawl)
  • I- infection
  • R- reduced sensory input (blind, deaf. dark)
  • I- intracranial problems )CVA, Bleed, Meningitits)
  • U- urinary retention and fecal impaction
  • M-myocardial problems (MI, dysrhythmia, CHF)

97

Postoperative Cognitive Dysfunction:

most is mild and resolves during the first ___ months

3

98

Postoperative Cognitive Dysfunction:

can be severe w/ a ___ year mortality

1

99

Postoperative Cognitive Dysfunction:

DX requires neuropsychologic testing when

b4 and after sx

100

Postoperative Cognitive Dysfunction:

what are risk factors

  • Cardiac Sx
  • underlying Cerebralvascular disease
  • Advanced age
  • Lower educational level
  • pre-existing dementia
  • Decreased ADLs

101

Postoperative Cognitive Dysfunction:

is GA a role in it?

unclear

102

Old farts?

is there one ideal anesthestic?

Nope

103

thats it

yeah!!!