geri week 7

  1. Age related changes that affect the actions of bioactive substances in the body: Diminished renal function (3)
    • Effect on concentration of bioactive substances
    • decreased clearance of water soluble medication
    • Consider medications with a narrow therapeutic range
  2. Cont: Diminished Hepatic Blood Flow (2)
    • Serum concentration of medications affected by liver metabolism
    • Volume of distribution also affected
  3. Cont: Slower function of cytochrome p-450 system (2)
    • Enzymes responsible for metabolism of medications
    • Clearance of medications is delayed in older adults
  4. Cont: Decreased in total body water, increase in proportion of body fat to lean body mass, and decreased serum albumin levels: (4)
    • Higher serum concentrations
    • Lower serum concentrations
    • prolonged duration of action
    • therapeutic versus adverse effects
  5. Factors that affect bioactive substances (6)
    • Receptor sensitivity in the brain
    • thermoregulation
    • fluid regulation
    • baroreceptor control of blood pressure
    • body size
    • gender
  6. Changes that affect behaviors related to taking bioactive substances
    • Age related changes
    • functional impairments
  7. Risks factors that affect bioactive substances (5)
    • Attitudes of the older adults
    • Level of knowledge
    • Socioeconomic issues
    • health care providers
    • myths
  8. Pathologic processes and functional impairments (2)
    • Medication -disease interactions: effect of the disease on medications, therapeutic effect of medications can be affected by the disease process
    • Potential for adverse effects
    • Pathologic conditions themselves can affect adherence to medication regimens.
  9. Behaviors based on myths and misunderstandings (4)
    • medications are a quick fix for symptoms
    • over the counter medications are safe
    • prescribing patterns of health care practitioners
    • Nurses should always consider the beliefs of the older adult related to treatment of illness and disease
  10. Communication barriers
    • Reluctance of older adults to question treatment and medications
    • lack of confidence in communication skills
    • hearing difficulties
    • attitude of the health care practitioner
    • language barriers
  11. inappropriate prescribing practices (4)
    • beers criteria: identification of medications that are not appropriate for use in the older adult
    • anticholinergic drugs, tricyclic antidepresseants, antipsychotics, barbiturates, and benzodiaazepines
    • psychoytropic drug use in long-term care
    • recent research utilizing the beers criteria
  12. Polypharmacy and inadequate monitoring of medication (3)
    • Use of multiple medications with the increased prevalence of multiple chronic conditions
    • Potential for drug interactions and adverse side effects
    • need for medication monitoring - barriers in the older adult population
  13. Medication nonadherence: financial concerns and other contributing factors (5)
    • Medication nonadherence/noncompliance
    • factors contributing to nonadherence
    • cost of medications
    • lack of health insurance for prescription medication
    • medicare part d prescription drug program
  14. Insufficient recognition of adverse medication effects (40
    • multitude of potential causes for adverse medication effects in the older adult
    • prescribing cascade
    • adverse effects more common with advancing age
    • often unrecognized
  15. Medication Interactions (3)
    • Interact with almost any other substance
    • prescription and over the counter medication
    • consequences of medication interactions
    • - altered therapeutic effects
    • - risk for adverse effects
  16. Medication-medication interactions (4)
    • number of medications taken
    • serum levels affected
    • ex. warfarin
    • medication-herb interactions also common
  17. Medication and nutrients (5)
    • Interactions may affect the nutrient itself of the medication effects
    • Common nutrients that affect medication
    • Serious consequences in the older adult
    • altered absorption in the stomach
  18. Medications and alcohol (5)
    • CNS depression
    • health care providers often do not accurately assess an older adult's alcohol consumption
    • over-the counter preparations may have alcohol as an ingredient
    • older adults are more susceptible to interactions between alcohol and medications
    • increased risk for adverse effects
  19. Other interactions (2)
    • Medications and caffeine: caffeine not only in beverages, affects action of medication
    • Medication and nicotine: affects therapeutic action of the medication, dosages of medications may need adjustment
  20. Function consequences associated with bioactive substances (3)
    • increased potential for altered therapeutic action with risk factors
    • Consequences of adverse effects
    • medication interactions with other substances
  21. Adverse medication effects (4)
    • residents long term care facilities
    • anticholingeric toxicity
    • altered mental status
    • tardive dyskinesia
  22. Linking medication assessment to overall assessment
    Identify clues to problems or complaints

    Assess for residual adverse effects

    Expected versus actual outcomes of medication interventions

    Functional ability to take medications

    Assessment of the living environment

    Risks for nonadherence
  23. Nursing diagnoses (4)
    • Instrumental self-care deficit
    • noncompliance
    • other nursing diagnoses for adverse effects of medications are also appropriate
    • readiness for enhances therapeutic regimen mangamen
  24. planning for wellness outcomes (6)
    • adherence to therapeutic regimens
    • identification and prevention of adverse effects
    • compliance behavior
    • health promoting behaviors
    • knowledge
    • self-care
  25. Nursing interventions to promote healthy medication-taking patterns
    Teaching about medications

    –Written list of all medications

    • –Questions for health care
    • providers

    • –Communication with health care
    • providers
    • Education about herbs and other bioactive substances
  26. Addressing factors that affect adherence (4)
    • identification of methods to improve adherence
    • address factors that interfere with adherence
    • support independence
    • address potential financial barriers
    • -generic medications
    • - prescription assistance programs
  27. Decreasing the number of medications (6)
    • reduces the risk for adverse effects
    • evaluation of all medications used
    • communication with prescribing practitioners
    • utilize hospital admissions to evaluate medication
    • evaluation of PRN medications
    • evalution of medications for behavioral management in longterm settings
  28. Evaluating the effectiveness of nursing interventions (4)
    • Safety
    • effectiveness
    • medication-taking behaviors
    • therapeutic effects
Card Set
geri week 7
geri week 7