Topic_3_-_Drug_Therapy___Life_Span_Considerations____3_

Drug Therapy and Life Span Considerations

Objectives

  • Differentiate components of pharmacokinetics and pharmacodynamics for pediatric and geriatric clients.

  • Identify medication safety principles for pediatric and geriatric populations.

  • Recognize factors that affect medication adherence across the lifespan.

  • Discuss issues impacting older adults’ adherence to therapy.

  • Describe nursing implications for drug therapy in pediatrics and geriatrics.

Geriatric Considerations

Aging Population

  • Physiologic changes:

    • Reduction in total body water and lean body mass.

    • Decrease in kidney and liver mass and function.

    • Reduced capacity for maintaining physiological equilibrium.

Pharmacokinetics

  • Absorption, Distribution, Metabolism, Excretion.

Pharmacodynamics

  • Age-related changes in CNS and cardiovascular systems.

  • Variation in drug receptor quantities and sensitivity.

  • Decreased compensatory response to physiological changes.

Nursing Implications: Older Adult Drug Dosing and Monitoring

  • Polypharmacy risks and drug therapy considerations.

  • Beers criteria for inappropriate drug use.

  • Renal dosing and drug interactions.

  • Provide safety information.

Adverse Drug Events

  • Types include adverse reactions, medication errors, therapeutic failures, withdrawal events, overdoses.

Adherence Issues

  • Factors influencing nonadherence (under-dosing or overdosing) include lack of understanding of drug regimens.

  • Importance of medication education.

Health Teaching with Older Adults

  • Enhance client’s senses: clean eyeglasses, functional hearing aids.

  • Communication strategies: Speak clearly, face the client, limit distractions.

  • Respect client’s ability to learn, use large print teaching aids.

  • Review medications at each visit, encourage a list of drugs at appointments.

  • Monitor for confusion with new prescriptions and use memory aids.

Nursing Process: Client-Centered Collaborative Care

Assessment

  • Identify assessment cues related to elderly medication use.

Nursing Diagnoses

  • Ineffective health maintenance or knowledge deficits related to cognitive limitations.

Planning

  • Establish goals for elderly clients prescribed medications.

Nursing Interventions

  • Determine actions to meet medication goals and evaluate interventions.

Pediatric Considerations

Pediatric Pharmacology

  • Issues in research (informed consent, drug labeling, dosing).

  • Pediatric Research Equity Act for pediatric drug study requirements.

Pediatric Pharmacokinetics

  • Absorption: Influencing factors include age, health status, and route of administration.

  • Distribution: Depends on body fluid and tissue composition, protein-binding capability.

  • Metabolism: Affected by the child's maturational level and liver function.

  • Excretion: Infants have decreased renal blood flow and function.

Nursing Implications

  • Monitor for therapeutic effects and adverse reactions in pediatric dosing.

  • Account for developmental and cognitive differences in drug administration.

  • Ensure family-centered care.

Adolescent Considerations

  • Individualized care based on developmental stage, cognitive abilities, and emotional factors.

Nursing Process: Family-Centered Collaborative Care

Assessment

  • Assess medications for pediatric clients.

Nursing Diagnoses

  • Common diagnoses related to knowledge deficits and risk for injury.

Planning

  • Develop goals for pediatric clients regarding medications.

Nursing Interventions

  • Define appropriate interventions to achieves planned goals.

Evaluate Outcomes

  • Assess if goals have been met for pediatric clients.

References

  • McCuistion, L. E., Vuljoin-DiMaggio, K., Winton, M. B., & Yeager, J. J. (2023). Pharmacology: A patient-centered nursing process approach (11th ed.). Elsevier.