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► Med Misc 44 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

________ is a greater determinant of posts complications than anesthetic management

A

preop co-morbid diseases

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2
Q

the most commonly occurring post op complications in the elderly are

A

cardiac
Pulmonary
neuro

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3
Q

thoracic, major vascular, and interperitneal sx in the elderly can increase what 3 complications

A

increased bleeding
Increased risk of post op vent
Increased VAP

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4
Q

aging is associated with a progressive loss of functional reserve in what organ systems

A

all

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5
Q

a ____% decline in organ function occurs after the age of 30

A

1%

ex a 70 yo has a 40% decline in general function

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6
Q

the elderly generally maintain homeostasis but become increasingly less able to restore it when subjected to what?

A

trauma
stress
disease
drugs

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7
Q

what happens to their muscle mass?

A

decreased

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8
Q

what happens to their Fat

A

increased

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9
Q

What happens to the H20 levels

A

decreased

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10
Q

so what happens to hydrophilic drugs

A

decreased Vd (less H20)

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11
Q

So what happens to lipophilic drugs

A

increased Vd (more fat)

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12
Q

what happens to thermoregulation

A

it becomes impaired

Body heat preservation is a must

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13
Q

younger pts shiver at 36.1 C, pts over 80 don’t shiver until what temp

A

35 C

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14
Q

Shivering increasing O2 consumption by how much? and leads to hypoxia, acidosis, and CV compromise

A

400%

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15
Q

____ and ____ of the elderly to requires special attention b/c of fragile skin, decreased SQ fat, and poor skin turgor

A

positioning

padding

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16
Q

Common age related systemic anatomic and physiologic changes: what happens to
organ function

A

decreased

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17
Q

Common age related systemic anatomic and physiologic changes: what happens to
blood volume

A

decreased

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18
Q

Common age related systemic anatomic and physiologic changes: what happens to
protective reflexes

A

decreased

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19
Q

Common age related systemic anatomic and physiologic changes: what happens to
ability to retain heat

A

decreased

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20
Q

Common age related systemic anatomic and physiologic changes: what happens to
lean body mass

A

decreased

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21
Q

Common age related systemic anatomic and physiologic changes: what happens to
skin elasticity and collagen

A

decreased

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22
Q

Common age related systemic anatomic and physiologic changes: what happens to
intracellular water

A

decreased

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23
Q

Common age related systemic anatomic and physiologic changes: what happens to
body fat

A

increased

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24
Q

Common age related systemic anatomic and physiologic changes: what is a complication related to loss of protective reflexes

A

aspiration pneumonia

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25
Q

d/t the progressive loss of function in ALL organs what are 2 complications

A

increased risk for breakdown

decreased ability to repair

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26
Q

state what causes the altered CV physiology:

Increased LV wall thickness

A

increase in the size and Number of individual muscle fibers and adipocytes (fat cells)

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27
Q

state what causes the altered CV physiology:

Increased LV hypertrophy

A

chronic increases in afterload

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28
Q

state what causes the altered CV physiology:

Increased LV wall tension

A

chronic increases in after load

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29
Q

state what causes the altered CV physiology:

Increased afterload

A

decreased arterial compliance

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30
Q

state what causes the altered CV physiology:

Increased cardiac workload

A

reduction in arterial compliance results in increased after load, increased systolic bp, and LV hypertrophy

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31
Q

state what causes the altered CV physiology:

Increased Systolic Bp

A

reduced arterial compliance

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32
Q

state what causes the altered CV physiology:

Increased peripheral vascular resistance

A

reduction in arterial compliance caused primarily by fibrosis of the tunica media (middle layer)

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33
Q

state what causes the altered CV physiology:

increased circulation time

A

reduced myocardial pump fun leads to reduced CO which prolongs circulation time

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34
Q

what does the Decreased circulation time mean with IV induction

A

slower induction

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35
Q

what does Decreased circulation time mean with VAA’s inhalation induction?

