601 midterm Flashcards by sarah beeney

Changes found in the airway of older persons

-Upper airway nasal passages less cartilaginous reducing patency
-Proximal and distal airways become less cartilaginous resulting in airtrapping
-increased soluble and cellular inflammation
-alveoli increase in size and decrease in elasticity
-increased apoptosis and senescence markers
-skeletal muscle atropies and diaphragm weakens leading to inadequate ventilation

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when does the respiratory system decline and by how much per year

age 40, 35-50ml/year

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most common pulmonary related symptoms in older adults

-rhinitis
-dyspnea
-cough
-wheezing and chest tightness

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chronic rhinosinusitis symptoms

-longer than 12 weeks
-nasal discharge
-nasal congestion or obstruction
-facial pain or pressure
-loss of smell
(2+ is diagnostic)

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risk factor for chronic rhinosinusitis

-increasing age
-smoking

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older adults with chronic rhinosinusitis also are frequently colonized with

staph aureus

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Otitis media is frequently seen with what

chronic rhinosinusitis

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bacterial rhinosinusitis is associated with what symptoms

-purulent nasal discharge
-facial pain or pressure

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treatment of clear nasal discharge in rhinosinjusitis

-analgesics
-saline irrigation
-decongestants (caution in old people with HTN and BPH)

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When to rx abx for rhinosinusitis

when symptoms are present for 7+ days and continue to worsen

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CRS treatment

-saline irrigation
-topical nasal steroids (cause epistaxis)

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S/S of asthma

-nocturnal wheezing/dyspnea
-cough
-chest tightness
-improvement of FEV1 of at least 12% after SABA is key

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Diagnostic tests for asthma

-improvement of FEV1 of at least 12% after SABA is key
-Provication tests (methacholine challenge)
-sputum esinophilia
-elevated IgE
-elevated fractional excretion of nitric oxide

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Diagnostic tests for COPD

-reduced and irreversible FEV1/FVC <70%

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Symptoms of COPD

-dyspnea
-cough
-sputum production
-wheezing
-chest pain

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COPD grading scale

mild: >80%
mod: 50-80%
severe: 30-50%
very severe <30% or FEV1 <50%

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General COPD treatment

-inhaler therapies (bronchodialators and iCS)
-smoking cessation
-supplemental o2
-pulmonary rehabilitation

Interstitial lung disease

a spectrum of diffusee parenchymal and fibrotic lung injuries with interstitial pulmonary fibrosis being the most closely related to aging

simptoms of ILD

-clubbing
-dyspnea
-cough
-crackles
-rales
-restrictive ventilatory impairment on PFT
-diffuse intersititial opacities
-alveolointerstitial inflammation with fibrosis

IPF and ILD can mix with COPD and lead to what on pft

psudonormilization

ILD chest radiographs will show

-reticular opacities in the mid and low lung
-CT will show subplural reticulation and honeycombig

Risk factors for PE

-CANCER
-surgery
-fractures
-bed rest
-sedentary periods

criteria used for PE

wells and geneva

Diagnostic tests for PE

-D-dimer (although it increases with age anyway)
-Ultrasound for DVT
-CT pulmonary angiogram

contraindications for a CT pulonary angiography

-renal impairment -dye allergies

Treatment for PE in those without renal insufficiency or obese

-Direct oral anticoagulants (apixaban, dabigatran, rivaroxaban)

Treatment of PE in cancer

low-molecular weight heparin

COPD patients should always have what vaccinatons

-Flu -Pne

Pneumo vaccinations in older adults

For all over 65: -PCV13 (prevnar 13) first -PPSV23 one year later for immunocompetent (8weeks for immunocompromised) a second immunization of PPSV23 for those over 65 5 years fro the first with one year from the pSCV13

Flu vaccinations

-yearly for everyone over 65

shingles vaccinaton

Shingrix for all over 65 even if previously immunized with zostavax 2 doses (2-5mo apart)

TDAP

One dose after 65 then Td every 10

5 A's in smoking cessation

Ask, advise, agree, assist and arrange

other methods of pain reduction than opioids

-exercise -topical analgesics -tai chi -PT -accupuncture -massage -nonopioids

as the body ages, what happens to total body of water

-total volume of water decrases (resulting in a higher blood concentration of stuff)

protein needs of the older adult

1-1.5g/kg and should make up 12-20% of calories

fiber needs in the older adult

14g per 1000 calories with 64 oz of water

thirst sensation in old age

is blunted

of fruit and veggie servings needed

5 to get K+, Vitamin A, C, E

b12 in older adults

absorption is less efficient encourage b12 fortified foods

activity reccomendations

150min of moderate every week or 75 vigorous intensity weekly

when does the benifit of ASA exceed risk and when to start, continue and stop

when CVD risk is high and bleeding risk is low Start if CVD over 15% Continue of over 10% stop if over 5% and bleeding risk is high.