1.
Alcohol: The most commonly consumed nonprescription drug used by adults.
Most older adults do not think of alcohol as a drug, so they do not think about it when taking meds.
Alcoholic beveragess can cause adverse reactions when taken in conjunction w/prescription and OTC drugs.
2.
Assessment: Nurses must be sure to assess older residents thoroughly before administering any medications.
After admin., nurses s/monitor older adults continually to determine whether med is having desired effect.
Residents s/also be observed for any ontoward effects or significant changes in medical condition or behavior of older person.
Nurses s/be particularly watchful for any signs of overdose or toxicity.
3.
Cognitive Changes: Lack of literacy skills needed to read labels an directions
Inability to understand and comply w/directions
Inability to make correct judgments about medications
May not recognize that they have to take medication
4.
Factors that Increase risk for Medication-Related Problems: Drug-testing methodology
Physiologic changes related to aging
Use of multiple medications
Cognitive and sensory changes
Knowledge deficits
Financial concerns
5.
Financial Factors/Saving Money: Older adults living on limited incomes may fail to take their medications or may make changes in the amount or frequency to conserve their supply.
Many frugal older adults save medications that were prescribed in the past, even if the drugs are no longer part of their therapy.
Often reluctant to discard costly medications, holding on to them "just in case" they are needed again.
6.
Geropharmacology: Study of how older adults respond to medication is a new but growing area.
The methodology used to test drugs and to establish therapeutic dosages does not take into account the unique characteristics of older adults.
Because older adults normally have had some changes in body function and are more likely to suffer from at least one disease process, they are not physiologically the same as younger adults.
7.
In the home: The responsibility of assessing medication-taking behaviors and teaching safe self-administration often falls to home health care nurse.
Because meds are a significant part of the medical plan of care, older adults who live independently must learn to take them properly.
8.
Medications: Can alter aging perons's ability to perform normal functions, can result in behavior changes, and can be life-threatening.
Adverse reaction to meds common in older adults.
9.
Nursing Intervention and Precautions: Could include use of safety devices, call signals, behavior monitoring, or any other specific precaution related to medications.
Care plan s/indicate when it is necessary to check vital signs, monitor lab values, or make any other special observations.
All parameters specified by physician s/be readily identified in care plan.
10.
Nursing Interventions related to Med. Admins.: R resident
R med
R amount
R dosage form
R route
R time
R documentation
R therapy (JACO)
11.
OTC PREP.: Many do not think of OTC meds. as real drugs, because no prescription is needed to purchase them.
OTC meds. are capable of potentiating or interfering w/effects of prescription meds., possibly resulting in serious harm.
Can also create or mask symptoms of disease
12.
Patient's rights: Right to know what medication they are receiving and why they are receiving it
Right to refuse to take medication
Right to privacy during injections or any other such procedures
Use of psychotropic drugs as chemical restraints presents a risk to rights of older adults
13.
Polypharmacy: The prescription, administration, or use of more medications than are clinically indicated, is a common problem in older adults.
14.
Prescription Medications: Directions provided may be very clear to a knowledgeable health care professional, but they are often misunderstood or misinterpreted by older adults.
Even simple misunderstandings can lead to improper self-medication and result in serious consequences
To reduce risks, older adults often require additional instruction.
15.
Safe Drug Admin.: Before administering a med, nurses s/have following info.:
Therapeutic effects of med.
Reasons this individual is receiving med
Normal therapeutic dosage of med
Normal route or routes of admin.
Any special precautions related to admin.
Common side effects or adverse effects of med.
16.
Safety and Noncompliance: Cognitive and sensory limitations
Special precautions and complicated time schedules
To reduce the risk for noncompliance, nurses s/encourage older adults to talk to physician and/or pharmacist to see whether there is any safe way to reduce the # of meds or simplify the medication schedule.
Associating med schedules w/ regular daily events
Explain importance of preparing med in a well-lit area
Ensure that containers are properly labeled.
Apply color codes, tape strips, pictures, or textures to help older adults recognize them.
Modify containers for ease of use.
Establish measures to distinguish and separate similar containers
Teach to store medications properly.
17.
Self-Medication and Older Adults
In an Institutional setting: 1. Delivery of adequate amounts of medication
2. Safe storage of medications that will be kept at bedside
3. Record-keeping of meds. taken
4. Follow-up assessments of med effectiveness or side effects.
Under OBRA legislation, residents of care facilities s/have option of self-medication if they are capable of doing so safely.
Physician's order stating self-medication is permitted is usually required.
18.
Sensory Changes: Vision changes may render an older person unable to read a medication label or to recognize the different sizes, shapes, or colors of various medications.
Adequately assessing person's ability to read labels accurately, by proper teaching, and by using special labesl or magnifying devices that facilitate safe administration.
19.
Sharing Med w/friends or relatives: Practice is common and persits because many older adults are unaware of dangers
All people must be aware that it is not safe to take a med. prescribed for someone else.
20.
Table 7-2: pg. 121
Aspirin-bleeding
Lasixs-dehydration
Digoxin-bottom out; bradycardia
21.
Teaching Older Adults About Medications: Info to Include on Med Teaching Sheets. box 7-8 128
Older adults and their families or significant others s/be given complete info about the prescribed meds and the proper method for taking them.
