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Principles II- Josh > Geriatric PPT and lecture notes > Flashcards

Geriatric PPT and lecture notes Flashcards

I added a few %'s b/c heather stated she likes to test them??? I dunno if thats true and why they would be important but I added a few important ones

1
Q

the Age is years for geriatric/elderly patients is what?

A

65

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2
Q

what % of population is over 65

A

12% (29.1 million)

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3
Q

what percent of the population is baby boomers?

A

13%

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4
Q

what % of those reaching 65 will require surgery sometime before death

A

50%

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5
Q

At least 1 in 4 pt’s presenting for surgery are how old

A

65

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6
Q

what are 6 chronic conditions seen with advanced age?

A
  • Heart disease
  • arthritis
  • Impaired vision
  • DM
  • Cerebrovascular disease
  • COPD
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7
Q

what are the 5 most common proedures performed in the geriatric population

A
  • cateract extraction
  • TURP
  • Herniorraphy
  • Cholecystectomy
  • Reduction of hip Fx
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8
Q

the NIH predicts that after age 70 there is a ______% increase in mortality r/t surgery.
and ____% attributed to anesthesia alone.

A

300%

2% (in general population it is 0.001%) so its a pretty significant increase

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9
Q

the NIH stated what 3 things were the most frequent causes of death in pt’s> 70 yo r/t surgical procedure

A
  • MI
  • Sepsis
  • Thromboembolism
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10
Q

*** what is the main CV change r/t aging ( 1 main concept to remember)

A

the general response is a decreasing response to stimulation of the ANS

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11
Q

Can the old heart compensate for stress?

A

nope

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12
Q

What happens to the cardiac reserve in the old fart?

A

reduced

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13
Q

what happens to CO in the old foggie?

A

decreases

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14
Q

CO decreases at what rate after the age of 30?

A

1% (its a linear relationship)

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15
Q

CO of an 80yo is ______% of that of a 20 year old?

A

50%

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16
Q

What decreases at a slower rate CO or CI?

A

CI

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17
Q

what happens to the HR is old farts?

A

Decreases

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18
Q

the Maximum HR decreases about ____% per decade after the age of 50?

A

5%

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19
Q

what happens to conduction time in the older population?

A

Slowed

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20
Q

the sympathetic response in HR decreases in the elderly b/c of what?

A

a decreased number of sympathetic receptors

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21
Q

* decreased CO and HR lead to what?*

A

Increased circulation time

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22
Q

** Sincce the decreasd CO and HR lead to increased circulation time, what does this mean to our pt’s? **

A

drugs take longer to circulate

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23
Q

What happens to BP with age?

A

Increases

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24
Q

The mean systolic BP reaches approximately what by age 70?

A

150

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25
Q

** what is important to remember with the elderly pt while in the OR in relation to BP*

A

Keep within 20% of baseline

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26
Q

what can happen to diastolic BP with age?

A

may actually fall ( decrease)

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27
Q

what happens to Systolic BP in elderly

A

Increase

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28
Q

what causes the increase in systolic BP in the oldies

A
  • decreased distensibility of great vessels

- Arterio-atherosclerotic deterioration of vascular walls

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29
Q

What happens to the baroreceptor relfex in response to exercise and stress?

A

Decreasesd barorecptor reflex

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30
Q

What can develop due to a decreased barorecptor relfex in the elderly in response to stress and exercise?

A

postural hypotension

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31
Q

** CO is maintained during stress and exercise by what? and what 3 things cause this to occur?

A
  • -Increased diastolic filling & stroke volume.
    1) not HR
    2) Cardiac dilitation
    3) compensatory response to decreased contractility and HR
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32
Q

** what is the main concept to understand in r/t old people and the effects of stress and exercise??***

A

it takes their bodies a long time to adjust to change.

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33
Q

Higher filling pressures are needed in the elderly to maintain SV b/c why

A

b/c of the prolonged contraction and relaxation times,

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34
Q

the elderly’s decreased tolerance to rapid HR causes what 2 things?

A
  • decreased filling time and resting time needed

- increased risk of MI

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35
Q

** main concept about HR and the elderly*

A

they cannot tolerate a high HR so keep it normal.

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36
Q

What are 6 anatomic changs of the heart

A
  • Myocardial hypertrophy
  • Endocardial thickening
  • Valvular fibrocalcifications
  • Decreased # of pacemaker cells
  • sclerosis of conduction system
  • Increase risk of HB
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37
Q

what are some examples of valvular fibrocalcifications in the elderly population

A
  • murmurs
  • endocarditis
  • stenosis
  • insufficiency
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38
Q

Is CAD involved in aging?

