You are on page 1of 9

Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances

that are usually produced by the body and are needed for normal body functioning). Prednisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; multiple sclerosis (a disease in which the nerves do not function properly); lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works. How should this medicine be used? Prednisone comes as a tablet, a solution (liquid), and a concentrated solution to take by mouth. Prednisone is usually taken with food one to four times a day or once every other day. Your doctor will probably tell you to take your dose(s) of prednisone at certain time(s) of day every day. Your personal dosing schedule will depend on your condition and on how you respond to treatment. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take prednisone exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor. If you are taking the concentrated solution, use the specially marked dropper that comes with the medication to measure your dose. You may mix the concentrated solution with juice, other flavored liquids, or soft foods such as applesauce. Your doctor may change your dose of prednisone often during your treatment to be sure that you are always taking the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, infection, or a severe asthma attack. Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment. If you are taking prednisone to treat a long-lasting disease, the medication may help control your condition but will not cure it. Continue to take prednisone even if you feel well. Do not stop taking prednisone without talking to your doctor. 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, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, and craving for salt. Call your doctor if you experience these or other unusual symptoms while you are taking decreasing doses of prednisone or after you stop taking the medication. Other uses for this medicine Return to top Prednisone is also sometimes used with antibiotics to treat a certain type of pneumonia in patients with acquired immunodeficiency syndrome (AIDS). Talk to your doctor about the risks of using this drug for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Return to top Before taking prednisone,

tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions. Ask your doctor or pharmacist for a list of the inactive ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); anticoagulants ('blood thinners') such as warfarin (Coumadin); certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) and voriconazole (Vfend);aprepitant (Emend); aspirin; carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin, in Prevpak); cyclosporine (Neoral, Sandimmune); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac, others); dexamethasone (Decadron, Dexpak); diuretics ('water pills'); efavirenz (Sustiva); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); HIV protease inhibitors including atazanavir (Reyataz), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); hormonal contraceptives (birth control pills, patches, rings, implants, and injections); lovastatin (Altocor, Mevacor); medications for diabetes; nefazodone; nevirapine (Viramune); phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate); sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate).Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor what herbal products you are taking or plan to take, especially St. John's wort. tell your doctor if you have an eye infection now or have ever had eye infections that come and go and if you have or have ever had threadworms (a type of worm that can live inside the body); diabetes; high blood pressure; emotional problems; mental illness; myasthenia gravis (a condition in which the muscles become weak); osteoporosis (condition in which the bones become weak and fragile and can break easily); seizures; tuberculosis (TB); ulcers; or liver, kidney, intestinal, heart, or thyroid disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking prednisone, call your doctor. if you are having surgery, including dental surgery, or need emergency medical treatment, tell the doctor, dentist, or medical staff that you are taking or have recently stopped taking prednisone. You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency. do not have any vaccinations (shots to prevent diseases) without talking to your doctor. you should know that prednisone may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection. Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles.

What special dietary instructions should I follow?

Return to top Your doctor may instruct you to follow a low-salt, high potassium, or high calcium diet. Your doctor may also prescribe or recommend a calcium or potassium supplement. Follow these directions carefully. Talk to your doctor about eating grapefruit and drinking grapefruit juice while you are taking this medication. What should I do if I forget a dose? Return to top When you start to take prednisone, ask your doctor what to do if you forget to take a dose. Write down these instructions so that you can refer to them later. Call your doctor or pharmacist if you miss a dose and do not know what to do. Do not take a double dose to make up for a missed dose. What side effects can this medication cause? Return to top Prednisone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

headache dizziness difficulty falling asleep or staying asleep inappropriate happiness extreme changes in mood changes in personality bulging eyes acne thin, fragile skin red or purple blotches or lines under the skin slowed healing of cuts and bruises increased hair growth changes in the way fat is spread around the body extreme tiredness weak muscles irregular or absent menstrual periods decreased sexual desire heartburn increased sweating

