Test #2 Aging PPt-Josh Flashcards
what is a rogressive process w/ diminishing ability to adapt to stressful events?
aging
what age is considered elderly?
65 and up
there is a __% decline in organ fxn per year after age 30!!
1%
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
Surgical Morbidity & Mortality:
what are some common surgical complications
- MI
- Dysrhythmias
- Cardiac arrest
- reintubation
Surgical Morbidity & Mortality:
the 30 day mortality rates increase every decade after age ___?
30
Cellular Effects of Aging:
there is a limited number of human _____!
Structural framwork for tissues
Effects of aging on Body Composition:
you have a loss of _____ muscle
Skeletal muscle (lean body mass)
Effects of aging on Body Composition:
there is an increased % of ______ fat, and a decreased _____ fat!!
body
SQ
Effects of aging on Body Composition:
they have a decreased skin ________
elasticity
Effects of aging on Body Composition:
there is reduced _____ and _____ tissue perfusion
skin
soft tissue
Effects of aging on Body Composition:
they have poor skin _____
turgor
Anesthestic Implications: Body changes
you must have careful positioning b/c what 3 main reasons
- fragile skin
- Poor skin turgor
- Decreased SQ fat
Anesthestic Implications: Body changes
you want to be cautious w/ adhesives d/t what 2 reasons?
- collagen loss
- decreased elasticity of skin
Anesthestic Implications: Body changes
why must u prevent hypothermia?
3 reasons
- low basal metabolic rate
- Hypothyroidism
- Hihgh BSA
Anesthestic Implications: Body changes
what are the 4 main effects of post op shivering
- increase O2 consumption 400%
- Hypoxia
- Acidosis
- Cardiopulmonary compromise
CV System:
Cardiac fnx declines by ____% btw the age of 20 & 80
50%
CV System: Peripheral Vascular changes
what happens to wall thickness and diameter
- increased
CV System: Peripheral Vascular changes
what happens to Aorta and large ateries?
Stiffiening
CV System: Peripheral Vascular changes
WHat occurs to vasodilation
decreased
CV System: Peripheral Vascular changes
they have systemic HTN form what?
decreased baroreceptor sensitivity
CV System: Myocardial changes
What happens to thickness of LV wall
thickens
CV System: Myocardial changes
what happens to compliance
decreased
CV System: Myocardial changes
what happens to Aortic valve cusps?
thickening
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
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
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
- Compromised thermoregulatin
- Decreased Baroreceptor sensitivity
- 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?
- reduction of elastic tissue
- 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)
- V/Q mismatch
- Increased physiological shunt
- 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?
- decreased airway clearance (cough/ swallowing)
- decreased Gag reflex
- Predisposition to aspiration
Airway changes:
what happens to their airway passages?
Narrows
Airway changes:
the narrowed airway passages mean what 3 things?
- more turbulant flow
- Increased work of breathing
- Difficult ventilation
Airway changes:
what 3 complications can occur form being endentulous
- poor mask seal
- loss of upper airway muscle tone
- difficult mask ventilation
Airway changes:
they develop cervical arthritis and OA, what 2 complication occur d/t this?
- limites extension & flexion
- 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?
- electrolyte abnormalities
- Hypovolemia
- 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)
- insulin
- Throxine
- Growth
- Renin
- 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
3
Postoperative Cognitive Dysfunction:
can be severe w/ a ___ year mortality
1
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!!!