Pulm in Elderly Flashcards
how many cases of lung cancer are attributed to tobacco smoke?
85-90% wtf people! lay off the cancer sticks!
Besides tobacco, what are some other risk exposures that contribute to lung cancer?
occupational exposure arsenic asbestos nickle uranim chromium silica beryllium diesel feul
If someone smokes AND has been exposed to tobacco smoke, how much greater is their risk of getting lung cancer?
80-90 fold higher
what form of screening provides greater reduction in risk of dying from lung cancer: CT or CXR?
CT. 20% lower risk
How many pack years should tip you off to go more aggressive with screening?
30 pack years
What is the recommendation for lung cancer screening in people aged 55-80?
If 30 pack year or more: annual low dose CT
If you’re screening for lung cancer in people aged 55-80, but they have quit, long long ago should they have quit to decrease the need to do yearly screenings?
30 pack year history indicates screening, but if they have quit greater than 15 years ago, don’t need to screen anymore
Other than quitting greater than 15 years ago, what else would stop the need for annual lung cancer screening via CT?
developing a health problem that significantly limits life expectancy
Does the clinical presentation of lung cancer vary?
yes
There are 4 types of lung cancer presentations, what are they?
local
intrathoracic spread
extrathoracic spread
paraneoplastic
S/S of LOCAL lung cancer
cough
chest pain
dyspnea
hemoptysis
What should you think if someone presents with hemoptysis?
lung cancer until proven otherwise
S/S of INTRA-THORACIC spread of lung cancer
Chest wall pain (TTP is likely not cardiac)
Dyshpagia
Hoarseness
Pleural Effusion
SVC obstruction by tumor (Superior Vena Cava)
What does the symptom of dyspnea indicate?
Local lung cancer
What does the symptom of dysphagia indicate?
Intra-thoracic spread of cancer
What does the symptom of hoarseness indicate?
Intra-thoracic spread of cancer
If superior vena cava is obstructed by tumor, how far has lung cancer spread?
intra-thoracic spread
S/S of EXTRA-THORACIC spread
Abdominal Pain Bone Pain Jaundice Lymphadeopathy Paralysis Seizures
S/S of PARA-NEOPLASTIC spread
clubbing Cushing syndrome Hypercalcemia Hypertrophic osteoarthropathy Lambert-Eaton Syndrome SIADH
Excess of what causes Cushing syndrome?
Cortisol
What is the hallmark of paraneoplastic syndrome?
Hypercalcemia
What is Lambert-Eaton Syndrome?
Immune system attacks own neuromuscular connections
What does Lambert-Eaton syndrome typically present with?
Leg weakness
Eye and facial muscle weakness
What does SIADH stand for?
Syndrome of Inapropropriate Anti-duretic Hormone
What secretes ADH?
Pituitary
What are some clinical signs of cushings?
Striae
Moon Facies
Buffalo Hump
What is the difference between dementia and delirium?
Dementia: chronic decline
Delirium: acute and caused by something organic. reversible.
When pneumonia presents in older adult, will there typically be greater or fewer symptoms?
Fewer.
What is one symptom pneumonia may present with?
Delirium
Admitting older adults to the hospital for treatment of pneumonia is aways a good idea! Right?
Nope. most will have long standing loss of some degree so think twice about admitting.
Pneumonia is among the top 10 causes of death.
Yup. This wasn’t a question, just know it’s bad.
Do more people get pneumonia in nursing facilities or at home?
rate of occurance is highest in nursing facilities
Risk factors for pneumonia in elderly (Diseases-5)
Dementia Seizures CHF Cerebrovascular Ds COPD
Level of activity that is risk factor for pneumonia
inactivity
How does swallowing affect risk of pneumonia?
Increases
Does surgery or hospitalization affect risk of pneumonia?
yup. increases
Etiology of Community Acquired Pneumonia
exposure through contact with pathogen via normal living activities in non-special needs community
Etiology of Hospital/Nosocomial acquired pneumonia
exposure to pathogen while hospitalized
Etiology of pneumonia acquired in nursing home
exposure to pathogen while hospitalized
Do all geriatric patients present with typical fever, cough, malaise when they have pneumonia?
