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Geriatrics Theory > lecture 2 > Flashcards

lecture 2 Flashcards

1
Q

what kind of blood goes of out pulmonary artery?

A

unoxygenated blood.

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2
Q

what happens when blood goes thru lungs?

A

picks up O2 and gets rid of CO2.

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3
Q

valve bw the r atrium/ventricle

A

tricuspid

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4
Q

vavle bw the l atrium/ventricle

A

mitral valve

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5
Q

thick microvascular basement membrance inc or dec?

A

inc- narrowed lumen, impaired O2, nutrient, waste xchange

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6
Q

elastin does what?

A

dec- less stretchy

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7
Q

collagen does what?

A

inc- scar tissue you want for structure.

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8
Q

dec elasticity of arteries does what?

A

dec baroreceptor response- less ability to sense changes in BP/HR. inc risk for falling, getting dizzy, passing out.

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9
Q

inc medial fibrosis and intimal thickening does what?

A

inc arterial tortuosity (twisted vessels, things get stuck there, impairs BF)

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10
Q

inc arterial tortuosity does what?

A

inc systemic vascular resistance (afterload)- left vent pushing against this pressure, higher the afterload, left vent tires out/hypertrophies

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11
Q

inc afterload does what?

A

inc systolic BP

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12
Q

inc systolic BP does what?

A

inc arterial insufficiency

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13
Q

inc vein fibrosis does what?

A

dilation/stretching

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14
Q

net effect of CV changes

A

dec tissue/organ perfusion

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15
Q

changes are ____ at rest

A

insignificant

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16
Q

changes are ____ with stress

A

significant

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17
Q

VS in elderly

A

may not see drastic change as a younger person. may have to look at other signs (confusion for pneumonia)

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18
Q

dec pacemaker/conduction tissue does what?

A

inc irritability

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19
Q

dec coronary artery BF does what?

A

inc LVH (l vent hypertrophy) and dec efficiency

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20
Q

by age 60 __% less BF to coronary arteries?

A

35

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21
Q

inc valve rigidity/thickening does what?

A

inc LVH- l vent pushing against valves that are stiff- dec efficiency

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22
Q

dec # of myocytes does what?

A

inc lipofuscin, collagen, and fat

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23
Q

lipofuscin

A

red pigment, indicates breakdown of RBC

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24
Q

collagen

A

scar tissue. want more stretchy tissue in heart cells

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25
Q

fat

A

dry tissue, doesnt conduct, can lead to inc irritability

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26
Q

inc lipfuscin, collagen, & fat leads to what?

A

fibrosis- less contractible heart

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27
Q

fibrosis does what

A

dec muscle strength/mobility bc heart not able to contract as well

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28
Q

dec muscle strength/ability leads to what

A

dec compliance & contractility

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29
Q

dec compliance and contractility leads to what?

A

dec efficiency

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30
Q

net effect of heart changes

A

dec myocardial efficiency

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31
Q

SA node

A

fires (pacemaker) and conducts thru atria. goes to the AV node, down bundle of His, into purkinje fibers, contracts l/r ventricles.

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32
Q

elec activity ______

A

precedes mech activity.

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33
Q

when u have irritation/damage to heart muscle, you ____

A

have higher risk of irritability of SA node.

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34
Q

if u have CAD, CHF, HTN, cardiomyopathy, elyte disturbance, thyrotoxicosis, cardiac surgery, high alcohol levels, high caffeine…

A

can irritate heart/SA node and can cause arrythmias.

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35
Q

p wave

A

electrical stim of atria

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36
Q

AV node stimulated

A

right before QRS

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37
Q

AV stimulated and putting out beat means what?

A

thats QRS… heart beat, ventricular stimulation

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38
Q

why QRS has up/down figure?

A

its going down bundle of His and back up again

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39
Q

ST segment

A

important in MI/ischemia

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40
Q

T wave

A

ventricular repolarization

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41
Q

S1

A

right after P wave. bc atria contracts, forces last bit of blood into ventricles, mitral/tricuspid valves close.
“lub”

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42
Q

S2

A

ventricles get stimulated, precipitates vent contraction, blood is contracted out into aortic/pulmonic valves and close
“dub”

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43
Q

S1 happens at…

A

the beginning of systole

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44
Q

S2 happens at…

A

the end of systole

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45
Q

systolic murmur

A

“lub-shhh-dub”

mostly some kind of valvular problem

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46
Q

clicks

A

might be from mitral valve prolapse, might be benign

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47
Q

S3

A

“kentucky”

represents CHF, in early diastole,

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48
Q

S4

A

“tennessee”

problem with vent going against very hardened/stiff arteries. Lot of pressure against them. Hear with HTN, in late diastole.

