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NSG 318 TOPIC 1-4 > TOPIC 4 > Flashcards

TOPIC 4 Flashcards

1
Q

What are the physiologic changes of a geriatric patient?

A

reduction in total body water and lean body mass
increase in body fat
reduction in kidney and liver mass and function
reduction in process that maintains equilibrium

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2
Q

What affects absorption in a geriatric patient?

A

GI changes
decrease in bowel surface area
slowed gastric emptying
decrease gastric blood flow
decrease swallowing ability
decreased nutrition

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3
Q

What affects distribution in geriatric patients?

A

decrease in muscle mass an increase in fat in patients so LIPID SOLUBLE DRUGS HAVE INCREASED DISTRIBUTION AND DECREASED ELIMINATION
decrease in albumin so increase in free drugs
increase in therapeutic effects as well as drug toxicity

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4
Q

What affects metabolism in geriatric patients?

A

decreased hepatic blood flow
deceased first pass metabolism
increased half life

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5
Q

What affects excretion in geriatric patients?

A

decreased renal excretion resulting in prolonged half life and elevated drug levels

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6
Q

What affects the pharmacodynamics in geriatric patients?

A

age related changes in CNS and cardiovascular system (drugs can more easily pass the BBB)
changes in the number of drug receptors
changes in the sensitivity of receptors to drugs
compensatory response to physiologic changes is decreased

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7
Q

Polypharmacy

A

use if more medications than is medically necessary

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8
Q

What are the risk factors of polypharmacy?

A

female, advanced age, multiple health care providers, use of OTC to herbals, multiple chronic diseases

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9
Q

Pharmacotherapy

A

the application of drugs for the purpose of disease prevention and treatment of suffering

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10
Q

What is the Beers criteria?

A

lists potentially inappropriate drugs that lead to adverse effects in the elderly
-renal dosing of drugs
-drug-drug interactions
-provides safety info

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11
Q

What are the 5 adverse drug events?

A

adverse drug reactions
medication errors
therapeutic failures
adverse drug withdrawal events
overdoses

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12
Q

adherence

A

ability of a patient to adhere/comply to a medication regimen

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13
Q

What can cause medical nonadherence?

A

patient not understanding the drug regimen
cognitive/physical/financial difficulties
nonadherence can cause under or over dosing

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14
Q

What are key points in health teaching for an older adult?

A

have the patients senses be as sharp as possible
speak in tones patient can hear
face patient when speaking
respect
large print and bright colors on teaching aids
review all drugs at each visit (drug reconciliation)
Vial of life
simple dosing schedule
encourage patient to report if the drug is not improving condition
memory aids

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15
Q

drug reconciliation

A

The process of identifying the most accurate list of all medications a patient is taking

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16
Q

vial of life

A

medical information for emergency personnel to use in the provision of care (document who to contact and patient wishes)

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17
Q

What are some items that the nurse should ASSESS related to an elderly client?

A

sensory and cognitive barriers
vitals, labs, weight, allergies
drug reconciliation
does patient need help with costs or transportation
does patient live alone
side or adverse effects?

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18
Q

What is included in the nursing DIAGNOSIS of an elderly client?

A

health maintenance
therapeutic regimen management
knowledge: teach the patient about the new medication

19
Q

What is included in the PLANNING/ what is your goal as the nurse for an elderly client who is prescribed a medication?

A

develop a drug regimen that is congruent w health goals and fits well with the patient lifestyle
list resources the patient can use for support
have them teach the regimen back to you

20
Q

What nursing INTERVENTIONS/IMPLEMENTATION would help you attain your goals for your patient?

A

monitor labs
check for side or adverse effects
check for changes in behavior
tell them to inform the nurse about any OTC or CAMs

21
Q

How would you EVALUATE your interventions to make sure that your elderly client is meeting the goal?

A

labs
evaluate adherence
therapeutic, side and adverse effects

22
Q

Why is there limited research for pediatric pharmacology?

