Transcript Chain of Survival and EMSC

Chapter 7
Medications and Older Adults
Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
1
Lesson 7.1
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Objectives
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Identify factors that increase the risk of
medication-related problems.
Discuss the reasons each of these factors
increases health risks for the aging person.
Describe how pharmacokinetics changes with
aging.
Discuss the pharmacologic dynamic changes
observed in the aging person.
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Objectives (cont.)
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Identify the risks related to aging and
pertinent nursing observations for specific
drug categories.
Explain specific precautions necessary when
administering medications to older adults in
an institutional setting.
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4
Risks Related to
Drug-Testing Methods
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5
Geropharmacology
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The study of how older adults respond to
medication is a new but growing area
Drug testing and establishing of therapeutic
dosages does not take into account the
unique characteristics of older adults
Older adults normally have some change in
body function and are more likely to suffer
from at least one disease process; they are
not physiologically the same as younger
adults
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6
Risks Related to the Physiologic
Changes of Aging
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Pharmacokinetics
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Study of drug actions in the body: absorption,
distribution, metabolism, and excretion
Drug absorption
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Gastric acid secretion decreases as we age
 When the concentration of acid is lower than
normal, drug absorption is reduced
 Decreased acidity also affects the breakdown of
capsules and tablet coatings in the stomach,
resulting in a variable absorption rate depending
on the way a drug is manufactured
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8
Pharmacokinetics (cont.)
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Drug distribution
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Water-soluble drugs tend to remain in higher
concentrations in the bloodstream because there
is less total body water
Fat-soluble drugs become trapped in the fatty
tissue because of decreased muscle mass and
increased adipose tissue
A decrease in hemoglobin and the plasma protein
albumin results in fewer available sites for proteinbound drugs
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9
Pharmacokinetics (cont.)
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Drug metabolism
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Aging often results in decreased activity of liver
cells
Reduction in perfusion decreases the liver’s
effectiveness in metabolizing drugs
When drugs are not metabolized effectively by the
older adult’s liver, the risk for toxicity increases
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10
Audience Response System
Question 1
The organ that is the primary site of drug
metabolism is the:
A. kidney.
B. pancreas.
C. lungs.
D. liver.
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11
Pharmacokinetics (cont.)
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Drug excretion
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Aging kidneys are significantly less effective at
removing waste products, including the
byproducts of medications
As the kidneys become less effective in the
excretion of drugs, more drug remains in the
circulation, leading to elevated drug levels and
symptoms of drug toxicity
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12
Pharmacodynamics
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Polypharmacy
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The prescription, administration, or use of more
medications than are clinically indicated, is a
common problem in older adults
The more medications taken, the greater the risk
for untoward reactions, drug interactions, and drug
toxicities
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13
Polypharmacy
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14
Risks Related to Cognitive or
Sensory Changes
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15
Cognitive Changes
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Lack of the literacy skills needed to read the
labels and directions
Inability to understand and comply with
directions
Inability to make correct judgments about
medications
May not recognize that they have to take
medication
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16
Sensory Changes
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Vision changes may render an older person
unable to read a medication label or to
recognize the different sizes, shapes, or
colors of the various medications
Adequately assessing the person’s ability to
read labels accurately, proper teaching, and
using special labels or magnifying devices
may help reduce the risks
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17
Risks Related to
Inadequate Knowledge
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18
Sharing Medications With
Friends or Relatives
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Practice is common and persists because
many older adults are unaware of the
dangers
All people, particularly older adults, must be
aware that it is not safe to take a medication
prescribed for someone else
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19
Over-the-Counter (OTC)
Preparations
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Many do not think of OTC medications as
“real” drugs, because no prescription is
needed to purchase them
OTC medications are capable of potentiating
or interfering with the effects of prescription
medications, possibly resulting in serious
harm
Can also create or mask symptoms of
disease
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Alcohol
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The most commonly consumed
nonprescription drug used by adults
Most older adults do not think of alcohol as a
drug, so they do not think about it when
taking medications
Alcoholic beverages can cause adverse
reactions when taken in conjunction with
many prescription and OTC drugs
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21
Prescription Medications
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The directions provided may be very clear to
a knowledgeable health care professional,
but they are often misunderstood or
misinterpreted by older adults
Even simple misunderstandings can lead to
improper self-medication and result in serious
consequences
To reduce the risks, older adults often require
additional instruction
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22
Risks Related to Financial
Factors
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23
Saving Money
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Older adults living on limited incomes may fail
to take their medications or may make
changes in the amount or frequency to
conserve their supply
Many frugal older adults save medications
that were prescribed in the past, even if the
drugs are no longer part of their therapy
Often reluctant to discard costly medications,
holding on to them “just in case.”
