Aging Adult Population Vascular Changes

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Questions and Answers

What is the GFR threshold for defining Chronic Kidney Disease?

  • 60 mL/min/1.73 m2 (correct)
  • 75 mL/min/1.73 m2
  • 40 mL/min/1.73 m2
  • 100 mL/min/1.73 m2

What serum creatinine level indicates a need for expert vascular access assessment?

  • 1.0 mg/dL
  • 1.5 mg/dL
  • 2.0 mg/dL (correct)
  • 2.5 mg/dL

What is the normal range for platelets in adult patients?

  • 200-500 thousand per mcl
  • 300-700 thousand per mcl
  • 100-300 thousand per mcl
  • 150-450 thousand per mcl (correct)

Which of the following describes the International Normalized Ratio (INR) range for patients on anticoagulant therapy?

<p>2.1-3.0 (D)</p> Signup and view all the answers

What should be considered before placing a vascular access device in thrombocytopenic patients?

<p>Licensed independent practitioner's direction (D)</p> Signup and view all the answers

What is Creatinine primarily a measure of?

<p>Kidney function (A)</p> Signup and view all the answers

What is a criterion for the early identification of a person with CKD who may need a hemodialysis fistula or graft?

<p>Elevated serum creatinine of 2 mg/dL or greater (B)</p> Signup and view all the answers

How should platelet transfusions be managed in relation to VAD insertion?

<p>They can be administered before or concurrently with VAD insertion. (C)</p> Signup and view all the answers

What is the purpose of monitoring INR in patients taking oral anticoagulants?

<p>To adjust VKA doses due to patient variability (B)</p> Signup and view all the answers

Which vascular access device (VAD) might be most appropriate for hypercoagulable patients?

<p>A peripherally inserted central catheter (PICC) (A)</p> Signup and view all the answers

Which chronic disease primarily affects arterial circulation in aging adults?

<p>Diabetes mellitus (B)</p> Signup and view all the answers

What is a common cause of leukocytosis in older adults?

<p>Infection (A)</p> Signup and view all the answers

Which lifestyle factor does NOT typically affect an aging adult's circulatory system?

<p>Regular exercise (C)</p> Signup and view all the answers

What is the normal range for White blood cell count in adults?

<p>4.5-10.0 thousand per mcL (A)</p> Signup and view all the answers

Which of the following conditions indicates a potential active infection in relation to WBC levels?

<p>WBC reading at 12,500/mm3 (C)</p> Signup and view all the answers

What is the normal Glomerular Filtration Rate (GFR) for adults?

<p>90-120 mL/min/1.73 m² (A)</p> Signup and view all the answers

Which factor is primarily NOT associated with skin changes in aging adults?

<p>Increased hydration (D)</p> Signup and view all the answers

What measurement method is used to evaluate kidney function via GFR?

<p>Mathematical comparison of creatinine excretion (C)</p> Signup and view all the answers

Which of these is a potential risk related to VAD devices in patients with elevated WBC?

<p>Bacterial seeding of the catheter (A)</p> Signup and view all the answers

What lifestyle factor listed below is often correlated with an increase in chronic stress in aging adults?

<p>Alcohol consumption (C)</p> Signup and view all the answers

What indicates the need for a comprehensive vascular access plan in patients with CKD?

<p>GFR less than 60 mL/min for more than 3 months (C)</p> Signup and view all the answers

Which of the following is a criterion for identifying a person with CKD who may require a hemodialysis fistula?

<p>Serum creatinine level of 2 mg/dL or greater (D)</p> Signup and view all the answers

What is the normal range for the International Normalized Ratio (INR) for patients not on anticoagulant therapy?

<p>1.0-1.2 (A)</p> Signup and view all the answers

What lifestyle factor can significantly worsen vascular health in aging adults?

<p>Chronic stress (B)</p> Signup and view all the answers

Why might a PICC be the most appropriate device for hypercoagulable patients?

<p>Lower risk of thrombosis (C)</p> Signup and view all the answers

What should be considered when placing a vascular access device in thrombocytopenic patients?

<p>Appropriate compressibility of insertion sites (C)</p> Signup and view all the answers

Which chronic disease is primarily associated with changes in arterial circulation due to aging?

<p>Diabetes mellitus (C)</p> Signup and view all the answers

What does an elevated serum creatinine level commonly indicate?

<p>Kidney impairment (C)</p> Signup and view all the answers

What is the primary purpose of measuring Glomerular Filtration Rate (GFR)?

