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apa2 > Geri Rupp > Flashcards

Geri Rupp Flashcards

1
Q

Geriatric population ___ fold increase of intra-op death

A

3

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2
Q

Elevated CV changes in geri

A

Elevated afterload,
elevated systolic pressure,
Left ventricular hypertrophy

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3
Q

Decreased CV changes

A

decrease in elasticity of arteries,
adrenergic activity decreases,
decreased heart rate both rest and max,
decreased baroreceptor response

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4
Q

Commonly on H&P

A 
Aortic stenosis,
Hx of arrhythmias,
CHF,
HTN,
CAD
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5
Q

Heart rate declines __ _____ per minute per year over the age of ____

A

1 beat,

50

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6
Q

_____ enlargement puts them at risk for ____ and very common A-____

A

Atrial,
SVT,
A-fib

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7
Q

COnduction system fibroses and loss of ___ node cells increase chances of _____

A

SA node,

arrhythmias

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8
Q

Left ventricular wall ______ by _____ the cavity

A

thickens,

decreasing

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9
Q

Eccentric hypertrophy

A

ventricular dilation while maintaining normal sarcomere lengths-the heart can expand to receive a greater volume of blood. The wall thickness normally increases in proportion to the increase in chamber radius

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10
Q

Concentric hypertrophy

A

In the case of CHRONIC pressure overload (as through anaerobic exercise, which increases resistance to blood flow by compressing the arteries), the chamber radius may not change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres

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11
Q

what causes drops in BP during induction with geriatrics?

A

decreases in their cv system-autonomic responses that maintain homeostasis progressively decline-autonomic dysfuntion

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12
Q

circulation time IV vs inhalation

A

slow IV drugs but speeds induction with inhalation agents

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13
Q

What are two cardiovascular responses that are altered to blunted B-receptor response?

A

decreased maximal heart rate and decreased peak ejection fraction (board question)

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14
Q

The elderly patient is more dependent on an _____ in ___-_____ volume than an ________ in heart rate to produce an _____ in CO.

A 
increase,
end-diastolic,
increase, 
increase.
These factors make the geri patient more prone to CHF when large volumes of IV fluids are administered in the presence of anesthetic-induced myocardial depression and hypotension.
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15
Q

Respiratory decrease changes

A

decrease in elasticity of lungs,
decrease in alveolar surface area,
decreased cough,
blunted response to hypercapnia and hypoxia,
decreased max breathing capacity,
vital capacity significantly decreases-25mL/yr starting at age 20,
total lung capacity decreases

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16
Q

respiratory changes increase

A 
increased residual volume,
vent/perf mismatch,
increased chest wall rigidity,
increased closing capacity and closing volume,
dead space increases,
FRC increases slightly
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17
Q

Lung H&P

A

Lung CA,
Pneumonia,
Emphysema,
Chronic bronchitis

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18
Q

Respiratory general

A

see an over distention of alveoli,
collapse of small airways,
this pts difficult to mask vent-edentulous,
arthritis in mouth opening and cervical spine,
no teeth does make for a better view,
increase risk of aspiration r/t decrease in airway reflexes,
shallow breathers in recovery room-Question to leave intubated with a pre-exisiting respiratory disease.

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19
Q

elderly have signs of both ____ and obstructive disease

A

restrictive

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20
Q

does Vd/Vt ratio increase or decrease with age

A

Bohr equation, increase?
150mL/450mL=0.33%
200mL/400mL=0.5%?

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21
Q

Elderly gastric

A

gastric pH rise,
Gastric emptying slows,
Some elderly patients have smaller stomach volumes than younger patients

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22
Q

Temperature regulation

A

Heat production decreases,
Heat loss increases,
Three things that put them at risk-decreased metabolic rate, decreased heat production, deficient thermostat control

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23
Q

Renal changes

A

decreased blood flow, GFR, renal mass, concentration, dilution, drug excretion, renin-aldosterone response.
Impaired sodium handling, fluid handling, and potassium excretion

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24
Q

Renal H&P

A

Prostatic obstruction, CHF, Hypertensive nephropathy, diabetic nephropathy

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25
Q

BUN gradually _____ by ____ mg/dl per year

A

increases 0.2%

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26
Q

Renal cortex replaced with ____ and _____ tissue

A

fat and fibrotic

27
Q

serum creatinine is the same r/t

A

decrease in muscle mass and decreased production of creatinine

28
Q

Predisposed to dehydration as well as fluid overload r/t

A

sodium, diluting, and concentrating management changes

29
Q

Inability to reabsorb glucose increases or decreases?

