Chapter 5

Lifespan and Cultural Modifications

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Chapter 5

Lesson 5.1

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Learning Objectives

Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients

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U.S. Food and Drug Administration (FDA)

Establishes standards that require drug companies to provide consumers with specific drug information

Information is printed on product package insert (PPI)

Information includes: Description of therapeutic response Side effects Adverse effects Possible drug interactions

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The Pediatric Patient

Variables have a profound impact on drug action and effect

Neonates (less than 1 month of age) Small body mass Low body fat content High body water volume Increased membrane permeability

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The Pediatric Patient (cont.)

Variables have a profound impact on drug absorption No gastric acid present at birth No intestinal bacteria or enzyme function present Delayed gastrointestinal transit time Immaturity of liver, kidney, and renal excretion

systems

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Question 1

Drug effect in a neonate differs from that in an adult because of the newborn’s:

1. Larger head to body mass ratio.

2. High body fat content.

3. High body water volume.

4. Decreased membrane permeability.

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Absorption

Three principles in the pediatric patient The physiologic status of the infant or child

determines the blood flow at the site of intramuscular or subcutaneous drug administration.

Compared with older children and adults, premature infants have immature and unstable body processes.

A newborn’s skin, particularly that of premature infants, has a greater ability to absorb some chemicals because of its greater hydration.

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Distribution

Two factors The chemical properties of the drug (do not vary) The physiologic factors specific to the patient (do

vary)

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Metabolism

The majority of drug metabolism, or biotransformation, takes place in the liver.

In general, drug metabolism in infants is much slower than in older children and adults.

Until 3 to 4 years of age, children have the ability to increase production of liver enzymes.

Neonates have a decreased ability to metabolize drugs.

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Excretion

Renal system may still be immature at birth Decreased glomerular filtration Decreased tubular secretion Decreased tubular reabsorption

System still maturing over the first year of life Drug clearance can be compromised

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Adverse Drug Reactions

Children are exposed to drugs directly and indirectly Transplacentally during pregnancy or delivery Direct administration Through ingested breast milk

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The Geriatric Patient

Reacts differently to medications than younger adults do

Drugs absorbed, metabolized, and excreted more slowly and less completely

Variability in drug response and clearance related to aging organ systems and overall health or illness

Patients age differently; body responses vary

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Geriatric Patient Teaching

Drug nonadherence related to: Drug cost Difficulty obtaining drugs Diminished cognitive abilities Lack of desire to take on schedule Depression Feelings of being overwhelmed with physical

needs Physical disabilities requiring assistance to

administer

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Question 2

Drugs metabolized by the __________ should be used with caution in elderly patients.

1. stomach2. liver3. pancreas4. small intestine

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Chapter 5

Lesson 5.2

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Learning Objectives

Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients

Identify special considerations for providing care to individuals from different cultures

Describe specific nursing behaviors that assist in helping patients succeed with their medication plans

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Medications Used by Women

Females differ from males in hormonal makeup

Medication needs are often related to: Genital tract infections Menstruation Infertility Pregnancy Menopause

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Medications and Pregnancy

1961, thalidomide Teratogenic = likely to cause fetal or

embryonic damage or malformations Few “safe” medications during pregnancy Weigh benefit of drug for mother against risk

to fetus

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Medications, Pregnancy, and Breastfeeding

Some medications cross the immature blood-brain barrier of the fetus

Some medications cross the placenta to the fetus

Some medications pass into breast milk to the baby during nursing

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Childhood Immunizations

Essential for personal and national protection Factors related to delay in receiving

Health care provider belief of need to delay related to symptoms of mild illness

Parental refusal from concern over adverse effects

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Medications Used Throughout the Lifespan

Antidiabetic agents Antihypertensive agents Cholesterol-lowering drugs Smoking-cessation products Weight-loss drugs Antidepressant medications Impotence drugs Aspirin Caffeine

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Question 3

What percent of cases of childhood asthma have been linked to the effects of passive smoking?

1. 30%

2. 40%3. 50%

4. 60%

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Cultural Influences

Cultural assessment includes determining Values Religion Dietary practices Family lines of authority Family life patterns Beliefs and practices related to health and illness

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Nursing Assessment of Health Care Availability

Health disparity Health literacy

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Medication Nonadherence

Six major reasons for client nonadherence Medications are for prevention Increases with prolonged therapy Treatment requires significant changes in behavior Poor patient understanding Complexity of treatment plan Unpleasant side effects

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