Exam Two Flashcards
Define off-label.
Use of drug for some purpose for which it has not been approved
What is family-centered care?
Essential in ensuring safety during, and after, health care interventions, especially during drug administration
What is the Principle of Atraumatic Care?
Provision of therapy using interventions that minimize or eliminate psychological and physical distress experienced by patients, particularly children with their families
Reasons for limited pediatric research include?
- Difficulty in obtaining informed consent
- Parents are reluctant to put children at risk
- Pediatric drug market is small, equaling less profits
What factors influence drug absorption in children?
- Child’s age
- Health status
- Weight
- Route of administration
- Nutritional habits
- Physical maturity
- Hormonal difference
- Hydration
- Underlying disease
- GI disorders
- Thin skin
Changes in the GI system in children include what?
- Alkaline gastric pH at birth
- Decreased intestinal surface area
- Decreased microbe colonization
What factors influence drug distribution in children?
- Body fluid composition
- Body tissue composition
- Protein-binding capability
- Changes in the blood-brain barrier
Do children have a higher or lower fluid volume?
Higher
Is body fat percentage increased or decreased in children?
Decreased
Do children have increased or decreased plasma proteins and receptor sites?
Decreased
Does the reduction in plasma proteins and receptor sites result in more or less free drug in the blood?
More
How does an increased bilirubin affect free drug levels in the blood?
Bilirubin binds to plasma proteins, leading to increased free drug in the blood
Do neonates have a more permeable or less permeable blood-brain barrier?
More permeable
What factors affect drug metabolism in children?
- Maturation level
- Liver metabolism
- Overall metabolic rate
Do infants have increased or reduced blood flow to the liver?
Reduced
Do infants have more or less drug-metabolizing enzymes?
Less
What factors affect excretion of drugs through the kidneys in children?
- Renal blood flow
- GFR
- Renal tubular function
What measures how much blood passes through the glomeruli?
Glomerular Filtration Rate (GFR)
Do infants have decreased or increased renal blood flow?
Decreased
True or False: Toxicity effects can occur in children even when serum drug levels are within the recommended range.
True
True or False: Giving children choices can increase their cooperation with drug administration.
True
True or False: Honey can be used when giving medication to a 9 month old.
False
Infants have _____ protein sites than adults, resulting in _____ risk of toxicity.
- Less
- Increased
Gastric pH does not reach adult acidity until around _____ to _____ years of age?
2 to 3
Until about the age of _____, the pediatric patient requires a _____ dose of water soluble drugs to achieve therapeutic levels.
- 2
- Higher
The 18-month-old child has been prescribed an oral drug that is water-soluble. Based on the nurses knowledge of drug distribution, what modification needs to be made to the dosage in order to reach therapeutic level?
Increase dosage
Since the blood-brain barrier in infants is immature, what might this due to the drug outcome?
Increase risk for toxicity
What drug action does the nurse know about the rate of absorption for topical drugs to a 3-year-old child?
The drug will absorb faster due to thin skin
A child has been admitted for nausea, vomiting, and diarrhea, and the HCP has prescribed several drugs. Which concerns are appropriate for the nurse to have regarding drug administration?
A) Renal tubular function is decreased
B) Dehydration may lead to toxicity
C) The drugs should not be administered by the oral route
D) Rectal administration will promote quick absorption
E) Developmental levels must be considered
A, B, C, E
The nurse is teaching a group of parents how to administer drugs to their children. Which elements of drug administration will be included in the teaching?
A) Allow the children to determine the time of drug administration
B) Lightly restrain the child as needed
C) Praise the child after successful administration
D) Never threaten the child into taking the drug
E) Never tell the child what to expect; just give the drug
F) Herbal preparations should not be given to children
B, C, D, F
The nurse is teaching a group of parents how to administer drugs to their children. Which elements of drug administration will be included in the teaching?
A) Allow the children to determine the time of drug administration
B) Lightly restrain the child as needed
C) Praise the child after successful administration
D) Never threaten the child into taking the drug
E) Never tell the child what to expect; just give the drug
F) Herbal preparations should not be given to children
B, C, D, F
Any person over the age of 65 is considered an?
Older adult
Define polypharmacy?
- Use of multiple drugs and/or administration of drugs beyond what is clinically warranted
- Use of 5+ drugs
What is the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults document?
A document developed by a consensus panel of 12 experts in geriatric care to aid health care providers in the safe prescription and administration of drugs to older adults
Define adherence.
The extent to which a patient continues to an agreed-on mode of treatment without close supervision
What are the physiological changes in geriatric patients that affect their responses to drugs?
- Reduction in total body water and lean body mass
- Reduction in kidney and liver mass and function
- Reduction in physiological processes that maintain equilibrium
What are the GI changes in older adults that affect drug absorption?
- Decreased surface area of small bowel
- Slowed gastric emptying
- Decreased gastric flow
- Decreased gastric acid production
What changes in older adults affect drug distribution?
Increase in fat
- Decrease in water
- Decrease in plasm protein