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

vision problems eye pain, redness, or tearing sore throat, fever, chills, cough, or other signs of infection

seizures depression loss of contact with reality confusion muscle twitching or tightening shaking of the hands that you cannot control numbness, burning, or tingling in the face, arms, legs, feet, or hands upset stomach vomiting lightheadedness irregular heartbeat sudden weight gain shortness of breath, especially during the night dry, hacking cough swelling or pain in the stomach swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs difficulty breathing or swallowing rash hives itching Nursing DX/Clinic al Problem Problem Client Goals/Desired Outcomes/Objec tives Long Term: Nursing Interventions/Actions/ Orders and Rationale *Evaluate medications the client is taking to see if they could be causing activity intolerance. Rationale: Medications such as beta-blockers, lipidlowering agents, which can damage muscle, and some antihypertensives such as Clonedine and lowering the blood pressure to normal in the elderly can result in decreased functioning. (Ackley & Ladwig, 2008, p 121) *Assess nutritional * I Evaluation Goals Intervention s Goal met. Pt demonstra ted increased tolerance to activity. Pt was able to ambulate to the room door and back to the bed without any abnormal changes in vitals. Pt stated that he felt stable Continue intervention s as listed. Continue to evaluate the pts medications to see if they could be causing the activity intolerance. Continue to assess pts nutritional needs. Continue to provide emotional support and encouragem ent so that

Assessmen t

Subjective Pt states that he cannot walk any farther than the bathroom or the chair without experienci ng shortness of breath. Pt states that he was admitted because

Activity Pt will Intoleranc demonstrate e increased tolerance to activity by discharge.

he was experienci ng unusual shortness of breath

needs associated with activity intolerance. Rationale: The decline in body mass, with physical weakness, inhibits mobility, increasing liability to deep vein thrombosis, and pressure ulcers. (Ackley & Ladwig, 2008, p 120) *Provide emotional support and encouragement to the client to gradually increase activity. Rationale: Fear of breathlessness, pain, or falling may decrease willingness to increase activity. (Ackley & Ladwig, 2008, p 120)

after the pt may ambulating feel more . confident about resuming activity.

Objective Chart states chief complaint as shortness of air Diagnosis of congestive heart failure Pt demonstra tes dyspnea upon exertion and acitivty.

R/T Weakness and fatigue

Short Term: Pt will participate in physical activity with appropriate changes in heart rate, blood pressure, and respirations within three days, by [date]. *Obtain any necessary assistive devices or equipment needed before assisting in ambulation Rationale: Assistive devices can increase mobility by helping the client overcome limitations. (Ackley & Ladwig, 2008, p 120)

AEB Pt states that he cannot ambulate far

Goal met. Pt was able to participate in physical activity with appropriat e vitals changes. His vitals were checked before and after activity and there were no

Continue intervention s as listed. Continue to monitor vitals before and after activity. Continue to assess for pain before activity. Continue to obtain any assistive devices before activity.

without experienc ing shortness of breath. Diagnosis of congestiv e heart failure Chief complaint of shortness of breath

indications of unstable vitals.

Nursing Care Plans For Activity Intolerance Definition: Insufficient physiological or psychological energy to endure or complete required or desired daily activities Limitation Characteristics Activity Intolerance: Response not from normal blood pressure on the activity Response does not dati normal heart rate for activities EKG shows changes aritmia EKG showed ischemia changes inconvenience during activities Dyspnea at beraktifitas Reporting of fatigue Reporting of weaknes Related factors Nursing Diagnosis Activity Intolerance: Bedrest complete exhaustion imbalance between oxygen supply and demand immobility Lifestyle Defining Characteristics Activity Intolerance Subjective:

Verbal report of fatigue/weakness Exertional discomfort/dyspnea Objective: Abnormal heart rate/blood pressure response to activity Electrocardiographic changes reflecting arrhythmias/or ischemia Sample Clinical Applications Nursing Diagnosis Activity Intolerance Anemias, Angina, Tuberculosis, Uterine Bleeding Aortic Stenosis, Bronchitis, Emphysema, Diabetes Mellitus, Peripheral Vascular Disease, Rheumatic Fever, Dysmenorrhea, Heart Failure, Human Immunodeficiency Virus/Acquired Immunodeficiency Disease (HIV/AIDS), Labor/Preterm Labor, Leukemias, Mitral Stenosis, Obesity, Pain, Pericarditis, Thrombocytopenia. Nursing Outcomes Nursing Diagnosis Activity Intolerance

Patien will Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible. Patien will Use identified techniques to enhance activity tolerance. Patien will Participate in necessary/desired activities. Patien will Report measurable increase in activity tolerance. Patien will Demonstrate a decrease in physiological signs of intolerance

