Lifespan and Cultural Modifications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1 Chapter 5

Lifespan and Cultural Modifications

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.1

Chapter 5

Learning Objectives


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

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 responseSide effectsAdverse effectsPossible drug interactions

The Pediatric Patient


Variables have a profound impact on drug action and effect

Neonates (less than 1 month of age)Small body massLow body fat contentHigh body water volumeIncreased membrane permeability

The Pediatric Patient (cont.)


Variables have a profound impact on drug absorptionNo gastric acid present at birthNo intestinal bacteria or enzyme function

presentDelayed gastrointestinal transit timeImmaturity of liver, kidney, and renal

excretion systems

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.

Absorption


Three principles in the pediatric patientThe physiologic status (muscle mass and use) 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.

Distribution


Two factorsThe chemical properties of the drug (do not

vary)The physiologic factors specific to the patient

(do vary)

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.

Excretion


Renal system may still be immature at birthDecreased glomerular filtrationDecreased tubular secretionDecreased tubular reabsorption

System still maturing over the first year of life

Drug clearance can be compromised

Adverse Drug Reactions


Children are exposed to drugs directly and indirectlyTransplacentally during pregnancy or

deliveryDirect administrationThrough ingested breast milk

The Geriatric Patient


Reacts differently to medications than younger adults do

Drugs absorbed, metabolized, and excreted more slowly and less completely (stair – stepping)

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

Patients age differently; body responses vary

Geriatric Patient Teaching


Drug nonadherence related to:Drug costDifficulty obtaining drugsDiminished cognitive abilitiesLack of desire to take on scheduleDepressionFeelings of being overwhelmed with physical

needsPhysical disabilities requiring assistance to

administer

Question 2


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

1. stomach2. liver3. pancreas4. small intestine

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

Medications Used by Women


Females differ from males in hormonal makeup

Medication needs are often related to:Genital tract infectionsMenstruationInfertilityPregnancyMenopause

Medications and Pregnancy


1961, thalidomideTeratogenic = likely to cause fetal or

embryonic damage or malformationsFew “safe” medications during pregnancy

Check drug book for pregnancy catergoryPregnancy X- do not give!!

Weigh benefit of drug for mother against risk to fetus

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

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 illnessParental refusal from concern over adverse

effects

Medications Used Throughout the Lifespan


Antidiabetic agentsAntihypertensive agentsCholesterol-lowering drugsSmoking-cessation productsWeight-loss drugsAntidepressant medicationsImpotence drugsAspirinCaffeine

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%

Cultural Influences


Cultural assessment includes determiningValuesReligionDietary practicesFamily lines of authorityFamily life patternsBeliefs and practices related to health and

illness

Medication Nonadherence


Six major reasons for client nonadherenceMedications are for preventionIncreases with prolonged therapyTreatment requires significant changes in

behaviorPoor patient understandingComplexity of treatment planUnpleasant side effects

Chapter 6

Self-Care: Over-the-Counter Products, Herbal Therapies, and

Drugs for Health Promotion

Copyright © 2013, 2010, 2006, 2003, 2000, 1995,

1991 by Mosby, an imprint of Elsevier Inc. 24

Documenting Patient Health Care Practices

Nursing knowledge of productsOTC and prescription interactionContainer labelsComplementary and alternative medicine

(CAM)

25

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

***$6 billion spent on nonprescription remediesCommon influences

FriendsAdvertisements

Pros and Cons

Safety, purity, and effectivenessNatural estrogens – phytoestrogens

(flaxseed, red clover sprouts, and soy flour)

Time Variability in each doseCouncil for Responsible NutritionRefer to Tables 6-2, 6-3, 6-4

26

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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Lifespan and Cultural Modifications Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 1 Chapter 5