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TRANSCRIPT
Lifespan and Cultural Modifications
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.1
Chapter 5
Learning Objectives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.2
Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients
U.S. Food and Drug Administration (FDA)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.3
Establishes standards that require drug companies to provide consumers with specific drug information
Information is printed on product package insert (PPI)
Information includes:Description of therapeutic responseSide effectsAdverse effectsPossible drug interactions
The Pediatric Patient
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.4
Variables have a profound impact on drug action and effect
Neonates (less than 1 month of age)Small body massLow body fat contentHigh body water volumeIncreased membrane permeability
The Pediatric Patient (cont.)
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Variables have a profound impact on drug absorptionNo gastric acid present at birthNo intestinal bacteria or enzyme function
presentDelayed gastrointestinal transit timeImmaturity of liver, kidney, and renal
excretion systems
Question 1
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.6
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.
Absorption
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.7
Three principles in the pediatric patientThe 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.
Distribution
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.8
Two factorsThe chemical properties of the drug (do not
vary)The physiologic factors specific to the patient
(do vary)
Metabolism
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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.
Excretion
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Renal system may still be immature at birthDecreased glomerular filtrationDecreased tubular secretionDecreased tubular reabsorption
System still maturing over the first year of life
Drug clearance can be compromised
Adverse Drug Reactions
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Children are exposed to drugs directly and indirectlyTransplacentally during pregnancy or
deliveryDirect administrationThrough ingested breast milk
The Geriatric Patient
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.12
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
Geriatric Patient Teaching
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Drug nonadherence related to:Drug costDifficulty obtaining drugsDiminished cognitive abilitiesLack of desire to take on scheduleDepressionFeelings of being overwhelmed with physical
needsPhysical disabilities requiring assistance to
administer
Question 2
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Drugs metabolized by the __________ should be used with caution in elderly patients.
1. stomach2. liver3. pancreas4. small intestine
Learning Objectives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.15
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
Medications Used by Women
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.16
Females differ from males in hormonal makeup
Medication needs are often related to:Genital tract infectionsMenstruationInfertilityPregnancyMenopause
Medications and Pregnancy
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1961, thalidomideTeratogenic = likely to cause fetal or
embryonic damage or malformationsFew “safe” medications during pregnancy
Check drug book for pregnancy catergoryPregnancy X- do not give!!
Weigh benefit of drug for mother against risk to fetus
Medications, Pregnancy, and Breastfeeding
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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
Childhood Immunizations
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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 illnessParental refusal from concern over adverse
effects
Medications Used Throughout the Lifespan
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Antidiabetic agentsAntihypertensive agentsCholesterol-lowering drugsSmoking-cessation productsWeight-loss drugsAntidepressant medicationsImpotence drugsAspirinCaffeine
Question 3
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.21
What percent of cases of childhood asthma have been linked to the effects of passive smoking?
1. 30%2. 40%3. 50%4. 60%
Cultural Influences
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.22
Cultural assessment includes determiningValuesReligionDietary practicesFamily lines of authorityFamily life patternsBeliefs and practices related to health and
illness
Medication Nonadherence
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Six major reasons for client nonadherenceMedications are for preventionIncreases with prolonged therapyTreatment requires significant changes in
behaviorPoor patient understandingComplexity of treatment planUnpleasant side effects
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. 24
Documenting Patient Health Care Practices
Nursing knowledge of productsOTC and prescription interactionContainer labelsComplementary and alternative medicine
(CAM)
25
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
***$6 billion spent on nonprescription remediesCommon influences
FriendsAdvertisements
Pros and Cons
Safety, purity, and effectivenessNatural estrogens – phytoestrogens
(flaxseed, red clover sprouts, and soy flour)
Time Variability in each doseCouncil for Responsible NutritionRefer to Tables 6-2, 6-3, 6-4
26
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QUESTIONS?
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