NRG 303 – MIDTERM
facial expressions have been shown to communicate across
CHAPTER 5: COMMUNICATING WITH OLDER ADULTS
COMMUNICATION IS THE PROCESS OF EXCHANGING
INFORMATION: SENDING MESSAGES BACK AND FORTH BETWEEN
INDIVIDUALS OR GROUPS OF PEOPLE.
EFFECTIVE COMMUNICATION REQUIRES THE FOLLOWING:
The need or desire to share information.
Acceptance that there is value and merit in what the other
person has to say, demonstrated by a willingness to treat the
other person with genuine dignity and respect.
Understanding of factors that may interfere with or become
barriers to communication.
Development of the skills and techniques that facilitate
effective interchange of information.
INFORMATION SHARING (FRAMING THE MESSAGE)
Verbal communication - involves sending and
receiving messages using words. It can be formal, structured,
and precise; some is informal, unstructured, and flexible.
Formal or therapeutic communications - have a specific intent
and purpose. It is type of communication looks easy and
natural when performed, but it is a skill that requires time,
effort, and practice to develop.
Informal or social conversations - are less specific and are used
for socialization. Small talk; pleasantries; and conversations.
NONVERBAL COMMUNICATION
SYMBOLS - In the health care setting, uniform styles and colors
help patients distinguish the various caregivers.
TONE OF VOICE - is one of the most influential elements of
communication. There is a factor in the sound of your voice that
give meaning (conscious and unconscious) to the message
you’re sending.
BODY LANGUAGE - Another part of nonverbal communication
involves watching for the messages that patients are
communicating to us through their body language.
SPACE, DISTANCE, AND POSITION
o Proxemics - the study of the use of personal space in
communication
o Personal space - refers to how close we allow someone
to get to us before we feel uncomfortable
o Public space - a distance of 12 feet or more away
o Social space – a distance of between 4 and12 feet
o Personal space - a distance of 18 inches to 4 feet. A
nurse who communicates from within this space is
usually viewed as concerned and interested.
GESTURES - are a specific type of nonverbal communication
intended to convey ideas. Are highly cultural and generational:
some that are acceptable in one culture may be offensive in
another. Are helpful for people who cannot use words.
FACIAL EXPRESSIONS - The human face is most expressive, and
cultural and age barriers. Humans respond to facial expressions
from the time they are born.
EYE CONTACT - Looking someone in the eye is perceived in our
culture and other cultures as a measure of honesty. Eye contact
is often interpreted to be a sign of attentiveness and
acceptance.
PACE OR SPEED OF COMMUNICATION - the resulting difference
in rate of speech and movement. "Slower is Better".
TIMING - Related to the pace of communication but has other
distinct implications as well. The amount of time a person must
wait after seeking attention is important.
TOUCH – is a form of communication. No words are required,
and there is no need for high-level sensory or cognitive
functioning. Caring touch is a basic need for all humans, and
many older adults suffer from touch deprivation.
SILENCE - Saying nothing is also. Saying something. Being with
at times, no words are necessary; silence is therapeutic. Silence
is a language too.
ACCEPTANCE, DIGNITY, AND RESPECT IN COMMUNICATION
(Effective communication starts with proper introductions.
Determine how each older adult wishes to be addressed)
❖ EMPATHY - willingness to attempt to understand the unique
world of another person. The ability to put oneself in another
person’s place and to understand what he or she is feeling and
thinking in that situation.
BARRIERS TO COMMUNICATION
HEARING IMPAIRMENT - The following actions are likely to be
beneficial:
o Stand in front of the person, at eye level.
o Do not eat or drink while you are having a conversation.
o Keep your hands away from your face when speaking.
o Try different ways (words) of saying the same thing.
o Speak more slowly and slightly louder while modulating
the voice to a lower pitch. Avoid exaggerated mouth
motions during speech.
o Use visual cues or written materials that support the
spoken words.
APHASIA - Some commonly recommended approaches include
the following:
o Keep messages simple but adult.
o Use nonverbal modes of communication, such as
picture boards, gestures, yes/no responses, and
facial expressions.
o Use visual aids to support.
 TRY PRAISE REASSURE COMMUNICATING WITH VISITORS AND FAMILIES ("THE
Try increasingly specific Praise Reassure the SIGNIFICANT OTHERS")
guesses or questions. attempts person that it
To determine concerns to speak, is okay to
(e.g., is something and avoid be frustrated,
wrong with your meal? correcting or c but avoid empty
The coffee? It’s too riticizing platitudes such
hot? You want milk?). errors as “you’ll be fine”

