NUR 2030 Module 6

western medicine

incompatible with holistic medicine focuses on specific diseases, their causes, and treatments Sometimes, the disease is viewed even more specifically and categorized as a change in DNA structure or a malfunction of one enzyme the total patient is lost in this focus of categorizing disease To be most effective at achieving positive patient outcomes, the nurse must consciously direct care toward a holistic treatment of each individual patient

psychosocial stress

increases the secretion of corticosteroids, which in turn may increase susceptibility to certain infections and suppress immune cell function

Potential fetal consequences include

intrauterine fetal death, physical malformations, growth impairment, behavioral abnormalities, and neonatal toxicity

leading causes of poisonings in children under the age of 6 is

iron poisoning Iron is often found in vitamins of all kinds: prenatal, pediatric, and adult vitamins Prenatal vitamins may hold a particular danger due to the increased amounts of iron and other components

The opposite effect, fast acetylation (extensive metabolizers),

is found in many patients of Japanese descent

The ventrogluteal site

is preferred for IM injections, although the muscles of older children are developed enough for the nurse to use other sites

Because the older adult may be taking multiple medications prescribed by different providers,

it is especially important that the nurse perform a medication reconciliation before discharging the patient from an acute-care setting to the patient's home or other care facility

another community-related variable that can affect health care

literacy The nurse must be aware that these patients may not be able to read drug labels, understand written treatment instructions, or read brochures describing their disease or therapy

Alzheimer's disease is becoming recognized as a

major "women's health issue," along with osteoporosis, breast cancer, and fertility disorders

cerebral blood flow variances between males and females

may alter the response to certain analgesics. An example is the benzodiazepines given for anxiety; women experience slower elimination rates and this difference becomes more significant if the woman is taking oral contraceptives.

Premature, neonatal, and seriously ill infants

may be at greater risk for adverse effects because they lack drug metabolizing enzymes

patients with anxiety and depressive disorders

may benefit greatly from psychotherapy, self-help instruction, physical exercise, or improved sleep hygiene. Psychosocial interventions may lead to improved compliance with drug therapy

IV injections

may use scalp or feet veins; additional peripheral site options become available in late toddlerhood

nurse should teach parents to avoid placing medicine in

milk, orange juice, or cereals, because the child may associate these healthful foods with bad-tasting medications

The metabolic process, known as acetylation,

occurs abnormally slowly in certain Caucasians

adolescence

occurs between ages 13 and 16 years

older adulthood

over 65 experience more adverse effects from drug therapy than other age groups

infancy

period from birth to 12 months of age

the scalp veins can no longer be used for IV access;

peripheral veins are used for IV injections

psychosocial history of the patient

personal life of the patient with inquiries directed toward lifestyle preferences, religious beliefs, sexual practices, alcohol intake, and tobacco and nonprescription drug use

factors that influence administration of drugs during childhood

physiological variations, maturity of body systems, and greater fluid distribution in children. Drug dosages are vastly different in children

many women do not seek medical attention for

potential cardiac symptoms, because heart disease has traditionally been considered to be a "man's disease."

variables that can affect individual variation in response to pharmacotherapy

psychosocial, cultural, environmental genetics gender

culture

set of beliefs, values, and traditions that provide meaning for an individual or group

All category D and X drugs

should be avoided during pregnancy due to their potential for causing serious birth defects

IM injections for toddlers

should be given into the vastus lateralis muscle

No prescription drug, over-the-counter (OTC) medication, herbal product, or dietary supplement

should be taken during pregnancy unless the health care provider verifies that the therapeutic benefits to the mother clearly outweigh the potential risks for the unborn

teratogen

substance, organism, or physical agent to which an embryo or fetus is exposed that produces a permanent abnormality in structure or function, causes growth retardation, or results in death

The fetal membranes contain enzymes

that detoxify certain substances as they attempt to cross the membrane. For example, insulin from the mother is inactivated by placental enzymes during the early stages of pregnancy, preventing it from reaching the fetus.

