PowerPoint Chapter 5

Chapter 5 Lifespan and Cultural Modifications

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Chapter 5 Lesson 5.1

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Learning Objectives • Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients

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U.S. Food and Drug Administration (FDA) • Establishes standards that require drug companies to provide consumers with specific drug information • Information printed on product package insert (PPI) • Information includes: – – – –

Description of therapeutic response Side effects Adverse effects Possible drug interactions Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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The Pediatric Patient • Variables have a profound impact on drug action and effect • Neonates (less than 1 month of age) – Small body mass – Low body fat content – High body water volume – Increased membrane permeability Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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The Pediatric Patient (cont.) • Variables have a profound impact on drug absorption – No gastric acid present at birth – No intestinal bacteria or enzyme function present – Delayed gastrointestinal transit time – Immaturity of liver, kidney, and renal excretion systems Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Absorption • Three principles in the pediatric patient – The physiologic status of the infant or child determines the blood flow at the site of intramuscular or subcutaneous drug administration. – Compared with older children and adults, premature infants have immature and unstable body processes. – A newborn’s skin, particularly in premature infants, has a greater ability to absorb some chemicals because of its greater hydration.

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Distribution • Two factors – The chemical properties of the drug (do not vary) – The physiologic factors specific to the patient (do vary)

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Metabolism • The majority of drug metabolism, or biotransformation, takes place in the liver. • In general, drug metabolism in infants is much slower than that in older children and adults. • Until 3 to 4 years of age, children have the ability to increase production of liver enzymes. • Neonates have a decreased ability to metabolize drugs. Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Excretion Renal system may still be immature at birth Decreased glomerular filtration Decreased tubular secretion Decreased tubular reabsorption

System still maturing over the first year of life Drug clearance can be compromised

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Adverse Drug Reactions • Children are exposed to drugs directly and indirectly. – Transplacentally during pregnancy or delivery – Direct administration – Through ingested breast milk

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The Geriatric Patient • React differently to medications than younger adults • Drugs absorbed, metabolized, and excreted more slowly and less completely • Variability in drug response and clearance related to aging organ systems and overall health or illness • Patients age differently; body responses vary Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Geriatric Patient Teaching Drug non-adherence related to: – – – – – –

Drug cost Difficulty obtaining Diminished cognitive abilities Lack of desire to take on schedule Depression Feelings of being overwhelmed with physical needs – Physical disabilities requiring assistance to administer Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Chapter 5 Lesson 5.2

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Learning Objectives • Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients • Identify special considerations for providing care to individuals from different cultures • Describe specific nursing behaviors that assist in helping patients succeed with their medication plans Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Medications Used by Women • Females differ from males in hormonal make-up. • Medication needs often related to: – Genital tract infections – Menstruation – Infertility – Pregnancy – Menopause Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Medications and Pregnancy • 1961, thalidomide • Teratogenic = likely to cause fetal or embryonic damage or malformations • Few “safe” medications during pregnancy • Weigh benefit of drug for mother against risk to fetus Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Medications, Pregnancy, and Breastfeeding • Some medications cross the immature blood-brain barrier of the fetus • Some medications cross the placenta to the fetus • Some medications pass into breast milk to the baby during nursing

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Childhood Immunizations • Essential for personal and national protection • Factors related to delay in receiving – Healthcare provider belief of need to delay related to symptoms of mild illness – Parental refusal from concern over adverse effects

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Medications Used Throughout the Lifespan • • • • • • • • •

Antidiabetic agents Antihypertensive agents Cholesterol-lowering drugs Smoking-cessation products Weight-loss drugs Antidepressant medications Impotence drugs Aspirin Caffeine Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Cultural Influences • Cultural assessment includes determining – Values – Religion – Dietary practices – Family lines of authority – Family life patterns – Beliefs and practices related to health and illness Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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Nursing Assessment of Healthcare Availability • Health disparity

• Health literacy

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Medication Nonadherence • Six major reasons for client nonadherence – Medications are for prevention – Increases with prolonged therapy – Treatment requires significant changes in behavior – Poor patient understanding – Complexity of treatment plan – Unpleasant side effects Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.

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