RUNNING HEAD: Teaching Plan for Prednisone

Teaching Plan for Prednisone

Sara Aitken and Shawnee Cuthbert
Cedar Crest College

Teaching Plan for Prednisone

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Abstract

This teaching plan was designed for a 62 year old woman with Rheumatoid Arthritis. The patient was diagnosed and prescribed
Prednisone seven days ago. This nurse met with patient and taught the patient most aspects of taking Prednisone at the initial
appointment. The patient was advised to get a pill organizer which would be easier to open than a normal medication bottle and this nurse
helped the patient set up alarm reminders, on the patients cell phone, for when to take the medicine daily. Due to some possible serious
side effects, the patient was asked to return after one week of taking the medicine, for a follow up meeting. She has come back into the
office for some additional medication teaching and to address any new issues. One issue not covered in the teaching plan, but was a
concern for the patient, was the cost of medicine. Patient stated at the first appointment that she had to discontinue Embrel due to high
cost (approximately $1,500 a month.) This nurse called the pharmacy and informed the patient that Prednisone would cost approximately
$10 per month and she should call the health care provider for exact costs.

Teaching Plan for Prednisone

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NUR 314 Pharmacology Teaching Plan

Student Name
Sara Aitken
Shawnee Cuthbert

Medication: Prednisone (Prednisone Intensol, Deltasone.) Adrenal hormone: Glucocorticoid.

Intermediate-acting corticosteroid. Pregnancy Category B (Not applicable to this female client
due to menopause) (Vallerand, Sanoski, & Deglin, 2013, p. 365)
Note: Pregnancy Category C (Kee, Hayes & McCuistion, 2015, p. 753)

Nursing Diagnosis(s): Activity intolerance related to altered dexterity as evidence by inability to open pill bottles (Doenges,
Moorhouse, & Murr, 2013, p.39); Pain, chronic related to physical disability (RA) as evidence by patients statement of pain 7 out
of 10 during office visit (Doenges et al., 2013, p. 555); Imbalanced nutrition, more the body requirements related to steroid use as
evidence by 5lb. weight gain in 5 day period (Doenges et al., 2013, p. 533); Fluid volume, excess related to steroid use as evidence
by +1 peripheral edema (Doenges et al., 2013, p. 333); Impaired oral mucous membrane related to pharmacological side effects as
evidence by patient statement of xerostomia (Doenges et al., 2013, p.545); Self-care deficient related to musculoskeletal impairment
as evidence by patients statement of inability to button shirt (Doenges et al., 2013, p. 664); Disturbed body image related to
inability to perform activities of daily living as evidence by patients statement My hands are so gnarled, I cant do anything
anymore (Doenges et al., 2013, p. 100)
Assessment of Learner:
Patient has difficulty seeing small print.
Patient has difficulty with memory.
Patient has previous knowledge of
diabetes due to family history.
Patient is well educated, retired teacher.
Patient has social support with large
family in close proximity.
Patient has economic concerns about cost
of medication.
Patient has impaired hand mobility.

Assessment of Environment:
Turn the lights all the way up for better
vision.
Talk in office for increased comfort and
privacy.
Turn off phones and other noise to
decrease distractions.
Meet at patients preferable time to
increase focus and patient adherence.
Keep office door closed to decrease noise.

Learning Resources:
Medication pamphlets
Watch short film on RA
Refer to social services (insurance issues),
dietician (weight gain/diabetes), and
physical therapy (decreased dexterity) to
address additional needs
Give number to nursing hotline to address
questions after hours

Long Term Goal: Patient will maintain current hand dexterity by attending physical therapy twice a week for one year. Patient will
appear relaxed, able to sleep, and participate in activities at nine month follow up. Patient will verbalize increased confidence and
ability to cope with disease at nine month follow up. Patient will be within ten pounds of her current weight at one year follow up
through diet and exercise. Patient will continue with monthly checkups to monitor renal function, glucose, bone density, and
electrolytes for the duration of steroid use. At one year appointment patient will report 2 or less out of 10 on pain scale by adhering
to medication regimen. Patient will verbalize side effects of Prednisone and report any symptoms to the office.

Teaching Plan for Prednisone

Short Term Goals:

Nursing Interventions:

Scientific Principles:

Evaluation

Patient will verbalize

medication schedule at the
conclusion of the teaching
session.

