Geriatrics Flashcards
________ is a greater determinant of posts complications than anesthetic management
preop co-morbid diseases
the most commonly occurring post op complications in the elderly are
cardiac
Pulmonary
neuro
thoracic, major vascular, and interperitneal sx in the elderly can increase what 3 complications
increased bleeding
Increased risk of post op vent
Increased VAP
aging is associated with a progressive loss of functional reserve in what organ systems
all
a ____% decline in organ function occurs after the age of 30
1%
ex a 70 yo has a 40% decline in general function
the elderly generally maintain homeostasis but become increasingly less able to restore it when subjected to what?
trauma
stress
disease
drugs
what happens to their muscle mass?
decreased
what happens to their Fat
increased
What happens to the H20 levels
decreased
so what happens to hydrophilic drugs
decreased Vd (less H20)
So what happens to lipophilic drugs
increased Vd (more fat)
what happens to thermoregulation
it becomes impaired
Body heat preservation is a must
younger pts shiver at 36.1 C, pts over 80 don’t shiver until what temp
35 C
Shivering increasing O2 consumption by how much? and leads to hypoxia, acidosis, and CV compromise
400%
____ and ____ of the elderly to requires special attention b/c of fragile skin, decreased SQ fat, and poor skin turgor
positioning
padding
Common age related systemic anatomic and physiologic changes: what happens to
organ function
decreased
Common age related systemic anatomic and physiologic changes: what happens to
blood volume
decreased
Common age related systemic anatomic and physiologic changes: what happens to
protective reflexes
decreased
Common age related systemic anatomic and physiologic changes: what happens to
ability to retain heat
decreased
Common age related systemic anatomic and physiologic changes: what happens to
lean body mass
decreased
Common age related systemic anatomic and physiologic changes: what happens to
skin elasticity and collagen
decreased
Common age related systemic anatomic and physiologic changes: what happens to
intracellular water
decreased
Common age related systemic anatomic and physiologic changes: what happens to
body fat
increased
Common age related systemic anatomic and physiologic changes: what is a complication related to loss of protective reflexes
aspiration pneumonia
d/t the progressive loss of function in ALL organs what are 2 complications
increased risk for breakdown
decreased ability to repair
state what causes the altered CV physiology:
Increased LV wall thickness
increase in the size and Number of individual muscle fibers and adipocytes (fat cells)
state what causes the altered CV physiology:
Increased LV hypertrophy
chronic increases in afterload
state what causes the altered CV physiology:
Increased LV wall tension
chronic increases in after load
state what causes the altered CV physiology:
Increased afterload
decreased arterial compliance
state what causes the altered CV physiology:
Increased cardiac workload
reduction in arterial compliance results in increased after load, increased systolic bp, and LV hypertrophy
state what causes the altered CV physiology:
Increased Systolic Bp
reduced arterial compliance
state what causes the altered CV physiology:
Increased peripheral vascular resistance
reduction in arterial compliance caused primarily by fibrosis of the tunica media (middle layer)
state what causes the altered CV physiology:
increased circulation time
reduced myocardial pump fun leads to reduced CO which prolongs circulation time
what does the Decreased circulation time mean with IV induction
slower induction
what does Decreased circulation time mean with VAA’s inhalation induction?
faster induction
state what causes the altered CV physiology:
Increased conduction fibrosis
conduction system fibrosis and loss of SA node cells will increase the incidence of dysrhythemias
state what causes the altered CV physiology:
Increased incidence of dysrhytmias
conduction fibrosis of SA node
state what causes the altered CV physiology:
Increased vagal tone
a decrease in sensitivity of adrenergic receptors leads to a decrease in HR
what 5 factors r/t the CV system are unchanged in the geriatric population
Diastolic BP (main one) resting systolic function excitation-contraction coupling Ionized Ca++ levels Contractile proteins
state what causes the altered CV physiology:
Decreased Cardiac reserve
exagerated drops in bp adversely affecting the compensatory mechanism of the pt
state what causes the altered CV physiology:
Decreased Cardiac Output
aging process and increased Afterload
state what causes the altered CV physiology:
Decreased resting HR
increase in vagal tone (normal declining HR is loss of 1 BPM for each year over 50
state what causes the altered CV physiology:
Decreased Left Ventricular compiance
stiffer (less complaint) myocardial muscle fibers
state what causes the altered CV physiology:
Decreased Stroke volume
decreased myocardial pump function
state what causes the altered CV physiology:
Decreased Perfusion to vital organs
organs atrophy
state what causes the altered CV physiology:
Decreased CHRONOTROPIC and INOTROPIC responses
decreases in adrenergic receptor quality
state what causes the altered CV physiology:
Decreased baroreceptor function
decreased sensitivity of stretch receptors owing to normal aging process
state what causes the altered CV physiology:
Decreased adrenergic sensitivity
decrease in quality of receptors
state what causes the altered respiratory physiology:
Increased vocal cord stimulation for closure
the stimulus needed for vocal cord closure (protection) is markedly elevated (need increased stimulus to close vocal cords)
state what causes the altered respiratory physiology:
Increased airway obstruction
aging decreases the sensitivity of the need to clear secretions.
