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Chapter 5
Lifespan and Cultural Modifications
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Chapter 5
Lesson 5.1
Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
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Learning Objectives
• Identify specific considerations in
administering medications to pediatric,
pregnant, breastfeeding, or elderly
patients
Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
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U.S. Food and Drug
Administration (FDA)
• Establishes standards that require drug
companies to provide consumers with specific
drug information
• Information printed on product package insert
(PPI)
• Information includes:
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Description of therapeutic response
Side effects
Adverse effects
Possible drug interactions
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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
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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
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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 in premature infants,
has a greater ability to absorb some chemicals
because of its greater hydration.
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Distribution
• Two factors
– The chemical properties of the drug (do not
vary)
– The physiologic factors specific to the
patient (do vary)
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Metabolism
• The majority of drug metabolism, or
biotransformation, takes place in the liver.
• In general, drug metabolism in infants is much
slower than that 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.
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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
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Adverse Drug Reactions
• Children are exposed to drugs directly
and indirectly.
– Transplacentally during pregnancy or
delivery
– Direct administration
– Through ingested breast milk
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The Geriatric Patient
• React differently to medications than younger
adults
• 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
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Geriatric Patient Teaching
Drug non-adherence related to:
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Drug cost
Difficulty obtaining
Diminished cognitive abilities
Lack of desire to take on schedule
Depression
Feelings of being overwhelmed with physical
needs
– Physical disabilities requiring assistance to
administer
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Chapter 5
Lesson 5.2
Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc.
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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
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Medications Used by Women
• Females differ from males in hormonal
make-up.
• Medication needs often related to:
– Genital tract infections
– Menstruation
– Infertility
– Pregnancy
– Menopause
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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
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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
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Childhood Immunizations
• Essential for personal and national
protection
• Factors related to delay in receiving
– Healthcare provider belief of need to delay
related to symptoms of mild illness
– Parental refusal from concern over adverse
effects
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Medications Used Throughout
the Lifespan
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Antidiabetic agents
Antihypertensive agents
Cholesterol-lowering drugs
Smoking-cessation products
Weight-loss drugs
Antidepressant medications
Impotence drugs
Aspirin
Caffeine
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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
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Nursing Assessment of
Healthcare Availability
• Health disparity
• Health literacy
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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
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