ATI Chapter 51: Individual Considerations of Medication Administration

1) body weight

-because body tissues absorb medications, individuals, with a greater body mass require larger doses -because the percentage of body fat an individual has can alter the distribution of a medication, basing dosages on body surface area can be a more precise method of regulating an individuals response to a medication

promote adherence

-give clear and concise instructions, verbally and in writing -ensure that the dosage form is appropriate - administer liquid forms to clients who have difficulty swallowing -provide clearly marked containers that are easy to open -assist the client with setting up a daily calendar with the use of pill containers -discuss the availability of and access to local resources for obtaining and paying for medications -suggest that the client obtain assistance from a friend, neighbor, or relative

decrease the risk of adverse medication effects

-obtain a complete medication history and include all OTC medications -make sure medication therapy starts at the lowest possible dose -assess and monitor for therapeutic and adverse effects -monitor plasma medication levels to provide a rational basis for dosage adjustment -assess and monitor for medication-medication and medication-food findings -notify the provider of adverse effects

10 Factors affecting medication dosages and responses

1) Body weight 2) age 3) gender 4) genetics 5) biorhythmic cycles 6) tolerance 7) accumulation 8) psychological factors 9) diet 10) medical probelms

8) psychological factors

emotional state and expectations can influence the effects of a medication -the placebo effect describes positive medication effects that psychological factors, not biochemical properties of the medication, influence

polypharmacy

the practice of taking several medications simultaneously (prescription and over-the-counter [OTC]) with diminished bodily functions and some medical problems can contribute to the potential for medication toxicity

various factors

various factors affect how clients respond to medications. It is important for nurses to identify these factors to help them individualize nursing care when administering medications

3) gender

women respond differently to medications than men due to a higher proportion of body fat and the effects of female hormones

pregnancy

-any medication women who are pregnant ingest will affect the fetus. the FDA classifies medications in five categories that range from remote risk to proven risk of fetal harm -most medications are potentially harmful to the fetus. -medications women take during pregnancy include nutritional supplements and medications that treat N/V, gastric acidity, and mild discomforts -providers manage chronic medical disorders such as DM and HTN in conjunction with careful maternal-fetal monitoring -pregnancy is a contraindication for live-virus vaccines due to possible teratogenic effects.

additional pharmacokinetic factors specific to children

-decreased gastric acid production and slower gastric emptying time -decreased first-pass medication metabolism -increased absorption of topical medications (greater blood flow to the skin and thinner skin) -lower bp (more blood flow to the liver and brain and less to the kidneys) -higher body water content (dilutes water-soluble meds) -decreased serum protein-binding sites (until age 1 year). this can result in an increase in the serum level of protein-binging medications

other factors that affect medication therapy (pharmacology and older adults 65+)

-impaired memory or altered mental state -multiple or severe illnesses -changes in vision and healing -decreased mobility and dexterity -poor adherence -inadequate supervision of long-term therapy -limited financial resources

10) medical problems

-inadequate gastric acid inhibits the absorption of medications that require an acid medium to dissolve -diarrhea causes oral medications to pass through the GI tract too quickly for adequate absorption -vascular insufficiency prevents the distribution of a medication to affected tissue -liver disease or failure prevents or delays medication excretion, which can cause toxicity -prolonged gastric emptying time delays the absorption of medications in the intestines

physiologic changes with aging that affect pharmacokinetics (pharmacology and older adults 65+)

-increased gastric pH (alkaline) -decreased gastrointestinal motility and gastric emptying time, resulting in a slower rate of absorption -decreased hepatic enzyme function -decreased kidney function and glomerular filtration rate -decreased protein-binding sites, resulting in lower serum albumin levels -decreased body water, increased body fat, and decreased lean body mass

7) accumulation

-medication concentration in the body increases due to the inability to metabolize or excrete a medication rapidly enough, resulting in a toxic medication effect. -for older adults, decreased kidney and liver function are the major causes of medication accumulation leading to toxicity

lactaction

-most medications women take during lactation enter breast milk. - women who are lactating should avoid medications that have extended half-life, are sustained-released, or harmful to infants -for medications that are safe, administer them immediately after breastfeeding to minimize the medication's concentration in the next feeding *Use the lowest effective dosage for the shortest possible time.

