Prednisolone

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TABLE OF CONTENTS
Chapter 1
Introduction ………………………………………………………………. 1 1.1 Case study overview ..………………………………………….. 1 1.2 Prednisolone overview …………………………………………. 1 Chapter 2
Case Analysis [clinical complexities] ………………………………… 2 2.1 Complex Issues [COPD and hypertension] ………………… 2 2.2 Complex Issues [Prednisolone use] ………………………….. 2 Chapter 3
Prednisolone Pharmacokinetics …….………………………………… 3 Chapter 4
Prednisolone Pharmacodynamics …….……………………………… 4 Chapter 5
Nursing Considerations
5.1 Nursing considerations [COPD] ..…………………………….. 5 5.1.1 Clinical Manifestations of COPD .…………………….... 6 5.2 Nursing considerations [prednisolone use] ..…………….. 7 5.2.1 Clinical Manifestations [prednisolone use] …………… 7 Chapter 6

Communication and planning ………………………..……..…….…. 9 Appendix A ……………………………………………………………….. 11 References ……………………………………………………………… 12 Glossary ………………………………………………………………… 13

Chapter 1
Introduction __________________________________________________ 1.1 Case Study Overview

Jim, a 57 year old male, currently on the post surgery ward 8 days following a total right hip replacement began to deteriorate displaying signs of respiratory distress. Upon a review by the medical team Jim was diagnosed as having exacerbated COPD and prescribed prednisolone [refer to appendix A for details of Jim’s situation and presentation].

1.2 Prednisolone Overview

Prednisolone is a synthetic form of the naturally occurring corticosteroid known as prednisone produced by the adrenal glands (Craft et al, 2009; Porth & Matfin, 2009). Prednisolone is classed as an anti inflammatory medication and is used to treat a variety of inflammatory conditions including COPD (Porth & Matfin, 2009; Ynze et al, 2007).

The following report will present a discussion on the use of prednisolone for COPD, the complexities of Jim’s condition and nursing considerations that would be addressed in the management of Jim’s condition.

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Chapter 2
Case Analysis – Complex Issues ________________________________________________________________ 2.1 Complex Issues [COPD and Hypertension]

Jim is in hospital recovering from a total right hip replacement. However this is not a straightforward case as Jim’s medical history indicates a history of hypertension, heavy smoking and emphysema. These comorb - idities complicate Jim’s health status and recovery (Porth & Matfin, Dirksen et al 2011).

Hypertension and emphysema both have negative effects on ventilatory capacity, blood pressure and cardiac function which can lead to a variety of other risks such as respiratory acidosis, altered level of consciousness, respiratory and cardiac failure, coma and death (Marieb, 2011; Craft et al, 2009).

2.2 Complex Issues [Prolonged Prednisolone Use]

Jim’s case has the added complexity of prolonged prednisolone use as this increases arterial blood pressure, causes depression, disrupts intestinal function, disturbs sleep patterns and inhibits bone repair (Ynze et al, 2007; Bullock & Manias, 2009).

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Chapter 3
Pharmacokinetics of Prednisolone__________________________________________________ Pharmacokinetics

Prednisolone is rapidly absorbed orally through the jejunum with peak plasma levels at 1 – 2 hours and a half life of 2 – 4 hours (Bullock & Manias, 2009; Ynze et al, 2007). Upon absorption into the body prednisolone is then distributed throughout the body via general circulation bound to plasma protein albumin. Upon exerting it’s effect is then metabolised by the liver to an inactive form and excreted by the kidneys within the urine (Bullock & Manias, 2009; Ynze et al, 2007).

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Chapter 4
Pharmacodynamics of Prednisolone...
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