state what causes the altered respiratory physiology:
Increased risk of aspiration
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
state what causes the altered respiratory physiology:
Increased pulmonary complications
decrease in protective laryngeal reflexes and decreased ability to cough
state what causes the altered respiratory physiology:
Increased physiological deadspace
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.
state what causes the altered respiratory physiology:
Increased work of breathing
skeletal calcification and increased airway resistance
state what causes the altered respiratory physiology:
Increased POTENTIAL FOR HYPOXIA
decreased elasticity of lung
reduction in alveolar surface area
decrease efficiency of gas exchange
airway collapse
state what causes the altered respiratory physiology: Increased FRC (modest)
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
state what causes the altered respiratory physiology:
Increased closing volume and closing capacity (dramatic)
caused by airway collaps and distribution of TV to areas of the lung that are less perfused
state what causes the altered respiratory physiology:
Increased alveolar compliance
absorption of connective tissue and this results in a loss id protective netting to restrict or limit the expansion of the alveoli
state what causes the altered respiratory physiology:
Decreased elastin fibers ( reduced elasticty)
normal aging process
state what causes the altered respiratory physiology:
Decreased Tissue elasticity
muscles replaced with adipose tissue
state what causes the altered respiratory physiology:
Decreased Lung recoil
chest wall less compliant (stiffer) if the chest wall does not expand upward or outward, the lung will not expand fully, nor recoil fully
state what causes the altered respiratory physiology:
Decreased alveolar surface area
alveolar wall tissue is decreased
state what causes the altered respiratory physiology:
Decreased ability to cough
decreased muscle strength
state what causes the altered respiratory physiology:
Decreased chest wall compliance
cartilage and connective tissue become stiffer
what type of lung disease is displayed by the geriatric population d/t decreased chest wall compliance
restrictive (like the obese)
state what causes the altered respiratory physiology:
Decreased VC, ERV, IRV
as residual volumes increase, there is a decrease in VC, ERV, IRV
state what causes the altered respiratory physiology:
Decreased protective responses
laryngeal respones blunted
state what causes the altered respiratory physiology:
Decreased ease of mask ventilation
often edentulous
what happens to the lung volume and capacity in the elderly:
RV
increases
what happens to the lung volume and capacity in the elderly:
ERV
decreases
what happens to the lung volume and capacity in the elderly: FRC
INcreases
what happens to the lung volume and capacity in the elderly:
CC
increased
what happens to the lung volume and capacity in the elderly:
IC
decreases
what happens to the lung volume and capacity in the elderly:
VC
decreases
what happens to the lung volume and capacity in the elderly:
TLC
no change
Nervous system:
what happens to Duration of spinal action
increases
Nervous system:
what happens to SENSORY block with spinals
increases
Nervous system:
what happens to epidural volume cephalic spread?
increases
Nervous system:
what happens to CSF according to stolting
increases
Nervous system:
what happens to epidural motor block?
decreases
Nervous system:
epidural segment dosing
decreases
Nervous system:
what happens to dose of general anesthestics
decreases
Nervous system:
what happens to CSF according to Nagehout, M&M, and Miller
decreases
Nervous system:
what is the most common neurological complication
postop delerium (15-53%)
Nervous system:
postop delerium is characterized by what?
disruption of perception Disruption of thinking and memory Disruption in psychomotor behavior disruption in sleep wake cycle disruption in attention disruption in conciousness
Nervous system:
what are risk factors for post delerium
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
Nervous system:
post op delirium is most common in what 2 surgeries
orthopedic (28-60%)- femur CV surgery (32-47%)
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
POCD
post operative cognitive dysfunction
Nervous system: POCD
characterized by what?
memory deficits
difficulty concentrating
impaired comprehension
delayed psychomotor speed
Nervous system: POCD
there are no universally accepted diagnostic activity, no definition, no known cause, no cure, and no proven effective stratigies
just for knowledge
Nervous system: POCD
what are recommendations for prevention
keep anesthesia short
use short acting and rapidly metabolized drugs
pts at risk, use inhalation drugs
what is the most common comorbidity in the elderly
HTN
followed by CAD
Endocrine:
what happens to insulin resistance?
