Chapter 37, Problem 1CS

(1)

Summary Introduction

To determine:

What is in Advair, and what does the “50 mcg/250 mcg” mean? Explain the class and purposes of the drug(s) it contains?

Case summary:

A 73-year-old woman named as Ms. B worked in a local traffic tunnel for 25 years had developed chronic obstructive pulmonary disease (COPD) for 10 years. This is due to her exposure to constant environmental pollutants and cigarette smoking. After her retirement, she was admitted in hospital and quit smoking. She takes treatment for her COPD and upper respiratory infection. Her doctor ordered her to be under 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). 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. Ms.B daily food intake and output has to be carefully monitored. Her daily weight measurement, vital organ functions with breath sounds, and pulse oximetry every 2 hours until stable and chest physiotherapy twice a day was taken.

(2)

Summary Introduction

To determine:

What is the reason for tapering the methylprednisolone and prednisone before they are discontinued?

Case summary:

Ms. B health condition stabilizes 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 the following.

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! How do I know how many tablets to take? It's different each day!” What can you do to help her with the tapering dosage of prednisone?

Case summary:

Ms. B health condition stabilizes after 2 days, and her methylprednisolone is gradually reduced. A week later, her IV corticosteroid injection was stopped and she started oral prednisone 40mg/day. Her medical discharge report contains the following medication:

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? Advair or albuterol? Aren't they the same thing?” What is the nurse's best response?

Case summary:

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

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.