TOPIC 4

Question 1

What are the physiologic changes of a geriatric patient?

Answer 1

reduction in total body water and lean body mass
increase in body fat
reduction in kidney and liver mass and function
reduction in process that maintains equilibrium

Question 2

What affects absorption in a geriatric patient?

Answer 2

GI changes
decrease in bowel surface area
slowed gastric emptying
decrease gastric blood flow
decrease swallowing ability
decreased nutrition

Question 3

What affects distribution in geriatric patients?

Answer 3

decrease in muscle mass an increase in fat in patients so LIPID SOLUBLE DRUGS HAVE INCREASED DISTRIBUTION AND DECREASED ELIMINATION
decrease in albumin so increase in free drugs
increase in therapeutic effects as well as drug toxicity

Question 4

What affects metabolism in geriatric patients?

Answer 4

decreased hepatic blood flow
deceased first pass metabolism
increased half life

Question 5

What affects excretion in geriatric patients?

Answer 5

decreased renal excretion resulting in prolonged half life and elevated drug levels

Question 6

What affects the pharmacodynamics in geriatric patients?

Answer 6

age related changes in CNS and cardiovascular system (drugs can more easily pass the BBB)
changes in the number of drug receptors
changes in the sensitivity of receptors to drugs
compensatory response to physiologic changes is decreased

Question 7

Polypharmacy

Answer 7

use if more medications than is medically necessary

Question 8

What are the risk factors of polypharmacy?

Answer 8

female, advanced age, multiple health care providers, use of OTC to herbals, multiple chronic diseases

Question 9

Pharmacotherapy

Answer 9

the application of drugs for the purpose of disease prevention and treatment of suffering

Question 10

What is the Beers criteria?

Answer 10

lists potentially inappropriate drugs that lead to adverse effects in the elderly
-renal dosing of drugs
-drug-drug interactions
-provides safety info

Question 11

What are the 5 adverse drug events?

Answer 11

adverse drug reactions
medication errors
therapeutic failures
adverse drug withdrawal events
overdoses

Question 12

adherence

Answer 12

ability of a patient to adhere/comply to a medication regimen

Question 13

What can cause medical nonadherence?

Answer 13

patient not understanding the drug regimen
cognitive/physical/financial difficulties
nonadherence can cause under or over dosing

Question 14

What are key points in health teaching for an older adult?

Answer 14

have the patients senses be as sharp as possible
speak in tones patient can hear
face patient when speaking
respect
large print and bright colors on teaching aids
review all drugs at each visit (drug reconciliation)
Vial of life
simple dosing schedule
encourage patient to report if the drug is not improving condition
memory aids

Question 15

drug reconciliation

Answer 15

The process of identifying the most accurate list of all medications a patient is taking

Question 16

vial of life

Answer 16

medical information for emergency personnel to use in the provision of care (document who to contact and patient wishes)

Question 17

What are some items that the nurse should ASSESS related to an elderly client?

Answer 17

sensory and cognitive barriers
vitals, labs, weight, allergies
drug reconciliation
does patient need help with costs or transportation
does patient live alone
side or adverse effects?

Question 18

What is included in the nursing DIAGNOSIS of an elderly client?

Answer 18

health maintenance
therapeutic regimen management
knowledge: teach the patient about the new medication

Question 19

What is included in the PLANNING/ what is your goal as the nurse for an elderly client who is prescribed a medication?

Answer 19

develop a drug regimen that is congruent w health goals and fits well with the patient lifestyle
list resources the patient can use for support
have them teach the regimen back to you

Question 20

What nursing INTERVENTIONS/IMPLEMENTATION would help you attain your goals for your patient?

Answer 20

monitor labs
check for side or adverse effects
check for changes in behavior
tell them to inform the nurse about any OTC or CAMs

Question 21

How would you EVALUATE your interventions to make sure that your elderly client is meeting the goal?

Answer 21

labs
evaluate adherence
therapeutic, side and adverse effects

Question 22

Why is there limited research for pediatric pharmacology?

