Running head: Steroid Teaching Plan 1

Steroid Teaching Plan

Denay Kantor and Madison Pleasants

Cedar Crest College

STERIOD TEACHING PLAN 2
NUR 314 Pharmacology

Steroid Teaching Plan

Prednisone is a short-acting corticosteroids within pregnancy category C (Kee, Hayes, & McCuistion, 2015, p. 753). This
corticosteroid is used systemically and locally in a wide variety of chronic diseases including: Inflammatory, Allergic, Hematologic,
Neoplastic, Autoimmune disease. This specific agent suppresses inflammation and the normal tissue immune response. Its
bioavailability is 9-21% after being metabolized by liver to inactive metabolites. One serious contradiction, especially with someone
who has a familial history of diabetes, is that it may increase requirements for insulin or oral hypoglycemia (Vallerand, Sanoski, &
Deglin, 2015, p. 353). This group of drugs controls inflammation by suppressing or preventing many of the components of the
inflammatory process at the injured site. Corticosteroids have been widely prescribed for arthritic conditions, and although they are
not the drug of choice for arthritis because of their numerous side effects, they are frequently used to control arthritic flareups (Kee,
Hayes, & McCuistion, 2015, p. 344).

Nursing Diagnosis: Noncompliance related to clients value system as evidence by failure to properly
administer medications and evidence of exacerbation of symptoms (Sparks & Taylor, 2014, p.216).
Long Term Goal: Client will become compliant to medication criteria.

Short Term Goals Nursing Interventions: Scientific Principles: Evaluation

Client will identify factors
that can influence
noncompliance and ways to
avoid conflicting factors. (1)
Client will state at least three
positive aspects of taking the
medication.(2)
Nurse will assist patient in
identifying factors and define
areas that can be approved on.
Nurse will teach that the
benefit of Prednisone including
that it is used to treat chronic
diseases such as allergies,
Reasons for noncompliance
Client is able to identify
may range widely and include
factors such as hard-to-open
lack of knowledge, forgetting,
pill bottle and forgetfulness.
feeling better or worse, and
Nurse will speak with doctor
getting contradictory advice
regarding other medication
from family, friends, and
options including returning to
health care providers (Sparks
Enbrel.
& Taylor, 2014, p.216).
Understanding that Client stated she understands
compliance can reduce risk that medication compliance
factors, prevent complications, will not only aid the
and help manage certain autoimmune disease, but will
STERIOD TEACHING PLAN
NUR 314 Pharmacology
autoimmune disorders, and
inflammation. By controlling
inflammation and the
autoimmune disorder, pain
should diminish (Vallerand,
Sanoski, & Deglin, 2015, p.
354).
Client will be in
Nurse will contact social
communication with
worker to assist the client in
appropriate agencies to help
receiving financial assistance
the patient meet the cost of
as the medical record state the
medical treatment (Sparks &
client stopped taking
Taylor, 2014, p.216). (3)
medications for this reason.
Nurse will teach the client and
support system about the
Client will build a support
medication and requirements.
system around her to assist
All members of the support
medical treatment. 4)
system will have a full
understanding of what is
expected.
Nurse will approach patient in
Client will trust and feel
a nonjudgmental manner
accepted by the healthcare
(Sparks & Taylor, 2014,
team. (5)
p.215).
Nursing Diagnosis: Ineffective health maintenance related to inability to maintain health as evidence by
client stating she is bad at taking pills.
Long Term Goal: Clients inflammatory process will decrease without signs of infection.
3
chronic diseases may decrease inflammation and
encourage patient to comply pain.
(Sparks & Taylor, 2014,
p.216).
Client stated she has spoken
Helping patient meet the
with both the social worker
financial requirements of
and appropriate agencies to
treatment improves
receive the financial help
compliance (Sparks & Taylor,
required.
2014, p.216).
Client stated those she wanted
Support from patients family
as a support system and
helps foster compliance
contacted them to be a part of
(Sparks & Taylor, 2014,
the teaching group.
p.216).
This demonstrates
Client stated she trusts and
unconditional positive regard
understands the healthcare
for patient (Sparks & Taylor,
team.
2014, p.215).
STERIOD TEACHING PLAN 4
NUR 314 Pharmacology

