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BioScience II > Test #2 Aging PPt-Josh > Flashcards

Test #2 Aging PPt-Josh Flashcards

1
Q

what is a rogressive process w/ diminishing ability to adapt to stressful events?

A

aging

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2
Q

what age is considered elderly?

A

65 and up

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3
Q

there is a __% decline in organ fxn per year after age 30!!

A

1%

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4
Q

Surgical Morbidity & Mortality:

elderly have a higher iincidence of certain co-existing diseases, what are some of those common diseases?

A
  • DM
  • Ischemic heart disease
  • Malnutrition
  • Renal impairment
  • Cerebralvascular disease
  • Lung disease
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5
Q

Surgical Morbidity & Mortality:

what are some common surgical complications

A
  • MI
  • Dysrhythmias
  • Cardiac arrest
  • reintubation
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6
Q

Surgical Morbidity & Mortality:

the 30 day mortality rates increase every decade after age ___?

A

30

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7
Q

Cellular Effects of Aging:

there is a limited number of human _____!

A

Structural framwork for tissues

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8
Q

Effects of aging on Body Composition:

you have a loss of _____ muscle

A

Skeletal muscle (lean body mass)

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9
Q

Effects of aging on Body Composition:

there is an increased % of ______ fat, and a decreased _____ fat!!

A

body

SQ

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10
Q

Effects of aging on Body Composition:

they have a decreased skin ________

A

elasticity

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11
Q

Effects of aging on Body Composition:

there is reduced _____ and _____ tissue perfusion

A

skin

soft tissue

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12
Q

Effects of aging on Body Composition:

they have poor skin _____

A

turgor

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13
Q

Anesthestic Implications: Body changes

you must have careful positioning b/c what 3 main reasons

A
  1. fragile skin
  2. Poor skin turgor
  3. Decreased SQ fat
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14
Q

Anesthestic Implications: Body changes

you want to be cautious w/ adhesives d/t what 2 reasons?

A
  1. collagen loss
  2. decreased elasticity of skin
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15
Q

Anesthestic Implications: Body changes

why must u prevent hypothermia?

3 reasons

A
  • low basal metabolic rate
  • Hypothyroidism
  • Hihgh BSA
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16
Q

Anesthestic Implications: Body changes

what are the 4 main effects of post op shivering

A
  • increase O2 consumption 400%
  • Hypoxia
  • Acidosis
  • Cardiopulmonary compromise
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17
Q

CV System:

Cardiac fnx declines by ____% btw the age of 20 & 80

A

50%

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18
Q

CV System: Peripheral Vascular changes

what happens to wall thickness and diameter

A
  • increased
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19
Q

CV System: Peripheral Vascular changes

what happens to Aorta and large ateries?

A

Stiffiening

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20
Q

CV System: Peripheral Vascular changes

WHat occurs to vasodilation

A

decreased

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21
Q

CV System: Peripheral Vascular changes

they have systemic HTN form what?

A

decreased baroreceptor sensitivity

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22
Q

CV System: Myocardial changes

What happens to thickness of LV wall

A

thickens

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23
Q

CV System: Myocardial changes

what happens to compliance

A

decreased

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24
Q

CV System: Myocardial changes

what happens to Aortic valve cusps?

A

thickening

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25
Q

CV System: Myocardial changes

the increased LV wall thickness leads to what?

A

LVH

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26
Q

CV System: CV changes

what happens to the myocardial pump

A

Impaired pumping

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27
Q

CV System: CV changes

what happens to CO

A

Decreased

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28
Q

CV System: CV changes

what happens to circulation time

A

prolonged

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29
Q

CV System: CV changes

there is a greater reliance on _____ and ___ ____

A

LVEDV

&

Atrial Kick

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30
Q

CV System: CV changes

increased incidence of _____ ( a disease)

A

CAD

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31
Q

CV System: CV changes

WHat happens to their maximum HR

A

Lower

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32
Q

CV System: CV changes

what happens to their response to Catecholamines

A

Decreased response

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33
Q

Anesthesia: CV

what is the best predictor of postoperative functional status

A

preoperative functional status

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34
Q

Anesthesia: CV

does routine testing improve outcomes?

A

Nope

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35
Q

Anesthesia: CV

prop testing should be reserved for what pts?