DELIVERING BAD NEWS - important concepts include

the following:
o Prepare yourself. Make sure you have all of the
proper information and that it is accurate.
o Think through what you want to say so that the
message is compassionate and culturally sensitive.
o Establish an environment respectful of patient’s privacy.

DEMENTIA - Dementia causes both cognitive and language

deficits. The older person suffering from dementia has no
control over this change.
CULTURAL DIFFERENCES

HAVING DIFFICULT CONVERSATIONS

(The following guidelines are suggestions based on conflict
resolution research)

SKILLS AND TECHNIQUE

INFORMING - it uses direct statements regarding facts. A good
information statement is clear, concise, and expressed in words
the patient can understand. When the nurse is informing, the
nurse is active and the patient is passive.
DIRECT QUESTIONING - it is best to keep communication
conversational and not too aggressive. Direct questioning
is appropriate when information must be obtained quickly;
however, if it is overused, patients may become defensive.
USING OPEN-ENDED TECHNIQUES - open-ended
communication techniques include open-ended questions,
reflective statements, clarifying statements, and paraphrasing.
CONFRONTING - Confronting is used when there
are inconsistencies in information or when verbal and nonverbal
messages appear contradictor. Confrontation is one of the
most difficult communication techniques to use and should be
used only after good rapport has been establish.
IMPROVING COMMUNICATION BETWEEN OLDER ADULT AND Face older individuals when speaking. Speak clearly.
PHYSICIAN Try to avoid microphones or amplifiers that might distort
sounds or interfere with hearing aids.
Repeat information, and use visual cues or materials to
Reinforce a verbal message. Reinforce verbal information with
printed material and audiovisual aids, such as videos.
Encourage hands-on practice. Use as many senses as possible,
but not necessarily all at once, as this may be confusing

CHAPTER 6: MAINTAINING FLUID BALANCE AND MEETING

The quality of communication between nurses and physicians can
NUTRITIONAL NEEDS
have a significant impact on the quality-of-care older patients
receive.
Nutrition plays an important role in health maintenance,
rehabilitation, and prevention and control of disease.
ISBAR-R is an acronym that stands for Introduction, Situation,
Background, Assessment, Recommend action, and Readback
NUTRITION AND AGING
Good nutrition practices play a vital role in health maintenance
and health promotion in older adults.
CALORIES are units of heat that are used to measure the
available energy in consumed food.
BASAL METABOLIC RATE the rate at which the body uses
calories.
BODY MASS INDEX (BMI) is a number calculated using a
person’s weight and height that is a reliable way to measure
body fatness for most people.
Studies have shown that caloric needs in healthy individuals
decrease gradually with age, as there is a decrease in muscle
and lean tissue mass and an increase in adipose tissue.

NUTRIENTS
General recommendations from the U.S. Department of
Agriculture (USDA) (2011) for the general population include:
o Enjoy food but eat less of it.
o Avoid oversized portions.
o Increase intake of fruits, vegetables, and whole grains.
o Choose low-fat or fat-free dairy products.
o Reduce intake of sodium.
o Drink water instead of sugary beverages.
REMEMBER o Make physical activity an everyday occurrence.
PLAN AHEAD AND HAVE - Plan ahead and have a focus for the
communication.
GATHER – Gather any assessment data you might need
before calling the physician.
KNOW - Know what you want to report or find out. Be
organized, clear, precise, and complete.
PROVIDE - Provide background information.
PROVIDE - Provide all necessary and relevant information that
might be needed.
IDENTIFY - Identify the patient by name, major diagnoses, and
any medications related to currently presenting symptoms or
concerns.
BE - Be prepared to clarify any data or information that the
physician may request.

