geriatrics

Question 1

sub optimal aging

Answer 1

feeling deleterious effects of normal physiological aging bc you aren’t engaging in preventative health care

Question 2

MSK changes w/ age

Answer 2

• sarcopenia: age-related loss of ability of muscles to regenerate, progressive loss of m mass and strength
• number of motor units decrease - each motor neuron must innervate larger number of muscle fibers, result in motor unit hypertrophy
• increase in fat mass, decrease in lean body mass - predictor of mobility restriction
• decreased bone mass and density - greater resorption than deposition, esp after 40s
• less water in articular cartilage - arthritis, decreased water in disks
• less extensible fascia, ligaments, tendons -> decreased ROM and flexibility
• type IIb fibers denervated and remaining motor unit hypertrophy
• 10% strength decline per decade, esp 60s and 70s
• decreased CSA of type II muscle fibers
• increased collagen stiffness d/t cross linkage btw fibers

Question 3

frailty syndrome

older adults

Answer 3

• unintentional weight loss
• muscle weakness
• slow gait speed
• exhaustion
• low physical activty

Question 4

NM changes with age

Answer 4

• decreased brain volume and conduction velocity
• increased ventricular size
• decreased periph nerve conduction velocity: decr ability to sense pain, decr joint proprioception and coordination, decr somatosensory input, impaired balance, increased gait instability
• decreased reaction speed

Question 5

CV changes with age

Answer 5

• CO decreases - less tolerance to exercise s/t decreased perfusion of peripheral tissues
• CO decr d/t decr venous return, arteriosclerosis effectign afterload esp in aorta, fibrotic changes in myocardium, decreased response to cardiac hormones
• increased BP, increased risk postural hypotension, decreased RHR, cardiac dysrhthmias
• increase myocyte volume in ventricles - encroaches on myocardium vasculature, increases risk for MI (decreased myocyte density but increased myocyte volume)
• greater risk for stroke, CAD, CHF
• decreased SA node pacemaker cells
• decreased sensitivity to beta-adrenergic stimulation
• increased calcification and fibrosis of heart. vales
• incr vascular tone -> incr BP
• decreased FEV1
• greater than 50% of all adults have some heart diseaes

if SV can be maintained w/ exercise, CO can be sustained despite low MHR

Question 6

pulm system changes with age

Answer 6

• stiffer chest wall, incr thoracic kyphosis
• diminished MSK pump - decreased VC of lungs and residvual volume incr
• decreased number and zie of alveoli, decreased expiratory flow rates, ciliary function in upper airways (more pneumonia)
• decreased strength/effectiveness of coughing

Question 7

integ changes with age

Answer 7

• decr dermal layer thickness, loss of elastin fibers
• loss of collagen - more prone to damage from shear forces
• pressure ulcers more common - vasc changes delay healing
• BV reduction in dermis - less thermoregulation
• decreased fever response
• decreased autonomic regulation of thermoreg responses
• decreased vasc, thickness, and elasticity of dermis
• increased pain threshold
• decreased subcutaneous adipose tissue
• decr sensory perception

Question 8

metabolic and endocrine changes with age

Answer 8

• basal metabolic rate decr with age
• changes in acid=base balance
• general decrease in hormone production and function
• higher blood glucose s/t reduction in beta cells in pancreas and peripheral resistance to insulin
• decreased insulin sensitivity
• decr hepatic insulin release control
• decr sensitivity to beta-adrenergic stimulation

Question 9

GI changes with age

Answer 9

• decr taste and smell - affect desire to eat
• loss of alveolar bone and dental issues - difficulty w mastication
• decr salivation
• loss of motility (peristalsis) - constipation and diverticulosis
• loss of control with sphincters
• decr E metabolism
• decr drug metabolism
• increased risk adverse side effects of meds
• decreased gastric acid production

Question 10

GU changes with age

Answer 10

• kidneys less effective s/t anatomic and physiologic changs like decr blood to kidneys, fewer nephrons, overalld ecrease in kidney size
• GFR decreases
• more difficult regulation of sodium levels in blood and clearance of some meds from body
• urinary frequency and nocturia
• prostate enlargement
• increased incontinence
• decr kidney function and filtration rate
• decr bladder capacity

Question 11

presbycusis

Answer 11

hearing loss in older adults

tinnitus also common with older adults

Question 12

working memory

Answer 12

• remembering info in middle of an activity
• items on grocery list

Question 13

episodic memory

Answer 13

personally experience events

Question 14

semantic memory

Answer 14

knowledge or facts

Question 15

procedural memory

Answer 15

performance of skills

Question 16

types of attention that decline with age

Answer 16

• dual tasking, switching attention
• no decline with age: sustained attention, selective attention

Question 17

intelligence and age

Answer 17

• declines but difficult to quantify d/t generational differences
• crystallized intelligence: accumulation of knowledge and skills, maintains or improves with age
• fluid intelligence: speed and ability to reason and problem solve, declines with age

Question 18

mild cognitive impairment

Answer 18

MCI
- lower than expected cog performance when compared to others in age group
- does not interfere with ADLS
- does not = eventual dementia

Question 19

4 parameters of pharmacokinetics

Answer 19

• absorption
• distribution
• metabolism
• excretion

what happens to drug once inside body

Question 20

pharmacokinetics and age

Answer 20

• decreased acidity in stomach, slower emptying times, decr motility alters absorption
• some drugs become more concentrated in blood stream and intensify effects
• slower metab d/t liver changes
• excretion slower d/t kidney functions

Question 21

pharmacodynamics

Answer 21

• how a drug exerts therapeutic effects on body at cellular or organ level

Question 22

3 drugs most responsible for adverse drug reactions (ADRs)

Answer 22

digoxin
warfarin
insulin

Question 23

advance directives

Answer 23

documents completed by pt prior to illness to dictate end-of-life care
- power of attorney and livign will

Question 24

do not rescuscitate

Answer 24

• medical order for pt wishes to not have cardiopulmonary resuscitation (CPR) if they stop breathing or heart stops
• does not apply to meds or HC treatements

Question 25

hospice

Answer 25

form of palliative care for terminally ill who have limited life expectancy

Question 26

living will

Answer 26

- document where pt dictates desires and preferences for health care treatment

Question 27

palliative care

Answer 27

- usually with serious illness - aims to relieve pain and suffering