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24
Medication Administration in the
Institutional Setting
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Safe Drug Administration
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Before administering a medication, nurses
should have the following information
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The therapeutic effects of the medication
 The reasons this individual is receiving the
medication
 The normal therapeutic dosage of the medication
 The normal route or routes of administration
 Any special precautions related to administration
 The common side effects or adverse effects of the
medication
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26
Lesson 7.2
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Objectives
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Discuss how medications fit into the nursing
plan of care.
Describe specific nursing interventions and
modifications in technique related to
medication administration in older adults.
Describe the older person’s rights as they
relate to medication administration.
Discuss the impact of age-related changes on
self-administration of medications.
Identify information that should be provided to
older adults regarding medications.
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Nursing Assessment and
Medication
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Assessment
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Nurses must be sure to assess older
residents thoroughly before administering any
medications
After administration, nurses should monitor
older adults continually to determine whether
the medication is having the desired effect
Residents should also be observed for any
untoward effects or significant changes in
medical condition or behavior
Nurses should be particularly watchful for any
signs of overdose or toxicity
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CARE Acronym for
Medication Assessment
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C – Caution/compliance
A – Adjust
R – Review regimen regularly
E – Educate
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31
Drug Categories with Precautions
Related to Aging
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There are many drug categories that have
precautions related to their use among the
elderly.
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32
Medications and the
Nursing Care Plan
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Nursing Interventions and
Precautions
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Could include the use of safety devices, call
signals, behavior monitoring, or any other
specific precaution related to medications
The care plan should indicate when it is
necessary to check vital signs, monitor
laboratory values, or make any other special
observations
All parameters specified by the physician
should be readily identified in the care plan
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34
Nursing Interventions Related to
Medication Administration
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Right resident
Right medication
Right amount
Right dosage form
Right route
Right time
Right documentation
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Right Resident
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Audience Response System
Question 2
The most accurate way to verify identity is to
compare the medication record with the
identification bracelet.
A. True
B. False
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37
Patient’s Rights and Medications
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Patient’s Rights
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Right to know what medication they are
receiving and why they are receiving it
Right to refuse to take medication
Right to privacy during injections or any other
such procedures
Use of psychotropic drugs as chemical
restraints presents a risk to the rights of older
adults
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39
Self-Medication and Older Adults
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In an Institutional Setting
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Under OBRA legislation, residents of care
facilities should have the option of selfmedication if they are capable of doing so
safely
A physician’s order stating that selfmedication is permitted is usually required
The nurse remains responsible for monitoring
the resident’s compliance and response to
the medications
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41
In the Home
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Because medications are a significant part of
the medical plan of care, older adults who live
independently must learn to take them
properly
The responsibility of assessing medicationtaking behaviors and teaching safe selfadministration often falls to the home health
care nurse
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42
Teaching Older Adults
About Medications
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Safety Alert
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Identification must be checked (following
agency policies) each time a medication is
administered
Failure to do this can result in serious errors
and harm to older adults
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44
Safety and Noncompliance
Issues
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Risk for Noncompliance
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Cognitive and sensory limitations
Special precautions and complicated time
schedules
To reduce the risk for noncompliance, nurses
should encourage older adults to talk to the
physician and/or the pharmacist to see
whether there is any safe way to reduce the
number of medications or simplify the
medication schedule
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46
Techniques That Improve Safety
and Compliance
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Associating medication schedules with
regular daily events
Explain the importance of preparing
medication in a well-lit area
Ensure that containers are properly labeled
Apply color codes, tape strips, pictures, or
textures to containers to help older adults
recognize them
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Techniques That Improve Safety
and Compliance (cont.)
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Modify containers for ease of use
Establish measures to distinguish and
separate similar containers
Teach older adults to store medications
properly
Obtain or devise a system to promote
compliance
Stress the importance of being alert when
taking medications
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Audience Response System
Question 3
Why do older persons sometimes fail to ask
questions about their medications?
A. They are illiterate.
B. They are afraid of being judged as ignorant
or bothersome.
C. They already know everything they need to
know.
D. They know the nurse is not the person to
ask about their medications.
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