PATIENT TEACHING
Education plays an important role in promoting and maintaining the
health of older adults. ❖ The plate is divided into color-coded food groups which include
vegetables, fruits, grains, and protein, with dairy on the side.
Regardless of the total amount of food consumed, the
proportion of food from each group should remain in balance.
❖ More precise standards for measuring the nutritional adequacy
of a diet are found in the dietary reference intakes (DRIs).

REMEMBER WHEN DOING HEALTH TEACHING

CARBOHYDRATES
Include sugars and starches that comprise approximately half of
the standard American diet.
Carbohydrates provide a ready source of energy for the body
and are divided into two categories: simple and complex.
o SIMPLE CARBOHYDRATES are used most readily by the
body because their bonds are easily broken.
o COMPLEX CARBOHYDRATES must be broken down into
simple sugars before they can be used by the body. This
breakdown requires time and energy.
PROTEINS
Proteins are composed of amino acids, which are essential for
tissue repair and healing.
Protein needs remain constant or may increase slightly with
aging to compensate for the loss of lean body tissue.
According to Dietary Guidelines for Americans (2010), the DRI
of protein for adult women is 46 g/day; for adult men, the RDA
is 56 g/day.
FATS
Fats, poultry, fish, eggs, and dairy products are good sources of
COMPLETE PROTEINS, which contain all of the amino acids
necessary for making and repairing tissues.
COMPLEMENTARY PROTEINS consist of two or more
incomplete proteins that together provide adequate amounts of
essential amino acids.
Fats is recommended that fats be limited to approximately 20%
to 35% of the total daily caloric intake. This recommendation
does not change with aging.
When considering fat intake in the diet, it is important to watch
the type of fats ingested. The body incorporates fats into
substances called LIPOPROTEINS, which contain cholesterol and
proteins. There are three important types of lipoproteins:
o high-density lipoprotein (HDL)
o low-density lipoprotein (LDL)
o very- low-density lipoprotein (VLDL)
VITAMINS
are organic compounds found naturally in foods. They can also
be produced synthetically.
MINERALS
are inorganic chemical elements that are required in many of
the body’s functions.
o CALCIUM, the most abundant mineral in the body, is
necessary for bone and tooth formation, nerve impulse
transmission and conduction, muscle contraction
(including cardiac function), and blood clotting. Dietary
sources of calcium are milk and dairy products.
o PHOSPHORUS is needed for normal bone and tooth
formation, activation of some B vitamins, normal
neuromuscular functioning, metabolism of
carbohydrates, regulation of acid-base balance, and
other physiologic processes.
o IRON - found in the center of the heme portion of
hemoglobin. Hemoglobin in the red blood cells
transports oxygen to and removes carbon dioxide from
the cells. Iron-deficiency anemia results from
inadequate intake of dietary iron. Pernicious anemia is
caused by a deficiency in intrinsic factor secreted by the
stomach.
o SODIUM is a commonly occurring mineral and is one of
the important elements in the body. Sodium ions are
involved in acid-base balance, fluid balance, nerve
impulse transmission, and muscle contraction.
o POTASSIUM is the major intracellular ion in the body.
Potassium ions play an important role in acid-base
balance, fluid and electrolyte balance, and (with
sodium) normal neuromuscular functioning.
o ZINC is a trace mineral that plays a role in protein
synthesis. In adults, insufficient zinc may result in
delayed wound healing, impaired immune function,
lethargy, skin changes, diminished sense of smell and
taste
o TRACE ELEMENTS such as magnesium, copper, iodine,
fluorine, chromium, selenium, nickel, and sulfur are
necessary in very small amounts for normal body
functioning.
WATER
Water is essential for life. Humans can survive for many days
without food but not without water.
Water plays a role in many aspects of normal body functioning.
The amount of fluid taken into the body should be in balance
with the amount eliminated from the body. This is referred to as
FLUID BALANCE
MALNUTRITION AND THE OLDER ADULT
Malnutrition is defined as a disorder of nutrition resulting from
unbalanced, insufficient, or excessive diet or from impaired
absorption, assimilation, or use of food.
The risk for developing nutritional deficiencies increases with
aging. Older adults who appear to be healthy may.
FACTORS AFFECTING NUTRITION IN OLDER ADULTS
PHYSIOLOGIC RISK FACTORS
o Chronic Health Factors such as chronic obstructive
pulmonary disease, chronic heart failure, arthritis,
dementia, and many others can interfere with obtaining
and preparing adequate nutritional food.
o Alcoholism is suspected to be a risk factor in a larger
percentage of older adults than is commonly
recognized.
o Sensory changes can cause problems with safe
preparation and storage of food.
o Pain, whether it is chronic or acute, can interfere with
an older person’s appetite
 o Medications can cause an unpleasant change in the NURSING PROCESS FOR RISK FOR IMBALANCED NUTRITION
taste of food; suppress appetite; or cause nausea and
vomiting.
o Problems with chewing, swallowing, or digesting are
common causes of impaired nutrition.
o Malabsorption
ECONOMIC RISK FACTORS
o Cost of food is a concern for many older adults with
limited income.
o Difficulty getting transportation to obtain food is a
serious problem or older adults, particularly those who
live alone.
o Obtaining an appropriate variety and sufficient amount
of food can be difficult for older adults.
SOCIAL RISK FACTORS
o Depression is a common reason for decreased appetite
in older adults.
o Loneliness or Social isolation is one of the more
common risk factors for nutritional problems in older
adults.
o Lack of motivation to cook is commonly an issue for
older adults.
INSTITUTIONAL FACTORS
o The repetitive nature of institutional meals.
o Problems maintaining the temperature and appearance
of food while serving many people
o Environmental concerns, such as the type of
background music being played, staff conversations, or
overhead announcements
o Problems related to being fed by others
o Behavior, appearance, or odors of tablemates
o Inability of an institution to meet the specific cultural
preferences or general likes or dislikes.

