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STUDY CARDS > Patient Education & Patient Focused Considerations > Flashcards

Patient Education & Patient Focused Considerations Flashcards

1
Q

INSULIN INTERACTIONS:

that increases glucose, antagonize insulin

A

corticosteroids
diuretics
thyroid drugs
sympathomimetic drugs
niacin

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2
Q

INSULIN INTERACTIONS:

increase hypoglycemic, decrease blood glucose

A

alcohol
sulfa antibiotics
anabolic streoids
MAOIs
Salicylates

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3
Q

INSULIN INTERACTIONS:

masks triglycerides, risk of not noticing HYPOGLYCEMIA

A

Non selective beta blockers

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4
Q

Age related changes have a dramatic effect on_______

Increased risk of adverse effects and toxicity at ?

A

Age related changes have a dramatic effect on pharmacokinetics (ADME)

Increased risk of adverse effects and toxicity at both ends of spectrum of life (newborn and OA)

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5
Q

Drugs cross the placenta primarily by _______.

A

diffusion

Placenta- access fetus by diffusion (high con to lower cont)

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6
Q

Factors Affecting Pregnancy Safety? (3)

A

Drug properties
Fetal gestational age
Maternal factors

frequency, doses

fetal gestational age (40 weeks): the greatest risk is in 1st trimester- due to rapid proliferation

maternal factor- kidney/live/ genetic

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7
Q

US Food and Drug Administration (FDA) has implemented?

A

REVISED pregnancy safety categories.

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8
Q

Drug levels in breast milk are usually ___ than in maternal circulation

Exposure depends on ___ of consumed milk

A

lower

volume

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9
Q

Drug Therapy During Breastfeeding

A

Breastfed infants are at risk for exposure to drugs consumed by the mother

Breast milk is not the primary route for maternal drug excretion

Consider risk–benefit ratio

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10
Q

Drug transfer to a fetus is most likely to occur in ____ semester- blood flow to fetus is highest, and are more likely to absorb it

A

LAST trimester

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11
Q

premature/ preterm infant

A

younger than 38 weeks gestation

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12
Q

neonate/ newborn infant

A

younger than 1 month

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13
Q

infant

A

1 month to younger than 1 yr

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14
Q

child

A

1 yr to younger than 12 yr

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15
Q

adolescent

A

13 to 19 yr

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16
Q

Neonatal and Pediatric Considerations: Pharmacokinetics

Absorption

  1. Gastric pH until 1 to 2 years
  2. Gastric emptying
  3. First pass elimination
  4. Bile salt formation,
  5. Bioavailability
  6. Intramuscular absorption
A

Gastric pH LESS acidic (MORE BASIC) until 1 to 2 years of age

Gastric emptying SLOWED- drug stays longer

First-pass elimination REDUCED- immature liver, more free drug is more available and can lead to toxicity

REDUCED bile salt formation

REDUCED bioavailability

***Intramuscular absorption FASTER and irregular

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17
Q

Neonatal and Pediatric Considerations:

Dose of drug and why?

A

IMMATURE vital organs absorption is affected

DECREASE the amount of drug they get

They get LOWER DOSE due to risk for toxicity

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18
Q

Neonatal and Pediatric Considerations:

Distribution

  1. total body water differences result in
  2. total body water, means?
  3. protein binding
  4. blood-brain barrier
A

Total body water differences result in INCREASED distribution and dilution of water-soluble drugs.

GREATER total body water means lower fat content.

DECREASED level of protein binding (low albumin)

IMMATURE blood–brain barrier means more drugs enter the brain

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19
Q

Neonatal and Pediatric Considerations:

Metabolism

  1. Liver function, production of enzymes
  2. Older children’s differences from younger ones, and dosage and frequent requirement
  3. Other factors to consider
A

Liver IMMATURE; does not produce enough microsomal enzymes

Older children may have increased metabolism, requiring higher doses or more frequent administration than infants.

