chapter 3: Lifespan Considerations Flashcards
Lifespan Considerations
- 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
Older Adult Patients
- 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.
Pharmacokinetics and the Older
Adult: Absorption
- 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
Pharmacokinetics and the Older
Adult: Metabolism
- Aging liver produces fewer microsomal enzymes, affecting drug metabolism.
- Reduced blood flow to the liver
Pharmacokinetics and the Older
Adult: Distribution
- 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)
Pharmacokinetics and the Older
Adult: Excretion
- Decreased glomerular filtration rate
- Decreased number of nephrons
- Drugs are cleared less effectively because of decreased excretion.
Nursing Process (ADPI): Assessment
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
Nursing Process (ADPI): Diagnosis (human needs statements)
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
Nursing Process (ADPI): Planning
Planning/Outcomes
* May involve patient, caregiver, or legal guardian
* Individualized
Nursing Process (ADPI): Implementation
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
Nursing Process (ADPI): Evaluation
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