A

decreases

30
Q

Decreased blood flow to renal in this pop increases their risk of

A

acute renal failure

31
Q

Diuretics predispose them to

A

hyperkalemia and hypokalemia

32
Q

Most specific test of renal failure

A

serum creatinine clearance (24hrs) to assess GFR (important)

33
Q

Cerebral blood flow and brain mass

A

decrease

34
Q

Neurotransmitters ______ (dopamine) and their receptors ________

A

decrease, decrease

35
Q

Degeneration of peripheral nerves does what to conduction and reactions leading to muscle______

A

SLOWS, atrophy

36
Q

Increase in thresholds

A

touch, temperature, pain, proprioception, hearing, and vision

37
Q

Dosages for locals and general anesthetics are

A

reduced.

38
Q

Spread of epidural

A

more cephalad spread

39
Q

epidrual has a _____ duration on analgesia and motor

A

shorter

40
Q

geriatrics need more____ to recover cognitively from general anesthetics

A

time

41
Q

______ incidence of confusion, delirium, and cognitive disruptions can be related to

A

drug effects, pain, previous dementia, hypoxemia, and metabolic disturbances

42
Q

very sensitive to anticholinergics like

A

scopolamine and atropine

43
Q

some suffer prolonged or even permanent cognitive problems— believed

A

to be non anesthetic related

44
Q

skin atrophies with age, prone to ______. veins frail and hard to ____. arthritic joints, make _______ difficult

A

tearing,
cannulate,
positioning

45
Q

pharmacokinetic-

A

relationship between drug dose and plasma concentrations

46
Q

pharmacodynamic-

A

relationship between plasma concentrations and clinical effect

47
Q

_____ in muscle mass and _____ in body fat

A

Decrease, increase (more in women on body fate)

48
Q

Do pharmacokinetics and pharmacodynamics changes?

A

Yes but research inconsistent with this population

49
Q

Total body water is

A

decreased (effects water soluble drugs)

50
Q

Reduced volume for water soluble drugs can lead to _____ plasma concentrations

A

HIGHER

51
Q

Conversely fat soluble drugs- with _____ volume of distribution, can ____ the plasma concentrations

A

increased, lower

52
Q

why do many drugs have prolonged effects?

A

d/t renal and hepatic function declining

53
Q

MAC for inhalation agents decrease __% per decade after age ____

A

4%, 40

54
Q

decreased CO causes onset to be more

A

rapid

55
Q

myocardial depressants effect ______ while the tachy response is ______

A

exaggerated, decreased

56
Q

Longer to wake up d/t _____ body fat, _____ hepatic, and _____ pulmonary gas exchange.

A

increased, decreased, decreased

57
Q

doses for barbiturates, opioid agonists, and benzodiazepines

A

Lower

58
Q

IS there a change n muscle relaxant effects?

A

No, but PROLONGED excretion (renal)

59
Q

Most plasma proteins are unchanged, albumin slight decrease, but alpha-1 glycoprotein _____- this one binds with ____ ______ and ________

A

increases, binds with local anesthetics and opioids

60
Q

what is progeria and what is another name for it?

A

premature aging, Hutchinson-Gilford syndrome

61
Q

Signs of progeria

A

ischemic heart disease, HTN, cerebrovascular disease, osteoarthritis, and diabetes mellitus. Mandibular hypoplasia, micrognathis, narrow glottic opening

62
Q

progeria apparent at what age and average lifespan?

A

6 months and 13 yo

63
Q

Overview

A 
choose drug doses wisely, 
think regional,
give beta blockers,
five antibiotics,
avoid hypothermia,
prepared for hemodynamic instability,
post-op analgesia carefully,
monitor for sub-clinical events,
allow more time to respond to questions, requests, drugs, and time to emerge/achieve extubation criteria,
Bad outcomes usually occur despite good care

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