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

Chapter 5 Lesson Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Learning Objectives  Identify specific considerations in administering medications to pediatric, pregnant, breastfeeding, or elderly patients 3 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

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

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

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

Distribution  Two factors  The chemical properties of the drug (do not vary)  The physiologic factors specific to the patient (do vary) 9 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

Adverse Drug Reactions  Children are exposed to drugs directly and indirectly  Transplacentally during pregnancy or delivery  Direct administration  Through ingested breast milk 12 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

Question 2 Drugs metabolized by the __________ should be used with caution in elderly patients. 1. stomach 2. liver 3. pancreas 4. small intestine 15 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Chapter 5 Lesson Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

Medications Used by Women  Females differ from males in hormonal makeup  Medication needs are often related to:  Genital tract infections  Menstruation  Infertility  Pregnancy  Menopause 18 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

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

Medications Used Throughout the Lifespan  Antidiabetic agents  Antihypertensive agents  Cholesterol-lowering drugs  Smoking-cessation products  Weight-loss drugs  Antidepressant medications  Impotence drugs  Aspirin  Caffeine 22 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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

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

Nursing Assessment of Health Care Availability  Health disparity  Health literacy 25 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

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