pharmacology and children

-providers base pediatric doses on body weight or BSA -newborns (>1 mos) and infants <1mos - 1 yr) have immature liver and kidney function, alkaline gastric juices, and an immature blood-brain barrier, making them especially sensitive to meds that affect the CNS. - providers base some meds on age due to a greater risk for decreased skeletal bone growth, acute cardiopulmonary failure, and hepatic toxicity -be alert when administering medications to children due to the risk of medication errors. -check dosage is accurate, initial peds meds are approx. , be aware meds don't undergo testing on children, limited sites exist for IV med admin, give written and verbal instructions to parents to promote adherence to medication regimens.

2) A young adult client in a provider's office tells the nurse that she uses fasting for several days each week to help control her weight. The client takes several medications for various chronic issues. The nurse should explain to the client that which of the following mechanisms that results from fasting puts her at risk for medication toxicity? a. increasing the metabolism of the medications over time b. increasing the protein-binding response c. increasing medications' transit time through the intestines d. decreasing the excretion of medications

b. increasing the protein-binding response Inadequate nutrition, such as starvation, can affect the protein-binding response of medications. It increases their response and thus increases the risk for medication toxicity.

3) A nurse is preparing medications for a preschooler. Which of the following factors should the nurse identify as altering how a medication affects children? (select all that apply). a. increased gastric acid production b. lower blood pressure c. higher body water content d. increased absorption of topical medications e. increased gastric emptying time

b. lower blood pressure c. higher body water content d. increased absorption of topical medications Children have a lower blood pressure Children have a higher body water content Children have increased absorption of topical medications

1) To promote adherence with medication self-administration, a nurse is making recommendations for an older adult client. Which of the following instructions should the nurse include? (select all that apply) a. adjust dosages according to daily weight b. place pills in daily pill holders c. ask for liquid forms if the client has difficulty swallowing pills d. ask a relative to assist periodically e. request child-resistant caps on medication containers

b. place pills in daily pill holders c. ask for liquid forms if the client has difficulty swallowing pills d. ask a relative to assist periodically Organizing medications in daily pill holders promotes medication adherence Providing a form of medication that is easier for the client to swallow promotes medication adherence Including the client's support system promotes medication adherence

4) A nurse is teaching a client who is lactating about taking medications. Which of the following actions should the nurse recommend to minimize in the entry of medication into breast milk? a. Drink 8 oz milk with each dose of medication. b. Use medications that have an extended half-life c. Take each dose right after breastfeeding d. Pump breast milk and freeze it prior to feeding the newborn

c. Take each dose right after breastfeeding Taking medication immediately after breastfeeding helps minimize medication concentration in the next feeding

5) A nurse in an outpatient clinic is teaching a client who is in her first trimester of pregnancy. Which of the following statements should the nurse make? a. "You will need to get a rubella immunization if you haven't had one prior to pregnancy" b. "You can safely take over-the-counter medications" c. "You should avoid any vitamin preparations containing iron." d. "Your provider can prescribe medication for nausea if you need it"

d. "Your provider can prescribe medication for nausea if you need it" Providers can prescribe medications to treat nausea and other discomforts of pregnancy

4) genetics

genetic factors such as missing enzymes can alter the metabolism of certain medications, thus enhancing or reducing a medication's action

9) diet

inadequate nutrition, such as starvation, can affect the protein-binding response of medications -it increases their response and thus increases the risk for medication toxicity

2) age

liver and kidney function are immature in young children and often decreased in older adults, which can cause heightened sensitivities to medications and thus necessitate proportionately smaller medication doses

6) tolerance

reduced responsiveness to a medication clients take over time, such as morphine, is pharmacodynamic tolerance. -other medications, such as barbituates cause metabolic tolerance as metabolism of the medication increases over time and the effectiveness of the medication declines. -cross-tolerance can occur with other chemically similar medications

5) biorhythmic cycles

responses to some medications vary with the biologic rhythms of the body