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Apex Flashcards > across the life span: geriatrics > Flashcards

across the life span: geriatrics Flashcards

1
Q

one metabolic equivalent (MET) corresponds with an oxygen consumption of

A

3.5mL/kg/min

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2
Q

walking up two flights of stairs without stopping is equal to

A

4 METS or 1000mL O2/min

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3
Q

activities equivalent to 1 met include

A

(poor functional capacity)
self care activities
working at a computer
walking 2 blocks slowly

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4
Q

activities equal to 4 mets include

A

Climbing up a flight of stairs without stopping
walking up a hill (>1-2 blocks)
light house work
raking leaves
gardening

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5
Q

activities equal to 10 mets or more

A

strenuous sports

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6
Q

for every met a patient can achieve, mortality decreases by

A

11%

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7
Q

frailty is characterized by what 2 things

A

decreased reserve and reduced resistance to stress (physiologic, physical, or psychosocial)

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8
Q

how does minute ventilation change in the elderly

A

increases. increased dead space = increased minute volume to maintain normal PaCO2

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9
Q

how does lung compliance change in the elderly

A

increases. easier to distend lungs. tired ole rubber band

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10
Q

how does lung elastane change in the elderly

A

decreases. rubber band is tired. she stretches better but doesn’t come back into place the same ever again. loss of elastic recoil. (increases dead space, decreases alveolar surface area, increases VQ mismatch and A-a gradient, decreases PaO2

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11
Q

how does chest wall compliance change in the elderly

A

decreases. stiffer, lesser tendency to expand.

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12
Q

how does response to hypoxia and hypercarbia change in the elderly

A

decreases because chemoreceptors are less sensitive to changes in pH, PaO2, and PaCO2
increased risk of hypoventilation, apnea, resp failure
(consider CPAP or BiPAP)

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13
Q

how do protective aw reflexes change in the elderly

A

decreased. reduced efficiency of cough and swallowing
greater stimulus to elicit cough reflex (better at bj’s when old????)
increased risk of aspiration (but die by the bj)

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14
Q

how does upper aw tone change in the elderly

A

decreases. decreased resp muscle strength. increased risk of resp failure and upper aw obstruction. consider CPAP or BiPAP in at risk patients.

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15
Q

which lung capacities increase as age increases

A

RV FRC and CC, minute ventilation

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16
Q

which lung capacities decrease as age increases

A

VC and ERV

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17
Q

which lung capacity doesn’t change as age increases

A

TLC

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18
Q

what happens to venous capacitance as we age

A

veins become stiffer which reduces venous capacitance

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19
Q

what happens to arterial compliance in the elderly and what is the pathophysiology

A

decreased, loss of elastin and increased collagen.
increased SVR and after load increases BP
increased PP
increased myocardial wall tension to overcome higher after load
increased LV thickness (concentric hypertrophy)

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20
Q

what happens to myocardial compliance in the elderly and what is the pathophysiology

A

impaired relaxation –> diastolic dysfunction
atrial kick is super important in non compliant ventricle.

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21
Q

what happens to cardiac conduction in the elderly

A

decreases due to fibrosis of concussion system, loss of SA node tissue

22
Q

VTE increases in elderly because of virchows triad which is

A

venous stasis
hypercoagulability
endothelial dysfunction

23
Q

what happens to pulse pressure in the elderly

A

widens because SBP increases to a much greater degree than DBP

24
Q

what happens to lusitropy in the elderly

A

aged heart is slower to return Ca2+ to SR which decreases lusitropy

25
Q

what happens to systolic function in the elderly

A

preserved!

26
Q

what happens to SV and CO in elderly

A

both decrease r/t decreased cardiac reserve

27
Q

what happens to HR in elderly

A

decrease because of decreased responsiveness to catecholamines

28
Q

what happens to baroreceptor sensitivity in the elderly

A

decreases

29
Q

what happens to sympathetic tone and plasma NE concentration in elderly

A

increases (but end organs are less responsive)

30
Q

what happens to PSNS tone in elderly

A

decreased. may decrease anticholinergics ability to increase HR

31
Q

what happens to autonomic sensitivity in the elderly

A

decreased. this means decreased response to baroreceptor reflex, thermoregulation, dehydration

32
Q

MAC decreases by ____% for each decade of life over 40 years

A

6%

33
Q

postoperative delirium versus postoperative cognitive dysfunction: onset

A

postop delirium: early postop period
postop cognitive dysfunction: weeks to months after surgery

34
Q

postoperative delirium versus postoperative cognitive dysfunction: presentation

A

postop delirium: easy to ID: disordered behavior, perception, memory, psychomotor skills
postop cognitive dysfunction: subtle and difficult to pinpoint (impaired concentration, comprehension, psychomotor skills)

35
Q

postoperative delirium versus postoperative cognitive dysfunction: risk factors

A

postoperative delirium (DELIRIUM pneumonic):
Drugs
Electrolyte imbalance
Lack of drug (withdrawal)
Infection (UTI and resp)
Reduced Sensory Input
Intracranial dysfunction
Urinary retention and fecal impaction
Myocardial event, male gender

cognitive dysfunction: advanced age, pre existing cognitive deficit, cardiac surgery, long duration of surgery, high ASA status, low level of education, anesthetic agents

36
Q

postoperative delirium versus postoperative cognitive dysfunction: treatmetn

A

postop delirium: tx underlying cause, antipsychotics, minimize polypharmacy

cognitive dysfunction: no tx, most cases are mild and tend to resolve after 3 months

37
Q

is there a higher or lower rate of false negative in elderly with epidural anesthesia

A

higher level of false negative related to reduced beta receptor sensitivity

38
Q

how does sensitivity to nerve tissue and LA’s change in elderly

A

it increases due to a decrease in number and diameter of myelinated fibers as well as conduction velocity

39
Q

how does sensitivity to spinal anesthesia change in the elderly

A

increased sensitivity due to greater spread (less CSF volume) and dura is more permeable to LA’s (reduce dose)

40
Q

how does sensitivity to epidural anesthesia change in the elderly

A

increased due to decreased epidural space volume

41
Q

how much does RBF decrease per decade

A

10%

42
Q

how is first pass metabolism affected in the elderly

A

increased concentration of drugs with high first pass metabolism
decreased concentration of drugs that require liver for activation

43
Q

what happens to total body fat as age increases

A

TBF increases as age increases. Vd of lipophilic drugs then increase

44
Q

what happens to TBW and BV as age increases

A

TBW and BV decrease, decreased Vd of hydrophilic drugs

45
Q

what happens to inhalation induction speed as age increases

A

decreased CO prolongs circulation time and actually increases speed of inhalation induction (but IV induction time is slower)

46
Q

a change in what best explains the prolonged time of drug delivery for propofol?

A

circulation time

47
Q

what happens to alveolar surface area in elderly patient

A

decreaed

48
Q

most sensitive indicator of drug clearance in elderly?

A

creatinine clearance.
reduced as a function of lower RBF and fewer nephrons to clear creatinine

49
Q

what does the x and y axis indicate on this illustration

A

x axis: age (horizontal)
y axis: total lung volume (which stays the same) (vertical)

reduction in elastic recoil over time causes overfill with gas and increase in RV
reduction in elastic recoil over time causes small aw’s to collapse during expiration, which increases CC as we age.

50
Q

at what age does CC exceed FRC when laying supine

A

45y

51
Q

does NE or decrease in the geriatric population

A

it increases but it causes a down regulation in adrenergic receptors and a decreased effect

Apex Flashcards (71 decks)

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