Geriatrics.txt

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drtrouta
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199348
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Geriatrics.txt
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2013-02-10 18:19:54
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Geriatrics
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Geriatrics.txt
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  1. Does CO increase or decrease in geriatric patients?
    Decrease
  2. Why do geriatric patients have an increased PVR?
    • Increased wall thickness & diameter
    • Stiffening of aorta & large arteries
  3. Does geriatric patients have an impaired pump?
    Yes
  4. Why do you see left ventricle hypertrophy in geriatric patients?
    Chronic increase in afterload d/t increased PVR
  5. Is CAD a normal part of the aging process?
    Yes
  6. Does blood volume increase or decrease in geriatric patients?
    Decrease
  7. What does prolonged circulation time and decreased perfusion of organs do to the onset of drugs?
    Delays induction time & slows onset of drug action
  8. Does lung compliance increase or decrease with age?
    Increase
  9. Does lung elasticity increase or decrease with age?
    Decreases
  10. What causes a decrease in FEV1 & FVC in the elderly?
    Decreased elasticity
  11. Does CC increase or decrease with age?
    Increase
  12. Does the A-a difference increase or decrease with age?
    Increase
  13. Does resting PaO2 increase or decrease with age?
    Decrease
  14. Does FRC increase or decrease with age?
    Increases d/t increased RV
  15. Does VC increase or decrease with age?
    Decrease
  16. Why does VC decrease in the aging adult?
    d/t the decreased elastic recoil
  17. Does the ventilator response to hypoxia/hypercarbia increase or decrease in the aging adult?
    Decrease
  18. What kind of structural changes can cause a decrease in lung capacity of aging adults?
    • Kyphosis
    • Massive scoliosis
  19. Why can’t the elderly tolerate the supine position?
    Increased closing capacity
  20. Is the CBF & CMRO2 increased or decreased in the elderly?
    Decreased
  21. Do neurons decrease in size & complexity in the elderly?
    Yes
  22. Does the elderly have decreased receptors and neurotransmitters?
    Yes
  23. Does the elderly lose neurons?
    Yes- 50,000 per day which decreases the makers neurotransmitters
  24. Which brain mass declines more? Gray or white
    Gray
  25. Does the elderly have an increased or decreased deafferentation?
    Decreased sensation
  26. Does the elderly have an increase or decrease in adrenal mass?
    Decrease
  27. What does a decrease in adrenal mass for the elderly mean?
    Decrease cortisol/sympathetic response
  28. As brain mass declines, what increases to compensate?
    CSF
  29. Does the elderly increase or decrease their CSF?
    Increase
  30. Does the elderly have an increased or decreased baroreceptor response?
    Decreased – less tachycardia IRT hypotension
  31. Does the elderly have an increased or decreased end-organ responsiveness to neurotransmitters?
    Decreased
  32. Does the elderly have an increased or decreased chrono/inotropic response to agonists such as Atropine & antagonists such as propranolol?
    Decreased
  33. What does the “endogenous beta-blockage of aging” mean?
    That the elderly have 2-4 times higher plasma epi/norepi levels that have a less effect
  34. Is the CBF autoregulation & cerebral vasoconstrictive response to hyperventilation intact in the elderly?
    Yes
  35. Does the elderly have an increase or decrease rate of gastric emptying?
    decreased
  36. What type of lung pathophysiology does the aging lungs reflect?
    Emphysema-like decreases
  37. How do you determine the resting arterial oxygen tension PaO2?
    PaO2= 100 – (0.4x age in years) mm Hg
  38. What happens to the SNS and PSNS in geriatrics?
    Increased SNS activity & decreased PSNS
  39. Are plasma drug levels increased or decreased in the elderly?
    Increased d/t contracted blood volume (decrease TBW d/t increase fat)
  40. How is IH affected by the aging adult?
    Decreases 4% each decade of life after the age of 40
  41. How is IV anesthetic agents affected by the aging adult?
    Decreased doses with slow titration
  42. Which IV induction agent might be the most appropriate for the elderly?
    Etomidate d/t the cardio-protectant qualities
  43. How is the dosing of narcotics affected by the aging adult?
    Doses decreased d/t the decreased Vd & protein binding
  44. Is the elimination half-life of narcotics increased or decreased in the aging adult?
    increased
  45. How is muscle relaxants affected by the aging adult?
    • Same dose d/t them being highly polarized, relatively fat insoluble
    • Increased elimination half-life (pick a short to intermediate acting)
  46. How does aging affect the kidneys?
    • Decreased RBF/GFR
    • Decreased urine concentration
    • Decreased drug excretion
    • Decreased ability to reabsorb glucose
  47. How much RBF do you lose after the age of 30?
    1% per year after the age of 30
  48. How much GFR do you lose per year?
    1-1.5%
  49. Is creatinine clearance increased or decreased in the elderly?
    Decreased
  50. If the CC is decreased in the elderly, what happens to the serum creatinine levels?
    Stable d/t the amount of creatinine produced (less)
  51. Why is it important to maintain a UO of >0.5ml//kg/hr in the perioperative period?
    D/T ARF being responsible for a high mortality rate
  52. Why does the elderly have a decreased hepatic blood flow?
    Decreased CO
  53. Does the aging process decrease the actual size of the liver?
    Yes – 40 to 50% by the age of 80
  54. How does again affect hepatic biotransformation of drugs?
    Decreases which causes vulnerability to cumulative drug effects
  55. Is hypercoagulability & peripheral thrombosis part of the aging process itself?
    No
  56. How does aging affect the body’s response to anemia?
    d/t bone marrow mass & spleen size decreasing, the hematopoetic response is decreased
  57. Does aging have an effect on RBC, WBC, the # or FX of platelets or coagulation?
    No
  58. Is there a decrease in the erythrocyte life expectancy in the elderly?
    No – only increased fragility
  59. Is anemia or disorders of hemostasis in the elderly part of the physiologic process of again?
    Nope – only d/t DZ
  60. Is the Vd for lipophilic drugs increased or decreased in the elderly?
    Increased
  61. Is the Vd for hydrophilic drugs increased or decreased in the elderly?
    Decreased d/t the decrease of TBW
  62. What is the beta elimination half-life of Valium in hours equal to?
    Patient’s age in years
  63. What are 3 major risk factors for mortality in elderly patients?
    • Need to perform emergency surgery
    • Site of surgery
    • Physical status of the Pt at the time of surgery
  64. What can anticholinergic drugs do to the elderly if there is no change to onset or peak?
    Increased cardiac arrhythmias if CV dz
  65. What happens to the heart conducting system in the elderly?
    Fibrosis/atrophy
  66. With a decrease in CO, does the elderly have an increased or decreased systolic BP?
    Increased
  67. Is an elderly Pt’s able to reach a maximum Hr?
    No
  68. Might the elderly have a normal CO at rest?
    Yes
  69. Does a slower HR speed up or slow down an IH induction?
    Speeds up
  70. Would a slow HR speed up or slow down an IV induction?
    Slow down
  71. Does hypothermia slow down emergence?
    Yes
  72. How much decline does organ dysfunction go through after the age of 30?
    1% each year after the age of 30

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