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Geriatrics > Impaired Capacity > Flashcards

Impaired Capacity Flashcards

1
Q

What decreases with age?

A 
Cardiac output
Max HR
Resting and maximal stroke volume
Venous return
Blood Flow
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2
Q

How does Blood Flow decrease?

A

25% increase in Left Ventricular thickness
Vessel rigidity
65 yo has 30-40% of aerobic capacity of young adult

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3
Q

What increases with age?

A

Blood Pressure: both resting & exercise
Cardiac Dysrhythmias
By 75 yo, <10% of SA node cells

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4
Q

Age related changes in the heart

A 
Increase adipose tissue 
Increase collagen content 
Decrease muscle cells (myocytes) 
Decrease innervation/nerve conduction tissue
Decrease sympathetic modulation of HR
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5
Q

What do age related in changed in the heart result in?

A

decrease excitability, decrease cardiac output, venous return and an INCREASE in dysrhythmias

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6
Q

What happens with the walls of the heart become less compliant?

A

Results in decreased ejection fraction Declines in Left ventricle expansion and contractility (i.e. reduced end diastole volume)

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7
Q

What happens with increased atrial size correlated to left ventricular compliance?

A

increased workload on the atria

hypertrophy of the aorta

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8
Q

End Diastolic Volume

A

volume of blood in ventricles before contraction

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9
Q

Preload

A

End diastolic pressure which is stretching the walls of ventricles to their greatest dimensions

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10
Q

Stoke Volume

A

Volume of blood ejected from the heart per heartbeat

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11
Q

Stroke Volume

A

Volume of blood ejected from the heart with each beat

Stroke volume = End diastolic volume – end systolic volume

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12
Q

What does stroke volume depend on?

A

contractility
preload
afterload

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13
Q

Contractility:

A

the more forceful the contraction

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14
Q

Preload

A

the end of stretch of the wall of ventricle

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15
Q

Afterload

A

the resistance that the ventricle must overcome to eject blood out of left ventricle

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16
Q

VO2

A

A physiological measure of how much oxygen the body uses at rest or during activity

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17
Q

When will VO2 increase?

A

Increases in proportion to intensity of exercise/physical activity and will plateau when maximal ability for oxygen delivery is reached, which is maximal oxygen consumption (V·O2 max).

18
Q

Aerobic Capacity

A

Ability to provide and sustain energy aerobically

Reflects the body’s ability to take up, deliver, and use oxygen.

19
Q

Oxygen Consumption (VO2):

A

Physiological measure of how much oxygen the body uses at rest or during activity. And increases in proportion to intensity of exercise/physical activity and will plateau when maximal ability for oxygen delivery is reached.

20
Q

VO2 Max:

A

Maximum amount of oxygen that can be taken in, transported and consumed by the working muscles per minute

21
Q

Factors Affecting Aerobic Activity

A

Age
Gender
Training
Physiological Make Up

22
Q

Age

A

VO2 max declines with age
After the age of 25 it decreases by 1% each year
Exercise regularly to combat these effects

23
Q

Gender

A

Men generally have higher VO2 max
Women have a VO2 max of 15-30% lower
Depends on age and other physiological factors

24
Q

Training

A

Fitness testing can determine VO2 max
Training can improve VO2 max by 10-20%
In addition, lifestyle and diet influence VO2 max

25
Q

For optimum aerobic performance we need

A

Slow twitch muscle fibers
Mitochondria
Myoglobin stores

26
Q

Other physiological factors that affect VO2 max

A

Size of the heart
Size of the lungs
Number of red blood cells

27
Q

What can affect reconditioning?

A

Illness
Functional limitations
Restricted activity
Cognitive limitations

28
Q

Age related physiological changes

A

Reduced maximal oxygen consumption secondary to decreased cardiac performance and skeletal muscle endurance
Conditions that affect functional mobility (stroke, Parkinson’s disease, osteoarthritis, bone fractures etc.)

29
Q

What is included in PT Exam?

A 
History
Systems Review
Tests and Measures
Evaluation, Diagnosis and Prognosis
Plan of Care and Interventions
30
Q

History:

A

Comprehensive history of a patient with impaired aerobic capacity helps to show contributory factors and to determine appropriate interventions.
Identification of risk factors for cardiovascular disease

31
Q

Signs and Symptoms highly suggestive of cardiovascular or pulmonary disease

A 
SOB at rest or with mild exertion
Pain
Discomfort in the chest, neck, jaw, arms, or other areas that may result from cardiac ischemia
Orthopnea
Paroxysmal nocturnal dyspnea
Bilateral ankle edema
Palpitations
Tachycardia
Intermittent leg claudication
Known heart murmur
Undue fatigue with usual activities
32
Q

Tests and Measures

A

Vital Signs
6-Minute Walk Test
Self-Report Measures

33
Q

Commonly Used Symptoms Scales

A

Angina Scale
Dyspnea Scale
Claudication Scale
Rating of Perceived Exertion (RPE)

34
Q

Angina Scale

A

Mild, barely noticeable
Moderate, bothersome
Moderately severe, very uncomfortable
Most severe or intense pain ever experienced

35
Q

Dyspnea Scale

A

Light, barely noticeable
Moderate, bothersome
Moderately severe, very uncomfortable
Most severe or intense dyspnea ever experienced

36
Q

Claudication Scale

A

Definite discomfort or pain, but only at initial or modest levels (established, but minimal)
Moderate discomfort or pain from which the patient’s attention can be diverted (e.g., by conversation)
Intense pain (short of grade 4) from which the patient’s attention cannot be diverted
Excruciating and unbearable pain

37
Q

Systolic BP change during activity?

A

Systolic BP reflect cardiac output and should also go up in proportion to the metabolic demand of the exercise or activity

38
Q

Diastolic BP during exercise?

A

Diastolic BP reflects total peripheral resistance, which remains relatively stable in most people during aerobic exercise

39
Q

Absolute exercise contraindications:

A

unstable angina
uncontrolled cardiac dyrhythmias symptoms of hemodynamic compromise
uncontrolled symptomatic heart failure
acute or suspected major cardiovascular event
acute systemic infection
a recent significant change in resting ECG suggestive of ischemia, MI or other cardiac event

40
Q

Relative exercise contraindications:

A 
known significant cardiac disease
severe atrial hypertension
tachydysrhythmia or bradydydysrhythmia
electrolyte abnormalities
uncontrolled metabolic disease
chronic infectious disease
mental or physical impairment leading to inability to exercise safely
41
Q

Absolute indications for terminating exercise

A 
Drop in systolic BP or greater than 10mmHG from baseline
Moderately severe angina (>2/4)
increasing nervous system symptoms
signs of poor perfusion
subject's desire to stop
technical difficulties with equipment
sustained ventricular tachycardia
ST elevation

Geriatrics (17 decks)

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