certain antihypertensive agents

that have the potential to cause or worsen male impotence

Cultural competence

the ability of health care providers to provide care to people with diverse values, beliefs, and behaviors, including the ability to adapt delivery of care to meet the needs of these patients

culturally competent care

the ability to customize the delivery of medications to meet patients' diverse cultural values, beliefs, and traditions for the purpose of optimizing care and positive outcomes

factors that influence the amount of drug secreted into breast milk.

the amount of drug that actually reaches the infant's tissues Some medications produce no adverse effects because they are destroyed in the infant's GI system or cannot be absorbed across the GI tract although many drugs are secreted in breast milk, some are present in such small amounts that they cause no noticeable harm infant's ability to metabolize small amounts of drugs

An 86-year-old male patient who lives with his son and daughter-in-law at home is confused and anxious and an antianxiety drug has been ordered. What concerns might the nurse have about pharmacotherapy for this patient?

the principal complication of drug therapy in the older adult populations are due to degeneration of oran systems multiple and sever illness, polypharmacy, and unreliable compliance. all pharmacokinetic processes from absorption through excretion will be altered in this age patient. the nurse would want to assess for the presence of other illnesses/diseases and what other drugs they are on that might interact with the prescription. whether there is a family member who can manage his meds

there are no absolute teratogens Because of the constant changes that occur during fetal development

the specific risk is dependent on when during gestation the drug is administered.

After a child has walked for about a year,

the ventrogluteal site may be used for IM injections, because it causes less pain than the vastus lateralis site

9.1

to deliver effective treatment, the nurse must consider the total patient in a holistic context.

genetic polymorphism

two or more versions of the same enzyme. The best characterized genetic polymorphisms have been discovered in enzymes that metabolize drugs (CYP 450 enzymes) and in proteins that serve as receptors for drugs

Testing drugs in human subjects to determine their teratogenicity

unethical and prohibited by law

Most drugs are category C because

very high doses in laboratory animals often produce teratogenic effects

When considering adult health, it is customary to divide this period of life into three stages

young adulthood middle adulthood older adulthood

A 22-year-old pregnant patient is diagnosed with a kidney infection, and an antibiotic is prescribed. The patient asks the nurse whether the antibiotic is safe to take. What factors are considered when a drug is prescribed for a patient who is pregnant?

antibiotics and other drugs may be required during pregnancy. the healthcare provider will consider the gestational age of the fetus, the pregnancy category of the drug being considered for use and other factors such as allergies that the patient may have that would cause the drug to be contraindicated for use.

drugs that are water soluble, ionized, or bound to plasma proteins

are less likely to cross the placenta

Genetic polymorphisms of CYP 450 enzymes

are often identified in specific ethnic groups, because people in an ethnic group have been located in the same geographic area and have married others within the same group for hundreds of generations

A large number of drugs are secreted into breast milk including

atenolol (Tenormin) ciprofloxacin codeine dapsone (Aczone) doxepin (Sinequan) erythromycin fluoxetine (Prozac) indomethacin (Indocin) lithium (Eskalith) naproxen (Naprosyn, others) paroxetine (Paxel) Hyponatremia phenytoin (Dilantin) sulfasalazine (Azulfidine) valproic acid (Depakene, Depakote)

The nurse understands that gender issues also influence pharmacotherapy. What are some important considerations for the nurse to remember about these differences? a. Men seek health care earlier than women. b. Women may not seek treatment for cardiac conditions as quickly as men. c. Women are more likely to stop taking medications because of side effects. d. All drug trials are conducted on male subjects.

b

The patient informs the nurse that he uses herbal compounds given by a family member to treat his hypertension. What is the most appropriate action by the nurse? a. Inform the patient that the herbal treatments will be ineffective. b. Obtain more information and determine whether the herbs are compatible with prescribed medications. c. Notify the health care provider immediately. d. Inform the patient that the health care provider will not treat him if he does not accept the use of conventional medicine only.

b

The patient informs the nurse that she will decide whether she will accept treatment after she prays with her family and minister. What is the role of spirituality in drug therapy for this client? a. Irrelevant because medications act on scientific principles b. Important to the patient's acceptance of medical treatment and response to treatment c. Harmless if it makes the patient feel better d. Harmful, especially if treatment is delayed

b

school age child

6 and 12 years of age The option of taking one medication before another or the chance to choose which drink will follow a chewable tablet helps distract children from the issue of whether they will take the medication at all Making children feel that they are willing participants in medication administration, rather than victims, is an important foundation for compliance. Praise for cooperation is appropriate for any pediatric patient and sets the stage for successful medication administration in the future

A 52-year-old female patient is admitted to the emergency department. She developed chest pressure, shortness of breath, anxiety, and nausea approximately four hours ago and now has chest pain. She tells the nurse that she "thought she had just overexerted herself gardening." How might her gender have influenced her decision to seek treatment?

