Test 2 Geriatrics Flashcards
what are the factors that influence perioperative outcomes in the the older adult?
- emergency surgery
- number of comorbidities
- type of surgical procedure
T/F: aging is synonymous with poor physiologic function
FALSE
what are the CV changes that occur in the geriatric patient
- heart and CV system less complaint 2. reduced capacity to increase HR in response to HoTN, hypovolemia, & hypoxia (end organ adrenergic responsiveness)
- prolonged circulation time
- calcification of cardiac conduction system and valves
- decreased venous and arterial compliance
- decreased sensitivity of baroreceptors
- more vulnerable to periop cardiac events
- frequently associated with CV coexisting dz: htn, hld, CAD, and CHF
prolonged circulation time in geriatric pts, will cause _________ inhalational induction, and ____________ IV induction
faster; slower
respiratory changes in the geriatric patient
- decreased chest wall compliance
- loss of elastic recoil
- reduced functional alveolar surface area
- increased lung compliance
- decreased ventilatory response to hypoxemia and hypercarbia
- progressive decrease in laryngeal/pharyngeal support and protective reflexes
- increased risk of postoperative pulmonary complications
what are the postop pulmonary complications in the geriatric patient
- atelectasis
- bronchospasm
- exacerbation chronic lung disease
- PNA
- prolonged mechanical ventilation 6. postoperative respiratory failure
closing volume exceeds FRC at approximately ________ years of age in the erect position, and at ___________ years of age in the supine position
65; 45
what are some dynamic and static lung changes in the geriatric patient
- decrease in vital capacity
- increase in residual volume
- increase in FRC with decreases in inspiratory reserve volume and expiratory reserve volume
- decrease in FVC
- decrease in FEV1
T/F: TLC remains unchanged with age or may slightly decrease
TRUE
with the geriatric population, GFR decreases about ____________%
25-50
what is the cause of decreased GFR in elderly patients?
decreased renal mass and decreased renal blood flow
what is the result of decreased GFR in the elderly patients?
- fluid overload
- accumulation of drugs/metabolites excreted by the kidneys
- decreased drug elimination
- electrolyte imbalances
- dehydration
after 40 years of age, renal blood flow decreases about ________% per decade
10
renal changes with aging (geriatric)
- decrease GFR 25-50%
- serum Cr unchanged if no renal failure d/t declining skM mass
- increased risk CKD
- decrease in renal blood flow
why is the geriatric patient at increased risk of CKD
- Coexisting Dz
- Fraility
- complex medical regimens and polypharmacy
what are the hepatic changes in the geriatric patient
- decrease in liver mass ~ 20-40%
- decreased drug metabolism
- decreased serum albumin
- increased alpha-1 acid glycoprotein
the decrease in albumin in the geriatric patients causes decreased binding of _________ drugs, like ____________ and ___________
acidic; benzodiazepines; opoids
alpha 1-amino glycoproteins increase in the elderly, AAGs, bind ____________ drugs like __________
basic; local anesthetics
when you are dosing drugs in the elderly, the dosing is dependent on ______________ and ______________
hepatic metabolism; concomitant liver Dz
what is the most notable endocrine organ to impact the aging adult pt and cause postoperative morbidity
pancreas
what are the changes to the endocrine system in the geriatric patient
- decline in number and fx of pancreatic islet beta cells (insulin)
- peripheral insulin resistance
- often compromises multiple organ systems
peripheral insulin resistance in the geriatric pt, puts pt at risk for ____________ and ___________ dz
HTN; CV
peripheral insulin resistance in the geriatric patient, increases the risk for what types of perioperative complications?
- CVA
- MI
- Ketoacidosis
- infection
50% of skM mass and strength is lost by age ______
80
2. greater hemodynamic stability