Chapter 37, Problem 1CS

(1)

Summary Introduction

To determine:

Define Advair and the meaning of “50 mcg/250 mcg” dose. Also, explain the drug class, its purpose, and its contents.

Case summary:

A 73-year-old woman termed as Ms.B worked in a local traffic tunnel for 25 years had developed the chronic obstructive pulmonary disease (COPD) for 10 years. She takes treatment for her COPD and upper respiratory infection. This is due to her exposure to constant environmental pollutants and cigarette smoking. After her retirement, she was admitted in hospital and quit smoking. Her doctor ordered her oxygen/nasal cannula at 2L/min, methylprednisolone (Solu-Medrol) 125 mg IV push, 80 mg IVPB every 6 hours, Advair 50 mcg/250 mcg (1 dose every 12 hours), and Albuterol 2.5 mg by nebulizer every 4 hours for 2 days, then every 4 hours as needed, piperacillin/tazobactam antibiotic therapy, 3.375 g IV every 6 hours. Her daily weight measurement, vital organ functions with breath sounds and pulse oximetry should be measured in every 2 hours until becoming stable, and chest physiotherapy has to be done twice a day.

(2)

Summary Introduction

To determine:

The reason behind tapering the methylprednisolone and prednisone before they are discontinued.

Case summary:

Ms. B’s health condition is stabilized after 2 days and her methylprednisolone is gradually reduced. A week later, her IV corticosteroid injection is stopped and started oral prednisone 40mg/day. Her medical discharge report contains as follows:

1. a) Prednisone – 40mg/day as PO for 3 days and reduce the dose 5mg/day after.
2. b) Advair – 50 mcg/250 mcg (1 dose every 12 hours).
3. c) Albuterol- 90 mcg/spray every 4 hours as needed as inhaler form.

(3)

Summary Introduction

To determine:

Ms. B states, “This is confusing to her. How do I know how many tablets to take? It's different each day!” The ways in which the nurse can help her with the tapering prednisone dosage.

Case summary:

Ms. B’s health condition is stabilized after 2 days and her methylprednisolone is gradually reduced. A week later, her IV corticosteroid injection is stopped and started oral prednisone 40mg/day. Her medical discharge report contains as follows:

1. a) Prednisone – 40mg/day as PO for 3 days and reduce the dose 5mg/day after.
2. b) Advair – 50 mcg/250 mcg (1 dose every 12 hours).
3. c) Albuterol- 90 mcg/spray every 4 hours as needed as inhaler form.

(4)

Summary Introduction

To determine:

While going over the medications Ms.B asks, “So which inhaler do I take if I feel short of breath? The Advair or the albuterol? Aren't they the same thing?” Find the nurse's best response.

Case summary:

Ms. B’s health condition is stabilized after 2 days and her methylprednisolone is gradually reduced. A week later, her IV corticosteroid injection is stopped and started oral prednisone 40mg/day. Her medical discharge report contains as follows:

1. d) Prednisone – 40mg/day as PO for 3 days and reduce the dose 5mg/day after.
2. e) Advair – 50 mcg/250 mcg (1 dose every 12 hours).
3. f) Albuterol- 90 mcg/spray every 4 hours as needed as inhaler form.