Lecture 10 Cardiopulmonary function and critical care considerations

Question 1

The Confusion Assessment Method for the ICU (CAM-ICU)

Answer 1

1. Evidence-based assessment tool for clinical delirium; should be used for all older adults admitted to an ICU.
2. Yes/no question format in the areas of: Acute onset or fluctuating course; inattention; disorganized thinking; and altered level of consciousness.
3. Can be used with nonspeaking, mechanically ventilated patients; can be adapted for use with patients with visual and hearing disturbances.

Question 2

The leading cause of death in older adults is _

Answer 2

Heart disease.

Question 3

Age-related changes affecting cardiovascular function

Answer 3

1. Myocardial degeneration and changes to neuroconduction mechanisms - impaired ability of the heart to contract.
2. Changes to all three vascular layers - arterial stiffening.
3. Altered baroreflex mechanism - impaired blood pressure regulation (older adult is slower to peak - gets winded easily - and slower to return to baseline - body works harder).

Question 4

Modifiable risk factors for cardiovascular diseases

Answer 4

1. Smoking.
2. High cholesterol.
3. High blood pressure - very prevalent and poorly controlled in this age group.
4. Physical inactivity - particularly a problem in older adults.
5. Overweight/obesity.
6. Diabetes.
7. Poor diet and excessive alcohol consumption.

Question 5

Non-modifiable risk factors for cardiovascular diseases

Answer 5

1. Genetics.
2. Age.
3. Gender.
4. Ethnicity.

Question 6

The most remediable risk factor to prevent cardiovascular disease is _

Answer 6

Smoking - but smokeless tobacco and e-cigarettes have a similar risk.

Question 7

The most prevalent risk factor for cardiovascular disease in the United States is _

Answer 7

Obesity.

Question 8

Among adults age 45 and older, there is a statistical correlation between household income and _

Answer 8

Stroke death.

Question 9

Changes in estrogen levels in women going through menopause (age 40-65) greatly increase their chances of _

Answer 9

Heart attack.

Question 10

In healthy older adults, changes in cardiac output, pulse, and blood pressure are _

Answer 10

Not typically noted.

Question 11

Orthostatic hypotension

Answer 11

A reduction in systolic blood pressure of at least 20 mm Hg or in diastolic blood pressure of at least 10 mm Hg when assuming a standing position.

Question 12

Postprandial hypotension

Answer 12

1. A reduction in systolic blood pressure of 20 mm Hg in a supine/sitting position within 120 minutes after eating a meal.
2. Can be prevented by eating smaller, more frequent meals.

Question 13

Pseudohypertension

Answer 13

Elevated systolic blood pressure readings that result from the inability of the external cuff to compress the arteries in older people with arteriosclerosis.

Question 14

White coat hypertension

Answer 14

The phenomenon of blood pressure readings being high only when checked by a health care practitioner.

Question 15

Atypical presentation of myocardial infarction

Answer 15

In more than 25% of cases, the classic symptom of chest pain may be absent and the person will instead present with fatigue, nausea, anxiety, headache, change in mental status, cough, visual disturbance, shortness of breath, or pain in the jaw, neck, or throat.

Question 16

Body mass index (BMI) ranges

Answer 16

18.5 - 25 = normal weight
Below 18.5 = underweight
25 - 30 = overweight
Above 30 = obese

Question 17

Age-related changes affecting respiratory function

Answer 17

1. Increased stiffness of the chest wall.
2. Enlarged alveoli.
3. Weaker respiratory muscles.
4. 40-50% reduction in ventilatory response to hypercapnia or hypoxia.
5. Diminished immune function - increased risk for tuberculosis, pneumonia, etc.

Question 18

Age-related alteration of _ contributes to increased prevalence of lung diseases in older adults.

Answer 18

T cells.

Question 19

Regarding respiratory function, poor oral care is associated with increased risk for _

Answer 19

Pneumonia.

Question 20

Aspiration pneumonia

Answer 20

Inflammation caused by food or secretions entering the bronchial tree.

Question 21

Risk factors for tuberculosis

Answer 21

1. Smoking.
2. Diabetes.
3. Malnutrition.
4. Debilitating conditions.

Question 22

Chronic obstructive pulmonary disease (COPD)

Answer 22

1. A group of diseases encompassing emphysema and chronic bronchitis.
2. Manifestations: Cough, dyspnea, wheezing, and sputum production.
3. Health promotion: Participation in self-management programs.

Question 23

Conditions that often occur in older adults and can contribute to physical deconditioning include _

Answer 23

1. Acute illness.
2. A sedentary lifestyle.
3. Mobility limitations.
4. Any chronic condition that interferes with physical activity.
5. Psychosocial influences, such as depression or lack of motivation.

Question 24

Normal physiologic cardiovascular changes in the older adult are most noticeable when _

Answer 24

The older adult is exercising.

Question 25

The early manifestations heart failure in the older adult may be _

Answer 25

Mental changes secondary to the physiologic stress (e.g., confusion).