Geriatrics Flashcards
A 70-kg patient can walk up two flights of stairs without stopping. How much oxygen is consumer per minute during this activity?
a. 250 mL
b. 500 mL
c. 1,000 mL
d. 1,500 mL
c. 1,000 mL
Walking up two flights of stairs without stopping is equal to ____ METS
4
One MET corresponds to oxygen consumption of
3.5 mL/kg/min.
__________ are classified as geriatric or elderly.
Patients 65 years of age or older
A bedside tool that allows us to measure functional reserve and identify those who are at greater perioperative risk is known as
metabolic equivalents or METs
Inability to achieve 4 METs is associated with
increased perioperative risk
Examples of activities that meet 4 METs levels include
climbing a flight of stairs without stopping and raking leaves
The subjective nature of METS makes it
a poor predictor of postoperative morbidity and mortality
_____________ is characterized by a decreased reserve coupled with reduced resistance to stress (physiologic, physical, or psychosocial).
Frailty
Frail patients are more likely to
suffer poor outcomes when exposed to perioperative stressors
The most significant risk factor for developing cancer is
getting older
For every MET a patient can achieve, mortality decreases by
11%
Answering “yes” to the following questions indicates the patient is ok for surgery without the need for additional cardiac testing.
- Can you walk up a flight of steps without stopping?
- Are you able to walk four blocks without stopping?
Activities that are equal to 1 METs include
self-care activities
working at computer
walking 2 blocks slowly
Which factor increases in the elderly?
a. dead space
b. lung elasticity
c. PaO2
d. chest wall compliance
a. dead space
What happens to minute ventilation as we age?
increased
What happens wot upper airway tone as we age?
decreased
What happens to protective airway reflexes as we age?
decreased
What happens to lung compliance as we age?
increased
What happens to chest wall compliance as we age?
decreased
What happens to the response to hypercarbia and hypoxia as we age?
decreased
What happens to lung elasticity as we age?
decreased
Older adults have ___________ related to decreased upper airway tone
increased risk of respiratory failure and upper airway obstruction
Older adults have ____________ related to decreased protective airway reflexes
reduced efficiency of cough and swallowing
higher risk of aspiration
Due to their decreased response to hypercarbia and hypoxia, older adults have
higher risk of hypoventilation
higher risk of apnea
higher risk of respiratory failure
Older adults have an increased __________ which requires an increased ___________ to maintain a normal PaCO2
dead space; minute ventilation
Which volumes and capacities are increased in the 70-year-old patient? (select 3)
a. closing capacity
b. residual volume
c. total lung capacity
d. vital capacity
e. expiratory reserve volume
f. functional residual capacity
a. closing capacity
b. residual volume
f. functional residual capacity
Closing capacity surpasses FRC at _____________ in the _________ position and _____________ when ________
45 in the supine; 65 when standing
As closing capacity surpasses FRC, this means that the small airways
will collapse during tidal breathing which sets the stage for V/Q mismatch, increased dead space, and decreased PaO2
What happens to FRC as we age?
increased
What happens to total lung capacity as we age?
no change
What happens to vital capacity as we age?
decreased
What happens to closing capacity as we age?
increased
What happens to inspiratory and expiratory reserve volume as we age?
decreased
What happens to residual volume as we age?
increased
What happens to FEV & FEV1 as we age?
decreased
The following changes occur in the cardiovascular system in response to aging EXCEPT:
a. diastolic dysfunction
b. loss of elastin in arterial wall
c. fibrosis of the cardiac conduction system
d. increased venous capacitance
d. increased venous capacitance
The most common coexisting disease in the elderly is
cardiac disease
The four most common cardiac conditions in the elderly are
HTN
CAD
CHF
myocardial ischemia
The best indicators of cardiac reserve are
exercise tolerance & the ability to perform daily living activities
What happens to myocardial mass in the elderly patient?
increased
What happens to arterial & venous compliance in the elderly patient?
decreased
What happens to myocardial compliance and conduction in the elderly patient?
decreased
In the postoperative period, _______________ is the most common cause of death.
myocardial infarction
Because of their decreased cardiac conduction, elderly patients are at an increased likelihood of
dysrhythmias such as atrial fibrillation, 1st degree block, 2nd degree block and sick sinus syndrome
_________ increases with age due to Virchow’s triad
The risk of DVT
Virchow’s triad includes
venous stasis
hypercoagulability
endothelial dysfunction
