Chapter_003.pptx

Chapter 3 Lifespan Considerations  Lifespan Considerations  The human body changes from the beginning of life to the end of life.  These lifespan changes have dramatic effects of the four phases of pharmacokinetics.  Special considerations:  Pregnancy ...

Chapter 3 Lifespan Considerations  Lifespan Considerations  The human body changes from the beginning of life to the end of life.  These lifespan changes have dramatic effects of the four phases of pharmacokinetics.  Special considerations:  Pregnancy  Newborn  Pediatric  Older adult 2 Drug Therapy During Pregnancy  Drugs cross the placenta by diffusion  Factors affecting safety:  Drug properties  Fetal gestational age  Maternal factors  FDA has implemented pregnancy safety categories.  New pregnancy safety categories are in progress 3  New Rule  Three subsections in the prescribing information:  Pregnancy  Lactation  Female and males of reproductive potential Because this is a phase-in process, nurses may see the A to X classifications and the new rule classifications. 4  Audience Response System Question #1 When teaching a pregnant woman about the use of drugs during pregnancy, which statement will the nurse include? A. Exposure of the fetus to drugs is most detrimental during the second trimester of pregnancy. B. Pregnant women must never take drugs to control high blood pressure. C. Drug transfer to a fetus is most likely to occur during the last trimester of pregnancy. D. A fetus is at greatest risk for drug-induced developmental defects during the second trimester of pregnancy. NOTE: No input is required to proceed. 5  Answer to System Question #1 ANS: C Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy. Exposure of a fetus to drugs is most detrimental during the first trimester of pregnancy, and fetuses are at greatest risk for drug-induced developmental defects during the first trimester of pregnancy. Pregnant women need to take medications to control situations such as high blood pressure. 6 Drug Therapy During Breastfeeding  Breastfed infants are at risk for exposure to drugs consumed by the mother.  Drug levels in breast milk are usually lower than those in the maternal circulation.  Consider risk-to-benefit ratio. 7  Neonatal and Pediatric Considerations: Pharmacokinetics  Absorption  Gastric pH less acidic until 1 to 2 years of age  Gastric emptying slowed  First-pass elimination is reduced due to an immature liver  Intramuscular absorption faster and irregular 8 Neonatal and Pediatric Considerations: Pharmacokinetics (Cont.)  Distribution  Greater total body water means lower fat content.  Decreased level of protein binding  Immature blood–brain barrier—more drugs enter the brain 9 Neonatal and Pediatric Considerations: Pharmacokinetics (Cont.)  Metabolism  Liver immature; does not produce enough microsomal enzymes  Older children may have increased metabolism, requiring higher doses than infants.  Other factors 10 Neonatal and Pediatric Considerations: Pharmacokinetics (Cont.)  Excretion  Kidney immaturity affects glomerular filtration rate and tubular secretion.  Decreased perfusion rate of the kidneys may reduce excretion of drugs. 11  Factors Affecting Pediatric Drug Dosages  Skin is thin and permeable.  Stomach lacks acid to kill bacteria.  Lungs have weaker mucous barriers.  Body temperatures less well regulated, and dehydration occurs easily.  Liver and kidneys are immature, impairing drug metabolism and excretion. 12  Methods of Dosage Calculation for Pediatric Patients  Body surface area method  Uses the West nomogram  Always use weight in kilograms, not pounds  Always use centimeters, not inches  Body weight dosage calculations  Uses mg/kg 13  General Considerations  Prepare all equipment and supplies first.  Have caregivers stay as appropriate.  Assess for comfort methods before, during, and after drug administration.  Infants  Toddlers  Preschoolers  School-age children  Adolescents 14  Audience Response System Question #2 When administering medications to pediatric patients, the nurse understands that the dosage calculations for pediatric patients are different than for adults because pediatric patients A. are more likely to develop edema. B. have more stomach acid. C. have skin that is less permeable. D. have immature liver and kidney function. NOTE: No input is required to proceed. 15  Answer to System Question #2 ANS: D It is true that pediatric patients have immature liver and kidney function, resulting in impaired drug metabolism and excretion. Pediatric patients lack stomach acid to kill bacteria and have skin that is thinner and more permeable. Pediatric patients are not more likely to develop edema. 16  Considerations for Older Adult Patients  Decline in organ function occurs with advancing age.  Drug therapy in older adults is most likely to result in adverse effects and toxicity. 17  Considerations for Older Adult Patients (Cont.)  Older adults: older than age 65 years  High use of medications  Polypharmacy  Noncompliance, nonadherence  Increased incidence of chronic illnesses  Sensory and motor deficits  Audience Response System Question #3 What does the nurse identify as a pharmacokinetic change that occurs in older adults? A. Gastric pH is more acidic. B. Fat content is decreased because of increased lean body mass. C. There is increased production of proteins by the liver. D. The number of intact nephrons is decreased. NOTE: No input is required to proceed. 19  Answer to System Question #3 ANS: D In older adults, the gastric pH is less acidic because of a gradual reduction in the production of hydrochloric acid in the stomach, fat content is increased because of decreased lean body mass, and there is decreased production of proteins by the aging liver and reduced protein intake. It is correct that the number of intact nephrons decreases in older adults. 20  Older Adults: Pharmacokinetics  Absorption  Gastric pH less acidic  Gastric emptying and movement through the GI tract is slowed  Blood flow to GI tract reduced  Absorptive surface of GI tract reduced 21 Older Adults: Pharmacokinetics (Cont.)  Distribution  Lower total body water percentages  Increased fat content  Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs) 22 Older Adults: Pharmacokinetics (Cont.)  Metabolism  Aging liver produces fewer microsomal enzymes, affecting drug metabolism.  Reduced blood flow to the liver 23 Older Adults: Pharmacokinetics (Cont.)  Excretion  Decreased glomerular filtration rate  Decreased number of nephrons  Drugs are cleared less effectively because of decreased excretion. 24 Older Adults: Problematic Medications INSERT UPDATED 10th edition Table 3-4 here into This slide. Thanks. 25  Medication Administration, Lifespan Considerations, and the Nursing Process Assessment  Age  Allergies to drugs and food  Dietary habits  Sensory, visual, hearing, cognitive, and motor-skill deficits  Financial status and any limitations  List of all health-related care providers  Medication Administration Considerations: Assessment  Listing of medications  Existence of polypharmacy  Self-medication practices  Laboratory test results  History of smoking and use of alcohol  Risk situations related to drug therapy identified by the Beers criteria  Medication Administration Considerations: Planning Human Needs Statements  Alteration in fluids and nutrients (less than body requirements)  Ineffective perception  Altered safety, risk for injury  Related to adverse effects  Related to idiosyncratic reactions Outcomes  May involve patient, caregiver, or legal guardian  Individualized 28  Medication Administration Considerations: Implementation  Basic Nine Rights of medication administration  Pediatric considerations for safe administration  Mixing medications to disguise taste  Age-appropriate terminology  Safety considerations  Older adult considerations for safe administration  Take as directed; do not double-up doses or discontinue without guidance from prescriber  Safety considerations  Be alert for polypharmacy 29  Medication Administration Considerations: Evaluation  Observe and monitor for therapeutic effects  Observe and monitor for adverse effects  Evaluate understanding of drug purpose, dose, dose frequency, adverse effects, special considerations 30  Case Study B. is a 6-month-old male who is being admitted for the treatment of pneumonia. The unit where B. is admitted is a combined adult and pediatric medical unit. The nurse assigned has little pediatric experience and has sought the advice of the experienced charge nurse. 1. What age-related considerations should the nurse take into account when preparing medications for B.? NOTE: No input is required to proceed. 31 Answer to Case Study Question #1 1. The nurse must consider the age and weight of the child for safe medication administration. A 6-month-old cannot swallow pills therefore, liquid preparation of medications must be available. High risk medications should be verified by a second RN. Pediatric medications have safe ranges and these should be calculated for all medications. If the drug dose raises concerns or varies from the safe range, contact the prescriber immediately. The nurse will have to consider how to safely administer the medication. Oral syringes are common methods to instill the medication in the mouth of the young child. 32  Case Study The nurse reviews the prescriber’s orders and notes the following: Administer acetaminophen 10 mg/kg/dose every 4 hours for fever greater than 102.6 temporal. The nurse needs to administer a dose. 2. What important data would the nurse need to verify? NOTE: No input is required to proceed. 33 Answer to Case Study Question #2 2. The nurse needs to verify an accurate weight. Children of this age should be weighed nude or with as little clothing as possible (diaper and t-shirt). The weight should be calculated in kilograms. The patient’s fever also must be documented. 34  Case Study  The nurse verifies the child’s weight on admission: 18.5 pounds.  Using the prescribed dose: 10mg/kg/dose 3. Calculate the mg of medication B. will receive per dose.  The acetaminophen unit dose label reads: Acetaminophen 160 mg/5 ml. 4. How many ml will the nurse prepare for one dose of acetaminophen for B.? (round to one decimal place) NOTE: No input is required to proceed. 35  Answers to Case Study Questions #3 and #4 3. 18.5 pounds equals 8.4 kg. 10 mg x 8.4 kg = 84 mg. 4. 84 mg/160 mg x 5 ml = 2.6 ml. 36  Audience Response System Question #4 The nurse caring for a pediatric patient calculates the safe range for the prescribed medication. Based on the nurse’s calculations, the dose ordered exceeds the high limit. What is the nurse’s next action? A. Contact the prescriber immediately. B. Administer only half the ordered dose. C. Proceed with administration of the prescribed dose. D. Contact pharmacy to substitute the prescribed medication with one that will calculate in the safe range. NOTE: No input is required to proceed. 37  Answer to System Question #4 ANS: A The nurse should contact the prescriber immediately and before administering the medications. Giving only half the prescribed dose is making a prescribed order which is not within the scope of practice for the nurse. Pharmacy cannot make treatment changes without the direction of the prescriber. 38