Flashcards
Geriatric care
Cards in this deck (23)
- 1Definitionanyone over 65 years and older
- 2Cardiovascular changesdecreased arterial elasticity, elevated afterload, systolic BP, left ventricular hypertrophy
decreased adrenergic activity, decreased heart rate, maximal heart rate, baroreceptor reflex - 3Cardio pathologyarteriosclerosis
coronary artery disease
hypertension
congestive cardiac failure
cardiac arrhythmias (AF)
aortiv stenosis - 4Respiratory changesdrying 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 - 5respiratory pathologyCOPD, emphysema, chronic bronchitis, pneumonia, lung cancer
- 6Renal changesreduced 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
- 7Gastrointestinal changesdecreased 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
- 8Integumentary changesvulnerable to mild mechanical stress, decrease elastin fibres, collagen - heat loss, barrier function less effective - bruising, water loss, infection
- 9Musculoskeletal changesprogressive loss of muscle strength, joint pain/stiffness - care when positioning, bone breakdown overcomes bone building - osteoporosis
- 10Nervous system changesloss of neurones, decreased reaction time, changes in sleep patterns, less rapid eye movements (REM) and deep sleep
- 11Pharmacological changespharmacokinetics - what body does to drug, absorption, distribution, metabolism, elimination
Pharmacodynamics - what drug does to body, physical interaction, receptors, enzymes systems - 12Changes in body composition effecting distribution and eliminationincreased 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 - 13Changes in body compositiondecreased intracellular water
decreased plasma volume, hypertension, on diuretics, - 14Pharmacokinetic change volume distribution, distribution, eliminationvolume 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 - 15Pharmacokinetic changes clearance, plasma protein bindingclearance - 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 - 16Pharmacodynamic changes inhalational agentsMAC - 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) - 17Pharmacologic changes - IV agentslower 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 - 18Pharmacologic changes muscle relaxants LAmuscle 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 - 19Pharmacologic changeslower 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 - 20Intraoperative considerationssharing 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 - 21Post op considerationsusual ABCs
pain management
delirium - return of hearing aids, glasses
fluids, hypotension management
pressure area care, skin care
hypothermia management
psychological care - 22Post op deliriumcharacterised by
incoherent thought and speech
disorientation
impaired memory
attention
adverse effects: increased morbidity, delayed function recovery and prolonged hospital stay, reversible - 23Do we or Don't weEthical 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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- User has deleted their subject information Flashcards on Geriatric care, created by Deleted user on 12/06/2018.
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- Created by Elizabeth Then · Jun 12, 2018
- Copied by Elizabeth Then · Jun 12, 2018
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