Transcript PowerPoint Chapter 5

Chapter 5
Lifespan and Cultural Modifications
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Learning Objectives
 Identify specific considerations in administering medications
to pediatric, pregnant, breastfeeding, or elderly patients
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
U.S. Food and Drug Administration
(FDA)
 Establishes standards that require drug companies to provide
consumers with specific drug information
 Information is printed on product package insert (PPI)
 Information includes:
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Description of therapeutic response
Side effects
Adverse effects
Possible drug interactions
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
The Pediatric Patient
 Variables have a profound impact on drug action and effect
 Neonates (less than 1 month of age)
 Small body mass
 Low body fat content
 High body water volume
 Increased membrane permeability
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
The Pediatric Patient (cont.)
 Variables have a profound impact on drug absorption
 No gastric acid present at birth
 No intestinal bacteria or enzyme function present
 Delayed gastrointestinal transit time
 Immaturity of liver, kidney, and renal excretion systems
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Question 1
Drug effect in a neonate differs from that in an adult
because of the newborn’s:
1. Larger head to body mass ratio.
2. High body fat content.
3. High body water volume.
4. Decreased membrane permeability.
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Absorption
 Three principles in the pediatric patient
 The physiologic status (muscle mass and use) of the infant or child
determines the blood flow at the site of intramuscular or
subcutaneous drug administration.
 Compared with older children and adults, premature infants have
immature and unstable body processes.
 A newborn’s skin, particularly that of premature infants, has a
greater ability to absorb some chemicals because of its greater
hydration.
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Distribution
 Two factors
 The chemical properties of the drug (do not vary)
 The physiologic factors specific to the patient (do vary)
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Metabolism
 The majority of drug metabolism, or biotransformation, takes
place in the liver.
 In general, drug metabolism in infants is much slower than in
older children and adults.
 Until 3 to 4 years of age, children have the ability to increase
production of liver enzymes.
 Neonates have a decreased ability to metabolize drugs.
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Excretion
 Renal system may still be immature at birth
 Decreased glomerular filtration
 Decreased tubular secretion
 Decreased tubular reabsorption
 System still maturing over the first year of life
 Drug clearance can be compromised
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Adverse Drug Reactions
 Children are exposed to drugs directly and indirectly
 Transplacentally during pregnancy or delivery
 Direct administration
 Through ingested breast milk
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
The Geriatric Patient
 Reacts differently to medications than younger adults do
 Drugs absorbed, metabolized, and excreted more slowly and
less completely (stair – stepping)
 Variability in drug response and clearance related to aging
organ systems and overall health or illness
 Patients age differently; body responses vary
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Geriatric Patient Teaching
 Drug nonadherence related to:
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Drug cost
Difficulty obtaining drugs
Diminished cognitive abilities
Lack of desire to take on schedule
Depression
Feelings of being overwhelmed with physical needs
Physical disabilities requiring assistance to administer
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Question 2
Drugs metabolized by the __________ should be used
with caution in elderly patients.
1.
2.
3.
4.
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stomach
liver
pancreas
small intestine
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Learning Objectives
 Identify specific considerations in administering medications
to pediatric, pregnant, breastfeeding, or elderly patients
 Identify special considerations for providing care to
individuals from different cultures
 Describe specific nursing behaviors that assist in helping
patients succeed with their medication plans
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Medications Used by Women
 Females differ from males in hormonal makeup
 Medication needs are often related to:
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Genital tract infections
Menstruation
Infertility
Pregnancy
Menopause
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Medications and Pregnancy
 1961, thalidomide
 Teratogenic = likely to cause fetal or embryonic damage or
malformations
 Few “safe” medications during pregnancy
 Check drug book for pregnancy catergory
 Pregnancy X- do not give!!
 Weigh benefit of drug for mother against risk to fetus
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Medications, Pregnancy, and
Breastfeeding
 Some medications cross the immature blood-brain barrier of
the fetus
 Some medications cross the placenta to the fetus
 Some medications pass into breast milk to the baby during
nursing
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Childhood Immunizations
 Essential for personal and national protection
 Factors related to delay in receiving
 Health care provider belief of need to delay related to
symptoms of mild illness
 Parental refusal from concern over adverse effects
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Medications Used Throughout the
Lifespan
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Antidiabetic agents
Antihypertensive agents
Cholesterol-lowering drugs
Smoking-cessation products
Weight-loss drugs
Antidepressant medications
Impotence drugs
Aspirin
Caffeine
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Question 3
What percent of cases of childhood asthma have been linked
to the effects of passive smoking?
1. 30%
2. 40%
3. 50%
4. 60%
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Cultural Influences
 Cultural assessment includes determining
 Values
 Religion
 Dietary practices
 Family lines of authority
 Family life patterns
 Beliefs and practices related to health and illness
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Medication Nonadherence
 Six major reasons for client nonadherence
 Medications are for prevention
 Increases with prolonged therapy
 Treatment requires significant changes in behavior
 Poor patient understanding
 Complexity of treatment plan
 Unpleasant side effects
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
Chapter 6
Self-Care: Over-the-Counter Products, Herbal
Therapies, and Drugs for Health Promotion
Copyright © 2013, 2010,
2006, 2003, 2000, 1995,
1991 by Mosby, an imprint of
Elsevier Inc.
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Documenting Patient Health
Care Practices
 Nursing knowledge of products
 OTC and prescription interaction
 Container labels
 Complementary and alternative medicine (CAM)
***$6 billion spent on nonprescription remedies
Common influences
Friends
Advertisements
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Pros and Cons
 Safety, purity, and effectiveness
 Natural estrogens – phytoestrogens (flaxseed, red clover
sprouts, and soy flour)
 Time
 Variability in each dose
 Council for Responsible Nutrition
 Refer to Tables 6-2, 6-3, 6-4
Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.
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 QUESTIONS?
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Copyright © 2013, 2010, 2006, 2003, 2000,
1995, 1991 by Mosby, an imprint of Elsevier Inc.