Other factors: liver enzyme production, genetic differences, and substances to which the mother may have been exposed during pregnancy

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20
Q

Dosage consideration for younger individuals

A

Decrease the dose= first pass effect affects ORAL meds, in the liver (has detoxify effects)

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21
Q

Neonatal and Pediatric Considerations: Pharmacokinetics

Excretion

  1. Kidney function, what does it affect
  2. Perfusion rate of kidneys
A

Kidney IMMATURITY affects GLOMERULAR FILTRATION RATE and tubular secretion.

DECREASED perfusion rate of the kidneys may reduce the excretion of drugs.

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22
Q

Factors Affecting Pediatric Drug Dosages

  1. Skin is
  2. Stomach lacks
  3. Lungs have
  4. Body temperature (what can occur)
  5. Liver and kidneys
A

Skin is thin and permeable.

Stomach lacks acid to kill bacteria.

Lungs have weaker mucus barriers.

Body temperatures are less well regulated, and dehydration occurs easily.

Liver and kidneys are immature, impairing drug metabolism and excretion.

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23
Q

Methods of Dosage Calculation for Pediatric Patients?

ALWAYS USE… 2

A

Body surface area method
~~~Uses the West nomogram

Always use weight in kilograms, not pounds.

Always use height in centimeters, not inches.

Body weight dosage calculations
Uses mg/kg

Weigh and measure child!!

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24
Q

General Considerations

A

Prepare all equipment and supplies first.
Have caregivers stay as appropriate.
Assess for comfort methods before, during, and after drug administration.

Infants
Toddlers
Preschoolers
School-age children
Adolescents

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25
Q

Older Adult Patients

5 NURSING CONSIDERATIONS

A

High use of medications
Polypharmacy
Nonadherence
Increased incidence of chronic illnesses
Sensory and motor deficits

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26
Q

Older adults age

A

older than age 65 years

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27
Q

Older adults

  1. Cardiovascular

CO
Blood flow

A

DECREASE OUTPUT= DECREASE ABSORPTION + DISTRIBUTION

DECREASE BLOOD FLOW= DECREASE ABSORPTION + DISTRIBUTION

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28
Q

OLDER ADULTS

  1. GI Tract

pH

Peristalsis

A

INCREASE PH (ALKALIME GASTRIC SECRETIONS) = ALTERED ABSORPTION

DECREASE PERISTALSIS = DELAYED GASTRIC EMPTYING

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29
Q

OLDER ADULTS

  1. Liver

Enzyme Production

A

DECREASE ENZYME PRODUCTION = DECREASE METABOLISM

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30
Q

OLDER ADULTS

  1. KIDNEY

BLOOD FLOW

KIDNEY FUNCTION

GFR

A

DECREASED BLOOD FLOW= DECREASED METABOLISM + DECREASED EXCRETION

DECREASE FUNCTION = DECREASE EXCRETION

DECREASE GFR = DECREASE EXCRETION

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31
Q

Older Adults: Pharmacokinetics

ABSORPTION

  1. pH
  2. gastric emptying
  3. GI tract movement
  4. BLOOD FLOW
  5. absorptive surface of GI TRACT
A

Gastric pH less acidic (like little babies)

Gastric emptying slowed

Movement through gastrointestinal (GI) tract slowed because of decreased muscle tone and activity

Blood flow to GI tract reduced

Decrease CO = decrease blood flow to major organs = decrease absorption (ABSORPTION FROM THE GI TRACT, CIRCULATION, LIVER, SYSTEMIC CIRCULATION)

Absorptive surface of GI tract reduced

Decreased ability of stomach to produce HCL

DECREASE muscle tone and activity in GI tract

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32
Q

OLDER ADULTS dosage

A

Decreased absorption of drugs- increase the dose for therapeutic response

start low, go slow

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33
Q

Older Adults: Pharmacokinetics

DISTRIBUTION

  1. TOTAL BODY WATER %
  2. FAT CONTENT
  3. PROTEIN PRODUCTION and relationship to binding of drugs
A

Lower total body water percentages (unlike infants)

Increased fat content (less lean muscle)

Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)

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34
Q

Older Adults: Pharmacokinetics

Metabolism

  1. Production of enzymes in the liver
  2. Blood flow to the liver
  3. leads to a prolonged ____ of many drugs
  4. potential for _______ if not monitored
A

Aging liver produces fewer microsomal enzymes, affecting drug metabolism.

Blood flow to the liver is reduced- accumulation and toxicity

Leads to a prolonged half-life of many drugs
~~~Potential for accumulation if not monitored