Nurse will teach the Patient about

the tapering schedule the Patient
is on. Nurse will also write out a
calendar of schedule for Patient to
take home. (Kee et al., 2015, p.
755)

Prednisone, when abruptly stopped

can cause adrenal crisis due to a
lack of cortisol (Kee et al., 2015, p.
755). Adrenal crisis can be life
threatening if not treated
immediately causing shock,
seizures, coma, and hypoglycemia
(MedlinePlus, 2014).

Patient stated she will take

60mg today and the next
three days, then 40mg for
four days, 20mg for four
days, and 10mg per day
indefinitely. She stated the
calendar will go on her
refrigerator because she
keeps her medications in
the kitchen.

Patient will verbalize how

to take and store
medication at the
conclusion of the teaching
session.

Nurse will provide written

instructions on the storage and use
of Prednisone (Kee et al., 2015, p.
755).

Glucocorticoids should only be

administered as ordered due to
multiple types and routes of the
medication (Kee et al., 2015, p.
755). Keep this medication in the
container it came in, tightly closed,
and out of the reach of children.
Store it at room temperature, away
from heat and moisture to prevent
degradation and altered
effectiveness of medication
(MedlinePlus, 2014).

The patient stated she will

take the oral medication
once a day with water. She
stated she will keep the
original bottle in her
kitchen cabinet away from
her grandchildren.

Patient will state 4 side

effects of the medication at
the end of the teaching
session.

Nurse will instruct the patient to

watch out for nausea, diarrhea,
abdominal distention, increased
appetite, sweating, headache,
depression, flushing, mood
changes, and cataracts (Kee et al.,
2015, p. 753).

These side effects can indicate

infection, adrenal insufficiency,
hypokalemia, hyperglycemia, and
psychosis which require medical
interventions to prevent permanent
damage (ATI, 2013).

The patient verbalized that

she will call the office if
she experiences swelling
and pain in the stomach,
confusion, vision
problems, and vomiting.

Teaching Plan for Prednisone

Patient will attend referral

appointment with dietician
and report nutrition plan at
next office visit in one
month.

Nurse will explain that weight

gain and osteoporosis are serious
side effects associated with
steroids. Nurse will provide a list
of recommended dieticians for the
patient to choose and help manage
these side effects.

Prednisone can cause hypokalemia,

hypocalcemia, and water retention
that increases the risk of diabetes,
osteoporosis, and hypertension.
Also the patient needs to avoid
grapefruit juice and herbal
supplements to prevent
hypokalemia (Kee et al., 2015, p.
755).

Patient stated she will

schedule dietician
appointment within one
month.

Patient will state

environmental
modifications to manage
disease progression at next
visit in one month.

Nurse will prepare patient for

possible life changes that might be
needed to further independence
and cope with disease progression
(Ignatavicius & Workman, 2013,
p. 341).

Patients with RA do not want to be

dependent. Fine motor activities
may become impossible but they
can be substituted for larger joints
and body surfaces (Ignatavicius &
Workman, 2013, p. 341).

Patient stated she and her

husband will make a list of
environmental changes and
adaptive devices to assist
her and will bring them to
the next appointment.

Patient will adhere to

regular lab testing.

Nurse will explain to patient that

we need to monitor electrolyte
and glucose levels on this
medication and set up
appointments to complete those
tests (Ignatavicius & Workman,
2013, p. 338).

Chronic steroid therapy can cause

sodium or fluid retention,
potassium depletion, and elevated
glucose level causing diabetes,
osteoporosis, and hypertension
(Ignatavicius & Workman, 2013, p.
338).

Patient wrote scheduled lab

tests on calendar and
verbally agreed to keep
those appointments.

Teaching Plan for Prednisone

Patient will verbalize

importance of taking
medication at the same
time each day, with food,
and preferably before bed
time, at the end of the
teaching session.

Nurse will verbally explain to

patient the importance of taking
the medicine at the same time
each day (Kee et al., 2015, p. 755)
and that it may be better to take
Prednisone in the evening with a
snack, before bed. (MedlinePlus,
2014)

Sign and symptoms of rheumatoid

arthritis have circadian rhythms
and are more prominent in the
morning. Timing of glucocorticoid
administration may be important
with respect to the natural secretion
of endogenous glucocorticoids.
(Kirwan & Buttgereit, 2012)

Patient stated that she will

begin taking Prednisone
that evening after a light
snack to avoid possible GI
upset and to reduce pain
the next morning.

Patient will verbalize

importance of monitoring
blood glucose levels at the
end of the teaching session.

