1a. Geriatrics Flashcards
Frailty
slowness, grip weakness, weight loss, exhaustion, decrease in physical activity
why are older adults at risk of airway obstruction?
decrease in laryngeal and pharyngeal support
why are older adults at increased risk of pulmonary aspiration?
decreased protective airway reflexes
how does HTN contribute to perioperative risk?
perioperative risk doubles for every 20-mm Hg systolic/10-mm Hg diastolic increase in blood pressure
effects of aging in geriatrics: pulse pressure … why?
widens d/t greater/disproportionate % increase in SBP
what happens to the regulation of Ca2+ in the elderly patient?
impaired Ca2+ homeostasis. leads to myocardium generating force over a longer period after excitation (AKA reduced LV relaxation) and contributes to diastolic dysfunction.
what causes stiffening of arteries in geriatric patients?
loss of elastin and increased collagen
stiff arteries leads to …
systolic HTN
myocardial hypertrophy
impaired diastolic relaxation
what are the anesthetic consequences of stiffening arteries in geriatric patients?
labile BP, diastolic dysfunction, and sensitivity to volume status
what is the most common conduction abnormality in geriatric patients and what is the mechanism?
atrial fibrillation
calcification of pacemaker and His-bundle cells
failure of the geriatric patient to maintain preload l/t to what?
what is the pt dependent on as a result? hint: HR
an exaggerated decrease in CO; the geriatric patient is dependent on NSR and low-normal HR
effects of aging in geriatrics: lung compliance
(parenchyma)
INCERASES
effects of aging in geriatrics: chest wall compliance
DECREASES
effects of aging in geriatrics: physiologic shunt
INCREASES
effects of aging in geriatrics: oxygen exchange
inc/dec at what level?
decreases at the alveolar level
increased compliance causes…
what happens to the small airways?
small airway diameter to narrow, eventually increasing CLOSING VOLUME
closing volume exceeds FRC at approximately what ages according to position?
SUPINE: 45 years
STANDING: 65 years
effects of aging in geriatrics: vital capacity
DECREASES
what lung volumes are increased in geriatrics?
residual volume
FRC
closing volume
effects of aging in geriatrics: total lung capacity
unchanged
effects of aging in geriatrics: FVC
decreased
effects of aging in geriatrics: FEV1
decreased
effects of aging in geriatrics: gas exchange
what happens to PaO2?
impaired
(Mean PaO2 on room air decreases from 95 mm Hg at age 20 to less than 70 mm Hg at age 80)
what occurs as a result of stiff chest wall (decreased compliance)?
increased WOB and impaired gas exchange
increased WOB, impaired gas exchange, and increased V/Q mismatch increases the risk of what in the geriatric patient?
respiratory failure
what occurs as a result of increased lung compliance?
increased V/Q mismatch (and impaired gas exchange)
increased small airway closure in the geriatric patient contributes to what? what should the CRNA consider as a result?
increased anatomic dead space
alveolar recruitment maneuvers
effects of aging in geriatrics: liver size
decreases in mass 20-40%
how does the change in liver mass affect the pharmacokinetics of drugs?
decreased drug metabolism, prolonged half-life, and increased or decreased distribution of medications
effects of aging in geriatrics: albumin
decreased
what is the affect of decreased albumin levels in older adults?
effects of aging in geriatrics: alpha1-acid glycoprotein (AAG)
increased
what is the affect of increased AAG levels in older adults?
effects of aging in geriatrics: endocrine
decline in # and function of pancreatic islet beta cells leading to decreased insulin secretion and insulin resistance
effects of aging in geriatrics: thermoregulation
impaired (d/t decreased hypothalamic function)
effects of aging in geriatrics: basal metabolic rate
decreased
what is the main anesthetic implication of impaired thermoregulation in older adults?
slowed anesthetic elimination
effects of aging in geriatrics: peripheral vasoconstriction in response to cold
decreased
strategies to prevent intraoperative hypothermia in geriatric patients
fluid warmer, thermal mattress, forced air warmer
effects of aging in geriatrics: GFR and effects
decreased; decreased renal drug clearance
effects of aging in geriatrics: renin and aldosterone
decreased
effects of aging in geriatrics: Na+ conservation
impaired
what renal effects contribute to dehydration in the geriatric patient?
kidneys do not respond to nonrenal loss of water
why is serum creatinine not a reliable test of kidney function in the older adult?
often remains unchanged
what are the effects of decreased renal function in geriatrics?
accumulation of metabolites and drugs excreted by the kidneys
electrolyte imbalances
effects of aging in geriatrics: sensitivity to anesthetic agents
increased; decrease dose of induction agents and avoid benzodiazepines
effects of aging in geriatrics: BBB
more permeable
POCD
cognitive impairments i.e. memory deficits and delayed psychomotor (pts may or may not recover)
risk factors for POCD
high alcohol intake or alcohol abuse, increasing age, high ASA, hx of CVA, cardiac surgery, postoperative delirium
beneficience
to do good
obligation or responsibility to help the patient
nonmaleficence
do no harm
to not intentionally harm the patient