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49
Q

Afib

A

350-650 bmp

atria quivering. some foci arent getting thru. when it does… QRS… but dont march out evenly.

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50
Q

in Afib, there is no ___

A

atrial kick… no last little contraction, no last little squeeze of blood into ventricle before mitral/tricuspid valves close.

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51
Q

what happens if no atrial kick?

A

25% of blood is left in the atria.. it sits there and pools. risk for clotting.

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52
Q

what do you give to when there is inc risk for clotting?

A

anticoagulants. usually coumadin.. but start with heparin… then give coumadin and wait a week to kick in… but keep heparin going.

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53
Q

normal valves

A

open/close nicely. no bld in or out, no leakage.

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54
Q

diseased valves

A

l vent pumping bld thru valve but valve isnt opening. bld comes back bc not totally closing. stuff regurgitates back. puts more stress on l vent. overtime, gets worn out.

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55
Q

modifiable CVD risk factors:

A 
smoking
HTN
inc cholesterol
inactivity
DM
obesity
inc triglycerides/ LDLs
stress
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56
Q

nonmodifiable CVD risk factors:

A

heredity
age
sex
race

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57
Q

most common 1st sign of CHD in older men

A

MI

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58
Q

most common 1st sign of CHD in older women

A

angina

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59
Q

MIs in women are ___

A

underrecognized

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60
Q

HF definition

A

heart unable to pump sufficient bld to meet tissue/organ demands; cant pump well enough

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61
Q

HF epidemiology

A

prevalence doubles/decade.

approx 10% of pts in 80+ have HF; poor prognosis if cause is not identified/fixed bc continues to get worse.

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62
Q

Systolic HF

A

damaged pump. can be due to CAD, MI, ischemia, cor art blockage, alcoholism, chemo, radiation, viral toxicity, drugs (cocaine/amphetamines)

63
Q

Diastolic HF

A

dec stretch/filling. so restricted, cant get as much in there. tend to back up.

64
Q

effects of diastolic HF

A

respiratory complaints, pulm congestion, systemic effects

65
Q

left-sided failure caused by

A

left vent dysfunction- usually dont have enough pump “f”. bld isnt able to get pumped out of heart and backs up into lungs.

66
Q

right-sided failure caused by

A

bld backing up from right vent into systemic system. so HTN, bld backing up into liver/abd area.

67
Q

symptoms are left-sided failure

A

pulm symptoms. edema/fluid in lungs

68
Q

symptoms of right-sided failure

A

abd edema, periph edema, inc liver “f” test, inc JVD, ind fluid in spleen

69
Q

how does hypothyroidism relate to myocardial failure

A

everything slows down, HR/BP/endocrine, not able to pump enough bld bc HR so slow to perfuse. means arteries arent getting enough bld as well.

70
Q

how does anemia relate to volume overload?

A

dont have enough O2 carrying capacity of bld. Heart has to compensate with inc HR. HR is pumping bld out and gets tired from overpumping to try to get O2 out there since not enough is getting to tissues.

71
Q

how does thyrotoxicosis relate to volume overload?

A

too much rubbing of engine/endocrine system. Fast HR/ high BP, all systems overworking. Turning out bld, ventricles pushing out faster & faster. Leads to HF.

72
Q

what do you assess for CHF pts

A

pulm edema, fatigue, dyspnea, tachycardia, edema, nocturia, skin changes, behavioral changes, chest pain, wt changes

73
Q

when treating CHF pts with diuretics, look for:

A

improvement in lung sounds, is HR down?

74
Q

what labs can you do for CHF pt

A

chem panel, ABG/O2 sat, liver studies, CXR, EKG/monitor, echo, BMP

75
Q

why do liver studies?

A

shows r sided failure.

76
Q

CXR shows?

A

enlargement of heart, fluid in lungs.

77
Q

echo shows

A

size of chambers in heart, valves and how well theyre working, ejection fractions, how forcefully ventricles are contracting

78
Q

BMP shows

A

hormone released by heart to help inc contractility of heart. there are high levels in pts with CHF

79
Q

Meds for pts with CHF

A

O2, morphine, diuretics (lasix), ace inhibitors, digitalis, nitroglycerin

80
Q

what does morphine do?

A

helps chest pain, opens up cor arteries & helps them perfuse, relaxes bronchioles, helps them breathe better, dec anxiety

81
Q

what do diuretics do?

A

helps bring water out of lungs/body, helps them breathe better.