A

faster induction

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36
Q

state what causes the altered CV physiology:

Increased conduction fibrosis

A

conduction system fibrosis and loss of SA node cells will increase the incidence of dysrhythemias

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37
Q

state what causes the altered CV physiology:

Increased incidence of dysrhytmias

A

conduction fibrosis of SA node

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38
Q

state what causes the altered CV physiology:

Increased vagal tone

A

a decrease in sensitivity of adrenergic receptors leads to a decrease in HR

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39
Q

what 5 factors r/t the CV system are unchanged in the geriatric population

A 
Diastolic BP (main one)
resting systolic function
excitation-contraction coupling
Ionized Ca++ levels
Contractile proteins
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40
Q

state what causes the altered CV physiology:

Decreased Cardiac reserve

A

exagerated drops in bp adversely affecting the compensatory mechanism of the pt

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41
Q

state what causes the altered CV physiology:

Decreased Cardiac Output

A

aging process and increased Afterload

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42
Q

state what causes the altered CV physiology:

Decreased resting HR

A

increase in vagal tone (normal declining HR is loss of 1 BPM for each year over 50

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43
Q

state what causes the altered CV physiology:

Decreased Left Ventricular compiance

A

stiffer (less complaint) myocardial muscle fibers

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44
Q

state what causes the altered CV physiology:

Decreased Stroke volume

A

decreased myocardial pump function

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45
Q

state what causes the altered CV physiology:

Decreased Perfusion to vital organs

A

organs atrophy

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46
Q

state what causes the altered CV physiology:

Decreased CHRONOTROPIC and INOTROPIC responses

A

decreases in adrenergic receptor quality

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47
Q

state what causes the altered CV physiology:

Decreased baroreceptor function

A

decreased sensitivity of stretch receptors owing to normal aging process

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48
Q

state what causes the altered CV physiology:

Decreased adrenergic sensitivity

A

decrease in quality of receptors

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49
Q

state what causes the altered respiratory physiology:

Increased vocal cord stimulation for closure

A

the stimulus needed for vocal cord closure (protection) is markedly elevated (need increased stimulus to close vocal cords)

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50
Q

state what causes the altered respiratory physiology:

Increased airway obstruction

A

aging decreases the sensitivity of the need to clear secretions.

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51
Q

state what causes the altered respiratory physiology:

Increased risk of aspiration

A

d/t vocal cord stimulation being elevated, thus putting the pt at a higher risk for aspiration.
aslo chest wall rigidity increases and the ability to cough is also decreased

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52
Q

state what causes the altered respiratory physiology:

Increased pulmonary complications

A

decrease in protective laryngeal reflexes and decreased ability to cough

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53
Q

state what causes the altered respiratory physiology:

Increased physiological deadspace

A

the breakdown of alveolar septa reduces total alveolar surface area, increasing both anatomic and physiologic headspace. these changes disrupt the normal matching of ventilation and perfusion within the lungs, increasing both shunting and deadspace.

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54
Q

state what causes the altered respiratory physiology:

Increased work of breathing

A

skeletal calcification and increased airway resistance

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55
Q

state what causes the altered respiratory physiology:

Increased POTENTIAL FOR HYPOXIA

A

decreased elasticity of lung
reduction in alveolar surface area
decrease efficiency of gas exchange
airway collapse

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56
Q 
state what causes the altered respiratory physiology:
Increased FRC (modest)
A

30% of the alveolar wall tissue is lost b/y age 20-80, diminishing elastic recoil and parenchymal traction that maintains airway patency. this produces increased residual volume, closing volume, and FRC

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57
Q

state what causes the altered respiratory physiology:

Increased closing volume and closing capacity (dramatic)

A

caused by airway collaps and distribution of TV to areas of the lung that are less perfused

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58
Q

state what causes the altered respiratory physiology:

Increased alveolar compliance

A

absorption of connective tissue and this results in a loss id protective netting to restrict or limit the expansion of the alveoli

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59
Q

state what causes the altered respiratory physiology:

Decreased elastin fibers ( reduced elasticty)

A

normal aging process

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60
Q

state what causes the altered respiratory physiology:

Decreased Tissue elasticity

A

muscles replaced with adipose tissue

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61
Q

state what causes the altered respiratory physiology:

Decreased Lung recoil

A

chest wall less compliant (stiffer) if the chest wall does not expand upward or outward, the lung will not expand fully, nor recoil fully

62
Q

state what causes the altered respiratory physiology:

Decreased alveolar surface area

A

alveolar wall tissue is decreased

63
Q

state what causes the altered respiratory physiology:

Decreased ability to cough

A

decreased muscle strength

64
Q

state what causes the altered respiratory physiology:

Decreased chest wall compliance

A

cartilage and connective tissue become stiffer

65
Q

what type of lung disease is displayed by the geriatric population d/t decreased chest wall compliance

A

restrictive (like the obese)

66
Q

state what causes the altered respiratory physiology:

Decreased VC, ERV, IRV

A

as residual volumes increase, there is a decrease in VC, ERV, IRV

67
Q

state what causes the altered respiratory physiology:

Decreased protective responses

A

laryngeal respones blunted

68
Q

state what causes the altered respiratory physiology:

Decreased ease of mask ventilation

A

often edentulous

69
Q

what happens to the lung volume and capacity in the elderly:
RV

A

increases

70
Q

what happens to the lung volume and capacity in the elderly:
ERV

A

decreases

71
Q

what happens to the lung volume and capacity in the elderly: FRC

A

INcreases

72
Q

what happens to the lung volume and capacity in the elderly:
CC

A

increased

73
Q

what happens to the lung volume and capacity in the elderly:
IC

A

decreases

74
Q

what happens to the lung volume and capacity in the elderly:
VC

A

decreases

75
Q

what happens to the lung volume and capacity in the elderly:
TLC

A

no change

76
Q

Nervous system:

what happens to Duration of spinal action

A

increases

77
Q

Nervous system:

what happens to SENSORY block with spinals

A

increases

78
Q

Nervous system:

what happens to epidural volume cephalic spread?

A

increases

79
Q

Nervous system:

what happens to CSF according to stolting

A

increases

80
Q

Nervous system:

what happens to epidural motor block?

A

decreases

81
Q

Nervous system:

epidural segment dosing

A

decreases

82
Q

Nervous system:

what happens to dose of general anesthestics

A

decreases

83
Q

Nervous system:

what happens to CSF according to Nagehout, M&M, and Miller

A

decreases

84
Q

Nervous system:

what is the most common neurological complication

A

postop delerium (15-53%)

85
Q

Nervous system:

postop delerium is characterized by what?

A 
disruption of perception
Disruption of thinking and memory
Disruption in psychomotor behavior
disruption in sleep wake cycle
disruption in attention
disruption in conciousness
86
Q

Nervous system:

what are risk factors for post delerium

A 
old age
male
dementia
ETOH abuse
Depression
duration of anesthesia
poor functional status
abnormal electrolytes
parkinsons dz
CV disease
dehydration
metabolic dz
intraop anticholinesterases
ICU admission
surgery type
87
Q

Nervous system:

post op delirium is most common in what 2 surgeries

A 
orthopedic (28-60%)- femur 
CV surgery (32-47%)
88
Q

Nervous system:

what is not the same as post of delirium, has a subtle onset and may not present for weeks to months after sx

A

POCD

post operative cognitive dysfunction

89
Q

Nervous system: POCD

characterized by what?

A

memory deficits
difficulty concentrating
impaired comprehension
delayed psychomotor speed

90
Q

Nervous system: POCD
there are no universally accepted diagnostic activity, no definition, no known cause, no cure, and no proven effective stratigies

A

just for knowledge

91
Q

Nervous system: POCD

what are recommendations for prevention

A

keep anesthesia short
use short acting and rapidly metabolized drugs
pts at risk, use inhalation drugs

92
Q

what is the most common comorbidity in the elderly

A

HTN

followed by CAD

93
Q

Endocrine:

what happens to insulin resistance?

A

Increased Insulin resistance

94
Q

Endocrine:

what happens to heat loss

A

increased heat loss

95
Q

Endocrine:

what happens to basal O2 consumption

A

decreased

96
Q

Endocrine:

what happens to Heat Production

A

decreased

97
Q

Endocrine:

what happens to liver mass, hepatic blood flow, and liver metabolism

A

decreased

98
Q

Endocrine:

why does basal and metabolic O2 consumption decline as one ages

A

d/t general loss of lean body mass

99
Q

Endocrine:
the combo of Heat production decrease, heat loss increase, and hypothalamic temperature regulating centers reseting to a lower level all predispose the patient to what?

A

hypothermia

100
Q

Endocrine:

why does DM increase in the elderly

A

d/t the decline in pancreatic function

101
Q

Endocrine:

what are 2 mechanisms responsible for elevated blood sugars

A

sluggish insulin response to hyperglycemia

Resistance to effects of insulin at peripheral receptors

102
Q

Gastrointestinal & hepatobiliary system:

what happens to liver mass

A

decreases

103
Q

Gastrointestinal & hepatobiliary system:

what happens to hepatic blood flow

A

decreases

104
Q

Gastrointestinal & hepatobiliary system:

what happens to Liver function

A

decreases

105
Q

Gastrointestinal & hepatobiliary system:

what happens to albumin production

A

decreases

106
Q

Gastrointestinal & hepatobiliary system:

what happens to Gastric pH

A

increases

107
Q

Gastrointestinal & hepatobiliary system:

what happens to gastric emptying

A

decreases

108
Q

Gastrointestinal & hepatobiliary system:

what happens to Plasma cholinesterase levels in men

A

decreases

109
Q

Gastrointestinal & hepatobiliary system:

why is there a concern for a full stomach in the elderly

A

Gastric pH rises (more alk), gastric emptying prolonged

110
Q

Gastrointestinal & hepatobiliary system:

hepatic blood flow decreases but what happens to hepatocellular function?

