Begin assessing an elderly patient by obtaining a complete history of medications used by the patient. This includes all prescription drugs, over-the-counter drugs, home remedies, vitamins, and herbal treatments. Make sure that you determine the medications that have been prescribed and medications that the patient actu-ally takes. Include those that are taken at the patient’s discretion. Some patients don’t take all of the medications that are prescribed to them because of the cost of the medication or some unpleasant or undesirable side effects. Also note how often the medications are taken.
List all practitioners who prescribed medications for the patient, including the patient’s primary physician, orthopedist, and cardiologist. Create a list of all phar-macies providing medication to the patient. Review the expiration dates for all medications. Ask the patient how they self-medicate, if they maintain a medica-tion schedule, and if they ever forget to take their medicamedica-tion. If they do, ask what medications they’ve skipped and what they do when they forget or skip a dose.
Determine if the patient has any barriers to taking medication safely such as allergies, physical handicaps, memory loss, cultural beliefs, and financial con-straints. Also, learn if the patient has support from family, friends, and neigh-bors. Most importantly, be aware of the cost of medication prescribed to the
patient. The elderly typically live on a fixed income and may be unable to pur-chase expensive medications—even if the benefit outweighs the cost. Always keep medication for the elderly simple and to a minimum.
Summary
There are five steps in the nursing process. These are assessment, diagnosis, plan-ning, intervention, and evaluation. The assessment step collects data about the patient that is analyzed to arrive at a nursing diagnosis. A care plan is then devel-oped that describes what must be done to address the symptoms of the nursing diagnosis. The care plan is then enacted during the intervention step and the results are then evaluated. The care plan terminates if the goals of the plan are achieved or revised if the goals are not achieved. Before any medication is given to a patient, the nurse must assess a number of factors that include the drug order, drug actions, interactions, and contraindications.
Educating the patient about medication is an important responsibility for the nurse. The nurse must explain why the medication is given and how the patient can self-medicate. The nurse must also make sure that the patient and the family know the signs and symptoms of adverse side effects from the medication as well as any toxic effects and dietary considerations to follow while taking the medication.
Cultural factors typically influence the patient’s belief about health and can impact medication prescribed to treat a patient’s illness. The nurse must put aside his or her own opinion about those beliefs and work within those limita-tions when caring for the patient.
Genetic, ethnic, and racial differences play a role in the physiological response to drugs. Some groups of patients are less responsive to certain medications be-cause of genetic factors; other groups of patients can experience a toxic effect because of hereditary traits.
Drugs can have different effects on the very young and the elderly because of physiological changes in their bodies. The very young have immature organs that are not yet able to metabolize, absorb, distribute, and excrete cer-tain drugs.
Likewise, the elderly have mature organs that might have lost the capability to properly process medication. Furthermore, the elderly may require multiple medications simultaneously that can result in drug interactions that produce adverse side effects.
Quiz
1. A medical diagnosis
(a) is the same as a nursing diagnosis.
(b) identifies the disease that inflicts the patient.
(c) is a problem statement that identifies the potential or actual health problem.
(d) None of the above.
2. An expected outcome is
(a) the patient’s condition after a care plan is executed.
(b) the goal of a care plan.
(c) adverse reaction to a medication.
(d) a side effect to a medication.
3. After the patient is shown how to self-medicate, the nurse should (a) show a film to the patient on self-medication.
(b) make sure the patient’s family is shown how to medicate the patient.
(c) make sure the patient has the prescription for the medication.
(d) ask the patient to demonstrate how he or she will self-medicate.
4. A healthcare provider should administer medication to a patient even if the patient’s cultural beliefs disagree with receiving medication.
(a) True (b) False
5. A infant receives a full dose of the drug given to its mother when the infant breastfeeds.
(a) True (b) False
6. A dose for a pediatric patient is determined by (a) the patient’s weight.
(b) the patient’s height.
(c) the patient’s age.
(d) the patient’s sex.
7. Adverse reaction to medication is a leading cause of death in elderly patients.
(a) True (b) False
8. Which of the following is a type of intervention?
(a) Nurse-initiated
(b) Physician or advanced practitioner initiated (c) Collaborative
(d) All of the above
9. Knowledge deficit related to language difficulties is a common nursing diagnoses related to drug therapy.
(a) True (b) False
10. NANDA is a guide to nursing diagnosis.
(a) True (b) False