Nursing Priority Nursing Care Plans For Activity Intolerance Identify causative/precipitating factors Assist client to deal with contributing factors and manage activities within individual limits To promote wellness (patient teaching/discharge considerations) NURSING DIAGNOSIS: Risk for activity intolerance related to: 1. decrease in available energy associated with an inadequate nutritional status and a slowed metabolic rate when inactive; 2. loss of muscle mass, tone, and strength associated with disuse and inadequate nutritional status; 3. eventual decrease in cardiac reserve associated with:

A. increased cardiac workload resulting from the increased venous return in a recumbent position B. decreased coronary blood flow resulting from a shortened diastolic filling time (a result of the progressive increase in heart rate that occurs when a person is immobile) C. weakening of the myocardium (not usually a factor until client has been immobilized for 3 weeks or longer); 4. difficulty resting and sleeping associated with inability to assume usual sleep position, frequent assessments and treatments, fear, anxiety, unfamiliar environment, and discomfort resulting from current illness/injury. Desired Outcome The client will not experience activity intolerance as evidenced by: 1. no reports of fatigue and weakness 2. ability to perform activities of daily living within physical limitations/restrictions without exertional dyspnea, chest pain, diaphoresis, dizziness, and a significant change in vital signs. Nursing Actions and Selected Purposes/Rationales 1. Assess for signs and symptoms of activity intolerance: A. statements of fatigue or weakness B. exertional dyspnea, chest pain, diaphoresis, or dizziness C. abnormal heart rate response to activity (e.g. increase in rate of 20 beats/minute above resting rate, rate not returning to preactivity level within 3 minutes after stopping activity, change from regular to irregular rate) D. a significant change (15-20 mm Hg) in blood pressure with activity. 2. Implement measures to prevent activity intolerance: A. perform actions to promote rest and/or conserve energy: I. minimize environmental activity and noise II. organize nursing care to allow for periods of uninterrupted rest III. limit the number of visitors and their length of stay IV. assist client with self-care activities as needed V. keep supplies and personal articles within easy reach VI. implement measures to reduce fear and anxiety (see Diagnosis 13, action b) VII. implement measures to promote sleep (see Diagnosis 10, action c) B. perform additional actions to reduce cardiac workload and help maintain adequate cardiac reserve: I. place client in a semi- to high Fowler's position periodically if allowed II. instruct client to avoid activities that create a Valsalva response (e.g. straining to have a bowel movement, holding breath while moving up in bed) III. implement measures to improve breathing pattern and airway clearance (see Diagnoses 1, action b and 2, action b) in order to promote adequate tissue oxygenation IV. discourage smoking and excessive intake of beverages high in caffeine such as coffee, tea, and colas C. perform actions to help maintain muscle strength (see Diagnosis 6, actions a.1 - 4)

D. perform actions to maintain an adequate nutritional status (see Diagnosis 3, action c) E. when activity can be increased: I. increase activity gradually II. instruct client in energy-saving techniques (e.g. using shower chair when showering, sitting to brush teeth or comb hair). 3. Instruct client to: A. report a decreased tolerance for activity B. stop any activity that causes chest pain, shortness of breath, dizziness, or extreme fatigue or weakness. 4. Consult physician if signs and symptoms of activity intolerance develop and persist or worsen. Numbness and tingling are abnormal sensations that can occur anywhere in your body, but are often felt in your fingers, hands, feet, arms, or legs. Causes There are many possible causes of numbness and tingling:

Sitting or standing in the same position for a long time Injuring a nerve (a neck injury may cause you to feel numbness anywhere along your arm or hand, while a low back injury can cause numbness or tingling down the back of your leg) Pressure on the nerves of the spine, such as from a herniated disk Pressure on peripheral nerves from enlarged blood vessels, tumors, scar tissue, or infection Shingles or herpes zoster infection Lack of blood supply to an area (for example, from atherosclerosis or frostbite) Other medical conditions, including: o Carpal tunnel syndrome (pressure on a nerve at the wrist) o Diabetes o Migraines o Multiple sclerosis o Seizures o Stroke o Transient ischemic attack (TIA), sometimes called a "mini-stroke" o Underactive thyroid o Raynaud's phenomenon Abnormal levels of calcium, potassium, or sodium in your body A lack of vitamin B12 or other vitamin Use of certain medications Nerve damage due to lead, alcohol, or tobacco Radiation therapy Animal bites Insect, tick, mite, and spider bites Seafood toxins