Ch 3 Lifespan Considerations-Lilley

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity?

A) Decrease the amount of drug given

An older adult patient will often experience a reduction in the stomach's ability to produce gastric acid. The nurse knows that this change:

A. Take into account age-related changes in body systems that affect pharmacokinetic activity. Gastric acidity is reduced in the elderly and may alter the absorption of drugs that require high acidity to dissolve.

grapefruit effect

Grapefruit juice decreases the ability of the gut to process sertraline. Grapefruit breaks down intestinal enzymes that break down drugs, resulting in less drug broken down and more drug absorbed--dangerously elevated levels!

unintentional noncompliance in elderly

Problems with manual dexterity, Forgetfulness, Failure to understand instructions, Taking several drugs throughout the day

factors that affect drug absorption

The rate at which a drug undergoes absorption is influenced by physical and chemical properties of the drug, including the rate of dissolution, surface area available for absorption, lipid solubility of the drug, and pH partitioning.

When calculating pediatric dosages, what will the nurse take into consideration?

d. Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.

drugs that are highly protein bound:

long duration of action

narrow therapeutic index

narrow safety margin and even a small increase in dose may produce adverse or toxic effects Indicates that there is not much margin between a dose that produces a desired effect and a dose that may produce a toxic, even lethal effect.

Nomogram

- a graphic tool for estimating drug dosages using various body measurements

Pediatric

- pertaining to a person who is 12 years of age or younger

Elderly

- pertaining to a person who is 65 years of age or older

Neonate

- pertaining to a person younger than one month of age

Active transport

- the active energy requiring movement of a substance between different tissues via pumping mechanisms contained within a cell membrane

Diffusion

- the passive movement of a substance (a drug) between different tissues with a area of higher concentration to an area of lower concentration

Polypharmacy

- the use of many different drugs concurrently in treating a patient, who often has several health problems

When teaching a pregnant mother about the effects of medication on the fetus, the nurse recognizes that the greatest harm from maternally ingested medications occurs during which time period?

A) First trimester most harm, but likely hood of drugs transfer is 3rd trimester

Age of adult renal function

Adult levels of renal function are achieved by 1 year of age

Lifespan ages

Age 65 to 74 years is considered elderly. The adult age range is 19 to 54 years. The older adult age range is 55 to 64 years. The aged age range is 75 to 84 years.

The nurse is admitting an 82-year-old patient for treatment of heart failure. During assessment of the patient's history, the nurse notes a subjective complaint of chronic constipation. Of the prescribed medications the patient was taking prior to admission, which would the nurse suspect might contribute to this gastrointestinal complaint?

Calcium channel-blocking drugs may worsen constipation in the elderly population and thus should be avoided.

When evaluating renal function in the elderly, the nurse knows that the best indicator of renal function is:

Creatinine clearance is the proper indicator of renal function in an elderly person; the serum creatinine level does not reflect kidney function in the elderly because the source of creatinine, lean muscle mass, is reduced in parallel with the decline of kidney function. Therefore, the creatinine level may appear to be "normal" even when renal function is reduced.

considering the age-related changes in the kidney of the older adult, the nurse recalls that which drug response is possible?

Decreased renal excretion causes drug accumulation and is the most important cause of adverse drug reactions in the elderly. Drug half-life is lengthened.

The physiologic changes that normally occur in the older adult have which implication for drug response in this patient?

Drug half-life is lengthened, Drug half-life is extended secondary to diminished liver and renal function in the elderly.

Women may experience more problems than men when taking aspirin because of a decrease in which factor? Gastric emptying Correct Amount of alcohol dehydrogenase Gastric acidity Levels of hepatic enzymes

Generally, a woman's stomach empties solids more slowly than a man's does, and it may have greater gastric acidity, thus slowing the absorption of certain types of medicines (e.g., aspirin). Decreased gastric emptying allows the aspirin to have prolonged contact with the lining of the stomach, causing increased potential for ulceration and increased absorption. The alcohol dehydrogenase enzyme does not affect the absorption of aspirin. Women have greater gastric acidity than men, which may cause delayed drug absorption. Hepatic enzymes do not affect the process of drug absorption.

A student nurse is preparing to administer a topical medication to a pediatric patient. Which statement by the student indicates a correct understanding about topical drug absorption in this patient?

Infants wearing plastic coated diapers are more susceptible to skin absorption because the plastic acts as an occlusive dressing that increases hydration of the skin. Topical administration with percutaneous absorption is usually effective in infants because the outer layer of skin is not fully developed. Skin is fully hydrated at this age, and water soluble drugs are readily absorbed. Inflammation actually increases the amount of drug absorbed.

