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Special Pops II > 1a. Geriatrics > Flashcards

1a. Geriatrics Flashcards

1
Q

Frailty

A

slowness, grip weakness, weight loss, exhaustion, decrease in physical activity

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2
Q

why are older adults at risk of airway obstruction?

A

decrease in laryngeal and pharyngeal support

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3
Q

why are older adults at increased risk of pulmonary aspiration?

A

decreased protective airway reflexes

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4
Q

how does HTN contribute to perioperative risk?

A

perioperative risk doubles for every 20-mm Hg systolic/10-mm Hg diastolic increase in blood pressure

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5
Q

effects of aging in geriatrics: pulse pressure … why?

A

widens d/t greater/disproportionate % increase in SBP

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6
Q

what happens to the regulation of Ca2+ in the elderly patient?

A

impaired Ca2+ homeostasis. leads to myocardium generating force over a longer period after excitation (AKA reduced LV relaxation) and contributes to diastolic dysfunction.

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7
Q

what causes stiffening of arteries in geriatric patients?

A

loss of elastin and increased collagen

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8
Q

stiff arteries leads to …

A

systolic HTN
myocardial hypertrophy
impaired diastolic relaxation

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9
Q

what are the anesthetic consequences of stiffening arteries in geriatric patients?

A

labile BP, diastolic dysfunction, and sensitivity to volume status

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10
Q

what is the most common conduction abnormality in geriatric patients and what is the mechanism?

A

atrial fibrillation
calcification of pacemaker and His-bundle cells

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11
Q

failure of the geriatric patient to maintain preload l/t to what?
what is the pt dependent on as a result? hint: HR

A

an exaggerated decrease in CO; the geriatric patient is dependent on NSR and low-normal HR

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12
Q

effects of aging in geriatrics: lung compliance

(parenchyma)

A

INCERASES

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13
Q

effects of aging in geriatrics: chest wall compliance

A

DECREASES

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14
Q

effects of aging in geriatrics: physiologic shunt

A

INCREASES

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15
Q

effects of aging in geriatrics: oxygen exchange

inc/dec at what level?

A

decreases at the alveolar level

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16
Q

increased compliance causes…

what happens to the small airways?

A

small airway diameter to narrow, eventually increasing CLOSING VOLUME

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17
Q

closing volume exceeds FRC at approximately what ages according to position?

A

SUPINE: 45 years
STANDING: 65 years

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18
Q

effects of aging in geriatrics: vital capacity

A

DECREASES

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19
Q

what lung volumes are increased in geriatrics?

A

residual volume
FRC
closing volume

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20
Q

effects of aging in geriatrics: total lung capacity

A

unchanged

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21
Q

effects of aging in geriatrics: FVC

A

decreased

22
Q

effects of aging in geriatrics: FEV1

A

decreased

23
Q

effects of aging in geriatrics: gas exchange

what happens to PaO2?

A

impaired

(Mean PaO2 on room air decreases from 95 mm Hg at age 20 to less than 70 mm Hg at age 80)

24
Q

what occurs as a result of stiff chest wall (decreased compliance)?

A

increased WOB and impaired gas exchange

25
Q

increased WOB, impaired gas exchange, and increased V/Q mismatch increases the risk of what in the geriatric patient?

A

respiratory failure

26
Q

what occurs as a result of increased lung compliance?

A

increased V/Q mismatch (and impaired gas exchange)

27
Q

increased small airway closure in the geriatric patient contributes to what? what should the CRNA consider as a result?

A

increased anatomic dead space

alveolar recruitment maneuvers

28
Q

effects of aging in geriatrics: liver size

A

decreases in mass 20-40%

29
Q

how does the change in liver mass affect the pharmacokinetics of drugs?

A

decreased drug metabolism, prolonged half-life, and increased or decreased distribution of medications

30
Q

effects of aging in geriatrics: albumin

A

decreased

31
Q

what is the affect of decreased albumin levels in older adults?

A
32
Q

effects of aging in geriatrics: alpha1-acid glycoprotein (AAG)

A

increased

33
Q

what is the affect of increased AAG levels in older adults?

A
34
Q

effects of aging in geriatrics: endocrine

A

decline in # and function of pancreatic islet beta cells leading to decreased insulin secretion and insulin resistance

35
Q

effects of aging in geriatrics: thermoregulation

A

impaired (d/t decreased hypothalamic function)

36
Q

effects of aging in geriatrics: basal metabolic rate

A

decreased

37
Q

what is the main anesthetic implication of impaired thermoregulation in older adults?

A

slowed anesthetic elimination

38
Q

effects of aging in geriatrics: peripheral vasoconstriction in response to cold

A

decreased

39
Q

strategies to prevent intraoperative hypothermia in geriatric patients

A

fluid warmer, thermal mattress, forced air warmer

40
Q

effects of aging in geriatrics: GFR and effects

A

decreased; decreased renal drug clearance

41
Q

effects of aging in geriatrics: renin and aldosterone

A

decreased

42
Q

effects of aging in geriatrics: Na+ conservation

A

impaired

43
Q

what renal effects contribute to dehydration in the geriatric patient?

A

kidneys do not respond to nonrenal loss of water

44
Q

why is serum creatinine not a reliable test of kidney function in the older adult?

A

often remains unchanged

45
Q

what are the effects of decreased renal function in geriatrics?

A

accumulation of metabolites and drugs excreted by the kidneys
electrolyte imbalances

46
Q

effects of aging in geriatrics: sensitivity to anesthetic agents

A

increased; decrease dose of induction agents and avoid benzodiazepines

47
Q

effects of aging in geriatrics: BBB

A

more permeable

48
Q

POCD

A

cognitive impairments i.e. memory deficits and delayed psychomotor (pts may or may not recover)

49
Q

risk factors for POCD

A

high alcohol intake or alcohol abuse, increasing age, high ASA, hx of CVA, cardiac surgery, postoperative delirium

50
Q

beneficience

A

to do good
obligation or responsibility to help the patient

51
Q

nonmaleficence

A

do no harm
to not intentionally harm the patient

Special Pops II (6 decks)

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