Foundations Chapter 51: Individual Considerations of Medication Administration PDF

CHAPTER 51 UNIT 4 PHYSIOLOGICAL INTEGRITY Psychological factors: Emotional state and expectations SECTION: PHARMACOLOGICAL AND PARENTERAL THERAPIES can influence the effects of a medication. The placebo...

CHAPTER 51 UNIT 4 PHYSIOLOGICAL INTEGRITY Psychological factors: Emotional state and expectations SECTION: PHARMACOLOGICAL AND PARENTERAL THERAPIES can influence the effects of a medication. The placebo effect describes positive medication effects that CHAPTER 51 Individual psychological factors, not biochemical properties of the Considerations medication, influence. Diet: Inadequate nutrition (starvation) can affect the of Medication protein‑binding response of medications. It increases Administration their response and thus increases the risk for medication toxicity. Medical problems Inadequate gastric acid inhibits the absorption of Various factors affect how clients respond to medications that require an acid medium to dissolve. medications. It is important for nurses to identify Diarrhea causes oral medications to pass through the gastrointestinal tract too quickly for adequate absorption. these factors to help them individualize nursing Vascular insufficiency prevents the distribution of a care when administering medications. medication to affected tissue. Liver disease or failure impairs medication metabolism, which can cause toxicity. FACTORS AFFECTING MEDICATION Kidney disease or failure prevents or delays medication DOSAGES AND RESPONSES excretion, which can cause toxicity. Prolonged gastric emptying time delays the absorption Body weight: Because body tissues absorb medications, of medications in the intestines. 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 (BSA) can be a more precise method of PHARMACOLOGY AND CHILDREN regulating an individual’s response to a medication. Although most medications adults take are useful for children, the dosages are different. Providers base Age: Liver and kidney function are immature in young pediatric dosages on body weight or BSA. children and often decreased in older adults, which can Newborns and infants (2 days to 1 year old) have cause heightened sensitivities to medications and thus immature liver and kidney function, alkaline gastric necessitate proportionately smaller medication doses. juices, and an immature blood‑brain barrier, making Sex: Males and females can have varied responses to them especially sensitive to medications that affect the medications, including an increased therapeutic response CNS. Providers base some medication dosages on age in some cases, or increased risk of harm in others. due to a greater risk for decreased skeletal bone growth, acute cardiopulmonary failure, and hepatic toxicity. Genetics: Genetic factors (missing enzymes) can alter the Be particularly alert when administering medications to metabolism of certain medications, thus enhancing or children due to the increased risk for reducing a medication’s action. The usual effect is either medication errors. fewer benefits from the medication or greater medication ◯ Check that dosages are accurate for weight or BSA. toxicity. ◯ Initial pediatric dosages are an approximation. Biorhythmic cycles: Responses to some medications ◯ Be aware that most medications do not undergo vary with the biologic rhythms of the body. For example, testing on children. hypnotic medications work better when clients take them ◯ Some adult medication forms and concentrations at their usual sleep time than at other times. require dilution, calculation, preparation, and administration of very small doses for children. Tolerance: Reduced responsiveness to a medication clients ◯ Limited sites exist for IV medication administration. take over time (morphine) is pharmacodynamic tolerance. ◯ Give written and verbal instructions to parents to Other medications (barbiturates) cause metabolic promote adherence to medication regimens. tolerance as metabolism of the medication increases over time and the effectiveness of the medication declines. Additional pharmacokinetic factors specific to children Cross‑tolerance can occur with other chemically similar Decreased gastric acid production and slower gastric medications. emptying time Decreased first‑pass medication absorption due to Accumulation: Medication concentration in the body immaturity of the liver increases due to the inability to metabolize or excrete a Increased absorption of topical medications (greater medication rapidly enough, resulting in a toxic medication blood flow to the skin and thinner skin) effect. For older adults, decreased kidney and liver Higher body water content (dilutes function are the major causes of medication accumulation water‑soluble medications) leading to toxicity. Decreased protein‑binding sites in the blood (until age 1 year). This can result in an increase in the blood level of protein‑binding medications. FUNDAMENTALS FOR NURSING CHAPTER 51 Individual Considerations of Medication Administration 313  PHARMACOLOGY AND PHARMACOLOGY: OLDER ADULTS (65+ YEARS) PREGNANCY, LACTATION, AND REPRODUCTIVE POTENTIAL PHYSIOLOGIC CHANGES WITH AGING The U.S. Food and Drug Administration (FDA) has THAT AFFECT PHARMACOKINETICS previously classified medications in five categories that range from remote risk to proven risk of fetal harm. The Increased gastric pH (alkaline) agency now requires labeling that details three risk Decreased gastrointestinal motility and gastric sections: pregnancy, lactation, and females and males of emptying time, resulting in a slower rate of absorption reproductive potential. Decreased blood flow through the cardiovascular system, liver, kidneys Decreased hepatic enzyme function PREGNANCY Decreased kidney function and glomerular filtration rate Most medications are potentially harmful to the Decreased protein‑binding sites, resulting in lower fetus. Prescribers must weigh the benefits of maternal blood albumin levels medication administration against possible fetal risk. Decreased body water, increased body fat, decreased Medications taken during pregnancy include nutritional lean body mass supplements (iron, vitamins, minerals) and medications the provider prescribes to treat nausea, vomiting, OTHER FACTORS AFFECTING gastric acidity, and mild discomforts. MEDICATION THERAPY Providers manage chronic medical disorders (diabetes mellitus and hypertension) in conjunction with careful Impaired memory or altered mental state maternal‑fetal monitoring. Multiple or severe illnesses Pregnancy is a contraindication for live‑virus vaccines Changes in vision and hearing (measles, mumps, rubella, varicella, yellow fever). Decreased mobility and dexterity Poor adherence Inadequate supervision of long‑term therapy LACTATION Limited financial resources Most medications taken during lactation enter Polypharmacy: The practice of taking several breast milk. Clients who are lactating should avoid medications simultaneously (prescription, medications that have an extended half‑life, are over‑the‑counter [OTC], herbal, and recreational) with sustained‑release, or are harmful to infants. diminished bodily functions and some medical problems For medications that are safe, administer them can contribute to the potential for medication toxicity. immediately after breastfeeding to minimize the medication’s concentration in the next feeding. Use the NURSING INTERVENTIONS lowest effective dosage for the shortest possible time. Decreasing the risk of adverse medication effects Obtain a complete medication history and include any REPRODUCTIVE POTENTIAL prescription medications, OTC medications, recreational Some medications include special considerations for clients drugs, and herbal supplements. of reproductive potential to reduce the risk of fetal harm Make sure medication therapy starts at the lowest and to preserve reproductive ability, if desired. possible dose. Other medications can affect hormone levels that Assess and monitor for therapeutic and adverse effects. affect reproduction and lead to infertility. This can be a Monitor plasma medication levels to provide a rational desired or undesired effect for the client. basis for dosage adjustment. Specific interventions can include pregnancy testing Assess and monitor for medication‑medication and before and during medication therapy, and beginning or medication‑food interactions. altering contraceptive use. Document findings. Ensure the client understands the effect of prescribed Notify the provider of adverse effects. medications on reproductive potential, and understands Promoting adherence any specific actions to take during medication use. 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 and using 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. 314 CHAPTER 51 Individual Considerations of Medication Administration CONTENT MASTERY SERIES