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Domain 2 : Geriatrics > Physiological Changes In Geriatric Patients > Flashcards

Physiological Changes In Geriatric Patients Flashcards

1
Q

Elderly

A

65-74

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2
Q

Aged

A

75-74

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3
Q

Very old

A

> 85

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4
Q

Geriatric

A

> 65

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5
Q

Anatomical Upper respiratory

A

Edentulous
Loss of buccal fat
Decrease cervical spine extensions

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6
Q

Anatomical lower resp

A

Altered collagen network
Loss of elastic recoil
Incidenced alveolar airspace with reduced exchange

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7
Q

Anatomical MSK

A

Muscle loss
Vertebral column degeneration
Rib calcification
Increased chance of atelectasis impaired diaphragm function, loss of muscle mass and structural changes

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8
Q

Floop

A

Ristrictive pattern

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9
Q

Physiological resp

A 
IRV reduced
ERV REDU
DECRE vital capacity
High closing volume
RV increase
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10
Q

Implications

A

High FRC with high closing volume which exceed FRC making patients prone to atelectasis

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11
Q

Central resp

A

Response to hypoxia and hypercabia is impaired with high sensitivity to sedatives

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12
Q

Implications

A 
Decrease clearance of secretions
Decrease mucociliary function
Less efficient cough
Reduced oesophagial motility
Less effective protective upper airway reflexes
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13
Q
A

Neirexial
Avoid sedatives
Avoid intermediate and long acting neuromuscular Blockers
Neutralize stomach acide

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14
Q

Anaesthesia implications

A 
Increase work of breathing
Basal atelectasis
Reduced baseline paO2
High A-a gradient
Impaired cough and pharyngeal function
Compromised compansation, early collapse, high risk of post-op pulmonary complications
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15
Q

Cardiac vascular

A

Atherosclerosis
Aeteril stiffening+ thickning
Arterial fibrosis
Arrhythmia AF

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16
Q
A

Increased afterload
Diastolic dysfunction
Labile blood pressure
Less sensitive to Badrenagic

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17
Q

Dystonia of aging

A
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18
Q

Anaesthesia implications

A
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19
Q

Other associated CVS conditions

A

Asymptomatic IHD
Calcific AS
Calcification of conduction sy

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20
Q

CNS

A 
Decrease brain mass
Loss of brain cells
Low blood flow
Cognitive dysfunction
Impaired senses
BP and temp control
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21
Q

Cognitive dysfunction diagnosis

A
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22
Q

Cognitive dysfunction pathophysiology

A

Inflammatory mediators
BBB dysfunction
Microglial activation resulting in apoptosisand and oncre pro inflammatory cytokine release

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23
Q

Cognitive dysfunction

A
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24
Q

Neuro cognitive disorders spectrum

A

Emergence delirium - immediately PACU
Postpartum DELIRIUM- 24-72hrs postop
Postop cognitive dysfunction - weeks - months post anaesthetic

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25
Q
A

Peripheral nerve detriation
Gene dysfunction with decrease mylination
Decrease conduction from reduced mylinated nerves
Change sensation : decrease spinal cord volume and bony degeneration

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26
Q

Autonomic

A 
Limited adaptation to stress
Decrease activity of parasympathetic and Sympathetic activation
Decrease baroreceptor reflex sensitivity
Slow and weak homeostasis
Increased sympathetic tone
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27
Q
A

Avoid drugs with sympathomimetic

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28
Q

Pain control

A

Altered pin threshold
Reduced pain tolarance
Increased sensitivity to opioid
Risk of accumuation

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29
Q

Renal

A

GFR, Creat excretion reduced
Blunted RAAS
Prostate
UTI

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30
Q

Implications

A

Renal function assessment using forest or BUN may underestimate severity

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31
Q

Implications RASS

A

Ability to adjust volume and electrolyte imbalance

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32
Q

Renal

A
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33
Q
A

Increased concentration of renaly excreted drugd
Ability to dilute urine impaired cannot handle water and salt load
Suceptible to contrast and nsaids renal failure