A

High risk sx

< METS 4

3 or more risk factors for CAD

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36
Q

Changes in ANS:

what happens to PNS

A

DIminished

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37
Q

Changes in ANS:

what happens to SNS

A

Increased

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38
Q

Changes in ANS:

what happens to their response to Beta stimulation

A

Reduced

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39
Q

Changes in ANS:

the changes are manifested in what 3 main ways

A
  1. Compromised thermoregulatin
  2. Decreased Baroreceptor sensitivity
  3. Dehydration
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40
Q

Respiratory changes: Alveolar Level

there is a ___% reduction in alveolar surface area available for gas exchange by age 70

A

15%

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41
Q

Respiratory changes: Alveolar Level

the 15% reduction in alveolar surface area available for gas exchange is due to what 2 things?

A
  1. reduction of elastic tissue
  2. Increased Collagen
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42
Q

Respiratory changes: Alveolar Level

there is an _______ alveolocapillary membrane thickness

A

increased

43
Q

Respiratory changes: Alveolar Level

the increased alveolocapillary membrane thickness means what?

A

a decline on PaO2

PaO2 90mmHg @ 20ys and 70 mmHg @ 80 yrs

44
Q

Respiratory changes: Alveolar Level

what is teh equation for PaO2?

A

PaO2= 100-(0.4 x age)

45
Q

Respiratory changes: Alveolar Level

what happens to alveolar compliance?

A

Decreased

46
Q

Respiratory changes: Alveolar Level

why is there a decreased in alveolar compliance (3)

A
  1. V/Q mismatch
  2. Increased physiological shunt
  3. Decreased efficiency of O2 exchange
47
Q

Respiratory changes: Function

what happens to FEV1 & FVC

A

decreased

48
Q

Respiratory changes: Function

what happens to closing volumes

A

Increased

49
Q

Respiratory changes: Function

there is a __% decrease in TLC by age 70

A

10 %

50
Q

Respiratory changes: Function

there is a diminished response to CNS response to ___ and ____

A

hypoxia and

Hypercarbia

51
Q

Airway changes:

what happens to their larygeal and pharyngeal responses?

A

diminished

52
Q

Airway changes:

the diminished laryngeal and pharyngeal responses mean what 3 things?

A
  1. decreased airway clearance (cough/ swallowing)
  2. decreased Gag reflex
  3. Predisposition to aspiration
53
Q

Airway changes:

what happens to their airway passages?

A

Narrows

54
Q

Airway changes:

the narrowed airway passages mean what 3 things?

A
  1. more turbulant flow
  2. Increased work of breathing
  3. Difficult ventilation
55
Q

Airway changes:

what 3 complications can occur form being endentulous

A
  1. poor mask seal
  2. loss of upper airway muscle tone
  3. difficult mask ventilation
56
Q

Airway changes:

they develop cervical arthritis and OA, what 2 complication occur d/t this?

A
  1. limites extension & flexion
  2. Difficult intubation
57
Q

Renal changes:

renal atrophy results in approx ___% reduction in the number of functioning nephrons by age 80

A

50%

58
Q

Renal changes:

ther is a __-__% per year decline in glomerular filtration rate

A

1-1.5%

59
Q

Renal changes:

RBF decreases __-__% per year after age 25

A

1-2%

60
Q

Renal changes:

By age 65, RBF decreases __-__%

A

40-50%

61
Q

Renal changes:

they have a inability to concentrate urine and preserve H2O and Sodium, this can lead to what 3 complications?

A
  1. electrolyte abnormalities
  2. Hypovolemia
  3. Dehydration
62
Q

Renal changes:

ARF contributes to __ in 5 postop deaths

A

1 in 5

63
Q

Hepatic System:

what happens to tissue mass

A

decreased

64
Q

Hepatic System:

is there a lot of changes in hepatocellular fxn?

A

No there is only a few

65
Q

Hepatic System:

what happens to hepatc blood flow?

A

Decreased

66
Q

What happens to filtration rate?

A

Decreased

67
Q

Hepatic System:

what happens to excretatory capacity

A

reduced

68
Q

Malnutrition:

w/ malnutrition the serumm albumin is what?

A

< 3 g/dL

69
Q

GI changes:

what happens to Gastric residual volume?

A

Increased

70
Q

cGI changes:

what happens to the sphincters? and one inparticular?

A

Dysfuntion occurs

mainly LES

71
Q

GI changes:

what are some anesthestic implications?

A

RSI?

Avoid LMA?