NURSING INTERVETION AND IMPLEMENTATION

Assess the individual carefully to determine the
Causes of a problem.
Schedule weekly weight checks.
SOCIAL AND CULTURAL ASPECTS OF NUTRITION Keep a dietary record of the amount, type, and frequency of
Food is more than a means of meeting nutritional needs. Food is food intake.
also used as part of religious ceremonies, in social interactions, Explain the importance of nutrition to overall health or disease
and as a means of cultural expression. Throughout history, food control.
has been linked to the gods. Determine food likes and dislikes.
Cultural influences the food we eat in our homes from early in Assess the condition of the skin, hair, nails, and mucous
life reflect our culture. membranes.
Consult with the dietitian.
Institute measures to increase or decrease nutritional intake.
Complete a thorough documentation of nutritional status,
including assessment, interventions, referrals, and patient
response.

THE FOLLOWING MEASURES CAN BE TAKEN TO INCREASE THE

PATIENT’S INTAKE:
PROVIDE - Provide a selection of nutritious foods.
LIMIT - Limit excess intake of fluids during meal
SUPPLEMENT - Supplement food intake with nutritious snacks.
ASK - Ask family members to bring the person’s favorite dishes
from home.
SERVE - Serve meals in an attractive manner.
PROVIDE - Provide a social environment for meals by
encouraging older adults to eat in the dining room.
 PREPARE - Prepare food by opening cartons, buttering toast, or
performing other activities that may be difficult for the older
person
AVOID - Avoid hurrying the individual during meals.
REQUEST - Request a modification in the form of food served if
the individual has difficulty chewing
PROVIDE - Provide assistive devices such as plate sides, gripper
spoons, and adaptive cups.
PROVIDE - Provide oral hygiene before meal
ASSIST - Assist the individual to the toilet before meal
PROVIDE - Provide supplemental tube feedings, if ordered.
TIME - Time medication administration to not interfere with
meals
PLAY - Play relaxing music at mealtime.
REFER - Refer individuals for special counseling if emotional
difficulties are interfering with appetite.
THE FOLLOWING MEASURES CAN BE TAKEN TO DECREASE INTAKE:
Assist in the selection of low-calorie food.
Plan low-calorie snacks into the daily routine.
Increase diversional activities to decrease snacking.
Encourage increased activity levels. Inc
THE FOLLOWING INTERVENTIONS SHOULD TAKE PLACE IN THE
HOME:
Assist the individual in obtaining resources such as Meals-on-
Wheels, food stamps, a housekeeper, or shopping services.
Involve the family in shopping and meal planning.
Identify senior citizen meal programs available in the
community.
Use any appropriate interventions that are used in the
institutional setting.
NURSING PROCESS FOR RISK FOR IMBALANCED
FLUID VOLUME
FLUID BALANCE is not an everyday problem in healthy older
adults.
Common risk factors for dehydration include:
o a decreased thirst sensation
o decreased effectiveness of the kidney at concentrating
urine
o hormonal changes, including decreased aldosterone
secretion and renin activity
o side effects of medications
o altered level of mentation
o altered levels of functional ability
o fear of incontinence
ASSESSMENT/DATA COLLECTION
o What are the vital signs (i.e., blood pressure, pulse,
respiration, and temperature)?
o What is the appearance of the skin? Is it moist? Dry?
o Describe the skin turgor? Is the tongue dry and/or
furrowed? Skin temperature?
o Does the individual complain of thirst? Weakness?
o Does the individual manifest any mood changes, such as
restlessness or confusion?
o What is the fluid intake per nursing shift? Per day?
o Is the person receiving fluids through non-oral routes,
such as nasogastric?
EXCESS FLUID VOLUME can result from excessive intake or
inadequate elimination of fluids. A primary indication of excess
fluid volume is edema, which may manifest as swelling of
dependent extremities and increased abdominal girth.