A

research risk
hard to obtain informed consent from parents

23
Q

Pediatric Research Equity Act

A

Requires study of pediatric drug use

24
Q

What affects absorption in a pediatric patient?

A

age, health status, weight
route of administration
nutritional habits, physical maturity, hormonal differences
hydration, underlying disease, GI disorders

25
Q

When does the GI tract in an infant reach maturity?

A

6-8months

26
Q

What affects topical medications in pediatric patients?

A

children have thin and porous skin, so the medication may absorb more into their skin
nurses should focus the topic only on the site intended to affect

27
Q

What are some conditions that may affect oral drug absorption in a pediatric patient?

A

gastric acidity, gastric emptying, gastric motility, GI surface area, enzyme levels and intestinal flora

28
Q

When does the gastric acid reach adult level?

A

around 2-3 years of age

29
Q

What affects distribution in pediatric patients?

A

body fluid composition: neonates and infants have 75% water
body tissue composition: neonates and infants have less body fat
protein binding capability: less albumin and fewer protein receptor sites in neonates and infants
effectiveness of barriers (skin and BBB)

30
Q

Due to the increased amount of body fluid composition in infants, what needs to be considered about the drug?

A

increase the dose of water-soluble drugs until about the age of two

31
Q

The decreased amount of albumin and protein receptor sites in infants can cause…

A

increased level of unbound drugs
this can cause increase toxicity

32
Q

BBB in infants

A

the BBB in infants is immature and drugs can more easily pass, so this can increase CNS drug toxicity

33
Q

What can affect metabolism in pediatric patients?

A

maturity level of the child
liver metabolism (decreased hepatic blood flow and liver enzymes)
higher metabolism rate

34
Q

What can affect excretion in pediatric patients?

A

infants have decreased renal blood flow, GFR, and renal tubular function

35
Q

What are some important nursing implications when dosing and monitoring a drug of a pediatric patient?

A

monitor for therapeutic effects and adverse reactions
check med math calculations

36
Q

What are some nursing implications when administering drugs to a pediatric patient?

A

differentiate the developmental from cognitive/chronologic age
maintain safety AND comfort
family-centered care (teach caregiver and patient)

37
Q

What are some considerations a nurse should pay attention to in an adolescent patient?

A

physical body changes (puberty)
cognitive level and abilities
emotional factors
independence from parents
self-care behaviors
impact of chronic illness

38
Q

What items would be included in the ASSESSMENT of a pediatric patient related to medication?

A

the developmental age, health status, nutritional status, hydration status
literacy level and readiness to learn of both caregiver and child
economic issues, cultural patters that may lead to non adherence
allergies
drug reconciliation
age, weight, height

39
Q

What are included in nursing DIAGNOSES of a pediatric patient?

A

knowledge; my be deficient due to cognitive limitation/ misinterpretation
health maintenance: ineffective due to cognitive limitations or lack of resources
risk for injury

40
Q

What PLANNING or goals would the nurse develop for the pediatric patient relates to medication?

A

patient and family need to recognize the the need for the drug administration and the rationale behind it
have family and patient incorporate the drug regimen into their life style
patient and family demonstrate and have confidence how to safely administer the drug
patient will remain free of drug related injuries

41
Q

What nursing INTERVENTIONS would be appropriate to meet the goals for the pediatric patient receiving medication?

A

nurse provided resources and support to patient and caregivers
avoid use of restraints
include both patient and family in the educational process
follow rights of safe drug administration
assist in management of complex drug schedules
provide drug reconciliation list
support patient and family decisions
two methods of identification
ask open ended questions

42
Q

How would you EVALUATE that pediatric patient goals are met?

A

evaluate physiologic ands psychologic response
evaluate caregiver knowledge on the drug dosage, schedule and side effects
evaluate therapeutic and adverse effects of the drug

43
Q

What are factors that impede absorption of drugs delivered IM and SUB-Q

A

dehydration, cold temperature, altered cardiac status

NSG 318 TOPIC 1-4 (6 decks)

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