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AP 1 > Test 2: Geriatrics (pt 1/3) > Flashcards

Test 2: Geriatrics (pt 1/3) Flashcards

1
Q

Chronological age is a less important risk factor than ______.

A

Underlying comorbidities.

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2
Q

Why are older adults at risk for perioperative complications and negative outcomes?

A

-Prone to progressive decline of baseline functions
-Age-related comorbid diseases cause an increase in physical status classification
-More postop complications: cardiac, pulmonary, and neurologic

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3
Q

What are the factors that influence periop outcomes in older adults?

A

-Emergency surgery
-# of comorbidities
-type of surgical procedure

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4
Q

What are the risk factors for developing postoperative delirium?

A

-Cognitive & Behavioral disorders
-Coexisting Dz
-Metabolic Disturbances
-Functional Impairements
-Polypharmacy, Hx of UTI, presence of foley catheter

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5
Q

A time-dependent biologic continuum that begins with birth and persists with gradual impairments of organ subsystems, and ultimately causes an organism to become more susceptible to illness and death.

A

Aging

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6
Q

By the age of _____, most age-related physiologic functions in humans have peaked and gradually decline thereafter.

A

30

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7
Q

True/False: Aging patients may be able to maintain homeostasis, but become increasingly less able to tolerate changes or restore homeostasis when exposed to surgical stress, trauma, or diseases.

A

True

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8
Q

Why are the heart and vascular systems less compliant in the older adult?

A

-Increase in AL and SBP
-Ventricular thickening (hypertrophy) and prolonged ejection times
-This combination of ventricular hypertrophy and slower myocardial relaxation often results in late diastolic filling and dysfunction.

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9
Q

Why are the heart and vascular systems less compliant in the older adult?

A

-Increase in AL and SBP
-Ventricular thickening (hypertrophy) and prolonged ejection times

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10
Q

Why is atrial contraction so important in the maintenance of adequate ventricular filling?

A

The combination of ventricular hypertrophy and slower myocardial relaxation in older adults often results in late diastolic filling and dysfunction.

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11
Q

Older adults exhibit _____ end-organ adrenergic responsiveness, and a reduce capacity to ______ HR in response to hypotension, hypovolemia, and hypoxia

A

decreased; increase

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12
Q

Prolonged circulation time causes a ____ induction time with inhalation agents, and a ____ of IV drugs.

A

faster; delayed onset. Give IV agents time to circulate before giving more.

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13
Q

Calcification of the conducting system and valves predisposes the elderly to what conditions?

A

-Atrial Fibrillation
-Sick Sinus Syndrome
-1st and 2nd degree HB
-arrhythmias
-Aortic/Mitral Valve Stenosis/Regurgitation

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14
Q

What are the CV changes associated with decreased venous and arterial compliance in the older adult?

A

-Decreased venous return and reduced atrial filling (due to decreased vein compliance)
-Increased PVR and cardiac workload (decreased arterial elasticity)
-Decreased CO and CV (decreased conduction velocity and reduction in venous blood flow)

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15
Q

What is the effect of aging on baroreceptor response?

A

There is decreased sensitivity of baroreceptors in the aortic arch and carotid sinuses in response to blood pressure changes, which results in increased episodes of hypotension.

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16
Q

What is the most common cardiac complication and the leading cause of death in the postoperative period?

A

Myocardial Infarction

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17
Q

What are the most frequently associated cardiovascular coexisting diseases in the older adult?

A

-HTN
-Hyperlipidemia
-CAD (Ischemic Heart Dz)
-CHF

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18
Q

How does myocardial hypertrophy occur in older adults?

A

Apoptotic cells are not replaced, and there is compensatory hypertrophy of existing cells; reflected waves during late systole create strain on myocardium leading to hypertrophy

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19
Q

What are the consequences of myocardial hypertrophy?

A

Increased ventricular stiffness; prolonged contraction; and delayed relaxation.

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20
Q

What are the anesthetic considerations r/t myocardial hypertrophy?

A

Failure to maintain preload leads to an exaggerated decrease in CO; excessive volume more easily increases filling pressures to congestive failure levels; dependence on sinus rhythm and low-normal HR

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21
Q

How does myocardial stiffening occur in older adults?

A

Increased interstitial fibrosis; amyloid deposition

22
Q

What are the consequences of myocardial stiffening in older adults?

A

Ventricular filling dependent on atrial pressure

23
Q

How does reduced LV relaxation occur in older adults?

A

Impaired calcium homeostasis; reduced β-receptor responsiveness; early reflected wave

24
Q

What are the consequences of reduced LV relaxation?

A

Diastolic Dysfunction

25
Q

How does Reduced Beta-Receptor responsiveness occur in older adults?

A

Diminished coupling of β-receptor to intracellular adenylate cyclase activity; decreased density of β-receptors

26
Q

What are the consequences of Reduced Beta-Receptor responsiveness?

