Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
34 Cards in this Set
- Front
- Back
|
Growth
Development |
term that characterizes the progressive increase in physical (bodily size)
Is a related term that refers to the FUNCTIONAL changes in the physical, psychomotor, and cognitive capabilities of a living being. Growth and physical generally progress together, the other two don't. |
|
|
Development of a person is a complex process that links the
|
biophysical with the psychosocial, ethnocultural, and spiritual components to make ea. individual a unique human being.
|
|
|
Pregnancy
|
in general, drugs that are water soluble, ionized, or bound to plasma proteins are less likely to cross the plasma
Major physiological and anatomical changes occur in the endocrine, GI, cardiovascular, circulatory, and renal systems of clients. |
|
|
Absorption
|
pressure of expanding uterus on blood supply to abdominal organs affect absorption of drugs given. Gastric emptying delayed GI slowed by progesterone - longer absorption time for oral drugs. gastric acidity - decreased. Increased tidal volume (absorption of inhaled drugs easier!)
|
|
|
Distribution and Metabolism
|
increase cardiac output, increase plasma volume, and change regional blood flow. Increased BV - dilution of drugs and decreases plasma protein concentrations. blood flow to uterus, kidnesy and skin is increased (less in skeletal muscles). 3rd trimester - changes in lipid levels. Drug metabolism increases for certain drugs -anticonvulsants (need more of drug)
|
|
|
Excretion
|
by 3rd trimester, blood flow through kidneys increase 40%-50%. Rate of excretion may be increased - affecting dosage timing and onset of action
|
|
|
Focus in Prenatal Stage
|
Pharmacologically - must be to eliminate potentially toxic agents that may harm the mother or unborn child. Teratogens - agents that cause fetal malformations - 3% of teratogenic events in all pregnancies.
|
|
|
Drugs on ovum and fetus
|
before implantation, ovum not affected by maternal use of drugs (no vascular exchange yet). Nicotine - can create a negative ENVIRONMENT and cause fetal damage - growth retardation
|
|
|
1st trimester
|
58-60 days, fetus at greatest risk for developmental anomalies while skeleton and major organs are developing. Drug therapy should be delayed until AFTER the 1st trimester when possible
|
|
|
2nd Trimester
3rd Trimester |
4-6 months - Nurse teaching is vital at this point, still could cause harm to baby
7-9 months - more stuff flows btwn mom and fetus. Fetus can't metabolize or excrete well. Duration of drug in baby is longer |
|
|
Review FDA Pregnancy Categories
A, B, C, D, X Examples of D or X categories |
p78
associated with teratogenic effects: testosterone, estrogens, ergotamine, ACE inhibitors, tetracycline, Depakote, warfarin, and more |
|
|
No prescription drug, OTC medication, herbal product, or dietary supplement should be taken during pregnancy unless the physician verifies that the therapeutic benefits to the mother clearly outweigh the potential risks for the unborn.
|
C categories - (many drugs in here) because very high doses often produce teratogenic effects in animals.
|
|
|
Pregnancy registries
|
will help identify medications that are safe to be taken during pregnancy. These registries gather info. from women who took medications during pregnancy. Ex - Antipyschotic, antiretroviral, asthma, epilepsy, rheumatoid arthritis, immunosuppressant medicines
|
|
|
Lactating Client
|
CNS medications very lipid soluble and pass through milk and affect baby. Protein binding rugs remain in maternal plasma (warfarin DOES NOT come through). IF you gotta administer it, do it AFTER breastfeeding. NO radioactive drug and breastfeeding!
|
|
|
Recommendations for medication given during lactation:
|
1. Drugs w/ shorter half-life are preferable. Mom doesn't breastfeed while drug is at its peak level.
2. Choose drugs w/ high protein binding ability so they don't get into breast milk and 2 obvious others! |
|
|
Nurse should do history and prenatal assessment to :
|
Eliminate potentially hazardous substances, substitute alternative drugs, or adjust medication dosages.