Increased Insulin resistance
Endocrine:
what happens to heat loss
increased heat loss
Endocrine:
what happens to basal O2 consumption
decreased
Endocrine:
what happens to Heat Production
decreased
Endocrine:
what happens to liver mass, hepatic blood flow, and liver metabolism
decreased
Endocrine:
why does basal and metabolic O2 consumption decline as one ages
d/t general loss of lean body mass
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?
hypothermia
Endocrine:
why does DM increase in the elderly
d/t the decline in pancreatic function
Endocrine:
what are 2 mechanisms responsible for elevated blood sugars
sluggish insulin response to hyperglycemia
Resistance to effects of insulin at peripheral receptors
Gastrointestinal & hepatobiliary system:
what happens to liver mass
decreases
Gastrointestinal & hepatobiliary system:
what happens to hepatic blood flow
decreases
Gastrointestinal & hepatobiliary system:
what happens to Liver function
decreases
Gastrointestinal & hepatobiliary system:
what happens to albumin production
decreases
Gastrointestinal & hepatobiliary system:
what happens to Gastric pH
increases
Gastrointestinal & hepatobiliary system:
what happens to gastric emptying
decreases
Gastrointestinal & hepatobiliary system:
what happens to Plasma cholinesterase levels in men
decreases
Gastrointestinal & hepatobiliary system:
why is there a concern for a full stomach in the elderly
Gastric pH rises (more alk), gastric emptying prolonged
Gastrointestinal & hepatobiliary system:
hepatic blood flow decreases but what happens to hepatocellular function?
nothing (very little changes)
Gastrointestinal & hepatobiliary system:
what 2 things impairs the livers ability to metabolize anesthetics and NDMR
reduced hepatic blood flow
potential reduction in P450 enzyme
Gastrointestinal & hepatobiliary system:
what 2 things are responsible for inadequate perioperative hepatic function
reduced liver tissue mass
reduced blood flow
Gastrointestinal & hepatobiliary system:
levels of what are reduced in elderly men
plasma cholinesterase
Renal Function:
what happens to BUN
increases
Renal Function:
what happens to ability to develop hypo and hyperkalemia
increases
Renal Function:
what happens to kidney mass
decreases
Renal Function:
what happens to renal blood flow and plasma flow
decreases
Renal Function:
what happens to GFR
decreases
Renal Function:
what happens to renal function
decreases
Renal Function:
what happens to creatinine production
decreases
Renal Function:
what happens to
respons to ADH
decreases
Renal Function:
what happens to response to Aldosterone
decrease
Renal Function:
what happens to concentrating ability
decreases
Renal Function:
renal blood flow decreases 50% about ____% per decade
10%
Renal Function:
why does renal blood flow decrease?
d/t decrease in CO and decreases in renal vascular bed
Renal Function:
the reduction of renal plasma flow leads to what?
decreased renal function
Renal Function:
GFR decreases about ___ to ___% per decade
6-8%
Renal Function:
what is the most sensitive indicator of renal function in the elderly
creatinine clearance
Renal Function:
the combination of decreased renal function and reduced cardiac function makes the geriatric patients prone to what
fluid overload
Renal Function:
elderly release large amounts of what in response to hypertonic saline loads
ADH
Renal Function:
what happens to the bodies response to ADH an daldosterone
decreasd
Renal Function:
as renal function declines so does the ability to do what
excrete drugs
Renal Function:
what are 5 common age related renal anatomic and physiologic changes
decreased renal blood flow Decreased GFR Decreased ability to concentrate urine decreased ability to conserve water decreased elimination of drugs
Pharmacology:
what happens to circulation time
increases (takes longer to circulate)
Pharmacology:
what happens to body fat
increases
Pharmacology:
what happens to Vd for lipid soluble drugs
increases
Pharmacology:
what happens to recovery from VAA’s
increases (takes longer()
Pharmacology:
what happens to muscle mass
decreases
Pharmacology:
what happens to Body heat production
decreases
Pharmacology:
what happens to core body temp
decreases
Pharmacology:
what happens to basal metabolic requirments
decrease
Pharmacology:
what happens to MAC requirements
decreases
Pharmacology:
what happens to total body water
decreases
Pharmacology:
what happens to Vd for water soluble drugs
decreases
Pharmacology:
what happens to dosing of barbs, bento, opioids
decreases
Pharmacology:
what causes the decrease in Total body water
decrease in muscle mass
increase in body fat
Pharmacology:
why is there more af a drug that can cross the BBB
reduced plasma protein binding
Increased free drug
Pharmacology:
MAC is reduced ___to __ % per decade over the age of 40
4-6%
Pharmacology:
why may recovery from VAAs be prolonged?
increased Vd (increased body fat), decreased hepatic function, and decreases pulmonary exchange
Pharmacology:
what happens to the response of all muscle relaxants
unaltered