A

Yes

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39
Q

The elderly have an increased risk of dveloping what rhythm change?

A

HB

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40
Q

Elderly can have up to ___% decrease in pacemaker cells

A

80

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41
Q

*** main summary points of the CV changes in the elderly*
3 things that decrease????

A
  • CO
  • Maximum HR
  • BP (diastolic)
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42
Q

*** main summary points of the CV changes in the elderly*
3 things that increase????

A
  • LVEDP
  • SV
  • Heart size
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43
Q

the cardiac reserves are decreased to the margin of error that can be tolerated is what?

A

Decreased

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44
Q

Inhalation agents, induction agents as well as others that cause a decrease in CO must be used _________ or ________ to prevent an exaggerated response

A

Judiciously or Avoided

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45
Q

What are 3 reasons the preoperative ECG is essential in the lderly

A
  • serves as a baseline
  • serves as a diagnostic tool
  • shows ischemic patterns (ST elevation MI, ST depression ischemia)
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46
Q

What do you want to rememebr about homemeds preop

A
  • evaluate HTN meds
  • assess fluid/electrolyte balance
  • if on diuretics watch K+
  • maintain meds unless contraindicated (hold insulin, use inhalers, always BB, hols ACEi’s)
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47
Q

*** what is the best lead to monitor intraop and why?

A

V5, best one to use over lead II b/c has a better detection of ischemia (ST depression)

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48
Q

*** 3 things to remember during induction

A

-slower aproach
- Judicious use of drugs
- Slow circulation time
REMEMBER EVERYTHING SLOWS

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49
Q

in relation to respiratory changes there is usually a decrease in what 2 things

A
  • elasticity

- maximum lung function

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50
Q

Respiratory changes begin as early as what age?

A

30

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51
Q

respiratory changes that decrease with age?

A
  • Forced Vital Capacity (FVC)
  • Forced Expiratory Volume in 1 sec (FEV1)
  • alveoli and pulmonary capillaries
  • muscle strength
  • flexibility of rib cage
52
Q

the loss of paranchymal support of the small airways causes what

A

early collapse at increasingly higher lung volumes

53
Q

FEV1 decreases from about 4.5L at age 20 to about _______L at age 80

A

2.5L

54
Q

the loss of paranchymal support and decrease in FEV1 cause the lveoli to do what in the elderly

A

remain more distended and less distensible on inspiration

55
Q

what causes a decreased MV

A

decreae in both rate and TV

56
Q

what causes the decreased O2 consumption an dCO2 production

A

decreased metabolic rate

decreased airway reflexes

57
Q

what causes the decreased alveolar gas exchange

A

VQ mismatch

uneven inspired gas distribution

58
Q

what pulmonary factors increase with age

A
  • dead space
  • FRC
  • Alveolar size
  • closing volumes
  • secretions
59
Q

What causes increased dead space

A
  • large airways increase in diameter

- Small airways increase in diameter

60
Q

What causes the increase in functional residual capacity (FRC)

A

the ratio of residual volume to total lung capacity decreases from 20% in early years ti 35-40% in elderly

61
Q

what causes the increased alveolar size

A

septal membranes weaken and stretch

62
Q

what causes increased closing volumes

A

loss of elastic recoil

63
Q

what causes increased secretions

A
  • Tracheobronchial production of secretion increase

- decreased ability to eliminate secretions

64
Q

what are 3 respiratory factors that remain unchanged in the pulmonary system

A
  • PaCO2 (resting) (the hypoxic and hypercarbic drive is reduced by half
  • Pulmonary circulating volume (pulmonary capillary beds decreases, less reserve)
  • total lung capacity (TLC)
65
Q 
**** Main points from respiratory changes****
Total Lung Capacity (TLC)?
Residual Volume (RV)?
Functional Residual Capacity (FRC)
Vital Capacity (VC)
A

TLC- Decreased
RV- increased
FRC- increased
VC- Decreased

66
Q

Vital Capacity

A

the maximum amt of air a person can expel from lungs after maximum inhalation

67
Q

FRC

A

the volume of air present in the lungs, specifically the parenchyma tissues, at the end of passive expiration

68
Q

RV

A

the volume of air remaining in the lungs after a maximal exhalation

69
Q

TLC

A

maximum volume to which the lungs can be expanded with the greatest possible inspiratory effort

