care of adults and geriatric patients

Question 1

describe aging

Answer 1

a natural process that begins at birth

Question 2

when do age related changes begin

Answer 2

adult years (19-65)

Question 3

who are the largest consumers of healthcare

Answer 3

• older adults (65+)
• many “frequent flyers”/readmissions

Question 4

describe polypharmacy

Answer 4

• use of multiple meds
• interactions can lead to greater complications and diminished mental status
• risk-benefit ratio
• complicated assessment/reassessment process

Question 5

describe risk-benefit ratio

Answer 5

relationship between the negative and positive effects of a medication, increases as patient ages

Question 6

True or False?

cardiovascular disease is the number one cause of death in adults, including older adults

Answer 6

True

Rationale: cardiovascular disease is the number one cause of death in adults, including older adults. in patients with hypertension, the control of blood pressure is key to the prevention of cardiovascular disease

Question 7

describe pharmacodynamics in older adults

Answer 7

• involves drug actions on target cells resulting in alterations in cellular reactions and functions
• beers criteria - guideline for providers
• prescriber vs administration nurse → nurse is responsible for knowing what they are giving

Question 8

describe beers criteria

Answer 8

• published by the American Geriatric Society (AGS)
• list of potentially inappropriate use of medications in older adults r/t disease or drug syndrome interactions
• update every 3 years

Question 9

describe prevention of adverse effects

Answer 9

• prone to adverse drug reactions → decrease in amount of receptors needed for drug distribution
• there are many drugs that produce adverse effects in older adults
• there are multiple strategies for preventing adverse drug reactions - such as assessing healthy history/home meds, prescription, OTC and herbals, ability to be accurate historian, and assessing lab values

Question 10

what lab values are important in preventing adverse effects

Answer 10

• BUN/CR → indicate kidney function; elevated indicates kidneys are not functioning, increased risk for toxicity
• ALT/AST → indicates liver function; elevated levels indicates liver is not functioning, increased risk for toxicity

Question 11

describe factors that may affect absorption in older adults

Answer 11

• GI tract changes
• decreased circulation
• decreased muscle mass
• slow absorption rates = changes in peak serum drug levels

Question 12

describe some factors that may affect distribution in older adults

Answer 12

• diminished cardiac output
• increase body fat/lean body mass and body fluid decreases
• decrease serum albumin

Question 13

describe some factors that may affect metabolism in older adults

Answer 13

• hepatic changes
• genetic determinants

Question 14

describe some factors that may affect excretion in older adults

Answer 14

diminished renal blood flow/# of functioning nephrons/GFR and tubular secretion

Question 15

describe factors that affect medication adherence and aging

Answer 15

• polypharmacy
• economic factors
• administration difficulty - vision impairment/arthritis (dexterity)
• starting slow with low doses
• asymptomatic - skip doses/discontinue medication when we feel better

Question 16

describe the assessment phase of nursing process when caring for older adults r/t medication

Answer 16

• med list
• parameters for meds/home equipment for self monitoring vs homecare visits
• daily administration (routes/ability to swallow/read syringe markings
• altered physical condition: GI, nutrition, recent illness

Question 17

describe the diagnosis phase of nursing process when caring for older adults r/t medication

Answer 17

• sufficient or deficient knowledge
• risk for injury/adverse drug effects
• noncompliance, overuse, underuse

Question 18

describe the planning/goals phase of nursing process when caring for older adults r/t medication

Answer 18

• verbalizes essential drug information
• receives and takes medications as prescribed
• avoids preventable drug side effects/administers safely

Question 19

describe the interventions phase of nursing process when caring for older adults r/t medication

Answer 19

• health promotion
• prevent/decrease need for drug therapy
• use nondrug measures to enhance side effects (diet and exercise)
• assist with appointment scheduling for follow up

Question 20

describe the evaluation phase of nursing process when caring for older adults r/t medication

Answer 20

outcomes of the nursing process/required change