<p>To evaluate kidney function (D)</p> Signup and view all the answers

What skin change is commonly observed in aging adults?

<p>Collagen depletion (D)</p> Signup and view all the answers

What role does serum creatinine play in assessing kidney function?

<p>Serves as a waste marker from muscle metabolism (B)</p> Signup and view all the answers

What does a platelet count below 150 thousand per mcl suggest?

<p>Possible thrombocytopenia (C)</p> Signup and view all the answers

What impact can cigarette smoke exposure have on the vascular system of aging adults?

<p>Cumulative vascular damage (C)</p> Signup and view all the answers

What is a key purpose of monitoring INR in patients taking anticoagulants?

<p>To adjust vitamin K antagonist doses (D)</p> Signup and view all the answers

What is a potential consequence of elevated white blood cell counts in patients before vascular access device placement?

<p>Increased risk of bacteremia (D)</p> Signup and view all the answers

What is the minimum required GFR for diagnosing Chronic Kidney Disease?

<p>60 mL/min (D)</p> Signup and view all the answers

Which of the following is NOT a chronic condition affecting arterial circulation?

<p>Anorexia nervosa (D)</p> Signup and view all the answers

What might an upward trend in white blood cell counts signify in an aging adult?

<p>Possible active infection (A)</p> Signup and view all the answers

Which factor is generally associated with poorer kidney function in aging adults?

<p>Low intake of fluid (B)</p> Signup and view all the answers

How can IV drug use affect the circulatory system of aging individuals?

<p>It can lead to chronic infections (D)</p> Signup and view all the answers

Flashcards

Vascular Changes in Aging

A general deterioration of the circulatory system due to the natural aging process and damage caused by various chronic ailments like diabetes, hypertension, and kidney issues. This can lead to narrowed arteries and decreased blood flow.

Leukocytosis

An increase in the number of white blood cells in the bloodstream, often indicating an infection or other health problem. This rise can be attributed to various factors such as infections, trauma, or certain types of cancer.

Glomerular Filtration Rate (GFR)

A test used to measure the filtering capacity of the kidneys. It determines how much blood is filtered by the glomeruli, the tiny filters inside the kidneys, each minute.

Hypertension

A chronic condition that affects primarily arterial circulation and can contribute to the overall aging process. It involves a persistent elevation of blood pressure, putting strain on the cardiovascular system.

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Diabetes Mellitus

A metabolic disorder characterized by elevated blood sugar levels due to either insufficient insulin production or the inability of the body to effectively use insulin. Chronic diabetes can significantly damage the blood vessels, impacting circulation.

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Chronic Kidney Disease

A condition where the kidneys are not functioning properly, leading to an accumulation of waste products in the blood. Chronic kidney disease can also negatively impact the circulatory system due to the buildup of toxins.

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Lifestyle Factors Affecting Circulation

A group of factors influencing an individual's circulatory system and general well-being. These include lifestyle choices such as diet, stress management, alcohol consumption, smoking habits, and substance abuse.

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Skin Changes Related to Aging

Factors contributing to skin changes associated with aging. These include the loss of collagen, reduced hormone levels, dehydration, and environmental exposure like smoking.

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eGFR (Estimated Glomerular Filtration Rate)

A formula used to estimate the GFR, considering factors such as creatinine levels, age, gender, and ethnicity. It provides an indication of kidney function and can help identify potential issues.

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Hyperthyroidism

A condition where there is a higher than normal level of thyroid hormone in the bloodstream, potentially contributing to various health problems. This can affect the circulatory system by impacting heart rate and blood pressure.

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What is Chronic Kidney Disease (CKD)?

Chronic Kidney Disease (CKD) is diagnosed when your glomerular filtration rate (GFR) is less than 60 mL/min/1.73 m2 for at least 3 months, regardless of the cause.

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What is Serum Creatinine?

Serum creatinine is a waste product produced during muscle metabolism. It's a good indicator of kidney function. Elevated levels suggest impaired kidney function.

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What is the significance of a GFR below 60 mL/min/1.73 m2 for 3 months?

A GFR below 60 mL/min/1.73 m2 for 3 months or more means CKD is present. This indicates a need for vascular access planning, especially if hemodialysis may be necessary.

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What are Platelets and why are they important for vascular access?

Platelets are small blood cells that help to stop bleeding. Low platelet count (thrombocytopenia) can complicate vascular access placement.

