Test #2 Aging PPt-Josh Flashcards by Study Study

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

aging

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what age is considered elderly?

65 and up

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

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Surgical Morbidity & Mortality:

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

DM
Ischemic heart disease
Malnutrition
Renal impairment
Cerebralvascular disease
Lung disease

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Surgical Morbidity & Mortality:

what are some common surgical complications

MI
Dysrhythmias
Cardiac arrest
reintubation

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Surgical Morbidity & Mortality:

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

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Cellular Effects of Aging:

there is a limited number of human _____!

Structural framwork for tissues

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Effects of aging on Body Composition:

you have a loss of _____ muscle

Skeletal muscle (lean body mass)

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Effects of aging on Body Composition:

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

body

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Effects of aging on Body Composition:

they have a decreased skin ________

elasticity

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Effects of aging on Body Composition:

there is reduced _____ and _____ tissue perfusion

skin

soft tissue

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Effects of aging on Body Composition:

they have poor skin _____

turgor

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Anesthestic Implications: Body changes

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

fragile skin
Poor skin turgor
Decreased SQ fat

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Anesthestic Implications: Body changes

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

collagen loss
decreased elasticity of skin

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Anesthestic Implications: Body changes

why must u prevent hypothermia?

3 reasons

low basal metabolic rate
Hypothyroidism
Hihgh BSA

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Anesthestic Implications: Body changes

what are the 4 main effects of post op shivering

increase O2 consumption 400%
Hypoxia
Acidosis
Cardiopulmonary compromise

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CV System:

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

50%

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CV System: Peripheral Vascular changes

what happens to wall thickness and diameter

increased

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CV System: Peripheral Vascular changes

what happens to Aorta and large ateries?

Stiffiening

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CV System: Peripheral Vascular changes

WHat occurs to vasodilation

decreased

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CV System: Peripheral Vascular changes

they have systemic HTN form what?

decreased baroreceptor sensitivity

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CV System: Myocardial changes

What happens to thickness of LV wall

thickens

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CV System: Myocardial changes

what happens to compliance

decreased

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CV System: Myocardial changes

what happens to Aortic valve cusps?

thickening

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CV System: Myocardial changes the increased LV wall thickness leads to what?

LVH

CV System: CV changes what happens to the myocardial pump

Impaired pumping

CV System: CV changes what happens to CO

Decreased

CV System: CV changes what happens to circulation time

prolonged

CV System: CV changes there is a greater reliance on _____ and ___ \_\_\_\_

LVEDV & Atrial Kick

CV System: CV changes increased incidence of _____ ( a disease)

CAD

CV System: CV changes WHat happens to their maximum HR

## Footnote Lower

CV System: CV changes what happens to their response to Catecholamines

Decreased response

Anesthesia: CV what is the best predictor of postoperative functional status

preoperative functional status

Anesthesia: CV does routine testing improve outcomes?

Nope

Anesthesia: CV prop testing should be reserved for what pts?

High risk sx \< METS 4 3 or more risk factors for CAD

Changes in ANS: what happens to PNS

DIminished

Changes in ANS: what happens to SNS

## Footnote Increased

Changes in ANS: what happens to their response to Beta stimulation

Reduced

Changes in ANS: the changes are manifested in what 3 main ways

1. Compromised thermoregulatin 2. Decreased Baroreceptor sensitivity 3. Dehydration

Respiratory changes: Alveolar Level there is a \_\_\_% reduction in alveolar surface area available for gas exchange by age 70

15%

Respiratory changes: Alveolar Level the 15% reduction in alveolar surface area available for gas exchange is due to what 2 things?

1. reduction of elastic tissue 2. Increased Collagen

Respiratory changes: Alveolar Level there is an _______ alveolocapillary membrane thickness

increased

Respiratory changes: Alveolar Level the increased alveolocapillary membrane thickness means what?

a decline on PaO2 PaO2 90mmHg @ 20ys and 70 mmHg @ 80 yrs

Respiratory changes: Alveolar Level what is teh equation for PaO2?

PaO2= 100-(0.4 x age)

Respiratory changes: Alveolar Level what happens to alveolar compliance?

Decreased

Respiratory changes: Alveolar Level why is there a decreased in alveolar compliance (3)

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

Respiratory changes: Function what happens to FEV1 & FVC

decreased

Respiratory changes: Function what happens to closing volumes

Increased

Respiratory changes: Function there is a \_\_% decrease in TLC by age 70

10 %

Respiratory changes: Function there is a diminished response to CNS response to ___ and \_\_\_\_

hypoxia and Hypercarbia

Airway changes: what happens to their larygeal and pharyngeal responses?

diminished

Airway changes: the diminished laryngeal and pharyngeal responses mean what 3 things?