70
Q

Anesthetic concerns r/t pulmonary changes

A
  • Onset and emergence of inhalation anesthetics may be delayed
  • Higher Fi02 may be needed
  • Increased secretions may cause need for pulmonary toilet during periopertive period
  • increased closing volumes may require PEEP
71
Q

pulmonary toilet

A

Pulmonary hygiene, (formerly referred to as pulmonary toilet) is a set of methods used to clear mucus and secretions from the airways
-Methods used for pulmonary hygiene include suctioning of the airways, chest physiotherapy, blow bottles,[3] and nasotracheal suction.[5] Bronchoscopy, in which a tube is inserted into the airways so that an examiner can view them, can be used therapeutically as part of pulmonary hygiene.[4] Incentive spirometry and use of analgesics (pain medications) that do not inhibit breathing are also parts of pulmonary toilet.[6] Coughing is also important for ridding the airways of secretions, so healthcare providers are careful not to oversedate patients, because that could inhibit coughing.[7] Tracheotomy facilitates pulmonary toilet.[8] Percussion, another method, loosens secretions and allows the cilia of the airways to remove material. Positioning is another method for promoting drainage of secretions; sometimes patients are placed in a prone position to aid in this purpose.

72
Q

what can cause the onset and emergence of inhalational anesthetics to be delayed

A
  • decreased vent pattern

- increased shunting

73
Q

what things decrease in the nervous system in response to aging

A
  • brain weight
  • opiate receptors
  • Nerve conduction
  • cerebral blood flow
  • epidural space
  • thermoregulation
74
Q

Why does the brain weight decrease?

A

atrophic changes mainly frontal lobe

decreased # of neurons (cerebral cortex)

75
Q

what are things that occur do to the decrease in # of opiate receptors

A
  • *decrease sensitivity to pain
  • increased sensitivity to narcs/inhaled agents
  • decreased MAC and Narc requirement
76
Q

what is important to remember while positioning a pt due to decrease in opiate receptors

A

decreased sensations to pain, so extra protection

77
Q

is autoregulation maintained dispite decreased blood flow in the elderly?

A

YES

78
Q

***** age for aged?

A

> 80

79
Q

***** age for elderly/ geriatric

A

> 65

80
Q

Why is thermoregulation decreased

A
  • less fat

- less shivering

81
Q

what are anesthetic implications for CNS r/t need to maintain normal BP to sustain cerebral perfusion

A
  • maintain bp within 20% baseline

- HTN may cause CVA

82
Q

what are anesthetic implications for CNS r/t preoperative period

A 
-evaluate:
hearing
sight
organic brain syndrome
other changes
(know baselines)
83
Q

what are anesthetic implications for CNS r/t positioning

A

be carefull less sensitive to pain

84
Q

what are anesthetic implications for CNS r/t regional anesthestics

A
  • CSF pressure lower (less incidence of spinal H/A
  • CSF specific gravity higher
  • greater dispertion of LA
  • Les CV reserve so greater hypotension with sypathetic block
  • smaller doses for epidurals may be needed
85
Q

what are anesthetic implications for CNS r/t induction/emergence

A
  • slower times

- decreased circulation times

86
Q

what are anesthetic implications for CNS r/t agents

A

more sensitive

87
Q

what are anesthetic implications for CNS r/t temperature

A

monitor closely due to loss of regulation

88
Q

what decreases with age in the renal system?

A
  • renal mass
  • GRF(46% by 90yo)
  • Nephron number and size
  • perfusion (1-2%/year after 25yo)
89
Q

What happens to secretion of aldosterone with aging? what are the consequences?

A
  • – decreased secretion
  • increased Na and H2O loss
  • Increased K+ retention
90
Q

what happens to drug elimination r/t renal system in he elderly

A

decreases

91
Q

what happens to SQ fat

A

loss

92
Q

what occurs to skin

A

becomes thinner

93
Q

what happens to body hair?

A

loss

94
Q

******** what 3 things all contribute ti loss of body heat in the elderly?

A

loss of SQ fat
Thinner skin
Loss of body hair

95
Q

what happens to the risk of adverse drug reactions in the elderly?

A

increases
3% in ages 30 or less
21.3% in people over 70

96
Q

what 2 things cause alterations in drug absorption

A 
delayed GI motility
Circulatory changes (slow)
97
Q

what 3 things cause alterations in GI (all tend to slow absorption)

A
  • delayed absorption
  • GASTRIC SECRETIONS MORE ALKALINE
  • passive diffusion of drugs across cell membrane more difficult
98
Q

what 4 things effect absorption of drugs in relation to absorption

A
  • circulatory times slowed
  • delays in onset of IV/inhaled drugs
  • periphreal circulation slowed
  • slowed IM absorption
99
Q

what changes in body composition cause alterations in volume of distribution?

A
  • fat content of TBW increases 20-40%

- lean body mass decreases by 10-20%

100
Q

what causes alteration in drug binding in the elderly?