Answer 22

research risk
hard to obtain informed consent from parents

Question 23

Pediatric Research Equity Act

Answer 23

Requires study of pediatric drug use

Question 24

What affects absorption in a pediatric patient?

Answer 24

age, health status, weight
route of administration
nutritional habits, physical maturity, hormonal differences
hydration, underlying disease, GI disorders

Question 25

When does the GI tract in an infant reach maturity?

Answer 25

6-8months

Question 26

What affects topical medications in pediatric patients?

Answer 26

children have thin and porous skin, so the medication may absorb more into their skin nurses should focus the topic only on the site intended to affect

Question 27

What are some conditions that may affect oral drug absorption in a pediatric patient?

Answer 27

gastric acidity, gastric emptying, gastric motility, GI surface area, enzyme levels and intestinal flora

Question 28

When does the gastric acid reach adult level?

Answer 28

around 2-3 years of age

Question 29

What affects distribution in pediatric patients?

Answer 29

body fluid composition: neonates and infants have 75% water body tissue composition: neonates and infants have less body fat protein binding capability: less albumin and fewer protein receptor sites in neonates and infants effectiveness of barriers (skin and BBB)

Question 30

Due to the increased amount of body fluid composition in infants, what needs to be considered about the drug?

Answer 30

increase the dose of water-soluble drugs until about the age of two

Question 31

The decreased amount of albumin and protein receptor sites in infants can cause...

Answer 31

increased level of unbound drugs this can cause increase toxicity

Question 32

BBB in infants

Answer 32

the BBB in infants is immature and drugs can more easily pass, so this can increase CNS drug toxicity

Question 33

What can affect metabolism in pediatric patients?

Answer 33

maturity level of the child liver metabolism (decreased hepatic blood flow and liver enzymes) higher metabolism rate

Question 34

What can affect excretion in pediatric patients?

Answer 34

infants have decreased renal blood flow, GFR, and renal tubular function

Question 35

What are some important nursing implications when dosing and monitoring a drug of a pediatric patient?

Answer 35

monitor for therapeutic effects and adverse reactions check med math calculations

Question 36

What are some nursing implications when administering drugs to a pediatric patient?

Answer 36

differentiate the developmental from cognitive/chronologic age maintain safety AND comfort family-centered care (teach caregiver and patient)

Question 37

What are some considerations a nurse should pay attention to in an adolescent patient?

Answer 37

physical body changes (puberty) cognitive level and abilities emotional factors independence from parents self-care behaviors impact of chronic illness

Question 38

What items would be included in the ASSESSMENT of a pediatric patient related to medication?

Answer 38

the developmental age, health status, nutritional status, hydration status literacy level and readiness to learn of both caregiver and child economic issues, cultural patters that may lead to non adherence allergies drug reconciliation age, weight, height

Question 39

What are included in nursing DIAGNOSES of a pediatric patient?

Answer 39

knowledge; my be deficient due to cognitive limitation/ misinterpretation health maintenance: ineffective due to cognitive limitations or lack of resources risk for injury

Question 40

What PLANNING or goals would the nurse develop for the pediatric patient relates to medication?

Answer 40

patient and family need to recognize the the need for the drug administration and the rationale behind it have family and patient incorporate the drug regimen into their life style patient and family demonstrate and have confidence how to safely administer the drug patient will remain free of drug related injuries

Question 41

What nursing INTERVENTIONS would be appropriate to meet the goals for the pediatric patient receiving medication?

Answer 41

nurse provided resources and support to patient and caregivers avoid use of restraints include both patient and family in the educational process follow rights of safe drug administration assist in management of complex drug schedules provide drug reconciliation list support patient and family decisions two methods of identification ask open ended questions

Question 42

How would you EVALUATE that pediatric patient goals are met?

Answer 42

evaluate physiologic ands psychologic response evaluate caregiver knowledge on the drug dosage, schedule and side effects evaluate therapeutic and adverse effects of the drug

Question 43

What are factors that impede absorption of drugs delivered IM and SUB-Q

Answer 43

dehydration, cold temperature, altered cardiac status