NURSING DIAGNOSES
o Deficient fluid volume
o Excess fluid volume
o Risk for deficient fluid volume
o Risk for imbalanced fluid volume
o Readiness for enhanced fluid balance
NURSING GOALS/OUTCOMES IDENTIFICATION
o The nursing goals for older individuals with or at risk for
deficient fluid volume or excess fluid volume are to:
▪ manifest vital signs within normal limits or
limits specified by the physician;
▪ evidence moist oral mucous membranes and
good skin turgor without evidence of edema;
▪ maintain a stable weight within normal limits;
▪ exhibit balanced fluid intake and output;
▪ report no problems related to thirst or
weakness;
▪ exhibit blood studies (hemoglobin, hematocrit,
serum electrolytes, BUN, creatinine) within
normal limits;
▪ verbalize an understanding of the
recommended dietary and fluid intake;
▪ demonstrate behaviors necessary to maintain
appropriate fluid intake;
▪ demonstrate a selection of appropriate foods
and fluids;
▪ verbalize an understanding of prescribed
medication(s), including the frequency and any
precautions; and
▪ verbalize signs and symptoms that should be
reported
NURSING INTERVENTIONS/IMPLEMENTATIONS
o Complete a thorough assessment.
o Monitor vital signs.
o Monitor intake and output.
o Monitor laboratory values.
o Weigh the patient daily before breakfast.
o Measure changes in girth of body parts such as legs and
abdomen.
o Maintain adequate fluid intake.
▪ Offer smaller amounts of fluid at more frequent
intervals.
▪ Keep preferred beverages at the bedside
▪ Use smaller containers such as medication cups
or small juice glasses when offering beverages
▪ Keep beverages easily available for individuals
who are not in their rooms (e.g., in day rooms,
activity rooms, lounges, or other common
areas).
▪ Encourage the intake of foods with a high fluid
content, such as fruits, vegetables, soups, and
cooked cereals
▪ Administer nasogastric, gastric, or parenteral
fluids as ordered by the
Implement the following measures to decrease intake
o Avoid keeping fluids at the bedside.
o Offer frequent oral hygiene.
o Provide lozenges or hard candy.
o Plan a schedule to distribute limited fluids throughout
the day
o Limit the quantity of foods that are high in fluid content
NURSING INTERVENTIONS continuation
o Administer medications as ordered by the primary care
provider.
 o Refer to the dietitian, if appropriate.
o Provide appropriate skin care.
CHAPTER 7: MEDICATIONS AND OLDER ADULTS
Problems related to medications are common in older adults, and
they are costly in terms of both time and money.
Medications can alter an older adult’s ability to perform normal
functions, can result in behavior changes, and can be life
threatening.
GEROPHARMACOLOGY
➢ The study of how older adults respond to medication, is a new
but growing area.
ADVERSE DRUG REACTIONS
➢ Are common in older adults.
➢ In addition, older people are more likely to develop iatrogenic
(treatment-related) complications secondary to medications
taken during a hospital stay.
➢ ADRs also have been linked to an increased risk for falls and
automobile accidents. Hospitalizations from ADRs cost older
adults and taxpayers several billion dollars each year.
RISK-RELATED TO DRUG-TESTING METHODS
➢ Most drug testing is performed on people who are healthier,
younger, and have been exposed to fewer medical interventions
than the older adult who might actually be prescribed the
medication.
➢ 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 young adults.
FACTORS THAT INCREASE THE RISK FOR MEDICATION-RELATED
PROBLEMS
Drug-testing methodology
Physiologic changes related to aging
Use of multiple medications, over-the-counter medications, and
herbal supplements
Cognitive and sensory changes
Knowledge deficits
Financial concerns
RISK-RELATED TO THE PHYSIOLOGIC CHANGES IN AGING
PHARMACOKINETICS
o Is the study of drug actions within the body, including
absorption, distribution, metabolism, and excretion.
DRUG ABSORPTION
o Most medications are taken orally and are absorbed
