Transcript Geriatric Nursing Medications and the Older Adult

Chapter 7
Medications and Older Adults
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• Chapter 7
• Lesson 7.1
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Learning Objectives
• Identify factors that increase the risk of
medication-related problems.
• Discuss why each of these factors increases
health risks for the aging person.
• Describe how pharmacokinetics is altered with
aging.
• Discuss the pharmacologic dynamic changes
observed in the aging person.
• 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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RISKS RELATED TO DRUGTESTING METHODS
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Geropharmacology
• The study of how older adults respond to
medication is a new but growing area.
• The methodology used to test drugs and to
establish therapeutic dosages does not take into
account the unique characteristics of older
adults.
• Because older adults normally have had some
changes 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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RISKS RELATED TO THE
PHYSIOLOGIC CHANGES OF
AGING
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Pharmacokinetics
• The study of drug actions within the body,
including absorption, distribution, metabolism,
and excretion
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Pharmacodynamics
• Polypharmacy
• 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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Figure 7-1; Page 117
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RISKS RELATED TO
COGNITIVE OR SENSORY
CHANGES
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Cognitive Changes
• 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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Sensory Changes
• 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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RISKS RELATED TO
INADEQUATE KNOWLEDGE
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Sharing Medications With Friends
or Relatives
• This 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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Over-the-Counter (OTC)
Preparations
• 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.
• OTC medications can also create or mask
symptoms of disease.
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Alcohol
• 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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Prescription Medications
• 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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RISKS RELATED TO FINANCIAL
FACTORS
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Saving Money
• 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.
• Older adults often are reluctant to discard costly
medications, holding on to them “just in case”
they are needed again.
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MEDICATION ADMINISTRATION
IN THE INSTITUTIONAL
SETTING
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Safe Drug Administration
• 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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• Chapter 7
• Lesson 7.2
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Learning Objectives
• 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
related 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
• 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 of the older
person.
• Nurses should be particularly watchful for any
signs of overdose or toxicity.
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Table 7-2; Page 121
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MEDICATIONS AND THE
NURSING CARE PLAN
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Guiding Rule for Medication
Administration in Older Adults
• Achieve the maximal therapeutic benefits while
giving the smallest necessary amount of
medication.
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Nursing Interventions and Precautions
• Interventions 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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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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Figure 7-2; Page 122
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PATIENT’S RIGHTS AND
MEDICATIONS
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Patient’s Rights
• 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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SELF-MEDICATION AND
OLDER ADULTS
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In an Institutional Setting
• 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 self-medication is
permitted is usually required.
• The nurse remains responsible for monitoring
the resident’s compliance and response to the
medications.
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In the Home
• 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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TEACHING OLDER ADULTS
ABOUT MEDICATIONS
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Box 7-8; Page 128
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SAFETY AND
NONCOMPLIANCE ISSUES
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Risk for Noncompliance
• 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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Techniques That Improve Safety and
Compliance
• Associate 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
• 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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