Nope, may just “not seem right”
What are some non-pulm symptoms of pneumonia in elderly?
N/V/D Mayalgia Arthralgia Confusion Falls General decline in over-all health Fatigue
What is the most common extra-pulmonary symptom of pneumonia in elderly?
fatigue
Pulmonary symptoms of pneumonia in elderly
cough
SOB
Sputum production
Hemoptysis
What is the most common pulmonary symptom of pneumonia in elderly?
cough
PE findings for pneumonia? what are you expecting to find?
crackles
wheezes
dullness to percussion
egophony
What does increase RR indicate in elderly
it’s the most sensitive presentation of pneumonia in elderly
How long should you count to get an accurate RR?
30-60 seconds
Is RR valid if you count for 15 seconds?
No, only accurate if you count for 1 minute
What RR indicates severe pneumonia?
> 28
What will most people report or present with in pneumonia?
fatigue
How much of the >75 yo population has COPD?
10%
Is COPD adequately diagnosed and treated?
no, under dx and tx
What will SPO2 be doing in COPD?
it will be low. Might be first indication that something is wrong.
Areas that are affected by aging in respiratory function
structure, function, control
What happens to elastic recoil in aging?
goes down
Bronchiolar diameters ____ and alveolar ducts _____ (size)
Bronchiolar diameters diminish. Alveolar ducts enlarge
What does the change in bronchioles and alveoli result in?
decreased expiratory flow and decreased surface area for gas exchange
Advancing age = airways in dependent portions of lungs to close at higher volumes.
no idea what this means, but it’s in the ppt.
What happens to costochondra cartilages?
they become calcified.
What does calcified constochondral cartilage lead to?
less lung expansion because the intercostal muscles shorten
Which parts of the immune system are dysregulated in aging?
adaptive and innate
What happens to cytokine production in aging?
increases
What disease process do cytokines play an integral role in?
COPD
The immune system response triggers a cascade of constant inflammation. COPD is though by some to be an autoimmune condition
This is in her ppt, but I think it’s more food for thought than anything else.
How do you diagnose COPD in the older adult?
spirometry and history of exposure to noxious agents
Everyone being hospitalized for respiratory issues should have what?
CXR
If you suspect pneumonia, as a general rule for elderly patients, what blood tests should you order?
CBC and BMP.
Look at electrolytes
What’s with the tongue?
look to see if it’s dry
Is CT or CXR more sensitive for finding pneumonia?
CT
How does COPD present in the older adult?
Complicatedly. Might have SOB, fatigue, cough.
OR
Might have few or no respiratory complaints if they have other comorbidities
What happens to coughing as someone ages?
becomes less vigorous
Aging itself is though too be what kind of state?
inflammation. This adds to the difficulty of maintaining healthy lung function
What does spirometry measure?
lung function. measures volume and rate of air on inhalation and expiration
What could impact the validity of spirometry tests?
cognitive deficits or comorbidities that limit the patient’s ability to perform the test or understand the instructions
What is the most commonly used PFT?
spirometry
What is the normal FEV1 value?
80-120%
What is the normal FVC value?
80-120%
How close should the FEV1/FVC ratio be to predicted ratio to be considered normal?
with in 5%
What is the TLC (total lung capacity) normal value?
80-120%
What is the normal FRC (functional residual capacity)?
75-120%
What does FVC stand for?
Forced vital capacity
How is spirometry performed?
Patient inhales maximally then exhales as rapidly and as completely as possible
How much of their volume can normal lungs expire in 6 seconds?
80%
Based on oximetry, when should you order O2?
if O2 Sat is
Arterial Blood Gas will show the arterial oxygen pressure (paO2). If it’s below ___ patients should be given oxygen
60mmHg
Red flags during pulmonary exam in older patients (5)
crackles in base of lungs Cyanosis Markedly decreased exercise tolerance Severe fatigue "dad's just not himself"
What should you ALWAYS consider as a possible cause of respiratory symptoms?
cardiac pathology
What should you consider as a possible cause of delirium?
O2
