Medication administration safety and clinical decision-making for elderly patients

Clinical Decision Making Process in Regards to Drug Therapy for the Elderly

The objective of this study is to examine how an undergraduate student nurse would use the clinical decision-making process in regards to drug therapy for the elderly. Included will be issues and considerations for clients from different cultural and indigenous groups. The nurse role is significantly involved in the preparation and administration of medications and therapeutic substances in elderly care.

Professional Legal and Ethical Implications of Medication Administration

It is reported that laws on administration of medication "vary from state to state." (Hauswirth, 2012) While doctors, physicians, physician assistants, nurse practitioners and nurses are "generally trained and authorized to administer medical, however, other medical disciplines are reported to be limited in administration of medications except in specific situations such as in residential care settings. It is also reported that the distribution of and access to medications that are able to be abused or those referred to as controlled substances are restricted by state and federal laws.

III. Factors In Administration of Medication to Elderly

Factors involved in administration of medications in the elderly include the patient's diet, renal function, ability to take medications orally, as well as other factors related to the patient's health status including cardiovascular changes and specifically the reduction in the hearts elasticity and the aorta and great arteries compliance. The result is a higher systolic arterial pressure in addition to "impedance to left ventricular ejection, and subsequent left ventricular hypertrophy and interstitial fibrosis." (Mangoni and Jackson, 2004) The elderly patient experiences changes in their stomach and primarily in regards to changes involving "the secretion of hydrochloric acid and pepsin, which are decreased under basal conditions." (Mangoni and Jackson, 2004) The liver is also affected by aging in regards to a "progressive reduction in liver volume and liver blood flow." (Mangoni and Jackson, 2004) Finally, there are body composition changes that are significant in the elderly in that there is reported to be a "progressive reduction in total body water and lean body mass, resulting in a relative increase in body fat." (Mangoni and Jackson, 2004)

IV. Pharmacodynamics and Pharmokinetics of Common Medications

Pharmacodynamics refers to what medication does when administered and pharmokinetics refers to what the body does with the medication. In the elderly, impact of the advances of aging results in the body's functions becoming impaired in the regulatory processes providing "functional integration between cells and organs." (Mangoni and Jackson, 2004) The result is a "failure to maintain homeostasis under conditions of physiological stress." (Mangoni and Jackson, 2004) This reduction in homeostatic ability is reported to negatively impact various regulatory systems in the elderly individual's body resulting in significant pharmacokinetic and pharmacodynamic changes. Included in pharmokinetic changes is a reduction in "renal and hepatic clearance and an increase in volume of distribution of lipid soluble drugs" and the prolonging of elimination half-life. (Mangoni and Jackson, 2004) Pharmacodynamic changes are reported to be such that "involve altered sensitivity to several classes of drugs such as anticoagulants, cardiovascular and psychotropic drugs. " (Mangoni and Jackson, 2004)

Summary and Conclusion

The nurse plays a significant role in the administration of medication to the elderly and therefore must be aware of the legal and ethical issues related to medication administration to those who are advancing in age. As well the nurse must necessarily be aware of the changes that the body of the elderly person is undergoing in order to safety administer medicine to this specific patient group.