34
Q

Temp

A

Lowe BMR
Validation of skin vessels
Impaired thermoregulation

35
Q
A

Shivering
High O2& met demand
Slow drug metabolism
At risk for mi

36
Q

Preop

A

Is patient in optimum heath
Is there room to improve physical or cognitive function
Asses meds that may impact anaesthesia

37
Q

Goals

A
38
Q

Consent issues

A
39
Q

Comprehensive geriatric assessment

A 
Systematic evaluation of cormobidities
Functional status
Neuro cognitive function 
Sensory impairment
Substance abuse 
Fraility 
Nutrition 
Medications
40
Q

Fraility

A

Fraility is a syndrome of decreased physiological reserves and resistance to stressor.

41
Q

Fraility types

A

Physical

Index

42
Q

Fraility screening tool

A 
F
R
A
L
Prefrail 
frail
Robust
43
Q

Time up and go test

A

Patient should sit in a standard chair with a line 10fee in length in front of the chair. They should use standard footwear and walking aid and should not receive any assistance.

44
Q

Surgical risk calculator geriatric

A
45
Q

Cognition definition

A

Level of cerebral function that describes the mental process of acquiring knowledge and understanding through thought, experience and senses

46
Q

Cognition

A 
Working memory
Comprehension
Language production
Calculation
Reasoning
Problem solving
Decisions making
47
Q

Assessment of cognitive function

A

DSM V (5)

48
Q
A

Preexisting cognitive impairment

49
Q

Postoperative de

A

Emergence delirium

Persistent or recurrent delirium

50
Q

Post op cognitive impairment

A

Delayed neuro cognitive recovery <30 days post op

Neuro cognitive disorder postoperative >30 - 12/12

51
Q

Postoperative cognitive dysfunction

A

An objective measure in cognitive function that typically persists beyond the period expected for normal recovery from the physiological and pharmacological effects of anaesthesia

52
Q

Diagnosis

A

Preop neurophysiological testing decline of > 1.96SD for >2 domains

53
Q

Screening test

A

MiniCog

54
Q

MiniCog assessment tool step 1

A

Step 1 3 word registration

55
Q

Step 2

A

Clock drawing 10min past 11

56
Q

Step 3

A

Reask word recall

57
Q

Scoring

A

Word recall 0-3
Xlock draw 0-2
Total < 3 dementia

58
Q

New efinition

A

Cognitive concern
Daily living activity assessment
Objeive test

59
Q

Function status

A 
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
60
Q

Instrumental activity of daily living

A 
Ability to telephone
Shopping
Food prep
Housekeeping
Laundry
Mode of transport
Responsibility for own meds
Ability to handle finances
61
Q

Postop delirium

A

Acute state of confusion and inattention, which may be accompanied by an altered level of consciousness

62
Q

Mnemonic for post op delirium

A

A
I
C
D _ disorganized thinking

63
Q

Diagnosis delirium

A

Acute
Inattention
Conscious ultered
Disorganized thinking

Presence of 1st 2 +3rd or 4th point

64
Q

Risk factors for postoperative delirium

A 
Cognitive and behavioural disorders
Disease/illness
Metabolic
Functional impairment
Other
65
Q

Alcohol abuse

A

C-
A-
G-
E-

66
Q

Strategies to prevent delirium

A
67
Q

Cormobidities patient factors

A
68
Q

Fraility

A
69
Q

Nutritional status assessment

A
70
Q

Nutrition

A
71
Q

AGS Beers criteria

A
72
Q

AGS Beers criteria

A
73
Q

Preoperative testing

A

HB
Renal
Albumin

74
Q

Exan

A
75
Q

Anaesthesia

A
76
Q

Monitoring

A
77
Q

Positioning

A
78
Q

Hypothermia

A
79
Q

Drug adjustment

A
80
Q

Drugs avoid in beers list

A
81
Q

Postoperative concerns

A

Pain
CVS redp function
Delirium and cognitive dysfunction
Recovery

Domain 2 : Geriatrics (8 decks)

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