-although women tend to pay more attention to symptoms and to seek health care earlier than men, this does not hold true for cardiac conditions.

A 72-year-old African American patient with heart disease who has been treated for atrial flutter, a type of cardiac dysrhythmia, is taking the anticoagulant, warfarin (Coumadin). The health care provider suspects that the patient has a genetic polymorphism that causes the drug to be poorly metabolized. What could the nurse do to assist in monitoring for this effect?

-drugs that are poorly metabolized act for longer periods than expected in the body -the nurse would check appropriate lab values to assess whether unexpected drug action is continuing. -assess for signs of bleeding

young adulthood

18 to 40 years absorption, metabolic, and excretion mechanisms are at their peaks Medication compliance is positive within this age range The use of vitamins, minerals, and herbal remedies is prevalent Substance abuse is a cause for concern

environment effects on pharacotherapy

Population growth, complex technologic advances, and evolving globalization patterns have all affected health care

middle adulthood

40 to 65 years often take medication to control health alterations that could best be treated with positive lifestyle modifications sandwich age nurse must emphasize the importance of overall health of lifestyle choices, such as limiting lipid intake, maintaining optimal weight, and exercising

8.6

Preschool and younger school-age children can begin to assist with medication administration.

category X

Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities or risks. The use of the product is contraindicated in women who are or may become pregnant. There is no indication for use in pregnancy. Clomiphene, fluorouracil, isotretinoin, leuprolide, menotropins, methotrexate, misoprostol, nafarelin, oral contraceptives, raloxifene, ribavirin, statins, temazepam, testosterone and thalidomide, and warfarin

category D

Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective. Alcohol, ACE inhibitors, angiotensin receptor blockers (ARBs) in the second and third trimesters, gentamicin, carbamazepine, cyclophosphamide, lithium carbonate, methimazole, mitomycin, nicotine, nonsteroidal anti-inflammatory drugs (NSAIDs) in the third trimester, phenytoin, propylthiouracil, streptomycin, tetracyclines, valproic acid

category A

Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities to the fetus in any trimester of pregnancy. Prenatal multivitamins, insulin, thyroxine, folic acid

category B

Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and well-controlled studies in pregnant women. OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate risk to the fetus in any trimester. Penicillins, cephalosporins, azithromycin, acetaminophen, ibuprofen in the first and second trimesters

category C

Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. OR No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women. Most prescription medicines; antimicrobials such as clarithromycin, fluoroquinolones, and Bactrim; selective serotonin reuptake inhibitors (SSRIs); corticosteroids; and most antihypertensives

A 19-year-old male patient of Latin American descent presents to a health clinic for migrant farm workers. In broken English, he describes severe pain in his lower jaw. An assessment reveals two abscessed molars and other oral health problems. Discuss the possible reasons for this patient's condition.

Because this patient is a migrant worker with limited English skills, he may have limited access to care that relates to his socioeconomic status and possibly relates to his legal status. Even with care provided locally, limited health literacy skills may result in his delay in seeking treatment or decisions to treat himself.

8.3

Breast-feeding women must be aware that many drugs can appear in milk and cause adverse effects to the infant

excretion

By the third trimester of pregnancy, blood flow through the mother's kidneys increases by over 50%. This increase has a direct effect on renal plasma flow, glomerular filtration rate, and renal tubular absorption. Thus, drug excretion rates may be increased and doses of many medications may need to be adjusted.

community effects on pharacotherapy

Communities vary significantly in regard to population density, age distributions, socioeconomic levels, occupational patterns, and industrial growth

9.4

Community and environmental factors affect health and the public's access to health care and pharmacotherapy. Inadequate access to health care resources and an inability to read or understand instructions may compromise treatment outcomes.

