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med con iii > CVP ISSUES- OLDER ADULT > Flashcards

CVP ISSUES- OLDER ADULT Flashcards

1
Q

What happens to FEV1 as we age?

A

at about 10 years–> dramatic increase in FEV1

increase from 10 -20 years

gradual decline in FEV1 after age 20 ish

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2
Q

What happens to various lung volumes as we age?

A

DECREASED:
-IRV
-ERV

INCREASED
-residual volume (amount of air that cannot be expelled from the lungs)

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3
Q

Aging and the alveolar-arterial gradient

A

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

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4
Q

Oxygen saturation and living in elevation:

A

-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

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5
Q

Normal relationship between PaO2 and SpO2:

A

PaO2 > 80 mmHg –> SpO2 >93%

PaO2:< 60 mmHg –> SpO2 <88%

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6
Q

What happens to common PFTs with aging?

A

FEV1: decreased

FVC: dec

TLC : unchanged

VITAL CAPACITY: dec

FRC: inc.

RV: inc.

GAS EXCHANGE: dec

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7
Q

Aging and the MSK pump (MIP and MEP)

A

MIP:
-maximal inspiratory pressure

MEP
-maximal expiratory pressure

** overtime, inspiratory and expiratory muscle strength decreases

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8
Q

MVV- max voluntary ventilation changes with aging

A

(measure of respiratory muscle endurance)

-decrease in resp muscle endurance with aging

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9
Q

Aging and diaphragm

A

-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)

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10
Q

Aging and chest wall

A

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

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11
Q

Aging and pulmonary changes:

A

-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

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12
Q

Aging and arteriosclerosis:

A

-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

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13
Q

What type of pulmonary condition do the aging lungs look like?

A

obstructive pulmonary disease

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14
Q

Improvement in carotid artery compliance in late middle aged adults that underwent aerobic exercise program for 12 weeks:

A

30% increase after 12 week of mod intensity aerobic ex

previously sedentary later middle-aged men and women

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15
Q

Collagen changes in vasculature:

A

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

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16
Q

Aortic pulse wave velocity is NOT significantly different in premenopausal and postmenopausal women who have participated in ______

A

endurance training

  • regular aerobic exercise decreases aortic stiffness as we age

–> increases aortic compliance and decreases afterload stresses

17
Q

Aging and vascular system:

A

-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

18
Q

Cardiac muscle changes with aging

A

– ↑ LV wall thickness
– ↓ myocyte #
– ↑ lipid deposition; ↑ fibrosis & collagen
– ↓ heart compliance
–> diastolic dysfunction–> higher LV diastolic pressures

19
Q

Cardiac valve changes with aging

A

– ↑ thickness & calcification
– Alters filling & ejection pressures

-mitral valve changes-> diastolic dysfunction
-aortic valve–> systolic dysfunction

20
Q

Changes in the conduction system with aging:

A

-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

21
Q

Changes to HR and CO with aging:

A

HR:
-heart rate at rest: no change
-heart rate max: declines with age

CO:
-CO at rest: no change
-CO max: declines with age

22
Q

Neurohumoral changes with aging:

A

– 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

23
Q

Aging and Exercise: Effects on CO, HR, SV, BP, VO2

A

-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

24
Q

What is necessary for warm up and cool down time in ex prescription of elderly?

A

increase this time

–> because it takes more time for them to reach a physiologic steady state

25
Q

Why do older adults have an increased CV risk during exercise?

A

-more risk factors
-decreased responsiveness of CV system
-co-morbidities
-polypharm

26
Q

ACSM FITT FOR OLDER ADULT

A

FOR AEROBIC:

3 DAYS/WEEK VIGOROUS, 5 DAYS FOR MODERATE

3-5 DAYS/WEEK

30 MIN MOD/20 MIN VIGOROUS

FLEXIBILITY:
-AT LEAST 2 DAYS PER WEEK, AT LEAST 10 MIN/DAY

STRENGTH:
-AT LEAST 2 DAYS/WEEK
-MODERATE TO VIGOROUS INTENSITY
-70-80% 1 RM 2-3 SETS 8-10 REPS

27
Q
A

med con iii (14 decks)

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