Which factor associated with aging increases the risk of gastric irritation from nonsteroidal anti inflammatory drugs (NSAIDs) in older adult

Premature infants and geriatric patients have a slower gastric emptying time, partly because of their reduced acid secretion. A slower gastric emptying time may allow the drug to stay in contact with the absorptive tissue longer, thereby allowing for increased absorption with a higher serum concentration. There is also the potential for toxicity caused by extended contact time in the stomach for ulcerogenic drugs (e.g., NSAIDs). Decreased splanchnic blood flow has no effect on gastric irritation from NSAIDs. Secretion of gastric acid is decreased, not increased or prolonged, and the pH of the gastric acid is increased in older adults. Loss of cells from the gastric plexus is not a factor associated with gastric irritation from NSAIDs.

factors that affect drug distribution

Protein binding and first-pass effect both affect the drug's distribution,

When considering the physiologic changes that affect pharmacokinetics in the elderly, the nurse recognizes that which factors occur? Select all that apply

Several physiologic changes affect the absorption, distribution, metabolism, and excretion of drugs in the elderly. The correct answers in this list—increased body fat, increased gastric pH, and decreased hepatic mass—are just a few examples.

When initiating drug therapy in elderly adults, prescribed medications are typically started at what range of the normal adult dose, with the amount of medication increasing over time?

Start at one third to one half of the normal adult recommended dosage, and then gradually increase the dosage at appropriate intervals to assess for the therapeutic effect and the development of adverse effects. The starting range allows the health care provider to assess for therapeutic effects and the development of adverse effects. With measurement over time, the medication dosage for the elderly patient is able to be increased based on therapeutic effects and absence of adverse reactions. One fourth to one third is too low. One eighth to one fourth is also too low. One half to three fourths is too high and may cause adverse reactions in the patient.

Which factors affect the gastrointestinal absorption of medicines? (Select all that apply.)

The GI absorption of medicines is influenced by various factors, including gastric pH, gastric emptying time, the motility of the GI tract, enzymatic activity, the blood flow of the mucous lining of the stomach and intestines, the permeability and maturation of the mucosal membrane, and concurrent disease processes. Absorption by passive diffusion across the membranes and gastric emptying time depend on the pH of the environment.

A nurse working with elderly patients is concerned about the number of medications each patient is taking. Which will the nurse assess as the highest priority for the patients related to polypharmacy?

The highest priority for patients with multiple medications, polypharmacy, is the assessment for drug interactions. The more medications a patient takes, the higher the risk for drug interactions.

medication reconciliation

The process of identifying the most accurate list of all medications a patient is currently taking and then comparing the list against the physician's orders at each transition point (admission, transfer and discharge) along the continuum of care.

When administering medication to an infant, which principle of pharmacokinetics must the nurse keep in mind?

There is an increased risk of toxicity with use of topical agents, Topical administration with percutaneous absorption is usually effective for infants because their outer layer of skin (i.e., the stratum corneum) is not fully developed. Because the skin is more fully hydrated at this age, water soluble drugs are absorbed more readily. Absorption from the gastrointestinal (GI) tract is less predictable in infants than in adults because of rapid GI transit times and variations in gastric pH. Serum protein binding is less, not greater, in infants than in adults. Drugs are excreted, not metabolized, by the kidneys.

In administering medication to a patient with decreased albumin and globulin levels, what concerns the nurse most?

There may be increased free protein-bound drugs available, increasing the potential for adverse drug reactions. Although the total body protein concentration is unaffected, albumin concentrations gradually decrease, and other protein levels (e.g., globulins) increase. As albumin levels diminish, the level of unbound active drug increases. Initial doses of highly protein bound drugs should be reduced and then increased slowly if there is evidence of decreased serum albumin. Lower protein binding may also lead to a greater immediate pharmacologic effect because more active drug is available; however, the duration of action may be reduced because more of the unbound drug is available for metabolism and excretion. Albumin and globulin (plasma proteins) do not affect the absorption of water soluble drugs. Hepatic enzymes, not albumin and globulin (plasma proteins), are involved in the metabolism of a medication. Albumin and globulin (plasma proteins) are not involved in the distribution of lipid soluble drugs

intentional noncompliance in the elderly

Unpleasant side effects and believing that the prescribed dose is not needed

Which actions will the nurse perform to ensure the medication dose for a pediatric patient is correct? (Select all that apply.)

Use a current drug reference to determine usual dosage per 24 hours. Correct Determine the dose parameters by multiplying the weight by the minimum and maximum daily doses of the drug (the safe range). Correct Determine the total amount of the drug to administer per dose and per day. Correct Compare the drug dosage prescribed with the calculated safe range. Correct If the drug dosage prescribed varies from recommended reference range, notify the provider. Correct Use patients weight in kilograms

Which phenomenon occurs in the body as a person ages?

With aging, lean body mass and total body water decrease, and total fat content increases. The body weight of a preterm infant may be composed of 1% to 2% fat, whereas a full term newborn may have 15% fat. Adult total body fat ranges from 18% to 36% for men and 33% to 48% for women between the ages of 18 and 35 years. Generally, protein needs are highest at 0 to 6 months of age, then gradually decrease.

high alert medications

a medication that poses a heightened risk of injury or death when administered improperly Anticoagulants, narcotics and opiates, insulin, chemotherapy and sedatives are most common

factors that affect drug excretion

and glomerular filtration affects the drug's excretion.