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35
Q

Older Adults: Pharmacokinetics

Excretion

  1. GFR, why?
  2. Number of intact neurons
A

Decreased glomerular filtration rate due to decreased BF, and CO

Decreased number of intact nephrons

(Decreased GFR, CO, kidney perfusion and intact nephrons > delayed drug excretion and drug accumulation)

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36
Q

Liver function test

A

AST, ALT-assess ability to metabolize and eliminate meds > risk for toxicity and accumulation

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37
Q

Kidney test

A

Creatinine, BUN, urea, nitrogen, GFR

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38
Q

Opioid effects in OA

A

confusion, constipation, urinary retention, nausea, vomitoing, respiratory depression, falls

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39
Q

NSAIDs in OA

A

edema, nausea, gastric ulceration, bleeding, kidney toxicity

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40
Q

Antichollinergics and antihistamine in OA

A

blurred vision, dry mouth, constipation, and sedation, urinary retention, tachycardia

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41
Q

Anticoagulants in OA

A

major/ minor bleeding episodes, many drug interactions, dietary interactions

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42
Q

Antihypertensives

A

nausea, hypotension, diarrhea, bradycardia, heart failure, impotence

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43
Q

Antidepressants

A

sedation, strong cholinergic adverse effects

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44
Q

Cardiac glycosides

A

visual disorders, nausea, diarrhea, dysrhythmia, hallucinations, decreased apetite, weight loss

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45
Q

Older Adults: Beers Criteria for Prevention of Adverse Drug Events

A

A listing of drug and drug classes to be avoided in older adults

Identified disease states considered to be contraindications for some drugs

Three categories:
Potentially Inappropriate Drugs and classes in Older Adults

Potentially inappropriate medications to avoid with certain diseases

Medications to be used with caution in older adults

ISNP-SAFE MEDICATIONS FOR OAs

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46
Q

Ethnocultural Considerations

A

Canada is a multiculturally diverse nation.

Aboriginal populations are growing faster than the rest of the Canadian population.

The 2016 census reported 21.9% of Canadians identify as landed or permanent immigrants

Three in ten Canadians who are visible minorities are Canadian born.

47
Q

Ethnopharmacology

A

Provides an expanding body of knowledge for understanding specific impact of cultural factors on patient drug response

Hampered by lack of clarity in terms such as race, ethnicity (phenotype versus genotype?)

Ethnocultural assessment needs to be part of the assessment phase of the nursing process.

Not every patient from the same country shares the same culture.

48
Q

Phenotype

A

observable characteristic

49
Q

Genotype

A

genes, DNA

50
Q

Ethnocultural Influences and Genetics on Drug Response

A

Polymorphism

Medication response depends on the level of patient adherence (adherence is complex).

Use of natural heath remedies that may alter a drug response

Environmental and economic factors
Awareness of ethnocultural

51
Q

Polymorphism

A

age, size, body composition, gender > effects of drug therapy

critical in understanding how drugs may result in different responses in different individuals

52
Q

Ethnocultural Assessment

A

Languages
Health practices and beliefs
Past uses of medicine
Use of herbal treatment, folk or home remedies, natural health products
Use of over-the-counter drugs
Usual response to illness
Responsiveness to medical treatment
Religious practices and beliefs
Support for patient’s ethnocultural community
Dietary habits

53
Q

Ethnocultural Nursing Considerations and Drug Therapy

A

Important to be knowledgeable about drugs that may elicit varied responses in culturally diverse patients

Recognition that patterns of communication may differ

A thorough ethnocultural assessment is needed.
~~Maintaining, protecting, and restoring health

54
Q

Nursing Process

A

Assessment
~~Pediatric considerations
~~Older adult considerations
~~Ethnocultural considerations
Planning
Nursing Diagnosis
Planning
Implementation
Evaluation

55
Q

Should you give aspirin to anyone under the age of 18?

