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66 Cards in this Set

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Misfeasance
negligence; giving the wrong drug or dose that results in great harm patient's death
Nonfeasance
omission; omitting a drug dose that results in great harm patient's death
Malfeasance
giving the correct drug but by the wrong route that results in great harm patient's death
___ ____ ___ are state laws regarding drug administration by nurses and they vary from state to state.
Nurse Practice Acts
______ Sets standards for individual identifiable health information
Gives patients more control over their health records
HIPAA
Nurse’s primary obligation is to ________________.
The patient
Define geriatric patient
"The older adult", a person who is 65 years of age or older
Define frail elderly
All people older than 65 yrs of age who have one or more debilitating conditions
The “oldest old”
>85y/o
fastest growing population
Polypharmacy
Taking multiple medications simultaneously
One importance of Geropharmacology is to prevent/decrease ____ _____ _____ in the older population ( this causes 106,000 fatalities/yr.)
adverse drug reactions
0-39% of all persons are hospitalized because of ____ related problems
*2 examples?
drug

adverse drug reactions, noncompliance
There is a general decline in the _____ function of the elderly patient, which impacts drug therapy.
organ
Why would the older population have drug problems r/t noncompliance?
*a decrease in income means they cannot afford their drugs*
-forgetting to take their meds
-eyesight, taking the wrong drug or dose
why do the older adults have more problems with polypharmacy?
They are on more medications (prescribed, OTC, herbal, etc.) than the rest of the population
What adverse effects would the geriatric population have on the CNS?
changes in mental status because the BLOOD BRAIN BARRIER is not as selective in older adults
Why are renal tests not as accurate with the geriatric population?
loss of muscle mass = >creatinine. This will show abnormal results, but is normal for that person.
Problems with memory in the older population.
retrieval can be slowed *if not used on a regular basis* (use it or lose it*
How can older adults help with their memory problems?
memory aids
Changes with vision in the older population.
changes in the eyes leads to decreased vision
Changes in hearing with the older population
High frequency loss
equilibrium problems
more ear wax
Changes with respiratory system with the older population
weaker muscles
chest wall stiffens
increased use of accessory muscles
Changes in digestion/nutrition with the older population
decreased sense of taste
less efficient chewing
slower motility
Changes in Urinary elimination with the older population
*kidney: decreased blood flow*
*urinary muscles: hypertrophy of bladder muscle*

Will be on test
Changes in Musculoskeletal/Mobility with the older population
diminished muscle mass
degenerative changes in joints
changes in gait
The pharmacokinetic processes may be affected or impaired by the normal physiologic changes of aging BUT…the ___ ___ is more likely than age related changes to alter the older adults pharmacokinetics
disease process
Changes affect _______& _____ of the systemic availability of a drug.
extent and duration
Although absorption seems to be the least affected pharmacokinetic process during aging in the older adult , 1.____, 2._____ 3._____ ,& 4._____may influence the rate of absorption.
1. increase in gastric pH
2. decreased rate of blood flow
3. decrease in GI motility
4. decrease in BSA

Will be on test
The overall effects of aging on the__ __ _____ result in a slowed drug absorption rate.
Gastro Intestinal Tract
Several physiologic factors affect the distribution of a drug in older adults, including:
decreased ___ ____
reduced plasma ____ levels
less effective ____-____ ____
body mass
albumin
blood–brain barrier
Other age-related factors that may affect drug distribution include declining ______ _____, extreme changes in body weight, poor _____, dehydration, inactivity, and extended bed rest.
cardiac output
nutrition
________ efficiency gradually declines with age.
Metabolism
In the older adult, three major physiologic changes occur that effect metabolism:
1. the size of the liver changes.
2. blood flow to the ____ declines.
3. the ability to _____ drugs is reduced.
1. liver
2. liver
3. metabolize
Nurses may mistakenly interpret an older patient’s altered cognition as normal rather than the effect of a ____.
drug
Aging can substantially ______ renal efficiency.
decrease
A normal ______ level does not indicate normal renal function in elderly patients.
*creatinine

Will be on test
Because absorption is _______in the older adult, response to single doses of drugs is commonly delayed.
prolonged
The drug receptors in the older adult:
Do not function as efficiently
Decreases in the number of ______ are also associated with decreases in the respective neurotransmitters themselves.
receptors
Due to the older adult’s decreased ___ function and possibly ______ function, many drugs should be used with caution.
renal
metabolic
The Beers criteria
Is a list of possibly inappropriate medications for the elderly

*will be on test*
Use of inappropriate ____ may be a substantial problem in the current health care system.
drugs
The major organ systems (cardiovascular, respiratory, GI, genitourinary, endocrine, and others) all become much ___ ____ with advancing age.
less efficient
Decline in ____ function results in health problems that often require drug therapy.
organ
When assessing the older patient’s health status, assess for _________.
polypharmacy
_______ should always include a thorough inventory of all the drugs the patient is currently taking, dosage, and dosing schedule.
Assessment
Gaps in the knowledge of older adult patients indicate that _____ about drug therapy is needed.
teaching
Assess whether the older adult patient is taking the medication as _______.
prescribed
Assessment of several basic areas of ____ _____ is essential in drug therapy.
Swallowing difficulties?
Use of alt. medications?
BMs?
Exercise?
Dietary?
daily living
The ____ ____s of older patients is extremely important to their quality of life.
mental statu
____ regarding drug therapy should be considered when planning drug administration in the hospital.
Habits
Because older adults typically have ____ _____, question patients to determine whether their health insurance includes payment or partial payment for drug therapy.
fixed incomes
When assessing a geri patients ______, determine whether the patient lives alone or with other family members.
environment
When assessing a geri patients environment, assess the patient’s access to a _____.
pharmacy
Be sensitive to beliefs and ___ _____ that may have an effect on drug therapy.
cultural values
Some ethnic or cultural groups still practice ___ _____.
folk medicine
The number of some of the cytochrome P-450 isoenzymes, needed for drug metabolism, may vary based on ____ _____ traits.
genetic inherited
In order to maximize therapeutic effects,
_____ must be taken at the appropriate times.
dose
_______ does not always mean that the patient directly refuses to follow the recommended drug therapy schedule.
Nonadherence
In order to maximize therapeutic effects, make ____ ______ as easy to follow and as uncomplicated as possible.
drug regimens
Drugs should be used with great caution in older adults because these patients exhibit a narrow ___-_-____ ratio.
risk-to-benefit
Older adults are at increased risk for drug ____ or _____.
overdose or toxicity
Obtain a current _____ _____ and an accurate history of the patient’s usual abilities and changes in abilities or health status.
drug profile
___ _____ should be included in Pt. and family education to help prevent confusion
regarding drug use
times of administration.
Written instructions
Teach about expected or possible ___ _____ and
How to differentiate between them and normal signs of aging.
adverse effects
What can we, as nurses, do to help the geriatric population in regards to maximizing therapeutic effects and minimizing adverse effects? ____ _____
Health Teaching
(teaching aids, hearing aids, cleaning glasses, change tone of voice)