1. Chapters 6, 8, and 9 The Nursing Process, Drug Administration Throughout the Lifespan, Psychosocial, Gender and Cultural Influences on Pharmacotherapy

2. Chapter 6 The Nursing Process

3. Drug Administration Throughout the Life Span 8

4. Nursing Considerations Individuality of clients Nurse must consider the total patient in a holistic context Age, growth, and development of clients Relationship to pharmacokinetics and pharmacodynamics

5. Part 1 Pregnancy and Lactation

6. Drug Administration During Pregnancy and Lactation Many special considerations must be made How to treat illnesses or medical conditions that existed prior to the pregnancy with drugs Changes occur in endocrine, gastrointestinal, cardiovascular, circulatory, and renal systems

7. Changes During Pregnancy Absorption of drugs Abdominal/gastric changes affect absorption Inhaled drugs may be absorbed faster Distribution and Metabolism Changes in cardiac output, plasma volume, and regional blood flow change distribution and metabolism Drug excretion rates may increase

8. Definition: Teratogen A substance, organism, or physical agent to which a fetus is exposed that causes permanent abnormality, retardation, or death There are not “absolute” teratogens

9. Pregnancy Periods Preimplantation period: weeks 1 to 2 of first trimester Teratogen either causes death of the embryo or has no effect ***Embryonic period: weeks 3 to 8 Period of maximum sensitivity to teratogens Fetal period: weeks 9 to 40 or until birth Medications have prolonged duration of action

10. Five Pregnancy Categories of Drugs Developed by FDA No testing on humans possible, so data is sometimes limited Categories—A, B, C, D, X Gives no specific clinical information to help guide nurses or their patients about a medication’s true safety

11. Pregnancy Category A Drugs Studies performed with pregnant women No increased risk of fetal abnormalities shown

12. Pregnancy Category B Drugs Animal studies have shown no risk to fetus No studies done with pregnant women

13. Pregnancy Category C Drugs Animal studies have shown a risk to fetus No studies done with pregnant women

14. Pregnancy Category D Drugs Risk to fetus shown Benefits outweigh risk

15. Pregnancy Category X Drugs—Contraindicated Studies done with animals or pregnant women Fetal abnormalities shown

16. Pharmacology and Breastfeeding

17. Drugs Secreted Into Breast Milk Fortunately few instances of harm to infant Dangerous drugs usually have safe alternatives Drugs that are ionized, water soluble, or bound to plasma proteins less likely to enter breast milk

19. Factors That Affect Drug Exposure Through Lactation Time between drug administration and breast feeding Mother’s use of illicit drugs Amount of drug administered Amount that reaches fetus tissue Infant’s ability to metabolize drug

20. Patient Education Nurse should place focus on drug education of pregnant or lactating mother Thoroughly informed of risks to self and child

21. Medicating the Infant

22. Infants and Pharmacotherapy Birth to first 12 months Safety of child is primary Have child ingest all medication; difficult to estimate how much lost if spit up Nurse/parent should be aware of special procedures for drug administration Example: child should be held and cuddled while administering medication

23. Toddlers and Pharmacotherapy Period from 1 to 3 years Proper storage of drugs; no toddler access to medications Short, concise explanations; provide comfort after Oral drugs can be mixed with foods like jam or syrup Injections are given at specific locations with toddlers

24. Preschool and School Aged Children

25. Preschoolers and Pharmacotherapy 3 to 5 years of age Safe storage Can begin to assist with medications Brief explanation followed by administration Mix oral drugs with food or flavored beverages

26. School-Age Children and Pharmacotherapy Most children healthy in this period Offer longer, more detailed explanations Praise cooperation Offer choices when appropriate

28. Adolescents

29. Adolescents and Pharmacotherapy Need understanding and respect Educate about Hazards of tobacco and substance abuse Sexual intercourse Eating disorders Provide important medication information Allow time for questions Needs privacy and control

30. Young Adults and Pharmacotherapy Minimal need for prescription drugs unless chronic diseases or immune-related conditions exist Positive medication compliance Educate about substance abuse and treatment of sexually transmitted diseases

31. The Middle-Aged Adult

32. Middle-Aged Adults and Pharmacotherapy Changes begin around 45 years of age Prescribed drugs for stress-related illnesses Numerous life transitions Positive lifestyle changes could prevent drug therapy

33. Illnesses Requiring Drug Therapy for Late Middle-Age Adults Cardiovascular disease Hypertension Diabetes Cancer Obesity

34. The Older Adult

35. Older Adults and Pharmacotherapy Take multiple medications concurrently, or polypharmacy, is common Some predictable ailments, but much variability remains More adverse drug events in geriatric patients Reminder aids for administration may be used

36. Older Adults and Pharmacotherapy (cont'd) Maintain independence and dignity Reminder aids for drug administration may be beneficial

37. Absorption of Drugs Slower in Older Adults Diminished gastric motility Decreased blood flow to digestive organs Increased gastric pH

38. Distribution Diminished in Older Adults Increased body fat Reduced plasma level Less body water

39. Distribution Diminished in Older Adults (cont'd) Liver produces less albumin Decreased plasma protein–binding ability Increased levels of free drugs Increases potential for drug-drug interaction Decreased cardiac output

40. Metabolism Reduced in Older Adults Reduced first-pass metabolism Decreased production of liver enzymes Plasma level elevated Increases half-life of many drugs Tissue concentrations increased

41. Excretion Reduced in Older Adults Reduced renal blood flow Reduced glomerular filtration rate Decreased active tubular secretion Decreased nephron function Decreased drug excretion for drugs processed by the kidneys

42. Chapter 9 Psychosocial, Gender, and Cultural Influences on Pharmacology

43. Holistic Approach Each person: integrated biological, psychosocial, cultural, communicating whole person

44. Human Integration Pyramid Framework of human functional environment and interrelationships Impacts success of pharmacotherapy These dimensions often overlooked Levels interconnected and interdependent Holistic approach seems incompatible with Western medicine; nurse must focus on holistic approach

45. The human integration pyramid care model

46. Strong Spiritual or Religious Beliefs Affect Pharmacotherapy Outcomes Suffering Loneliness Despair Death Meaning Value Hope

47. Better Drug Compliance If client believes treatment is important and beneficial

48. Outcomes of Pharmacotherapy Influenced by Past experiences with medications Acceptability of taking medication in social environment Certain drugs carry social stigma Client’s attitude toward personal health Client’s expectations of pharmacotherapy

49. Ethnicity and Culture Ethnicity - biologic and genetic similarities Culture - set of beliefs, values, and norms that provide meaning for an individual or group Both have profound influence on medication outcomes

50. Variables of Culture and Ethnicity That Impact Pharmacotherapy Diet Alternative therapies Beliefs of health and illness Genetic differences

51. Cultures May Use Herbs and Alternative Therapies Along with modern medicines In place of modern medicines

52. Community Factors That Affect Pharmacotherapy Urbanization levels Age distributions Socioeconomic levels Occupational patterns Industrial growth

53. Influence of Illiteracy on Health Care 48% of English-speaking population is functionally illiterate Prevents client from being able to read drug labels Prevents understanding of written treatment instructions Prevents reading of brochures regarding medication or disease

54. Influence of Illiteracy on Health Care (cont'd) Prevents understanding of importance of pharmacotherapy Nurse may need to make extra effort to educate patients with illiteracy or that speak a foreign language

55. Genetic Polymorphisms Two or more versions of the same enzyme Caused by single-base mutation in DNA Amino acid change in enzyme Enzyme function changes Pharmacogenetics - study of genetic variations that cause differences in the way patients handle medications

56. Gender Differences