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

Airway changes: what happens to their airway passages?

Narrows

Airway changes: the narrowed airway passages mean what 3 things?

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

Airway changes: what 3 complications can occur form being endentulous

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

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

1. limites extension & flexion 2. Difficult intubation

Renal changes: renal atrophy results in approx \_\_\_% reduction in the number of functioning nephrons by age 80

50%

Renal changes: ther is a \_\_-\_\_% per year decline in glomerular filtration rate

1-1.5%

Renal changes: RBF decreases \_\_-\_\_% per year after age 25

1-2%

Renal changes: By age 65, RBF decreases \_\_-\_\_%

40-50%

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

1. electrolyte abnormalities 2. Hypovolemia 3. Dehydration

Renal changes: ARF contributes to __ in 5 postop deaths

1 in 5

Hepatic System: what happens to tissue mass

decreased

Hepatic System: is there a lot of changes in hepatocellular fxn?

No there is only a few

Hepatic System: what happens to hepatc blood flow?

Decreased

What happens to filtration rate?

Decreased

Hepatic System: what happens to excretatory capacity

reduced

Malnutrition: w/ malnutrition the serumm albumin is what?

\< 3 g/dL

GI changes: what happens to Gastric residual volume?

Increased

cGI changes: what happens to the sphincters? and one inparticular?

Dysfuntion occurs mainly LES

GI changes: what are some anesthestic implications?

RSI? Avoid LMA? Prophylactic antacids

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

1. insulin 2. Throxine 3. Growth 4. Renin 5. Aldosterone

Endocrine fxn: what happens to postprandial BGLs?

Increased

Endocrine fxn: what 2 complications occur from increased postprandial BGLs?

* Decreased liberation of insulin in response to hyperglycemia * resistance to effects of insulin

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

* increased risk of Aspiration * Poor wound healing * Infection * Cardiac and cerebralvascular event * Autonomic dysfunction

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?

120-180

Hemotological Changes: what happens to Bone marrow fnx?

Diminished

Hemotological Changes: what happens to hematopoiesis?

decreased

Oncologic and immune fxn changes: compromised cellular immunity can lead to what 2 d/o

Leukopenia lymphopenia

Oncologic and immune fxn changes: what is the most significant risk factor for the development of Cancer?

Age

CNS changes: what happens to brain mass?

decreased 30% by age 80

CNS changes: what happens to Neuronal density/ CMRO2 and CBF?

all decreased

CNS changes: what happens to neurotransmitter receptor sites

decreased

CNS changes: what happens to the fibers in the spinal cord tract

decreased

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

nope

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

Post op delerium

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

postop cognitive dysfunction

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

post op delerium

Postoperative Delerium: the Sx manifest how many days postop?

1-3

Postoperative Delerium: what are risk factors

* \> 70 y/o * Dementia * ETOH abuse * Prior PD * Visual disturbances * Prior ilness * certain injuries (HIP) * elevated BUN

Postoperative Delerium: what are perioperative risk factors

* Large blood loss * Blood products * Inadequate analgesia * narcotics/Benzos * Postop HCT \< 30%

Postoperative Delerium: do most pt's experience complete recovery?

Yes

Postoperative Delerium: what are 3 ways to help prevent it?

* Stimulate cognition * nutrition/fluid intake * Exercise

Postoperative Delerium: what is treatment

Haldol for agitation

Postoperative Delerium: what 2 main drugs do u want to avoid

* Chlorpromazine * Benzo

Delerium: whata re factors that precipitate delerium

* 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)

Postoperative Cognitive Dysfunction: most is mild and resolves during the first ___ months

Postoperative Cognitive Dysfunction: can be severe w/ a ___ year mortality

Postoperative Cognitive Dysfunction: DX requires neuropsychologic testing when

b4 and after sx

Postoperative Cognitive Dysfunction: what are risk factors

* Cardiac Sx * underlying Cerebralvascular disease * Advanced age * Lower educational level * pre-existing dementia * Decreased ADLs

Postoperative Cognitive Dysfunction: is GA a role in it?

unclear

Old farts? is there one ideal anesthestic?

Nope

thats it

yeah!!!