9.3

Culture and ethnicity are two interconnected perspectives that can affect pharmacotherapy. Differences in diet, use of alternative therapies, and beliefs about health and disease can influence patient drug response.

risk factors for using tobacco during pregnancy

Difficulty in getting pregnant. Increased incidence of miscarriage. Increased risk of premature delivery. Increased risk for sudden infant death syndrome (SIDS). Increased risk for certain birth defects such as cleft lip or cleft palate.

8.5

Drug administration to toddlers can be challenging; short, concrete explanations followed by immediate drug administration are usually best for the toddler.

8.4

During infancy, pharmacotherapy is directed toward the safety of the child and teaching the parents how to properly administer medications and care for the infant.

metabolism in older adults

Enzyme production in the liver decreases and the visceral blood flow is diminished, resulting in reduced hepatic drug metabolism. This change leads to an increase in the half-life of many drugs, which prolongs and intensifies drug response. The decline in hepatic function reduces first-pass metabolism. (Recall that first-pass metabolism relates to the amount of a drug that is removed from the bloodstream during the first circulation through the liver after the drug is absorbed by the intestinal tract.) Thus, plasma levels are elevated, and tissue concentrations are increased for the particular drug. This change alters the standard dosage, the interval between doses, and the duration of side effects

9.6

Gender can influence many aspects of health maintenance, promotion, and treatment, as well as medication response.

9.5

Genetic differences in metabolic enzymes that occur among different ethnic groups must be considered for effective pharmacotherapy. Differences in the structure of enzymes, called polymorphisms, can result in profound changes in drug response.

late middle age

Health impairments related to cardiovascular disease, hypertension, obesity, arthritis, cancer, and anxiety begin to surface in late middle age The use of drugs to treat hypertension, hyperlipidemia, digestive disorders, erectile dysfunction, and arthritis are common Adult-onset diabetes mellitus often emerges during this time of life. The use of antidepressants and antianxiety agents is prominent in the population older than age 50 Respiratory disorders related to lifelong tobacco use or exposure to secondhand smoke and environmental toxins may develop that require drug therapies

distribution and metabolism

Hemodynamic changes in the pregnant patient increase cardiac output, increase plasma volume, and alter regional blood flow. The increased blood volume in the mother causes dilution of drugs and decreases plasma protein concentrations, affecting drug distribution. Blood flow to the uterus, kidneys, and skin is increased, whereas flow to the skeletal muscles is diminished. Alterations in lipid levels may alter drug transport and distribution, especially during the third trimester. The level of drug metabolism increases for certain drugs, most notably anticonvulsants such as carbamazepine, phenytoin, and valproic acid, which may require higher doses during pregnancy. Fat-soluble drugs are distributed into the lipid-rich breast milk and may be passed to the lactating infant.

absorption

Hormonal changes as well as the pressure of the expanding uterus on the blood supply to abdominal organs may affect the absorption of drugs. Increased levels of progesterone can delay gastric emptying, thus allowing a longer time for the absorption of oral drugs. Gastric acidity is also decreased, which can affect the absorption of some drugs. Progesterone causes changes in the respiratory system during pregnancy—increased tidal volume and pulmonary vasodilation—that may cause inhaled drugs to be absorbed to a greater extent

absorption in older adults

In general, absorption of drugs is slower in the older adult due to diminished gastric motility and decreased blood flow to digestive organs. Because of increased gastric pH, oral tablets and capsules that require high levels of acid for absorption may take longer to dissolve and, therefore, take longer to become available to the tissues

distribution in older adults

Increased body fat in the older patient provides a larger storage compartment for lipid-soluble drugs and vitamins. Plasma levels are reduced, and the therapeutic response is diminished. Older adults have less body water, making the effects of dehydration more dramatic and increasing the risk for drug toxicity. For example, older patients who have reduced body fluid experience more orthostatic hypotension. The decline in lean body mass and total body water leads to an increased concentration of water-soluble drugs, because the drug is distributed in a smaller volume of water. The aging liver produces less albumin, resulting in decreased plasma protein-binding ability and increased levels of free drug in the bloodstream, thereby increasing the potential for drug-drug interactions. The aging cardiovascular system has decreased cardiac output and less efficient blood circulation, which slow drug distribution. This makes it important to initiate pharmacotherapy with smaller dosages and slowly increase the amount to a safe, effective level

An 8-month-old child is prescribed acetaminophen (Tylenol) elixir for management of fever. She is recovering from gastroenteritis and is still having several loose stools each day. The child spits some of the elixir on her shirt. Should the nurse repeat the dose? What are the implications of this child's age and physical condition for oral drug administration?

Nurse should consult w/ the pharmacy whether the dose needs repeated. Many oral elixirs are absorbed to some degree by oral mucosa membranes. the nurse could consider using an oral syringe to accurately measure and admin the meds to infants. conditions affecting GI tract such as gastroenteritis can affect drug absorption bc of their effect on increasing peristalsis

excretion in older adults

Older adults have reduced renal blood flow, glomerular filtration rate, active tubular secretion, and nephron function. This decreases drug excretion for drugs that are eliminated by the kidneys. When excretion is reduced, serum drug levels and the potential for toxicity markedly increase. Administration schedules and dosage amounts may need to be altered in many older adults due to these changes in kidney function. Keep in mind that the most common etiology of adverse drug reactions in older adults is caused by the accumulation of toxic amounts of drugs secondary to impaired renal excretion

8.9

Older adults take more medications and experience more adverse drug events than any other age group. For drug therapy to be successful, the nurse must make accommodations for age-related changes in physiological and biochemical functions

8.7

Pharmacologic compliance in the adolescent is dependent on an understanding of and respect for the uniqueness of the person in this stage of growth and development.

The nurse should educate parents about the following means of protecting their children from poisoning

Store all drugs and harmful agents out of the reach of children and in locked cabinets. Keep all household products and drugs in their original containers. Never put chemicals in empty food or drink containers. Always ask the pharmacist to place the medications for everyone in the household in child-resistant containers. Never tell children that medicine is candy. Keep the Poison Control Center number near phones, and call immediately if poisoning is suspected. Never leave medication unattended in a child's room or in areas where the child plays.

8.2

The effects of drugs on a growing embryo or fetus depend on the gestational stage and the amount of drug received. Pharmacotherapy during pregnancy should be conducted only when the benefits to the mother outweigh the potential risks to the unborn child. Pregnancy categories guide the health care provider in prescribing drugs for these patients

parental teaching points are important for infants

The infant should be held and cuddled while medications are being administered, and a pacifier should be offered if the infant is on fluid restrictions caused by vomiting or diarrhea. Medications are often administered to infants via droppers into the eyes, ears, nose, or mouth. Oral medications should be directed to the inner cheek and the child given time to swallow the drug to avoid aspiration. If rectal suppositories are administered, the buttocks should be held together for 5 to 10 minutes to prevent expulsion of the drug before absorption has occurred. In very young infants, the medication may be given via a nipple. Some believe this is controversial because the infant may associate the nipple with medication and refuse feedings. Special considerations must be observed when administering intramuscular (IM) or intravenous (IV) injections to infants. Unlike adults, infants lack well-developed muscle masses, so the smallest needle appropriate for the drug should be used. For volumes less than 1 mL, a tuberculin syringe is appropriate. The vastus lateralis is a preferred site for IM injections, because it has few nerves and is relatively well developed in infants. The gluteal site is usually contraindicated because of potential damage to the sciatic nerve, injury to which may result in permanent disability. Because of the lack of choices for injection sites, the nurse must rotate injection sites from one leg to the next to avoid overuse and to prevent inflammation and excessive pain. For IV medications, the feet and scalp veins may provide more easily accessible and preferred venous access sites.

9.2

The psychosocial domain must be considered when delivering holistic care. Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy.

slow acetylators (poor metabolizers)

The reduced hepatic metabolism and subsequent clearance by the kidney can cause the drug to build to toxic levels in these patients, who are known as

polypharmacy

The taking of multiple drugs concurrently has become commonplace among older adults dramatically increases the risk for drug interactions and side effects nurse should urge patients to report all prescription and OTC products on each office visit and teach the patients to use one pharmacy for their prescription needs

changes that alter drug pharmacokinetics and pharmacodynamics and may affect the success of therapy

absorption distribution and metabolism excretion

Local and systemic responses to some medications can differ between genders.

These response differences may be based on differences in body composition such as the fat-to-muscle ratio.

8.1

To contribute to safe and effective pharmacotherapy, it is essential for the nurse to apply fundamental concepts of growth and development across the life span.

preimplantation period

Weeks 1 to 2 of the first trimester called the "all-or-none" period because exposure to a teratogen either causes death of the embryo or has no effect Drugs are less likely to cause congenital malformations during this period because the baby's organ systems have not yet begun to form. Drugs such as nicotine, however, can create a negative environment for the embryo and potentially cause intrauterine growth retardation

General recommendations regarding pharmacotherapy during lactation

When feasible, pharmacotherapy should be postponed until the baby is weaned. The nurse can help the patient to identify nonpharmacologic therapies, if available, such as massage for pain or calming music for anxiety. If possible, administer the drug immediately after breast-feeding, or when the infant will be sleeping for an extended period, so that some time elapses before the next feeding. This will usually reduce the concentration of active drug in the mother's milk when she later breast-feeds her infant. The nurse should assist the mother in protecting the child's safety by teaching her to avoid illicit drugs, alcohol, and tobacco products during the lactation period. Drugs with a shorter half-life are preferable. Peak levels are rapidly reached and the drug is quickly cleared from the maternal plasma, which reduces the amount of drug exposure to the infant. The mother should avoid breast-feeding while the drug is at its peak level. Drugs that have long half-lives (or active metabolites) should be avoided because they can accumulate in the infant's plasma. Whenever possible, drugs with high protein-binding ability should be selected because they are not secreted as readily to the milk. OTC herbal products and dietary supplements should be avoided during lactation, unless specifically prescribed by the health care provider because the safety of most of these products to the infant has not been determined.

8.8

Young adults constitute the healthiest age group and generally need few prescription medications. Middle-aged adults begin to experience stress-related illnesses such as hypertension that require pharmacotherapy.

Patients characterized as slow acetylators may experience what effects related to drug therapy? a. They are more prone to drug toxicity. b. They require more time to absorb enteral medications. c. They must be given liquid medications only. d. They should be advised to decrease protein intake.

a

the most obvious community-related influence on pharmacotherapy

access to health care

preschool child

age from 3 to 5 years

toddlerhood

age period from 1 to 3 years

A patient undergoing treatment for cancer complains about nausea and fatigue. In approaching this patient problem holistically, what actions would the nurse take? (Select all that apply.) a. Give an antinausea drug as ordered and place the patient on bed rest. b. Observe for specific instances of nausea or fatigue and report them to the oncologist. c. Take a medication history on the patient, noting specific medication or food triggers. d. Talk to the patient about the symptoms, the impact they have on daily activities, and techniques that have helped lessen the problem. e. Encourage the patient to use alternative therapies such as herbal products.

b, d

pediatric patient

being any age from birth to 16 years and weighing less than 50 kg

Some persons of African American descent have decreased effects from

beta-adrenergic antagonist drugs such as propranolol (Inderal), because of genetic variances in plasma renin levels

A 16-year-old adolescent is 6 weeks pregnant. The pregnancy has exacerbated her acne. She asks the nurse if she can resume taking her isotretinoin prescription, a category X drug. What is the most appropriate response by the nurse? a. "Since you have a prescription for isotretinoin, it is safe to resume using it." b. "You should check with your health care provider at your next visit." c. "Isotretinoin is known to cause birth defects and should never be taken during pregnancy." d. "You should reduce the isotretinoin dosage by half during pregnancy."

c

An older adult patient has arthritis in her hands and takes several prescription drugs. Which statement by this patient requires further assessment by the nurse? a. "My pharmacist puts my pills in screw-top bottles to make it easier for me to take them." b. "I fill my prescriptions once per month." c. "I care for my 2-year-old grandson twice a week." d. "My arthritis medicine helps my stiff hands."