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What is International Normalized Ratio (INR)?

INR measures how long it takes for blood to clot. It's used to monitor patients taking blood thinners.

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What is a Comprehensive Vascular Access Plan?

A Comprehensive Vascular Access Plan involves assessing the patient's vascular system to determine the best and safest way to provide dialysis access.

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What should be considered when assessing a patient for vascular access?

When assessing a patient for vascular access, it's important to consider their overall health, including their platelet count, INR, and any other relevant factors.

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What is a hemodialysis fistula?

A hemodialysis fistula is a connection between an artery and a vein in the arm that can be used for dialysis. It's the preferred access for long-term hemodialysis.

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What is a Peripherally Inserted Central Catheter (PICC)?

A PICC is a central venous catheter that is inserted into a vein in the arm and threaded into a larger vein in the chest. It can be used for long-term access for medications and fluids.

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Why might a PICC be preferred over other vascular access methods in certain patients?

In patients who are at risk of bleeding, a PICC may be a better choice for vascular access than a traditional dialysis fistula or graft. Patients with a low platelet count (thrombocytopenia) might be more prone to bleeding, so a PICC might be chosen due to its placement in a central vein where compression is possible.

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Chronic Kidney Disease (CKD)

A condition where the kidneys are not working properly, causing a buildup of waste in the blood.

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Estimated Glomerular Filtration Rate (eGFR)

A formula that estimates the glomerular filtration rate considering factors like creatinine levels, age, gender, and ethnicity.

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What defines Chronic Kidney Disease?

Chronic Kidney Disease (CKD) is diagnosed when the glomerular filtration rate (GFR) is less than 60 mL/min/1.73 m2 for at least 3 months, regardless of the cause.

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Why is a GFR below 60 mL/min/1.73 m2 for 3 months significant?

A GFR below 60 mL/min/1.73 m2 for 3 months or more means CKD is present. This indicates a need for vascular access planning, especially if hemodialysis may be necessary.

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What are platelets and how do they relate to vascular access?

Platelets are small blood cells that help to stop bleeding. Low platelet count (thrombocytopenia) can complicate vascular access placement.

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What is the International Normalized Ratio (INR)?

INR measures how long it takes for blood to clot. It's used to monitor patients taking blood thinners.

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Study Notes

  • Cumulative damage to blood vessels due to multiple organ systems aging
  • Chronic conditions affecting arteries, including diabetes, hypertension, chronic kidney disease, hepatitis C, inflammatory bowel disease, cancer, and hypothyroidism
  • Skin changes such as collagen depletion, hormone reduction, and dehydration
  • Lifestyle factors affecting circulation: poor nutrition, chronic stress, alcohol use, smoking, environmental exposures (like cigarette smoke).

Laboratory Values-Device Placement

  • White Blood Cells (WBC): Normal range 4,500-10,000/mcL; higher counts (leukocytosis) usually indicate an infection, which may need treatment. (Trauma, hemorrhage, coronary occlusion, malignancy, pregnancy, and VAD device use in active infections can also cause leukocytosis.)
  • Other considerations: Infection in patients with vascular access devices can lead to systemic infections; consult with appropriate specialists to guide device type and appropriate insertion timing. Patients with elevated WBC or trending upwards may indicate infection not responding to antibiotics.

Kidney Function

  • Glomerular Filtration Rate (GFR): Normal range is 90-120 mL/min/1.73 m². Used to evaluate kidney function; estimates the blood filtered through glomeruli each minute..
  • Creatinine: Normal range 0.7-1.3 mg/dL (males) and 0.4-1.1 mg/dL (females). Indicates kidney function level and identifies kidney disease risk. Those with elevated creatinine or low GFR need a tailored vascular access plan. Low GFR or elevated creatinine in patients with CKD may necessitate prompt vascular access evaluation.

Coagulation Studies

  • Platelets: Normal range 150,000-450,000 per microliter. Placement of vascular access devices in thrombocytopenic patients should be carefully guided. Consideration given to insertion sites allowing for optimal compressibility. PICC lines may be more appropriate for patients with hypercoagulability.
  • International Normalized Ratio (INR): 1.0-1.2, 2.1-3.0 in treatment with anticoagulant therapy. Patients taking vitamin K antagonists need INR monitoring for appropriate dosage adjustment and risk assessment. INR is calculated from prothrombin time (PT). Be aware of possible heparin contamination from the vascular access device.

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