82
Q

which combo of meds help mortality rates

A

ace inhib and diuretics

83
Q

ace inhibitors do what

A

help with systolic/diastolic dysfunction. dec morbidity/mortality rates, improves outcome of pt.

84
Q

digitalis does what?

A

it is a positive inotrope and inc contractility of heart, dec HR, gives boost to get bld out. makes pts symptoms better but doesnt improve mortality.

85
Q

what do you watch out for when using digitalis?

A

cough, can inc k level and cause hyperkalemia.

86
Q

nitroglycerin does what

A

dec preload (amt of bld coming into heart), relaxes heart. its a coronary vasodilator and helps open up cor arteries, helps heart get O2 it needs.

87
Q

HTN

A

sbp >/= 140; dbp >/=90.

88
Q

patho of HTN

A

primary or essential most common= no clear cause; R/T aging changes in periph resistance; ranges from uncomplicated to complicated

89
Q

secondary HTN

A

non CV cause . usually caused by kidneys

90
Q

HTN can lead to what

A

HF, stroke, periph vascular disease, MI

91
Q

HTN risk factors

A 
age 60+
DM
dyslipidemia
positive fam hx
male gender
postmenopausal
smoking
target organ disease
CV disease
Nephropathy
PAD
Retinopathy
CVA/ TIA
92
Q

MI definition

A

death of cardiac tissue following reduction/interruption in BF bc blockage of bld/oxygenation to that tissue

93
Q

epidemiology of MI

A

35% of elders, 60% of elder hospitalizations R/T to MI

94
Q

patho of MI

A

prolonged ischemia -> irreversible hypoxia/cell death; R/T plaque obstruction, hemorrhage into plaque, embolus, coronary spasm, platelet aggregation.

95
Q

MI on EKG shows

A

ST elevation

96
Q

ST depression indicates

A

ischemia, can lead to infarction. inc risk for arrythmias

97
Q

what to assess in pts with MI

A

pain, NV, diaphoresis, fever, feelings of doom, dyspnea, confusion

98
Q

older pts MI symptoms

A

more muted, can have classic symptoms but may not. may only be confused so u have to really be clued in. usually have SOB, confusion, fatigue, GI upset.

99
Q

labs for MI

A

EKG, chem panel, CBC, cardiac enzymes, troponin, CPK/MB, CXR, echo, INR

100
Q

why CBC for MI?

A

see if anemia, bc will dec oxygenation as well. if severe, give transfusion to boost up bld count.

101
Q

CPK is what

A

indicator of muscle damage, but doesnt show where damage occured. Has to be broken down in MB bands which are specific to cardiac cells. so if MB elev, means that with CPK elev… cardiac muscle damage.

102
Q

why CXR for MI

A

to see if enlarged heart, any lung probs

103
Q

why echo for MI?

A

show how heart is “f”ing. is it stunned? is myocardium not pumping as well? EF?

104
Q

why INR for MI?

A

coag factors in body bc if pts arents already anticoagulated, give clot busters to break open clot in bld.

105
Q

meds for MI

A

morphine, o2, nitroglycerin, ASA, bblockers, ace inhibitors, digoxin, thrombolytics

106
Q

what does morphine do for MI

A

if NTG doesnt control pain. potent vasodilator, reduces workload of heart, helps pt feel less anxious. dec BP/HR. look out for dec respirations

107
Q

what does nitroglycerin do for MI?

A

potent vasodilator, reduces workload of heart, dec preload/afterload, can lower BP, if opens cor arteries well enough, can reduce pain of MI

108
Q

ASA does what for MI

A

helps stop new clots, breaks up older clots

109
Q

what does heparin do for MI?

A

only helps stop new clots from forming but doesnt break up clots already formed.

110
Q

what do thrombolytics do for MI?

A

break up clots, use bw 1-6 hours of having chest pain. 30 minutes ideally.

111
Q

what do Ace inhibitors do for MI?

A

help prevent ventricular remodeling.

112
Q

what do bblockers do for MI?

A

dec HR/BP/contractility. dec myocardial O2 demand. reduce size of infarction

113
Q

what to watch out for in MI pts when using bblockers?

A

hypotension, bradycardia

114
Q

digoxin does what for MI?

A

inc contractility, squeezes heart, dec HR to help perfuse cor arteries.

115
Q

dec pulmonary compliance

A

lungs get stiffer, less elastic recoil, more restriction, ossification of costile cartilages

116
Q

elders get ___ AP diameter

A

increased

117
Q

elders get slightly ___ TLC

A

smaller

118
Q

elders get ____ of apices and ____ of lower part of lung

A

overinflation; underinflation

119
Q

emphysema

A

can get air in but hard to get out.