A

nothing (very little changes)

111
Q

Gastrointestinal & hepatobiliary system:

what 2 things impairs the livers ability to metabolize anesthetics and NDMR

A

reduced hepatic blood flow

potential reduction in P450 enzyme

112
Q

Gastrointestinal & hepatobiliary system:

what 2 things are responsible for inadequate perioperative hepatic function

A

reduced liver tissue mass

reduced blood flow

113
Q

Gastrointestinal & hepatobiliary system:

levels of what are reduced in elderly men

A

plasma cholinesterase

114
Q

Renal Function:

what happens to BUN

A

increases

115
Q

Renal Function:

what happens to ability to develop hypo and hyperkalemia

A

increases

116
Q

Renal Function:

what happens to kidney mass

A

decreases

117
Q

Renal Function:

what happens to renal blood flow and plasma flow

A

decreases

118
Q

Renal Function:

what happens to GFR

A

decreases

119
Q

Renal Function:

what happens to renal function

A

decreases

120
Q

Renal Function:

what happens to creatinine production

A

decreases

121
Q

Renal Function:
what happens to
respons to ADH

A

decreases

122
Q

Renal Function:

what happens to response to Aldosterone

A

decrease

123
Q

Renal Function:

what happens to concentrating ability

A

decreases

124
Q

Renal Function:

renal blood flow decreases 50% about ____% per decade

A

10%

125
Q

Renal Function:

why does renal blood flow decrease?

A

d/t decrease in CO and decreases in renal vascular bed

126
Q

Renal Function:

the reduction of renal plasma flow leads to what?

A

decreased renal function

127
Q

Renal Function:

GFR decreases about ___ to ___% per decade

A

6-8%

128
Q

Renal Function:

what is the most sensitive indicator of renal function in the elderly

A

creatinine clearance

129
Q

Renal Function:

the combination of decreased renal function and reduced cardiac function makes the geriatric patients prone to what

A

fluid overload

130
Q

Renal Function:

elderly release large amounts of what in response to hypertonic saline loads

A

ADH

131
Q

Renal Function:

what happens to the bodies response to ADH an daldosterone

A

decreasd

132
Q

Renal Function:

as renal function declines so does the ability to do what

A

excrete drugs

133
Q

Renal Function:

what are 5 common age related renal anatomic and physiologic changes

A 
decreased renal blood flow
Decreased GFR
Decreased ability to concentrate urine
decreased ability to conserve water
decreased elimination of drugs
134
Q

Pharmacology:

what happens to circulation time

A

increases (takes longer to circulate)

135
Q

Pharmacology:

what happens to body fat

A

increases

136
Q

Pharmacology:

what happens to Vd for lipid soluble drugs

A

increases

137
Q

Pharmacology:

what happens to recovery from VAA’s

A

increases (takes longer()

138
Q

Pharmacology:

what happens to muscle mass

A

decreases

139
Q

Pharmacology:

what happens to Body heat production

A

decreases

140
Q

Pharmacology:

what happens to core body temp

A

decreases

141
Q

Pharmacology:

what happens to basal metabolic requirments

A

decrease

142
Q

Pharmacology:

what happens to MAC requirements

A

decreases

143
Q

Pharmacology:

what happens to total body water

A

decreases

144
Q

Pharmacology:

what happens to Vd for water soluble drugs

A

decreases

145
Q

Pharmacology:

what happens to dosing of barbs, bento, opioids

A

decreases

146
Q

Pharmacology:

what causes the decrease in Total body water

A

decrease in muscle mass

increase in body fat

147
Q

Pharmacology:

why is there more af a drug that can cross the BBB

A

reduced plasma protein binding

Increased free drug

148
Q

Pharmacology:

MAC is reduced ___to __ % per decade over the age of 40

A

4-6%

149
Q

Pharmacology:

why may recovery from VAAs be prolonged?

A

increased Vd (increased body fat), decreased hepatic function, and decreases pulmonary exchange

150
Q

Pharmacology:

what happens to the response of all muscle relaxants

A

unaltered

► Med Misc 44 (72 decks)

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