Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Apex > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

How does minute ventilation change in the elderly?

A

Increases (increased dead space > increased minute vent to maintain CO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does lung compliance change in the elderly?

A

Increase (think COPD esque) ~ easier to inflate the lungs

Increase in a given volume for a given pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does lung elasticity change in the elderly?

A

Decreases.
Elastic recoil is lost ~ this promotes small airway collapse.
>increased dead space
>Decrease alveolar surface area
>V/Q mismatch
> increased A-a gradient!
> reduced PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is chest wall compliance changed with age?

A

Decreased chest wall compliance.
Chest wall is stiffer and less tendency to expand.
>calcification of joints
>diaphragmatic flattening
>A:P diameter
>decreased intervertebral disc height.
>decreased muscle strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does old age alter the response to hypercarbia and hypoxia?

A

Chemoreceptors are less sensitive
> risk of Hypoventilation
>risk of apnea
> risk of resp failure

***consider bipap and cpap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does old age affect protective airway reflexes?

A

Reduced efficacy of cough and swallowing.
> increased risk of aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does old age affect airway tone?

A

Decreased muscle strength
> risk of resp failure
> risk of upper airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What lung components are INCREASED in old age?

A

FRC
Residual volume
Closing capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What lung components are decreased in old age?

A

Viral capacity
Inspiratory reserve volume
Expiratory reserve volume
FEV & FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what age does closing capacity surpass FRC in the supine position?

A

~ 45 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

At what age does closing capacity surpass FRC in the standing position?

A

~65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does old age affect TLC?

A

Not much
* increase in Residual volume reduces viral capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 4 most prevalent cardiac diseases in the elderly?

A

HTN
CHF
CAD
And MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the best indicators of cardiac reserve?

A

Exercise tolerance and the ability to perform daily living activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common cause of death for the elderly in the postoperative period?

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does the arterial system change with age?

A

Loss of elastin and increased collagen
> ^SVR
> ^ pulse pressure
> ^ myocardial wall tension
> ^ LV thickness (concentric hypertrophy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the venous system change with age?

A

Decreased
Loss of elastin and increased collagen
>capacitance fx is diminished
Changes in blood volume cause HUGE changes in pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does myocardial compliance change with age?

A

Decreased
Impaired relaxation > diastolic dysfunction
>greater pressure to fill
>filling pressure > volume
> ^HR reduces filling time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is so important in a non-compliant ventricle?

A

Atrial kick

**increased pressure in that atria can cause Afib (leads to a lack of priming)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is myocardial hypertrophy?

A

Increased
Concentric hypertrophy (reduces compliance and impairs relaxation)

21
Q

How does cardiac conduction change with age?

A

Decreased
Fibrosis of the conduction system

***loss of SA node tissue

(Increased likelihood of dysrhythmias)

22
Q

What is Virchow’s triad?

A

Venous stasis
Hypercoagulability
Endothelial dysfunction

23
Q

What is PRESERVED in the geriatric heart?

A

Systolic function

24
Q

What is increased in the geriatric heart?

A

SVR
pulse pressure
Prolonged circulation time

25
Q

What is reduced in the geriatric heart?

A

Diastolic fx
Stroke volume
HR
Decreased responsiveness to catecholamines
Decreased CO

26
Q

How is autonomic fx in the geriatric patient?

A

Decreased.
>reduced baroreceptor activity
> Syncope
> greater Hemodynamic compromise following sympathectomy

27
Q

How is the SNS tone affected in the geriatric patient?

A

Increased
**higher NE concentration in the plasma BUT reduced sensitivity

28
Q

How is PNS tone affect in the geriatric patient?

A

Decreased
May limit anticholinergic ability

29
Q

How does age affect the response to catecholamines?

A

Decreased
> impairs receptor density
> impaired B-receptor and adenylate cyclase coupling
> reduced ability to increase HR during hypotension/stress

30
Q

How much does MAC decrease for each decade of life after 40?

A

6%

31
Q

How much should the dose of IV agent he reduced for the geriatric patient?

A

30-40%

32
Q

How does aging affect the neutransmitter activity of the brain?

A

Reduced activity of Ach, NE, DA, and GABA

33
Q

How is brain mass affect in the geriatric patient?

A

Reduced! ~ but does not affect mental capacity
**Gray matter atrophies faster than white.

34
Q

How does aging affect the peripheral nerves?

A

Decreased myelinated nerves

35
Q

What is the most common CNS complication for the elderly?

A

Postoperative delirium

36
Q

What are the traits of postoperative delirium?

A

Onset: early post-op period
Presentation: easy to identify (disordered behavior, perception, memory)
Risk factors:
> D: drugs
> E: electrolyte imbalance
> L: lack of drugs (withdrawal)
> I: infection
> R: reduced sensory input
> I: intracranial dysfunction
> U: urinary retention/fecal impaction
> M: myocardial event
Tx: treat underlying cause, antipsychotics, and minimize poly pharmacy

37
Q

What are the traits of postoperative cognitive dysfunction?

A

Onset: weeks to months after surgery
Presentation: difficult to pinpoint (impaired concentration/ comprehension)
Risk factors:
> advanced age
> cardiac surgery
> long duration of surgery
> high asa status
> low education
Tx: no specific tx

38
Q

How does the elderly patient response to neuraxial anesthesia?

A

> Increased sensitivity of nerve tissue to local anesthetics (decreased number of myelinated nerves, diameter and conduction velocity)
increased sensitivity to intrathecal anesthetics ~ reduced CSF
increased sensitivity to epidural anesthetics ~ reduced epidural space
increased difficultly placing blocks

**reduced response to epi test dose (greater risk of false negative response)

39
Q

What factor remains the unchanged in the geriatric patient?

A

Serum creatinine

40
Q

How does aging affect the kidney?

A

> Decreased renal blood flow
Decreased renal mass ~decrease glomeruli
Decreased creatinine clearance ~ reduced as a function of renal blood flow
GFR ~ decreases by 1 mL/min/year
decrease response to acid load
decreased aldosterone (inability to conserve sodium - risk of dehydration
decreased antidiuretic hormone response

41
Q

Which protein production is increasing in a geriatric patient?

A

Alpha-1 acid glycoprotein

42
Q

How does aging affect the liver?

A

> decreased hepatic mass
decreased hepatic blood flow
decreased perioperative hepatic function
decreased albumin production
decreased pseudocholinesterase production
decreased phase 1 reactions (phase 2 stay the same!)
decreased first pass metabolism

43
Q

How does aging affect drug circulation?

A

Slower IV induction
Faster inhalation induction

44
Q

How does aging adjust surface area to body mass ratio?

A

Increased d/t Reduced lean body mass

45
Q

How does aging affect the total body fat?

A

Increased ~ increased Vd of lipophilic drugs

46
Q

How does aging affect lean body mass?

A

Decreased
Less muscle causes:
> Decreased nasal metabolic rate
> Decreased total body water
> Decreased blood volume
> Decreased plasma volume
> decreased plasma binding (increased free fraction~ albumin; decreased free fraction of basic drugs ~ 1-acid glycoproteins)
> decrease rate of recovery from volatile anesthetics

47
Q

What should the anesthetic provider anticipate for hydrophilic drugs in the geriatric population ?

A

Smaller Vd ~ higher than expected plasma concentration for a given dose

48
Q

What is the most sensitive indicator of renal function and drug clearance

A

Creatinine clearance

Apex (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions