Sean Whitfield - NURS 3540 Gerontological Nursing ALG 5 Completed PDF

NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide Module 5 Active Learning Guide Chapter 11 Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context concer...

NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide Module 5 Active Learning Guide Chapter 11 Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context concerning the course and career skills. Students should review the active learning guide before engaging with the module content, then work to complete the guide both during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. The active learning guide is not a complete composite of the information needed for the exam but a guide to navigating the content delivery. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will preview the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content before responding. Students will turn in the completed learning guide on Sunday night at 1159 pm. Faculty will review, award points, and return them to students to review prior to the exam. There are a possible 5 earned points for this learning guide. Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current research related to chapter topics. Resources for Best Practice provide suggestions for further information for chapter topics and tools for practice. Healthy People boxes refer to goals cited in Healthy People 2030. Clinical judgment and next generation NCLEX examination style questions are located at the end of every chapter. Please review these questions as they are good practice for the exam. I. Pharmacokinetics Define Pharmacokinetics: is the study of the movement and action of a medication in the body from the time it is administered to the time it is excreted. Define Pharmacodynamics:refers to the physiological interactions between a medication and the body, specifically the chemical compounds introduced into the body and the receptors on cell membranes. What age-related changes in the body have an effect on pharmacokinetics and pharmacodynamics? Absorption There are several normal age-related changes that have the potential to affect absorption and therefore the amount of the medication available for both therapeutic and adverse effects. Most medications are administered orally. This is potentially problematic due to an age-related reduction in saliva; if this is severe (xerostomia) due to confounding factors, NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide swallowing tablets and capsules can be difficult. A liquid formulation may be easier unless pathology-related dysphagia is present. Age-related decreases in esophageal motility (presbyphagia) further contribute to swallowing difficulties and in extreme cases can cause tissue erosions. Changes to the gastric mucosa may either increase or decrease initial absorption. Increases in gastric pH retard the action of acid-dependent medications. Delayed stomach emptying may diminish or negate the effectiveness of short-lived medications that could become inactivated before reaching the small intestine. Some enteric-coated formulations of medications, such as aspirin, which are specifically meant to bypass stomach acidity, may be delayed so long that their action begins in the stomach and may cause gastric irritation or nausea and bleeding. Once a medication has been administered orally (or enterally), it must be absorbed into the bloodstream. This usually begins in the stomach and continues through the large intestine. Slowed intestinal motility, although not a normal change of aging, is frequently encountered in late life. This additional time the medication has contact with the intestinal walls increases the risk for adverse reactions and unpredictable effects. Age-related changes in renal function (lost glomerular and tubular function) have a significant effect on medication and metabolite excretion (drug clearance). Most people lose 1% of their GFR per year starting at about 20 years of age. This change reduces the body’s ability to eliminate medications in a timely manner by prolonging their half-life, or the amount of time it takes to reduce a medication’s therapeutic effect by one-half. This results in more opportunities for accumulation and can lead to potential toxicity or other adverse events. Interview Activity: Briefly interview one older adult and ask them what medications they take and the side effects they have encountered. Please answer the following questions: a. Was the effectiveness of the medications worth the side effects? Yes. If the medication is the only alternative and if it is expensive. b. As a nurse, what suggestion might you have to help counteract or alleviate some of the side effects? Take the needed medication according to the right route, right time and with food if needed. II. Issues in Medication Use 1. Polypharmacy a. Define polypharmacy: using five or more medications b. What are the consequences of polypharmacy, and how does it affect the elderly? Increased health care cost Adverse drug reactions and events Drug interactions (drug, supplement, disease) Difficulty with compliance Reduced functional status Cognitive impairment Falls with fractures Urinary incontinence Poor nutrition NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide Medication cascade Frailty Hospitalization Death c. What happens when polypharmacy, herbs, and supplements are combined? An increased risk of drug toxicity due to an afffect on how the medications/supplements are metabolized. Please review the following herbs/supplements. Determine what they are used for, complications they may cause, and how you, the nurse, must respond. Supplement Use Complication Nurse Action Garlic Any anticoagulant or antiplatelet drug Risk of bleeding increases Advise person not to take without provider approval; stop 7 days before surgery Gingko Aspirin and other NSAIDs; antiplatelet drugs; antidiabetic drugs (insulin); antidepressants, MAOIs, SSRIs; antihypertensives; antiseizure medications Increases risk for bleeding; may alter blood glucose levels; may cause abnormal response or decrease effectiveness; may cause increased effect; increased risk for seizure Teach person not to take without approval of provider, stop 36 hours before surgery; monitor blood glucose level closely; advise not to take with these drugs; monitor blood pressure; advise against use; Ginseng Insulin and oral antidiabetic drugs; anticoagulant and antiplatelet drugs (aspirin and other NSAIDs; antihypertensives, cardiac drugs such as calcium channel blockers; Blood glucose levels may be altered; increased risk for bleeding; may alter effects of drug; may interfere with action; may cause additive effect Monitor blood glucose levels closely; advise use with caution and provider oversight; advise against use unless NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide immunosuppressants; stimulants provider monitors closely; advise against use (immunosuppre ssants, stimulants) Green Tea Warfarin, statins, acetaminophen; stimulants, caffeine May alter anticoagulant effects, increase risk of side effects; may cause additive effect Advise against use; advise to use with care Red Yeast Rice It is used as a flavoring agent, food preservative, and to help with circulation and digestion in traditional Chinese medicine. While the supplement is generally considered safe, it might carry the same potential side effects as statin cholesterol drugs. Drinking alcohol may increase your risk of liver damage. Triptans such as sumatriptan, zolmitriptan; statins; digoxin; alprazolam; ketoprofen; tramadol and some SSRIs; olanzapine; paroxetine; theophylline, albuterol; warfarin; amlodipine; estrogen or progesterone May increase risks of seroteonergic adverse effects, serotonin syndrome, cerebral vasoconstriction; may decrease plasma concentrations of these drugs; decreases effects; photosensitivity; increased risk for serotonin syndrome (tramadol, SSRIs, olanzapine); sedative-hypnotic intoxication; Advise against use with (triptans, digoxin, alprazolam, tramadol, olanzapine, paroxetine, warfarin, amlodipine); St. John’s Wort Avoid using red yeast rice together with other herbal/health supplements that can harm your liver, such androstenedion e, chaparral, comfrey, DHEA, germander, kava, niacin, pennyroyal oil, and others. NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide Echinacea used in alternative medicine as a possibly effective aid in treating the common cold, or vaginal yeast infections. Any anticoagulant drug such as warfarin sodium; digoxin increases metabolism, decreases drug blood level; may decrease anticoagulant effect; lowers efficacy of calcium channel; may decrease effect of hormones monitor levels of lipids; advise sunblock use; monitor drug effects; advise that this effect may occur You should not use this product if you are allergic to echinacea or if you have: Do not take echinacea without medical advice if you are using a medication to treat any of the following conditions: an autoimmune disorder such as rheumatoid arthritis, lupus, or psoriasis. Risk of bleeding increases; therapeutic digoxin level may be altered any type of infection (including HIV, malaria, or tuberculosis); anxiety or depression; asthma or allergies; cancer; erectile dysfunction; heartburn or gastroesophage al reflux disease (GERD); high blood pressure, high cholesterol, or a heart condition; migraine headaches; NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide psoriasis, rheumatoid arth ritis, or other autoimmune disorders; a psychiatric disorder; or seizures. Elderberry Elderberry has been used in alternative medicine as a possibly effective aid in treating constipation. Elderberry is also possibly effective in reducing the symptoms of influenza (the flu). Do not take elderberry without medical advice if you are using any of the following medications: medicine to prevent organ transplant rejection; medicine to treat multiple sclerosis; medicine to treat psoriasis, rheumatoid arthritis, or other autoimmune disorders; medicine to treat ulcerative colitis or Crohn's disease; or Melatonin Melatonin is most commonly used to: help decrease jet lag adjust sleep cycles in the blind (non 24-Hour Sleep Wake Disorder, or Non24) treat shift-work sleep disorders in people with alternating work schedules Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have an autoimmune disease such as: multiple sclerosis; lupus; or steroid medicine. rheumatoid arthritis. Avoid driving or operating machinery for at least 4 hours after taking melatonin, or until the drowsy effects are no longer present. Before using this medication, talk to your healthcare provider. You may not be able to use this medication if you have certain medical conditions, such Avoid using this medication with other prescription medications, over-the-counter drugs, or dietary supplements without asking your doctor, pharmacist or other healthcare provider. NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide for general insomnias Saw Palmetto Anticoagulants Avoid alcohol while taking this medication. Avoid coffee, tea, cola, energy drinks, or other products that contain caffeine, as it may counteract the effects of the melatonin. as: No longer recommended for BPH Do not take d. What foods interact with medications? diabetes depression a bleeding or blood clotting disorder such as hemophilia taking a blood thinner like warfarin high or low blood pressure epilepsy or other seizure disorder if you are using any medicine to prevent organ transplant rejection an autoimmune condition using other sedatives or tranquilizers NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide Interview Activity: Using the same older adult from above answer the following questions: a. Do you have prescriptions from multiple providers? The patient uses one provider to reduce the possibility of any unknown drug interactions that could turn into an adverse drug event. b. Do they take any herbal supplements? No. 2. Differentiate: a. adverse drug reaction, adverse drug event Adverse drug reactions (ADRs) and adverse drug events (ADEs) occur when there is a noxious response or side effect to a medication. They can result either from the administration of a single medication or from the interaction between multiple medications, supplements, or foods/beverages as previously discussed. When an ADR reaches the level of harm, it is referred to as an adverse drug event (ADE). Many of these must be reported to the US Food and Drug Administration (FDA) or other regulatory body. 3. What is the BEER’s list and criteria to be placed on the list? Beers Criteria The Beers Criteria are the result of an exhaustive review of medications considered to be frequently prescribed to older adults. The 2019 list includes (1) those medications that are “potentially inappropriate” for use with older adults, (2) those that are potentially inappropriate for older adults with certain conditions, (3) those that should avoided or have their dose changed for people with impaired renal function, and (4) a list of drug-drug interactions documented to be harmful to older adults Online Activity: Go to the website AGS Geriatrics Healthcare Professionals and look at the entire list of Beers’ Criteria and any products and tools that are available. What is your opinion of the tools and their usefulness? The tools are available to educate the user on the latest expert information in geriatrics from geriatric patient education to geriatric clinical care, to new screening kits, jounals, webinars and codes. The site NURS 3540 – Gerontological Nursing Module 5 Active Learning Guide and its tools look to be more than adequate to educate any user on what the Beer’s list/criteria is and how to use it. Application Questions or Case Studies An 80-year-old Hispanic widow is on an acute rehabilitation unit in the hospital following a right total knee replacement for osteoarthritis. She is 5 feet 2 inches tall and weighs 175 lb. She has a history of hypertension (since age 16) and non–insulin-dependent diabetes mellitus, hypothyroidism, and coronary artery disease. Her medication list includes Lipitor, metoprolol, glyburide, metformin, Cardizem, lisinopril, chlorthalidone, aspirin, Synthroid, and Tylenol for pain. She also reports that she takes garlic capsules, fish oil capsules, and some Chinese herbs because she has been told that they are effective for her chronic conditions. She lives alone in the family home in a low socioeconomic area of a large city. Her daughter lives about 1 hour away, and her son lives in a neighboring state. The widow expresses concern about the large number of medications that she takes, the difficulty in affording the cost of the medications, and the difficulty in managing all of the medications and the schedule for those medications. She also confides that she does not always take the medications “exactly the way they say I should.” When questioned further, she states, “The directions are confusing. I am not a doctor or nurse.” She also does not understand why she has to take multiple medications for the same problem: “Why isn’t one medicine for my diabetes good enough?” She also tells you that the medication schedule interferes with her daily activity schedule: “I can barely find time to go to Mass every day with all of those stupid pills you want me to take.” 1. Do you think that she is adhering to her medication regimen? Provide your reasoning for your answer. The patient is not adhering to her medication regimen per her own admission. She also confides that she does not always take the medications “exactly the way they say I should.” 2. Discuss two potential reasons for her nonadherence. Due to the large number of medications that she takes, the difficulty in affording the cost of the medications. Difficulty in managing all of the medications and the schedule for those medications (interferes with ADL’s). The direction are also confusing. The patient also may feel overwhelmed by the medical condition itself and does not have anymore “bandwidth” or energy to decypher her confusion and seek a resolution. 3. For the two reasons for nonadherence that you identified in question 2, provide two interventions to improve her adherence. Help the patient understand what each drug is for and to aid in understanding. Increases patient participation in their own wellness. Daily medication box to seperate medication by day and time. Reschedule and develop a new routine for ADL’s and other interests to help medication adherence. 4. What information should the nurse include in the medication teaching plan for the patient? Need to know possible adverse drug reactions and events due to polypharmacy. What will be needed by the patient if found having a adverse reaction/event. And the intended (SMART) goals for the health of the patient