Reference no: EM133440876

Case Study: Read the scenario, identify special considerations for dosage related side effects when discussing "at risk" populations such as elderly.

Ms. B. is a 73-year-old woman who worked in the local traffic tunnel for about 25 years and has had chronic obstructive pulmonary disease (COPD) for 10 years, caused by exposure to environmental pollutants while on the job and by cigarette smoking. She is now retired and is frequently admitted to the hospital for treatment of her condition. She quit smoking about 8 years ago. Ms. B. is now in the hospital for treatment of an acute exacerbation of her COPD and an upper respiratory tract infection. The physician has ordered the following: Oxygen per nasal cannula at 2 L/min, methylprednisolone (Solu-Medrol), 125 mg IVPB, then 80 mg IVPB every 6 hours; Advair 50 mcg/250 mcg, 1 puff every 12 hours; albuterol (Accuneb) 2.5 mg by nebulizer every 4 hours for 2 days, then every 4 hours as needed; piperacillin/tazobactam (Zosyn) antibiotic therapy, 3.375 g intravenously every 6 hours; measurement of intake and output; daily weight measurement; assessment of vital signs with breath sounds and pulse oximetry every 2 hours until stable; chest physiotherapy twice a day and as needed.

Questions:

1. What is in Advair, and what does the "50 mcg/250 mcg" mean? Explain the class and purposes of the drug(s) it contains. Within 2 days, Ms. B's condition stabilizes, and the methylprednisolone dose is gradually reduced. After 1 week, the IV corticosteroid is discontinued and she is started on oral prednisone (generic) 40 mg daily.
Her discharge medications include the following: prednisone (generic) 40 mg PO daily for 3 days, then taper and discontinue by reducing the dose by 5 mg daily. (Prescription calls for 5-mg tablets.) Advair 50 mcg/250 mcg, 1 puff every 12 hours albuterol (Proventil HFA) metered-dose inhaler, 90 mcg/spray, every 4 hours as needed.
2. What is the reason for tapering the methylprednisolone and prednisone before they are discontinued?
3. 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?
4. While going over the medications, Ms. B asks you, "So which inhaler do I take if I feel short of breath? The Advair or the albuterol? Aren't they the same thing?" What is the nurse's best response?