DO TAKE: iron, folic acid, and multivitamin supplements as prescribed during pregnancy. Some adverse drug reactions similar to discomforts of pregnancy. |
|
|
Drug Administration during childhood, factors to consider:
|
Physiological variations, maturity of body systems, and greater fluid distribution in children. These factors can exaggerate or diminish effectiveness of pediatric drug therapy. Almost all are calculated on infant's weight in kg.
|
|
|
Infancy
|
0-12 months. Medication often given via droppers into eyes, ears, nose or mouth. or tasty oral drugs through a bottle nipple. drops - buccal pouch for them to swallow. Use small needle and vastus lateralis (no gluteal site) for IM injections. (for children under 3 and infants).
|
|
|
Infancy cont'd
|
IV site - feet and scalp, and secure it! Medications are often prescribed in mg per kg per day. or body surface area. Liver and kidney are immature - drugs prolonged duration of action - greater impact. Natural immunity a child receives from the mother in utero slowly begins to decline. Immunizations.
|
|
|
Toddlerhood
|
1-3 years. Nurse teaches about things put into toddlers mouths! Give short, concrete explanations followed by immediate drug admin. physical comfort important! Oral administration mixed w/ small amount of jam, syrup, etc. . .
|
|
|
Children are not merely small adults; they have unique differences . . .
|
in physiology and biochemistry that may place them at risk in drug therapy. 28 drugs investigated in children and 18 labels changed to incorporate results of research findings.
|
|
|
Preschool Child
|
3-5 years old. After child has been walking for a year - ventrogluteal site may be used for IM injections, less pain than vastus lateralis, no on scalp veins - use peripheral veins for IV. Similarities to treating a toddler. Play act troubling experiences w/ dolls to feel safer about drug admin.
|
|
|
School Age Child
|
6-12 years. Child is pretty healthy. Better cooperation w/ nurse! Child can understand longer explanations. Offer choice:ex. which drug first and praise. Can use other sites now for IM injections, although ventrogluteal preferred.
|
|
|
Adolescence
|
13-16 old. Abstract thinking, logical conclusions. Skin problems, headaches, menstrual symptoms, and sports related injuries. contraceptive info. anorexia, bulimia, use of amphetamines (delay onset of fatigue) and anabolic steroids- athletes. Privacy and control in drug administration - treat like an adult. Like explanations.
|
|
|
Young Adult
|
18-40 yrs. -at physical peak, in good health including metabolism of drugs, good medication compliance, possible substance abuse
|
|
|
Middle Aged Adults
|
40-65 old. At 45, numerous transitions occur that often result in excessive stress - causing body to react. "Sandwich generation". Instead of medication, positive lifestyle changes may be better. CV disease, hypertension, etc begin to surface. Adult-onset of diabetes mellitus emerge. Antidepressants
|
|
|
Older Adults
|
65 and older. During 20th cent., an improved quality of life and the ability to effectively treat many chronic diseases contributed to increased longevity. BUT as they age, increase # of chronic health disorders and they take MORE drugs.
|
|
|
Polypharmacy
|
taking of multiple drugs concurrently. Commonplace among older adults. Increases risk for drug interactions and side effects. Variability exist in aging clients. Nurse assesses if client needs assistance in self admin. of drugs.
|
|
|
Older clients experience more . . .
|
adverse effects from drug therapy than does any other group. Some due to polypharmacy, some are predictable simply due to the aging process. Degeneration of organs, unreliable compliance, multiple and severe illness. Immune system fx diminishes - infection occurs more frequently.
|
|
|
Absorption
|
SLOWER in aging adult, slower gastric motility and decreased blood flow to digestive organs. Increase gastric pH slow absorption of medications that require high acidity to dissolve
|
|
|
Distribution in older adults -part 1
|
Increased body fat in older adult - larger storage of lipid soluble drugs and vitamins. plasma levels are reduced and therapeutic response is diminished. Dehydration increase risk for drug toxicity. Increase of conc. of water-soluble drugs, because the drug is distributed in a smaller vol of water.
|
|
|
Distribution in older adults-part2
|
Less albumin, decrease in plasma protein binding ability - Increased level of free drug in bloodstream, increasing potential for drug-drug interactions. Decrease in cardiac output -less efficient blood circulation - slows drug distribution. Start with SMALLER dosage and slowly increase to safe, effective level.
|
|
|
Metabolism in older adults
|
liver's production of enzymes decrease, reduced hepatic drug metabolism. Increase in half life of drugs. Reduces first pass. Altogether, it changes the standard dosage, interval btwn doses, and duration of side effects
|
|
|
Excretion of aging adults
|
Reduced renal blood flow, etc increases potential for toxicity increase. Note: Common etiology of adverse drug reactions is accumulation of toxic amounts of drugs secondary to impaired renal excretion.
|