through the gastrointestinal (GI) tract.
o First Pass Effect is a phase of drug absorption that is
altered in the older adult.
DRUG DISTRIBUTION
o There is typically a decrease in total body mass, lean
body mass, and total body water and an increase in
total body fat.
o Half-Life is the amount of time required for half of the
medication to be eliminated or metabolized.
DRUG METABOLISM
o Liver is the primary site of drug metabolism.
o Aging often results in decreased activity of liver cells,
decreased metabolic enzymes, and decreased cardiac
output, which results in reduced blood flow to the liver.
o This reduction in perfusion decreases the liver’s
effectiveness in metabolizing drugs.
DRUG EXCRETION
o Aging kidneys are significantly less effective at removing
waste products, including the by-products of
medications.
o Medications such as aminoglycosides, digoxin, lithium,
procainamide, and cimetidine are likely to reach toxic
levels because of poor renal excretion.
o Nonprescription drugs, such as alcohol and nicotine, can
also affect kidney function and cause changes in drug
elimination in older persons.
PHARMACODYNAMICS
o Responses to medications are less predictable in the
aging person.
o Pathologic changes in target organs may affect the
response to medications.
o Receptor sites on the target organs may respond more
or less sensitively to medications.
POLYPHARMACY
o Polypharmacy, the prescription, administration, or use
of more medications than are clinically indicated, is a
common problem in older adults.
o As mentioned previously, older adults ingest far more
medications than do younger people in addition to OTC
medications, herbs, and supplements that may be taken
with or without the primary care provider’s
recommendation or knowledge.
❖ People do not experience age-related physiologic changes at
the same rate. When considering an older adult’s response to
medication, it is more important to consider physiologic age
than chronologic age. The more physiologic changes
experienced, the greater the risk will be of an altered response
to medications. Even the most common physiologic changes of
aging can have a significant effect on pharmacokinetics and
pharmacodynamics.
❖ Many older adults use herbs and supplements as an alternative
to prescription medications, sometimes because they are less
expensive, and sometimes because they are marketed as
“natural,” which implies “safe.” Remember: Digoxin is an herb!
It is important to carefully question the older adult about
supplements and herbs they are taking.
POTENTIALLY INAPPROPRIATE MEDICATION USE IN OLDER ADULTS
BEERS CRITERIA
➢ a list of drugs that should usually be avoided by older adults,
was developed.
➢ PART I: Identifies medications best avoided by older adults
independent of diagnoses or conditions.
➢ PART II: Uses diagnoses or conditions as the primary
consideration for which medications should be avoided in the
older adult.
SCREENING TOOL OF OLDER PERSON’S PRESCRIPTIONS CRITERIA
(STOPP)
Also known as Screening Tool to Alert doctors to Right
Treatment Criteria (START)
Developed in the UK in response to perceived content gaps and
disagreement about BEERS content.
It emphasizes both sides of medication prescription in older
adults:
o Examination of medications to be considered for
prescription
o Examining medications already prescribed that might
be inappropriate
SIX BASIC GUIDELINES TO PRESCRIBE MEDICATIONS
Start low and go slow.
Start one drug and stop two.
Do not use a drug if the adverse effects are worse than the
disease.
Use as few drugs as possible and use nonpharmacological
approaches whenever possible.
Frequently assess the patient’s response.
Consider drug holidays.
RISK RELATED TO:
COGNITIVE CHANGES
o Lack of Literacy Skills
o Inability to understand and comply with directions
o Inability to make correct judgments about medications
SENSORY CHANGES
o Visual Changes
o Hearing Changes
RISK RELATED TO INADEQUATE KNOWLEDGE
Lack of knowledge about medications can result in serious
