chapter 3: Lifespan Considerations

Question 1

Lifespan Considerations

Answer 1

• The human body changes from the beginning of life to the end of life.
• These lifespan changes have dramatic effects of the four phases of pharmacokinetics.
• Special considerations:
• Pregnancy
• Newborn
• Pediatric
• Older adult

Question 2

Older Adult Patients

Answer 2

• Older adults: older than age 65 years
• High use of medications
• Polypharmacy
• Noncompliance, nonadherence
• Increased incidence of chronic illnesses
• Sensory and motor deficits
• Decline in organ function occurs with advancing age.
• Drug therapy in older adults is most likely to result in adverse effects
  and toxicity.

Question 3

Pharmacokinetics and the Older
Adult: Absorption

Answer 3

• Gastric pH less acidic
• Gastric emptying and movement through the GI tract is slowed
• Blood flow to GI tract reduced
• Absorptive surface of GI tract reduced

Question 4

Pharmacokinetics and the Older
Adult: Metabolism

Answer 4

• Aging liver produces fewer microsomal enzymes, affecting drug metabolism.
• Reduced blood flow to the liver

Question 5

Pharmacokinetics and the Older
Adult: Distribution

Answer 5

• Lower total body water percentages
• Increased fat content
• Decreased production of proteins by the liver, resulting in decreased
  protein binding of drugs (and increased circulation of free drugs)

Question 6

Pharmacokinetics and the Older
Adult: Excretion

Answer 6

• Decreased glomerular filtration rate
• Decreased number of nephrons
• Drugs are cleared less effectively because of decreased excretion.

Question 7

Nursing Process (ADPI): Assessment

Answer 7

Assessment
* Age
* Allergies to drugs and food
* Dietary habits
* Sensory, visual, hearing, cognitive, and motor-skill deficits
* Financial status and any limitations
* List of all health-related care providers
* Listing of medications
* Existence of polypharmacy
* Self-medication practices
* Laboratory test results
* History of smoking and use of alcohol
* Risk situations related to drug therapy identified by the Beers criteria

Question 8

Nursing Process (ADPI): Diagnosis (human needs statements)

Answer 8

Human Needs Statements (Nursing Diagnosis)
* Alteration in fluids and nutrients (less than body requirements)
* Ineffective perception
* Altered safety, risk for injury
* Related to adverse effects
* Related to idiosyncratic reactions

Question 9

Nursing Process (ADPI): Planning

Answer 9

Planning/Outcomes
* May involve patient, caregiver, or legal guardian
* Individualized

Question 10

Nursing Process (ADPI): Implementation

Answer 10

Implementation
* Basic Nine Rights of medication administration
* Older adult considerations for safe administration
* Take as directed; do not double-up doses or discontinue without guidance from prescriber
* Safety considerations
* Be alert for polypharmacy

Question 11

Nursing Process (ADPI): Evaluation

Answer 11

Evaluation
* Observe and monitor for therapeutic effects
* Observe and monitor for adverse effects
* Evaluate understanding of drug purpose, dose, dose frequency, adverse effects, special considerations