A

Do not give aspirin to anyone less than 18- can cause seizure, coma, death, and Reyes’s syndrome

56
Q

period of greatest danger of drug induced developmental defects

A

1st trimester

57
Q

3 factors that contribute to safety/ harm of drugs

A

drug’s properties
dosage and duration of therapy
concurrently administered drug

58
Q

fetal gestational age

A

1st trimester- rapid cell proliferation, organs are developing (NO SELF TREATMENT)

Last TRIMESTER- drug transfer TO occur

59
Q

maternal

A

mother’s physiology
(kidney and liver function > increase drug levels)
genotypes
precense of enzymes

60
Q

4 conditions require medications during pregannacy

A

HTN, epilepsy, diabetes, infection

61
Q

3 labels for pregnancy

A

pregnancy, lactation, F & M reproductive potential

62
Q

Breast feeding

A

circulation > breastmilk > infant

fat solubility, low molecular weight, non ionization, increase concentration

drug level in milk is lower (depends on volume of drug taken)

63
Q

eGFR

A

assess deterioration of kidney function and stage kidney disease

64
Q

Albuminuria

A

urine albumin to creatinine greater than 2.0 mg/mmol/L for men/ greater than 2.8 mg/ mmol/L for women

65
Q

serum creatinine levels

A

creatinine- by product of muscle metabolism

66
Q

medication response depends on

A

adherence, use of alternative natural health products

67
Q

European and African decent

A

slow acetylators- increase drug concentrations, decrease dose

68
Q

Japan + inuit

A

rapid acetylators; increase metabolism; increase dose

69
Q

Asian

A

poor metabolizers of antipsychotic/ antidepressants

lower dose

70
Q

white

A

rapid metabolizers

increase drug dose

71
Q

african RESPONDS BETTER TO WHICH PILLS

A

respond better to diuretics and calcium channel blockers

72
Q

chinese

A

decrease dose of antidepressant

73
Q

pediatrics

A

mg/kg

BSA- organ maturity is considered

74
Q

OA MAIN CONCERN

A

polypharmacy

75
Q

water composition of

infants
premature newborn
children
adult

A

infants- 75%
premature newborn- 85%
children- 64%
adult (40 to 60 years) F- 55% M- 47%
adult (60 above) F- 46% M- 52%