c

The nurse is preparing to give an oral medication to a 6-month-old infant. How should this drug be administered? a. By placing the medication in the next bottle of formula b. By mixing the medication with juice in a bottle c. By placing the medicine dropper in the inner cheek, allowing time for the infant to swallow d. By placing the medication toward the back of the mouth to avoid having the infant immediately spit out the medication

c

The nurse provides teaching about a drug to an older adult couple. To ensure that the instructions are understood, which of the following actions would be most appropriate for the nurse to take? a. Provide detailed written material about the drug. b. Provide labels and instructions in large print. c. Assess the patients' reading levels and have the patients "teach back" the instructions to determine understanding. d. Provide instructions only when family members are present.

c

To reduce the chance of duplicate medication orders for the older adult returning home after surgery, what actions should the nurse take? (Select all that apply.) a. Call in all prescriptions to the patient's pharmacies rather than relying on paper copies of prescriptions. b. Give all prescriptions to the patient's family member. c. Take a medication history, including all OTC and prescription medications and a pharmacy history with each patient visit. d. Work with the patient's health care provider to limit the number of prescriptions. e. Perform a medication reconciliation before sending the patient home.

c, e

the estrogen contained in oral contraceptives

causes an elevated risk of thromboembolic disorders

Some polymorphisms result in

changes in drug metabolism, with patients being classified as either poor, intermediate, extensive, or ultrarapid metabolizers

School-age children can safely take

chewable tablets and may even be able to swallow tablets or capsules The child should never be told that he or she is "too old" to cry and resist.

Asian Americans are less able to metabolize

codeine to morphine due to a genetic absence of the enzyme CYP2D6, a defect that interferes with the analgesic properties of codeine

To reduce the effect of a prescribed medication on the infant of a breast-feeding mother, how should the nurse teach the mother to take the medication? a. At night b. Immediately before the next feeding c. In divided doses at regular intervals around the clock d. Immediately after breast-feeding

d

A nurse is administering a liquid medication to a 15-month-old child. What is the most appropriate approach to medication administration by the nurse? (Select all that apply.) a. Tell the child that the medication tastes just like candy. b. Mix the medication in 8 oz of orange juice. c. Ask the child if she would like to take her medication now. d. Sit the child up, hold the medicine cup to her lips, and kindly instruct her to drink. e. Offer the child a choice of cup in which to take the medicine.

d, e

principal complications of drug therapy in the older adult population are due to

degeneration of organ systems, multiple and severe illness, polypharmacy, and unreliable compliance

psychosocial

describe one's psychological development in the context of one's social environment

keep in mind the following variables when treating patients from different ethnic groups

dietary considerations - certain foods have the potential to increase or decrease the effectiveness of a medication alternative therapies - interpret the effect of these herbal and alternative therapies on the prescribed medications to maximize positive outcomes. The nurse can explain that certain herbs or supplements may cause potential health risks when combined with prescribed drugs beliefs about health and disease - Cultures view health and illness in different ways

neonatal period

first 28 days of life

he most common needs for the pharmacotherapy of teens are

for skin problems, headaches, menstrual symptoms, eating disorders, contraception, alcohol and tobacco use, and sports-related injuries

Embryonic period

from 3 to 8 weeks postconception, there is rapid development of internal structures period of maximum sensitivity to teratogens. teratogenic agents taken during this phase can lead to structural malformation and spontaneous abortion. The specific abnormality depends on which organ is forming at the time of exposure

fetal period

from 9 to 40 weeks postconception or until birth alterations in the fetus and placenta maximize the transfer of substances from the maternal circulation to the fetal blood As a result, the fetus may receive larger doses of medications and other substances taken by the mother. Because the fetus lacks mature metabolic enzymes and efficient excretion mechanisms, medications will have a prolonged duration of action within the unborn child. Exposure to teratogens during the fetal period is more likely to produce slowed growth or impaired organ function, rather than gross structural malformations

Several drugs can cause

gynecomastia, an increase in breast size, which can be embarrassing for males

Pregnancy registries

help identify medications that are safe to be taken during pregnancy. gather information from women who took medications during pregnancy Information on babies born to women not taking the medication is then compared with data on babies born while the medication was taken during pregnancy. The effects of the medication taken during pregnancy are then evaluated. Registries may be maintained by drug companies, governmental agencies, or special-interest groups. A list of pregnancy registries is available from the FDA

ethnicity

implies that people have biologic and genetic similarities