A

serum albumin concentration decreases 20%

    • most drugs used bind to albumin
    • lower albumin levels allows more unbound active drug to circulate
101
Q

what slows rate of elimination of inhaled agents

A

decreased ventilation

102
Q

what happens to MAC values of the elderly

A

-decrease 20-30%

103
Q

Post operative problems in elderly

A
  • atelectasis/PNE
    -MI/CHF/ conduction problems
    Thromboembolism
104
Q

* is a question on the test ask about organs the answer is generally what??

A

DECREASED

105
Q

** why can’t elderly retain heat***

A

Can’t shiver

106
Q

7 common age related A&P changes??

A
  • DECREASED organ function
  • INCREASED body fat
  • DECREASED blood volume
  • DECREASED ability to retain heat
  • DECREASED in lean body mass
  • DECREASED skin elasticity
  • collagen loss
  • DECREASED intracellular water
107
Q

11 Common age related CV A&P changes

A
  • impaired pump fxn
  • prolonged circulation time
  • myocardial fiber atrophy
  • HTN
  • Impaired cardiac adrenergic receptor quality
  • Increased PVR
  • DECREASED CO
  • DECREASED organ fxn
  • DECREASED organ perfusion
  • left ventricular hypertrophy
  • CAD
108
Q

8 common pulmonary age related A&P changes

A
  • INCREASED lung compliance
  • DECREASED forced expiratory volume
  • INCREASED closing volumes
  • DECREASED resting arterial O2 tension
  • INCREASED alveolar-arterial differences
  • V/Q mismatch
  • DECREASING FRC
  • DECREASING TLC
109
Q

6 common age related CNS A&P changes

A

-DECREASED activity
- DECREASED O2 consumption
-REDUCED # of functioning receptors
- REDUCED production of NT
- Neuron loss
- DECREASED CBF
All decreased

110
Q

7 common Age related renal/hepatic changes

A
  • DECREASED renal blood flow
  • DECREASED urine concentrating ability
  • DECREASED ability to conserve H2O
  • DECREASED elimination of drugs
  • DECREASED hepatic blood flow
  • DECREASED plasma drug clearance

** all DECREASED

111
Q

surgical pt’s at risk for post operative delerium

A 
70 or older
Hx of delerium
ETOH abuse
preop narc use
preop depression
112
Q 
***************************************************she said to focus on this 
age related changes to pharmacokinetics
name the effect of the change!!
Contracted vascular volume
Decreased protein binding
Increased total body lipid storage sites
decreased renal and hepatic blood flow
A
  • high inital plasma concentrations
  • Increased availability of free drug
  • prolonged action of lipid-soluable drugs
  • prolonged action of drugs dependent on kidney and liver elimination
113
Q

Contracted vascular volume causes what r/t PK

A
  • high inital plasma concentrations
114
Q

Decreased protein binding causes what r/t PK

A

Increased availability of free drug

115
Q

Increased total body lipid storage sites causes what r/t PK

A

prolonged action of lipid-soluable drugs

116
Q

decreased renal and hepatic blood flow causes what r/t PK

A

prolonged action of drugs dependent on kidney and liver elimination

117
Q

What are some common coexisting diseases in elderly pts

A
  • systemic HTN
  • CAD
  • CHF
  • PV disease
  • COPD
  • Anemia
  • renal disease
  • liver disease
  • DM
  • Arthritis
  • Dementia
118
Q

how to calculate CO

A

HR x SV

119
Q

Average SV of a pt

A

60-80 mls

120
Q

Normal CO of a person (not elderly)

A

4.8-6.4 L/min

average hr 80x70ml=5,600ml=5.6 L/min

121
Q

what is Cardiac index

A

is a vasodynamic parameter that relates the cardiac output (CO) to body surface area (BSA),[1] thus relating heart performance to the size of the individual. The unit of measurement is litres per minute per square metre (l/min/m2).

122
Q

Normal CI

A

2.6 - 4.2 L/min per square meter

123
Q

How to calculate CI

A

CO/BSA=CI

124
Q

how to calculate BSA

A

0.007184 x Wkg^0.425 x Hcm^0.725

125
Q

so calculate the CO and CI for a 162cm 88kg pt with a HR of 76 (assume SV 65)

A 
CO= hr x SV
CO= 76 x 65=4940=4.94L/min

BSA=0.007184 x Wkg^0.425 x Hcm^0.725
BSA = 0.007184 x 88^0.425 x 162^0.725
BSA= 1.926m^2

CI=4.94/1.926=2.56490135

Principles II- Josh (17 decks)

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