PREDNISONE

(pred’ni-sone)
Apo-Prednisone , Deltasone, Meticorten, Orasone, Panasol, Prednicen-M, Sterapred, Winpred 
Classifications:
hormones and synthetic substitutes; adrenal corticosteroid; glucocorticoid
Pregnancy Category: C

 

NURSING IMPLICATIONS

Assessment & Drug Effects

  • Establish baseline and continuing data regarding BP, I&O ratio and pattern, weight, and sleep pattern. Start flow chart as reference for planning individualized pharmacotherapeutic patient care.
  • Check and record BP during dose stabilization period at least 2 times daily. Report an ascending pattern.
  • Monitor patient for evidence of HPA axis suppression during long-term therapy by determining plasma cortisol levels at weekly intervals.
  • Lab tests: Obtain fasting blood glucose, serum electrolytes, and routine laboratory studies at regular intervals during long-term steroid therapy.
  • Be aware that older adult patients and patients with low serum albumin are especially susceptible to adverse effects because of excess circulating free glucocorticoids.
  • Be alert to signs of hypocalcemia (see Appendix F). Patients with hypocalcemia have increased requirements for pyridoxine (vitamin B6), vitamins C and D, and folates.
  • Be alert to possibility of masked infection and delayed healing (antiinflammatory and immunosuppressive actions). Prednisone suppresses early classic signs of inflammation. When patient is on an extended therapy regimen, incidence of oral Candida infection is high. Inspect mouth daily for symptoms: white patches, black furry tongue, painful membranes and tongue.
  • Monitor bone density. Compression and spontaneous fractures of long bones and vertebrae present hazards, particularly in long-term corticosteroid treatment of rheumatoid arthritis or diabetes, in immobilized patients, and older adults.
  • Be aware of previous history of psychotic tendencies. Watch for changes in mood and behavior, emotional stability, sleep pattern, or psychomotor activity, especially with long-term therapy, that may signal onset of recurrence. Report symptoms to physician.
  • If a patient is receiving aspirin concomitantly with a corticosteroid, salicylism may be induced when the corticosteroid dosage is decreased or discontinued.
  • Be aware that long-term corticosteroid therapy is ordinarily not interrupted when patient undergoes major surgery, but dosage may be increased.
  • Monitor for withdrawal syndrome (e.g., myalgia, fever, arthralgia, malaise) and hypocorticism (e.g., anorexia, vomiting, nausea, fatigue, dizziness, hypotension, hypoglycemia, myalgia, arthralgia) with abrupt discontinuation of corticosteroids after long-term therapy.

Patient & Family Education

  • Take drug as prescribed and do not alter dosing regimen or stop medication without consulting physician.
  • Be aware that a slight weight gain with improved appetite is expected, but after dosage is stabilized, a sudden slow but steady weight increase [2 kg (5 lb) per wk] should be reported to physician.
  • Avoid or minimize alcohol and caffeine may contribute to steroid-ulcer development in long-term therapy.
  • Report symptoms of GI distress to physician and do not self-medicate to find relief.
  • Do not use aspirin or other OTC drugs unless they are prescribed specifically by the physician.
  • Report slow healing, any vague feeling of being sick, or return of pretreatment symptoms.
  • Be fastidious about personal hygiene; give special attention to foot care, and be particularly cautious about bruising or abrading the skin.
  • Report persistent backache or chest pain (possible symptoms of vertebral or rib fracture) that may occur with long-term therapy.
  • Tell dentist or new physician about prednisone therapy.
  • Carry medical information at all times. It needs to indicate medical diagnosis, medication(s), physician’s name(s), address(es), and telephone number(s).
  • Do not breast feed while taking this drug without consulting physician.

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