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Prevention of Adverse Drug Reactions in the Elderly课程教案、知识点、字幕

大家好

随着年龄的增长

老年人记忆力减退

学习新事物的能力下降

对药物的治疗目的 用药时间

用药方法常不能正确的理解

影响用药安全和药物治疗的效果

因此

全面评估老年人用药情况

密切观察和预防药物不良反应

是护士的一项重要任务

定期全面的评估老年人用药情况

应包括以下几个方面

用药史 各系统老化程度

用药能力和作息时间

以及心理 社会状况

详细评估老年人的用药史

建立完整的用药记录

包括既往和现在的用药记录

药物过敏史

引起副作用的药物

及老年人对药物的了解情况

仔细评估老年人各脏器的功能情况

例如肝 肾功能的生化指标

以反应其各系统老化程度

对于用药能力应该包括视力 听力

阅读能力 理解能力 记忆力

吞咽能力 获取药物的能力

发现不良反应的能力

还要评估作息时间

了解老年人的文化程度 饮食习惯

家庭经济状况

对当前治疗方案

和护理计划的认识程度和满意度

家庭的支持情况

对药物有无依赖

期望及恐惧等心理

都是心理 社会状况的评估内容

其次

老年人的药物不良反应发生率高

护士要密切观察和预防药物的不良反应

提高老年人的用药安全

密切观察药物副作用

要注意观察老年人用药后

可能出现的不良反应

及时处理

例如对于使用降压药的老年患者

要注意提醒其站立 起床时动作要缓慢

避免直立性低血压

老年人在用药后容易出现药物矛盾反应

也就是用药后出现

与用药治疗效果相反的特殊不良反应

例如用硝苯地平治疗心绞痛

反而加重心绞痛

甚至诱发心律失常

所以用药后要细心观察

一旦出现不良反应要及时停药 就诊

根据医嘱改服其他药物

保留剩药

老年人用药一般从成年人剂量的1/4开始

逐渐增大至1/3 1/2 2/3 3/4

同时要注意个体差异

治疗过程中要求连续性观察

一旦发现不良反应

及时协助医师处理

要选用便于老年人服用的药物剂型

例如口腔粘膜干燥的老人

服用片剂 胶囊制剂时

要给予充足的水来送服

胃肠功能不稳定的老年人

不宜服用缓释剂

因为胃肠功能的改变会影响缓释药物的吸收

对于有吞咽困难的老人

不宜选用片剂 胶囊制剂

宜选用液体剂型

例如冲剂 口服液等

必要时也可选用注射给药

老年人由于皮肤的弹性组织减少

常常会造成注射部位皮肤出血

应延长按压的时间

由于体温下降

血液循环减慢

老年人使用栓剂药物需要更长的融化时间

接受静脉治疗的老年人

要预防循环超负荷

特别注意观察出现血压升高 呼吸加快

气喘等肺水肿症状体征

根据老年人的用药能力 生活习惯

给药的方式应该尽可能的简单

当口服药物与注射药物疗效相似时

宜采用口服给药

由于许多的食物和药物同时服用

会导致相互作用而干扰药物的吸收

例如含钠基或碳酸钙的制酸剂

不可与牛奶

或者其他富含维生素D的食物一起服用

以免刺激胃液过多的分泌

或造成血钙或血磷过高

此外

如果给药间隔时间过长达不到治疗效果

而频繁的给药又容易引起药物中毒

因此

在安排用药时间和用药间隔时

既要考虑老人的作息时间

又应保证有效的血药浓度

老年人因为种种原因容易出现用药依从性较差

当药物未达到预期疗效的时候

要仔细询问患者是否按医嘱用药

对长期服用某一种药物的老年人

要注意监测其血药浓度

对老年人所用的药物剂量要进行认真记录

并注意保存

因此

掌握老年人的常见药物不良反应

及预防措施

是保证老年人安全用药

合理用药的前提

谢谢大家

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-1.1 Human Life Expectancy and Age Classification of the Elderly

--Human Life Expectancy and Age Classification of the Elderly

--【Vedio Recommendation】 How do we measure life expectancy ?

-1.2 Population Aging

--Population Aging

--【Literature Recommendation】World Report on Ageing and Health: 2015

-1.3 Influence and Countermeasures of Population Aging

--Influence and Countermeasures of Population Aging

--【Literature Recommendation】World Population Ageing Highlights:2019

-1.4 Goals and Principles of Elderly Care

--Goals and Principles of Elderly Care

--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice

-1.5 Theories Related to Elderly Care

--1.5.1 Personality Development Theory and Life Review

--1.5.2 Disengagement Theory and Activity Theory

--1.5.3 Self-efficacy and Chronic Disease Management

--【Vedio Recommendation】8 Stages of Development by Erik Erikson

--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging

--【Book Recommendation】Self-Efficacy in Changing Societies

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-1.6 Elderly Support and Elderly Care

--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care

--1.6.2 Home-based Elderly Care Model

--1.6.3 Institutional Elderly Care Model

--1.6.4 Integrated Medical and Nursing Care Model

--【Vedio Recommendation】Day in the Life of Home Care

--【Website Recommendation】Official Website of the National Institutes of Health

-Concept Map

--【Concept Map】General Introduction to Geronological Nursing

-【Test】CHAPTER 1

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-2.1 Aging Changes in the Elderly