Nurse will verbally teach patient

the importance of monitoring
closely blood glucose levels and
explain the relevance of the
current family history and that
Type II can be hereditary. Nurse
will also teach that Prednisone
increases glucose levels as a side
effect. (Kee et al., 2015, p. 755,
759)

Blood sugar levels will probably

increase when taking Prednisone.
(Kee et al., 2015, p. 755)
Prednisone increases blood glucose
levels and can cause
hyperglycemia in patients with a
predisposition of getting diabetes.
(Kee et al., 2015, p. 759)

Patient stated that glucose

levels are checked yearly,
due to family history, but
will now monitor at least
once a week with a home
glucose test.

Patient will state at least

three of the most common
drug-drug interactions at
the end of the teaching
session.

Nurse will give patient a large

print list of medicines which are
known to cause drug-drug
interactions with Prednisone.
Nurse will teach the importance of
patient reporting all current drugs,
OTC or prescribed, and herbal
supplements. (Vallerand et al.,
2013, p. 367)

There is a great risk for

hypokalemia, and loop diuretics
and thiazide increase this risk even
more. Hypokalemia increases the
risk of Digoxin toxicity so these
medicines should not be used
together, if possible. There is a risk
for GI upset if taking with
NSAIDs, including aspirin.
(Vallerand et al., 2013, p. 365)

Patient reported not taking

any other medicines and
states that the doctor will
be notified if adding any
OTC supplements or new
medications.

Teaching Plan for Prednisone

Patient will verbalize

importance of medication
adherence and be able to
state why tapering off over
1-2 weeks is necessary, at
the end of the teaching
session.

Nurse will teach patient how to

recognize common side effects
and educate on the importance
taking the drug as prescribed, and
not stopping the medicine without
consulting doctor. (Kee et al.,
2015, p. 755)

Side effects are common with

Prednisone and it is important to
know that the medicine should not
be stopped abruptly. Stopping
medicine without tapering off can
cause adrenal crisis. (Kee et al.,
2015, p. 755)
If you suddenly stop taking
prednisone, your body may not
have enough natural steroids to
function normally. This may cause
symptoms such as extreme
tiredness, weakness, upset
stomach, changes in skin color,
sores in the mouth, and craving for
salt. (MedlinePlus, 2014)

Patient stated what some

common side effects are,
and to call doctor with any
questions, before stopping
medication due to any side
effect discomfort.

Patient will state

importance of increasing
intake of foods containing
potassium, while taking
Prednisone, at the end of
the teaching session.

Nurse will teach patient verbally

about foods high in potassium (ie.
Bananas, potatoes) and reinforce
with a list to take home. (Kee et
al., 2015, p. 234) Nurse will
recommend taking potassium
supplements. (ATI, 2013)

Adverse side effects of Prednisone

include hypokalemia. Vallerand et
al., p. 365)
Steroids promote potassium loss
and sodium retention. (Kee et al.,
2015, p. 233)

Patient stated she loves

bananas and typically has a
potato product with dinner
at least 4x week and will
increase to 6-7x week now.
Patient will also carry food
list when going out to eat.

Teaching Plan for Prednisone

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References

ATI (2013). Pharmacology for Nursing, Edition 6.0: Content Mastery Series Review Module. USA: Assessment Technologies Institute,
LLC.
Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2013). Nursing diagnosis manual planning, individualizing, and documenting client
care. Philadelphia, PA: F.A. Davis Company.
Ignatavicius, D.D., & Workman, M.L. (2013). Care of patients with arthritis and other connective tissue disease. Medical-surgical
nursing patient-centered collaborative care (pp. 318-355). St. Louis, MO: Elsevier Saunders.
Kee J.L., Hayes, E.R., & McCuistion, L.E. (2015). Pharmacology a patient-centered nursing process approach. St. Louis, MO:
Elsevier Saunders.
Kirwan, J.R. and Buttgereit, F. (2012). Symptom control with lose-dose glucocorticoid therapy for rheumatoid arthritis. Oxford
Journals: Rheumatology, 51 (4), pages 14-20. http://rheumatology.oxfordjournals.org/content/51/suppl_4/iv14.full
MedlinePlus (2014). Prednisone. U.S. National Library of Medicine National Institutes of Health. Retrieved from
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601102.html
Vallerand, A.H., Sanoski C.A., & Deglin, J.H. (2013).Corticosteroids (Systemic). Daviss drug guide for nurses (pp. 363-370).
Philadelphia, PA: F.A. Davis Company