120
Q

net effect of emphysema

A

less pressure of O2 in system

121
Q

overall effects of emphysema

A

dec ventilation/gas xchange

122
Q

normal PaO2 of 80 yo

A

70 mmhg

123
Q

as age, what happens to chemoreceptors

A

get more blunted, lesser response to low O2 in bld and higher CO2; takes longer for elderly person to respond. less effective breathing control.

124
Q

dec mucociliary transport

A

lose ability to brush off foreign agents that come in. more risk of infx/trauma to lung.

125
Q

why do smokers have chronic bronchitis/infx?

A

cilia burned off when smokes, less ability to force invading agents out of lungs.

126
Q

dec effective cough reflex

A

not able to cough as effectively. when person has stroke/parkinsons, neurogenic innovation in throat ineffective.. higher risk for aspiration pneumonia from food/saliva

127
Q

dec acute antibody response to extrinsic antigen

A

not able to respond as much to virus/bact. higher risk for infx/nosocomial.
lose ability to form secretory IgA.. helps neutralize effective viruses.

128
Q

dec cellular immunity

A

dec T lymphocytes/macrophages responsible for fighting fungi, intracellular viruses, chronic infectious agents. dec tumor cells- less effective in fighting bacteria, extracellular viruses.

129
Q

why are elderly less likely to have temp when have pneumonia or other viruses?

A

might be related to dec in antigen response.. not putting up healthy virulent response.

130
Q

Pneumonia definition

A

acute lower resp tract infx & microbial invasion of normally sterile lung tissue (parenchyma)

131
Q

epidemiology of pneumonia

A

most common cause of infectious disease-related deaths in elders

132
Q

patho of pnemonia

A

infx and inflamm of distal parenchyma w/ influx of PMN leukocytes into alveolar spaces to attack invading agent, edema fluid, RBC breakdown, fibrin, etc.

133
Q

old-old are ___ more likely to get infx in hospital

A

2-5x

134
Q

pneumonia symptoms

A

can be subtle. cognitive changes, behavioral changes, confusion, may not see inc temp, might not see lab values go up right away.

135
Q

pts 85+ are __ more likely to die pf pneumonia than young old or old adults

A

5x

136
Q

cough up green means

A

leukocytes fighting infx

137
Q

cough up rusty color

A

has RBC/fibrin in it

138
Q

pneumonia by causative agent:

A

viral, bacterial (gm+/-), other agent (fungus)

139
Q

pneumonia by location

A

lobar, lobular, interstitial

CAP or HAP

140
Q

pneumonia by other mechanism

A

aspiration or hematogenous (originates from another site, like UTI)

141
Q

what to assess for in pts with pneumonia

A

cough, pain with cough/breathing, fever (might not have), dyspnea, elders may show vague signs or even only confusion

142
Q

Labs for pneumonia

A

CXR, CBC, ABG, O2 Sat, C&S (culture&sensitivity), Gm+/-, PFT, bld culture

143
Q

why CXR for pneumonia

A

to see fluid in lungs

144
Q

why CBC for pneumonia

A

to see inc WBC (bacterial)

to see inc lymphocytes (viral)

145
Q

why ABG for pneumonia

A

to see oxygenation status, CO2, hypercapnic?

146
Q

why C&S for pneumonia?

A

of sputum to see whats growing. it takes 3 days for result so treat empirically. when results come back, see if theres a better abx

147
Q

why blood culture for pneumonia?

A

to see if getting septic. do this before starting ABX bc you wanna catch whatever is causing sepsis withouth it being diminished by ABX

148
Q

meds for pneumonia

A

ABX, O2, analgesics, antipyretics, steroids, bronchodilators

149
Q

what do you wanna give to pneumonia pts?

A

lots of fluids! wanna keep them hydrated. even in CHF pts.. but be careful. you wanna help pull out toxins, fight infx, water will thin out mucus

150
Q

how do you wanna position pneumonia pts?

A

sit them up. encourage them that sitting up will help them get better and that you can give pain meds and pillow.

151
Q

why do you have to be cautious with diabetic pneumonia pts?

A

bc with diabetes, there is an inc of sugar in all tissues and bacteria loves sugar. bact can grow.

152
Q

immune system changes in elderly

A

dec thymus “f”
dec in precursor T cells that recognize antigens.
inc in memory T cells
less able to respond to antigens
less response to immunizations
inc immunoglobulins- autoimmune response, more antibodies.

153
Q

overall net effects of immune system changes

A

less able to fight infx

higher mortality/morbidity rate as one ages.

Geriatrics Theory (3 decks)

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