Prophylactic antacids

72
Q

Endocrine fxn:

atrophy of endocrine glands cause a reduced production of what hormones ( 5 main)

A
  1. insulin
  2. Throxine
  3. Growth
  4. Renin
  5. Aldosterone
73
Q

Endocrine fxn:

what happens to postprandial BGLs?

A

Increased

74
Q

Endocrine fxn:

what 2 complications occur from increased postprandial BGLs?

A
  • Decreased liberation of insulin in response to hyperglycemia
  • resistance to effects of insulin
75
Q

Endocrine fxn:

DM is an independent predictor of long term decreases in quality of life following sx. what are 5 complications r/t DM

A
  • increased risk of Aspiration
  • Poor wound healing
  • Infection
  • Cardiac and cerebralvascular event
  • Autonomic dysfunction
76
Q

Endocrine fxn:

you want to ensure adequate conrol of glucose b4 surgery!! in reality several weeks b4 if possible, you want to ensure the BGL is b/t what?

A

120-180

77
Q

Hemotological Changes:

what happens to Bone marrow fnx?

A

Diminished

78
Q

Hemotological Changes:

what happens to hematopoiesis?

A

decreased

79
Q

Oncologic and immune fxn changes:

compromised cellular immunity can lead to what 2 d/o

A

Leukopenia

lymphopenia

80
Q

Oncologic and immune fxn changes:

what is the most significant risk factor for the development of Cancer?

A

Age

81
Q

CNS changes:

what happens to brain mass?

A

decreased 30% by age 80

82
Q

CNS changes:

what happens to Neuronal density/ CMRO2 and CBF?

A

all decreased

83
Q

CNS changes:

what happens to neurotransmitter receptor sites

A

decreased

84
Q

CNS changes:

what happens to the fibers in the spinal cord tract

A

decreased

85
Q

CNS changes:

are the structurl changes in the CNS automatically associtaed w/ decline in cognitive fxn?

A

nope

86
Q

CNS changes:

what is the transient and flunctuating disturbance of conciousness that occurs shortly after sx

A

Post op delerium

87
Q

CNS changes:

what is teh persistant change in cognative performance diagnosed by neuropsychological tests

A

postop cognitive dysfunction

88
Q

CNS changes:

out of the last 2 which one has th ehighest association w/ the elderly

A

post op delerium

89
Q

Postoperative Delerium:

the Sx manifest how many days postop?

A

1-3

90
Q

Postoperative Delerium:

what are risk factors

A
  • > 70 y/o
  • Dementia
  • ETOH abuse
  • Prior PD
  • Visual disturbances
  • Prior ilness
  • certain injuries (HIP)
  • elevated BUN
91
Q

Postoperative Delerium:

what are perioperative risk factors

A
  • Large blood loss
  • Blood products
  • Inadequate analgesia
  • narcotics/Benzos
  • Postop HCT < 30%
92
Q

Postoperative Delerium:

do most pt’s experience complete recovery?

A

Yes

93
Q

Postoperative Delerium:

what are 3 ways to help prevent it?

A
  • Stimulate cognition
  • nutrition/fluid intake
  • Exercise
94
Q

Postoperative Delerium:

what is treatment

A

Haldol for agitation

95
Q

Postoperative Delerium:

what 2 main drugs do u want to avoid

A
  • Chlorpromazine
  • Benzo
96
Q

Delerium:

whata re factors that precipitate delerium

A
  • D- drug use
  • E- electrolytes
  • L- lack of drugs (withdrawl)
  • I- infection
  • R- reduced sensory input (blind, deaf. dark)
  • I- intracranial problems )CVA, Bleed, Meningitits)
  • U- urinary retention and fecal impaction
  • M-myocardial problems (MI, dysrhythmia, CHF)
97
Q

Postoperative Cognitive Dysfunction:

most is mild and resolves during the first ___ months

A

3

98
Q

Postoperative Cognitive Dysfunction:

can be severe w/ a ___ year mortality

A

1

99
Q

Postoperative Cognitive Dysfunction:

DX requires neuropsychologic testing when

A

b4 and after sx

100
Q

Postoperative Cognitive Dysfunction:

what are risk factors

A
  • Cardiac Sx
  • underlying Cerebralvascular disease
  • Advanced age
  • Lower educational level
  • pre-existing dementia
  • Decreased ADLs
101
Q

Postoperative Cognitive Dysfunction:

is GA a role in it?

A

unclear

102
Q

Old farts?

is there one ideal anesthestic?

A

Nope

103
Q

thats it

A

yeah!!!

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