CVP ISSUES- OLDER ADULT Flashcards
What happens to FEV1 as we age?
at about 10 years–> dramatic increase in FEV1
increase from 10 -20 years
gradual decline in FEV1 after age 20 ish
What happens to various lung volumes as we age?
DECREASED:
-IRV
-ERV
INCREASED
-residual volume (amount of air that cannot be expelled from the lungs)
Aging and the alveolar-arterial gradient
is the difference between the alveolar concentration (A) of oxygen and the arterial (a) concentration of oxygen.
NORMAL: 0 cmH2O
100-100 = 0
normally increases with age –> gas exchange gets more difficulty the older we get
the measurement of o2 in the blood decreases with age
Oxygen saturation and living in elevation:
-air pressure is reduced at higher elevations–> the amount of o2 is the same, what differs is the atmospheric pressure –> less pressure pushing oxygen gas into the bloodstream
-a pulse ox reading may be lower for someone in denver–> may be more reliant on supp oxygen
Normal relationship between PaO2 and SpO2:
PaO2 > 80 mmHg –> SpO2 >93%
PaO2:< 60 mmHg –> SpO2 <88%
What happens to common PFTs with aging?
FEV1: decreased
FVC: dec
TLC : unchanged
VITAL CAPACITY: dec
FRC: inc.
RV: inc.
GAS EXCHANGE: dec
Aging and the MSK pump (MIP and MEP)
MIP:
-maximal inspiratory pressure
MEP
-maximal expiratory pressure
** overtime, inspiratory and expiratory muscle strength decreases
MVV- max voluntary ventilation changes with aging
(measure of respiratory muscle endurance)
-decrease in resp muscle endurance with aging
Aging and diaphragm
-decreased diaphragm strength/force generation
-increased rigidity
-age related decline in Type II fibers combined with ms. atrophy
-dec MIP
-dec MEP
-dec MVV (endurance)
Aging and chest wall
Decreased chest wall compliance
-Thoracic rigidity
–> kyphoscoliosis
–> calcification and intercostal cartilage
–>arthritis of costovertebral joints
–> alteration of chest wall mechanics –> decreased compliance
-increased contribution of intercostal muscles (accessory muscles) for effective ventilation
–> due to thoracic rigidity
Aging and pulmonary changes:
-increased accessory ms. use
-increased WOB
-decrease gas exchange efficiency
–> increased risk of hypoxemia (desat)
-increased ventilation compared to younger at same work loads
-diminished cough reflex
–> increased susceptibility to resp infections
Aging and arteriosclerosis:
-with aging, vasculature gets stiffer
-our aorta and blood vessels stiffen
-increased LV afterload
-increased LV pumping work
-increased LV hypertrophy
–> can lead to heart failure
** with aging, CV decline looks like heart failure
What type of pulmonary condition do the aging lungs look like?
obstructive pulmonary disease
Improvement in carotid artery compliance in late middle aged adults that underwent aerobic exercise program for 12 weeks:
30% increase after 12 week of mod intensity aerobic ex
previously sedentary later middle-aged men and women
Collagen changes in vasculature:
ANIMAL STUDY:
-collagen I expression greater in older mice compared with younger controls–> stiffer arteries
-wheel running for 10-14 weeks reverses carotid artery collagen to levels at or below those of young controls
Aortic pulse wave velocity is NOT significantly different in premenopausal and postmenopausal women who have participated in ______
endurance training
- regular aerobic exercise decreases aortic stiffness as we age
–> increases aortic compliance and decreases afterload stresses
Aging and vascular system:
-large arteries relatively dilated—> decrease dilatation reserve
-increased arterial stiffness (decreased arterial compliance)
–> increased heterogeneity of endothelial cells in intima
–> increased size of smooth muscle layer in media
–> increased calcification and collagen deposition –> increased stiffness
–>fragmentation and atrophy of elastin fibers
-HTN common –> due to increased TPR
-increased LV afterload–> LV hypertrophy and possibly heart failure
Cardiac muscle changes with aging
– ↑ LV wall thickness
– ↓ myocyte #
– ↑ lipid deposition; ↑ fibrosis & collagen
– ↓ heart compliance
–> diastolic dysfunction–> higher LV diastolic pressures
Cardiac valve changes with aging
– ↑ thickness & calcification
– Alters filling & ejection pressures
-mitral valve changes-> diastolic dysfunction
-aortic valve–> systolic dysfunction
Changes in the conduction system with aging:
-decreased number of SA node pacemaker cells
-atrophy and fibrosis of conduction pathways
-increased risk of dysrhythmias
-10-15% of the population > 70 years has A FIB –> increased risk of clotting; may limit filling, decreased SV and decreased CO, decreased BP
Changes to HR and CO with aging:
HR:
-heart rate at rest: no change
-heart rate max: declines with age
CO:
-CO at rest: no change
-CO max: declines with age
Neurohumoral changes with aging:
– Sympathetic nervous system activity increases
* ↑ circulating catecholamines (Norepi; Epi); less of this binds to receptors
– Parasympathetic nervous system activity decreases
– ↓β- adrenergic responsiveness
* blunted post-synaptic responses;
decreased receptor sensitivity
–> REFRESH: Beta-1 agonists increase heart rate and blood pressure, while beta-2 agonists cause vasodilation in the myocardium.
-baroreceptor sensitivity decreases
–> increased orthostatic intolerance; increase risk of postural hypotension
Aging and Exercise: Effects on CO, HR, SV, BP, VO2
-CO at maximal workload can increase with ex training
-HR at submax workloads is reduced with ex training
-decrease BP at submax workloads
-SV at submax and max workloads is increased with ex training
-increase in VO2 max at max workloads
PERIPHERAL CHANGES
- Increased vascular compliance; decreased TPR (afterload)
– increased (A-V) O 2 diff: improved oxygen extraction by working muscles
– ↑ muscle mass; ↑ capillary density; ↑ aerobic enzymes
OTHER CHANGES
-improved BP, body weight, lipid profile, bone health
What is necessary for warm up and cool down time in ex prescription of elderly?
increase this time
–> because it takes more time for them to reach a physiologic steady state