76
Q

decrease blood flow to liver LEADS TO

A

altered metabolism

77
Q

School age

WHAT TO INCLUDE IN TEACHING

A

brief, concrete explanation
magical thinking
comfort measures after injection

78
Q

polymorphism

A

age
cultural beliefs
nutrition

79
Q

Neonates

A

immature renal system

80
Q

admitted from home

A

ask wife to bring meds in their original container

81
Q

antihypertensives

A

dizzy, fainted, decrease BP

82
Q

pregnancy

A

consult with HCP about taking medications during pregnancy

83
Q

Japanese had strong reactions unlike others

A

decrease dose

84
Q

3 domains of learning

A

cognitive
affective
psychomotor

85
Q

Cognitive domain

A

level at which basic knowledge is learned and stored

thinking process
incorportates a persons previour experiences

86
Q

Affective domain

A

conduct that expresses feelings, needs, beliefs, values, and opinions

87
Q

Psychomotor domain

A

learning of a new procedure or skill; often called the doing domain

demonstration, step by step approach

88
Q

Patient Education:Assessment

A

Adaptation to any illness
Age
Barriers to learning
Cognitive abilities
Coping mechanisms
Cultural background
Developmental status
Education, including literacy level
Emotional status
Environment at home and work
Folk medicine, home remedies, and alternative or complementary therapies
Family relationships
Financial status
Health literacy
Psychosocial growth and development
Health beliefs
Information patient understands about past and present medical conditions
Language(s) spoken
Level of knowledge about current medications
Misinformation about drug therapy
Mobility and motor skills
Current medications, including over-the-counter and herbal medications
Motivation
Nutritional status
Past and present health behaviours
Past and present experience with drug regimens and other therapies
Race and ethnicity
Religion or religious beliefs
Readiness to learn
Self-care ability
Sensory status
Social support

89
Q

Erikson’s Stages of Development

Infant- years and name of stage

A

Infant (birth to 1 year)
Trust versus mistrust

90
Q

toddler

ERIKSON

A

Toddler (1 to 3 years)
Autonomy versus shame and doubt

91
Q

preschool

ERIKSON

A

Preschooler (3 to 6 years)
Initiative versus guilt

92
Q

school aged

A

School-aged child (6 to 12 years)
Industry versus inferiority

93
Q

adolescent

A

Adolescent (12 to 18 years)
Identity versus role confusion

94
Q

young adult

A

Young adult (18 to 45 years)
Intimacy versus isolation

95
Q

middle aged adult

A

Middle-aged adult (45 to 65 years)
Generativity versus stagnation

96
Q

older adult

A

Older adult (older than 65 years)
Integrity versus despair

97
Q

Patient Education:Nursing Diagnoses

A

Deficient knowledge
Readiness for enhanced knowledge
Falls, risk for
Ineffective self-health management
Readiness for enhanced health management
Impaired memory
Injury, risk for
Nonadherence
Readiness for enhanced communication
Readiness for enhanced power
Readiness for enhanced decision-making
Sleep deprivation

98
Q

Patient Education:Planning

A

Goals and outcome criteria
Specific
Measurable
Realistic
Based on patient needs
Stated in patient terms
Time frame

99
Q

Patient Education:Implementation

A

Teaching–learning sessions
Consideration of age-related changes
Consideration of language differences
Safe administration of medications at home
Return demonstration with equipment.
For adults, it is recommended that materials be written at a Grade 8 level.

100
Q

Patient Education:Teaching–Learning Sessions

A

Individualize the teaching session
Use positive rewards or reinforcement for accurate return demonstration of procedures or techniques
Complete a medication calendar
Use audiovisual aids
Involve family members or significant others
Teach on a level that is meaningful to that patient

101
Q

Resources for non-English-speaking patients

A

Provide education in patient’s native language
Provide detailed written instructions in native language

102
Q

Patient Education:Evaluation

A

Verify whether learning has occurred.
Ask questions.
Have the patient provide a return demonstration.
Behaviour, such as adherence to a schedule
Occurrence of few or no complications
Develop and implement new plan of teaching as needed for: Nonadherence & Inadequate levels of learning

103
Q

Patient Education:Documentation

A

Learner assessment
Outcomes
Content provided
Strategies used
Patient response to the teaching session
Overall evaluation of learning

104
Q

hard of hearing

A

do not shout, speak normal but low pitch sound

105
Q

vision

A

clean glasses
large print
non glare
avoid contrast

106
Q

short term memory

A

small info at a time
written instruction
repeat info frequently

107
Q

teaching begins at

A

begins at time of diagnosis/ admission

individualized

108
Q

discharge plan

A

individualized

based on patients level of cognitive development

109
Q

MILD anxiety

A

results in learning by increasing the pts motivation to learn

110
Q

assess learning needs

A

validation of pt’s present level of knowledge

111
Q

Does not understand english

A

interpreter who can speak pts native language for sessions

112
Q

psychomotor domain

A

teach how to administer eyedrops
how to measure a pulse before taking beta blockers
how to give injection

113
Q
A

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