problems for older adults. This knowledge deficit, which can
relate to both prescription and nonprescription medications,
has many causes and manifests in different ways.
Older adults often lack adequate knowledge regarding their
prescription medications. They are often given one or more
prescriptions and simply told to take them according to the
directions. The directions provided may be very clear to a health
care professional, but they are easily misinterpreted by older
adults. Even simple misunderstandings can lead to improper
self-medication, leading to serious consequences. To reduce the
risks, older adults often require additional instruction to take
their prescriptions safely.
RISK RELATED TO FINANCIAL FACTORS
Medications are expensive. If an aging person requires more
than one medication, the cumulative cost can be overwhelming.
To save money, older adults living on limited incomes may fail
to take their medications or they may make changes in the
amount or frequency to conserve their supply. Because these
changes do not follow the recommended therapeutic schedule,
a wide variety of untoward responses can occur.
MEDICATION ADMINISTRATION IN AN INSTITUTIONAL SETTING
Before administering a medication, have the following
information:
o Reasons this individual is receiving the medication.
o Normal therapeutic dosage of the medication.
o Normal route or routes of administration.
o Any special precautions related to administration.
o Common side effects or adverse effects of the
medication.
o Signs of overdose and toxicity.
o Therapeutic effects of the medication.
NURSING ASSESSMENT AND MEDICATION
NURSING INTERVENTIONS RELATED TO MEDICATION
ADMINISTRATION
RIGHT RESIDENT
o Proper identification of the resident or patient is an
essential part of safe nursing care.
RIGHT MEDICATION
 o Because each medication has a generic name and one
or more trade names, and, because the appearance of a
medication can vary depending on the manufacturer,
nurses must use a reference source to verify that the
right drug is, in fact, available.
RIGHT AMOUNT
o The goal of drug therapy in older adults is to achieve the
maximal therapeutic benefits with the smallest amount
of medication necessary (Health Promotion).
RIGHT DOSAGE FORM
o Problems arise when the older person is unable to
swallow tablets or cannot swallow at all and relies on a
gastric or nasogastric tube for nourishment. For these
patients, nurses must consider safe alternatives.
RIGHT ROUTE
o Most medications are prescribed for oral
administration. When an oral medication is being
administered, the importance of the medication, the
preferences of the older person, and his or her
capabilities must be considered.
o Transdermal delivery is becoming an increasingly
popular route for drug administration. Transdermal
medications are administered using a “patch” consisting
of a center that contains the medication surrounded by
a skin overlay, which secures the patch to the skin.

RIGHT TIME
o Some medications are more effective or better
tolerated if given under specific conditions. For greatest
effect, medications that are ordered before meals
should be given when the stomach is empty.
Medications that are ordered after meals should be
given only after the person has eaten. Activities of daily
living can be affected by medications. Medications
should be administered when the drugs will interfere as
little as possible with normal activities.
RIGHT DOCUMENTATION
o Use care when documenting medications. Facilities use
a variety of different forms and records to document
various aspects of care, including medication
administration. To ensure that all medications are
administered properly, the rules of charting must be
followed.

PATIENT RIGHTS AND MEDICATION

Older adults also have the right to refuse to take medication.
Provide privacy for the older person during injections or any
other procedures.
Older adults have the right to know what medication they are
receiving and why they are receiving it.