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Descrição
FlashCards por Elizabeth Then, atualizado more than 1 year ago
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Criado por Elizabeth Then
mais de 6 anos atrás
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| Questão | Responda |
| Definition | anyone over 65 years and older |
| Cardiovascular changes | decreased arterial elasticity, elevated afterload, systolic BP, left ventricular hypertrophy decreased adrenergic activity, decreased heart rate, maximal heart rate, baroreceptor reflex |
| Cardio pathology | arteriosclerosis coronary artery disease hypertension congestive cardiac failure cardiac arrhythmias (AF) aortiv stenosis |
| Respiratory changes | drying of mucous membranes, decreased pulmonary elasticity, decreased alveolar surface tension, V/Q mismatching Increased chest wall rigidity Decreased muscle strength decrease cough, maximal breathing capacity |
| respiratory pathology | COPD, emphysema, chronic bronchitis, pneumonia, lung cancer |
| Renal changes | reduced bladder capacity and weakened muscles, decreased renal blood flow, GFR rate, decreased tubular function - impaired na and fluid handling, drug excretion, decreased renin-aldosterone responsiveness - impaired K handling |
| Gastrointestinal changes | decreased digestive gland secretions, mucous thicker - dysphagia, loss of teeth - digestion probelms, delays in gastric emptying - decreased peristalsis, gastric motility, changes in body water and mass - implications for drugs |
| Integumentary changes | vulnerable to mild mechanical stress, decrease elastin fibres, collagen - heat loss, barrier function less effective - bruising, water loss, infection |
| Musculoskeletal changes | progressive loss of muscle strength, joint pain/stiffness - care when positioning, bone breakdown overcomes bone building - osteoporosis |
| Nervous system changes | loss of neurones, decreased reaction time, changes in sleep patterns, less rapid eye movements (REM) and deep sleep |
| Pharmacological changes | pharmacokinetics - what body does to drug, absorption, distribution, metabolism, elimination Pharmacodynamics - what drug does to body, physical interaction, receptors, enzymes systems |
| Changes in body composition effecting distribution and elimination | increased body fat - prolonged effect and extends elimination time Decreased skeletal muscle mass - increased o2 consumption, decreased production heat, secondary to pharmacokinetic changes * not more sensitive to muscle relaxants, as fewer receptors at neuromuscular junction |
| Changes in body composition | decreased intracellular water decreased plasma volume, hypertension, on diuretics, |
| Pharmacokinetic change volume distribution, distribution, elimination | volume distribution - same concentration of fluid and drug present in plasma distribution - decreased total body weight and 2 x increased mean body fat = vd is diminished, higher plasma concentration vd is larger for lipid soluble drugs - lower plasma concentrations elimination - is effected by vd, if vd increased, half life will be prolonged |
| Pharmacokinetic changes clearance, plasma protein binding | clearance - renal and hepatic decline with age, prolonged duration of action Plasma protein binding - effects distribution and elimination, albumin decreases with age (binds opiods, benzos, barbiturates) Alpha-1 -acid glycoprotein (binds LA) is increased Plasma bound drugs cannot interact with end organ receptors ad are unavailable for metabolism and excretion |
| Pharmacodynamic changes inhalational agents | MAC - minimum alveolar concentration, reduction onset, V/Q mismatch, increased myocardial depression, increased vd, increased body fat, decrease hepatic function * MAC awake is lower in elderly, thus recovery time is prolonged in older patients * volatiles potentiate non-depolarising muscle relaxants (NDMR) |
| Pharmacologic changes - IV agents | lower doses for barbiturates, opiods, benzos e.g - thiopentone - brain concentration associated with EEG, vd increased opioids- smaller initial vd, prolonged elimination, increased brain sensitivity Midazolam - lipid soluble in body, vd large, elimination slowed, increased sensitivity at receptor level * Decreased MAC volatiles, reduced infusion rates propofol, potentiates NDMR |
| Pharmacologic changes muscle relaxants LA | muscle relaxants - prolonged onset due to decrease in CO, slow muscle blood flow, dependant on renal excretion, decrease in drug clearance LA- prolonged elimination, decrease excreation, dependent on hepatic excretion * duration of all muscle relaxants prolonged by - dehydration, hypokalaemia, hypoproteinaemia, hypothermia |
| Pharmacologic changes | lower drug doses required to achieve same end points in elderly use less drugs where possible use alternate drugs to treat HTN intraop, to avoid myocardial depression and prolonged emergence use balanced analgesic techniques to decrease resp depression choose less invasive procedure where possible |
| Intraoperative considerations | sharing of info - team time out anaesthetic considerations positioning/aware of sensory deficits hydration/fluid balance pressure area care/diathermy position warming/continence management pain management |
| Post op considerations | usual ABCs pain management delirium - return of hearing aids, glasses fluids, hypotension management pressure area care, skin care hypothermia management psychological care |
| Post op delirium | characterised by incoherent thought and speech disorientation impaired memory attention adverse effects: increased morbidity, delayed function recovery and prolonged hospital stay, reversible |
| Do we or Don't we | Ethical dilemma Moral debate quality of life vs expectations disease course vs life expectancy state of independence personal motivation surgical risks, non-operative management |
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