A

Increased circulating catecholamines; limited increase in HR and contractility in response to endogenous and exogenous catecholamines; impaired baroreflex control of BP

27
Q

What are the anesthetic implications associated with reduced beta-receptor responsiveness?

A

Hypotension from anesthetic blunting of sympathetic tone; altered reactivity to vasoactive drugs; increased dependence on Frank-Starling mechanism to maintain CO; labile BP, more hypotension

28
Q

How do conduction system abnormalities occur in older adults?

A

Apoptosis; fibrosis; fatty infiltration; and calcification of pacemaker and His-bundle cells

29
Q

What are the consequences of conduction system abnormalities in older adults?

A

Conduction block; sick sinus syndrome; AF; decreased contribution of atrial contraction to diastolic volume

30
Q

What are the anesthetic implications associated with conduction system abnormalities in older adults?

A

Severe bradycardia with potent opioids; decreased CO from decrease in end-diastolic volume

31
Q

How do stiff arteries and veins occur in older adults?

A

Loss of elastin; increased collagen; glycosylation cross-linking of collagen

32
Q

What are the consequences of stiffened arteries?

A

Systolic hypertension
Arrival of reflected pressure wave during end-ejection leads to myocardial hypertrophy and impaired diastolic relaxation

33
Q

What are the anesthetic implications associated with stiffened arteries?

A

Labile BP; diastolic dysfunction; sensitive to volume status

34
Q

What are the consequences associated with stiffened veins?

A

Decreased buffering of changes in blood volume impairs ability to maintain atrial pressure

35
Q

What are the anesthetic implications associated with stiffened veins?

A

Changes in blood volume cause exaggerated changes in cardiac filling

36
Q

What are the factors that contribute to a decrease in chest wall compliance in the elderly?

A

-Calcifications of the chest wall, intervertebral joints, and intercostal joints
-Decreased intercostal muscle mass
-Flattening of the diaphragm
-Loss of intervertebral disc height
-Changes in spinal lordosis

37
Q

Why is there a reduced functional alveolar surface area available for gas exchange in the elderly?

A

There is a generalized loss of elastic tissue recoil of the lung
(increase in lung compliance leads to V/Q mismatch)

38
Q

Why are the elderly predisposed to increased episodes of apnea?

A

The ventilatory response to hypoxemia and hypercarbia is decreased

39
Q

Why are the elderly at risk for airway obstruction?

A

Progressive decrease in laryngeal and pharyngeal support that accompanies aging

40
Q

Why are the elderly at risk for aspiration?

A

Protective airway reflexes (like coughing and swallowing) are decreased

41
Q

The elderly are at an increased risk for postoperative pulmonary complications (PPCs) such as:

A

-Atelectasis
-Bronchospasm
-Exacerbation of chronic lung dz
-PNA
-Prolonged mechanical ventilation
-Postoperative respiratory failure

42
Q

What are the lung volume changes associated with the elderly?

A

-Decrease in Vital Capacity
-Increase in Residual Volume
-Increase in FRC (with decreases in inspiratory reserve volume and expiratory reserve volume)
-TLC unchanged or may slightly decrease (due to its correlation with height)

43
Q

True/False: Structural Changes to the chest wall impair gas exchange and increase the risk for respiratory failure in elderly patients.

A

True

44
Q

Stiffness or decreased compliance in the elderly causes what?

A

-Increased WOB
-Need careful use of NDMRs, Opioids, and Benzos

45
Q

Structural changes in the lung parenchyma cause what?

A

-Impaired gas exchange
-Increased risk for respiratory failure

46
Q

Increased lung compliance in the elderly causes what?

A

-Increased V/Q mismatch
-Avoid high pressure & large Vt

47
Q

Increased small airway closures in the elderly cause what?

A

-Increased anatomic dead space (consider alveolar recruitment - PEEP)
-Decreased alveolar surface area (limit high inspired O2)
-Decreased PCBF (maintain PaCO2 near normal preoperative value)
-Decreased PaO2 (consider regional/local with sedation)

48
Q

Changes in the muscle strength of the elderly causes what?

A

Risk for Respiratory Failure & Aspiration

49
Q

What should you ensure with the elderly due to increased WOB?

A

Adequate hydration

50
Q

Due to decreased protective airway reflexes in the elderly, what are the anesthetic implications?

A

-Consider RSI w/GA
-Ensure full reversal prior to extubation
-Consider postop CPAP or BiPAP
-Vigilant monitoring
-Encourage cough/deep breathing postoperatively

51
Q

Decreased central/peripheral chemoreceptor sensitivity in the elderly causes what?

A

-Increased hypoventilation (consider postop CPAP)
-Increased apnea (vigilant monitoring)
-Decreased ventilatory responses (encourage cough/deep breathing; supplemental O2)

AP 1 (32 decks)

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