--2.1.1 Aging of the Respiratory System

--2.1.2 Aging of the Cardiovascular System

--2.1.3 Aging of the Digestive System

--2.1.4 Aging of the Urinary System

--2.1.5 Aging of the Endocrine System

--2.1.6 Aging of the Motor System

--2.1.7 Aging of the Nervous System

--2.1.8 Aging of the Sensory System

--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging

--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology

-2.2 Comprehensive Health Assessment of the Elderly

--Comprehensive Health Assessment of the Elderly

--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review

-2.3 Principles of Elderly Health Assessment

--Principles of Elderly Health Assessment

-2.4 Assessment of the Functional Status of the Elderly

--Assessment of the Functional Status of the Elderly

--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale

-2.5 Assessment of Cognitive Function in the Elderly

--Assessment of Cognitive Function in the Elderly

-2.6 Assessment and Adjustment of the Living Environment for the Elderly

--Assessment and Adjustment of the Living Environment for the Elderly

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-3.1 Overview of the Psychological Characteristics of the Elderly

--Overview of the Psychological Characteristics of the Elderly

-3.2 Influencing Factors of Psychological Changes in the Elderly

--Influencing Factors of Psychological Changes in the Elderly

-3.3 Common Psychological Issues and Their Management in the Elderly

--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)

--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)

--【Book Recommendation】Development Through the Lifespan

-3.4 Depression in the Elderly

--3.4.1 Overview of Depression in the Elderly

--3.4.2 Clinical Symptoms of Depression in the Elderly

--3.4.3 Caring for Elderly Patients with Depression

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-3.5 Elderly Patients with Dementia

--3.5.1 Identification of Dementia Symptoms in the Elderly

--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia

--3.5.3 Safety Care of Elderly Patients with Dementia

--【Website Recommendation】The Global Voice on Demaentia

-Concept Map

--【Concept Map】Elderly Mental Health and Mental Health Care

-【Test】CHAPTER 3

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-4.1 Precautions for Daily Care of the Elderly

--Precautions for Daily Care of the Elderly

-4.2 General Care of Elderly Skin

--4.2.1 Characteristics and General Care of Elderly Skin

--4.2.2 Skin Itching and Its Management in the Elderly

--【Website Recommendation】American Academy of Dermatology

-4.3 Clothing Hygiene for the Elderly

--Clothing Hygiene for the Elderly

--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly

-4.4 Dietary Care for the Elderly

--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs

--4.4.2 Dietary Care for the Elderly

--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics

--【Website Recommendation】Nutrition for older persons

-4.5 Sleep Guidance for the Elderly

--4.5.1 Sleep Characteristics of the Elderly

--4.5.2 Sleep Guidance for the Elderly

--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems

--【Website Recommendation】American Academy of Sleep Medicine

-4.6 Exercises Guidance for the Elderly

--4.6.1 Evaluation of Exercise Intensity in the Elderly

--4.6.2 Precautions Elderly Undertaking Exercises

--【Website Recommendation】American College of Sport Medicine

--【Book Recommendation】Handbook of Activities for the Elderly

-Concept Map

--【Concept Map】Elderly Daily Care

-【Test】CHAPTER 4

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--【Website Recommendation】How Drugs Work In the Elderly

-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly

--Common Adverse Drug Reactions and Their Causes in the Elderly

-5.3 The Principles of the Use of Medications in the Elderly

--The Principles of the Use of Medications in the Elderly

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-5.5 Medication Compliance in the Elderly

--Medication Compliance in the Elderly

-Concept Map

--【Concept Map】Medication Safety and Care for the Elderly

-【Test】CHAPTER 5

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-6.1 Falls in the Elderly

--6.1.1 Epidemiological Characteristics of Elderly Falls

--6.1.2 Risk Factors for Falls in the Elderly

--6.1.3 Prevention of Falls in the Elderly

--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)

-6.2 Dysphagia in the Elderly

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--Dry Mouth in the Elderly

--【Website Recommendation】Academy of Nutrition and Dietetics

-6.6 Elderly Nutritional Deficiencies

--Elderly Nutritional Deficiencies - emaciation

-6.7 Visual Impairment in the Elderly

--Visual Impairment in the Elderly

--【Website Recommendation】Senior Eye Exams

-6.8 Senile Deafness

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【Book Recommendation】The Meaning of Death by Herman Feife

-7.3 Nursing for Pain in the Dying Elderly

--Nursing for Pain in the Dying Elderly

--【Journal Recommendation】

-7.4 Nursing for Major Bleeding in the Dying Elderly

--Nursing for Major Bleeding in the Dying Elderly

-7.5 Nursing for Delirium in the Dying Elderly

--Nursing for Delirium in the Dying Elderly

-7.6 Nursing for Dyspnea in the Dying Elderly

--Nursing for Dyspnea in the Dying Elderly

--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA

-7.7 Psychological Problems and Nursing in the Dying Elderly

--Psychological Problems and Nursing in the Dying Elderly

--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross

-7.8 Grief Counseling for the Widowed Elderly

--Grief Counseling for the Widowed Elderly

--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela

-Concept Map

--【Concept Map】Hospice Care for the Elderly

-【Test】CHAPTER 7

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

Prevention of Adverse Drug Reactions in the Elderly笔记与讨论

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