Short Term Goals Nursing Interventions: Scientific Principles: Evaluation

Nurse will teach the client that
the glucocorticoid, Prednisone
Drugs like Prednisone need to
can not administer through the
be tapered to allow the Client stated she understands
Client will the importance of deltoid muscle and will be
adrenal cortex to produce it is to be taken orally. Client
maintain and administration administered orally (Hayes &
cortisol and other verbally explains back to
the correct dosage of McCuistion, 2014). 80 mg to
corticosteroids. Abrupt nurse why she will needs to
Prednisone by the end of the be taken daily orally for 5 days
withdrawal of the drug can taper off this medication and
teaching session. (1) then 60mg oral daily for 4 days
result in serve adrenocortical that she will discount after
and then 40mg oral daily for 4
insufficiency (Hayes & cycle.
days then 20 mg a day oral for
McCuistion, 2014, p. 753).
4 days and then 10mg a day
orally.
Nurse will teach the client to
Client writes a list of high
eat foods rich in potassium and
Prednisone promotes potassium foods such as,
Client will state foods that she maintain a sodium restriction.
potassium loss and sweet potatoes, avocadoes,
should take with her Fruits, vegetables, lean meats,
hypokalemia (Hayes & spinach, etc. Clients states she
medication, Prednisone. (2) and nuts are recommended for
McCuistion, 2014). will keep hydrated with water,
high potassium foods (Hayes
instead of soda.
& McCuistion, 2014)
Nurse will teach the client to This form of identification will Client states what the signs
report adverse signs and allow the nurse and other and symptoms of adverse
Client will state adverse
symptoms of moon face, puffy healthcare providers that an effects of the drug Prednisone.
reactions of the drugs
eyes, edema in feet, petechial, adverse reaction is affect. Client states she will call the
Prednisone. (3)
tachycardia, and ecchymosis Being aware of these effects physician if these side effects
(Hayes & McCuistion, 2014). ensure the clients safety. occur.
Nurse will encourage the client Glucocorticoid steroid such as
Client will describe feelings
to wear a Medic Alert card or Prednisone has many Client stated she will apply
about self-management of
bracelet, or bracelet stating interactions and side effects. for the Medic Alert card or
medications and her
glucocorticoid taken (Hayes & Having the client obtain this bracelet
condition. (4)
McCuistion, 2014). form of identification, such as
STERIOD TEACHING PLAN 5
NUR 314 Pharmacology

a bracelet will allow any

healthcare provider to be
aware of what kind of
medications the clients is
taking (Hayes & McCuistion,
2014).

Client will state she

Nurse will teach the
understands when taking Category C medications such a
importance of not taking a
Prednisone it maybe harmful s Prednisone has been tested Client stated she will not have
category C medication and that
for fetus, unless necessary and on animals that indicate a risk sexually intercourse while on
there has been risk versus
prescribed by healthcare to the fetus (Hayes & this medication.
benefit of the drug (Hayes &
provider (Hayes & McCuistion, 2014).
McCuistion, 2014, p.130).
McCuistion, 2014). (5)
Increase in aspirin can lead to
GI toxicity. Herbal laxatives
can lead to an increase in
Nurse will teach the family hypokalemia. Taking alcohol The client stated she does not
Clients family members will
with the client that Prednisone with this medication may take laxatives, drink alcohol
participate in the treatment
should not be taken with herbal cause a serious reaction. Look and family members will not
plan and drug interactions of
laxatives, alcohol, aspirin, and for flushing, weakness, administer over the counter
medication. (6)
NSAIDS. dizziness, headache or tingling. aspirin or NSAIDS.
Anticoagulants can cause
bleeding. (Hayes &
McCuistion, 2014).
Nursing Diagnosis: Risk for unstable blood glucose as evidence by medication adverse effects such as
hypoglycemia, inadequate blood glucose monitor, and physical activity (Sparks & Taylor, 2014, p.136).

Long Term Goal: Client will be able to monitor, control, and prevent unstable blood glucose.
Short Term Goals Nursing Interventions: Scientific Principles: Evaluation
STERIOD TEACHING PLAN
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Client will state the underlying
cause of changes in glucose
(Sparks & Taylor, 2014, p.136).
(1)
Client will state at least two
signs/symptoms of both
hypo/hyperglycemia (Sparks &
Taylor, 2014, p.136). (2)
Client will obtain serum
glucose values in the desired
range (Sparks & Taylor, 2014,
p.136). (3)
Client and family members will
have a full understanding
Nurse will teach client that
the underlying cause of
elevated serum glucose level,
include inadequate dietary
intake, illness, and poor
medication (Sparks & Taylor,
2014, p.136).
Nurse will teach the client that
signs/symptoms of
hypoglycemia are cool,
clammy, lightheadedness,
blurred vision, and mental
confusion (Treas & Wilkinson,
2014, p. 924). The
signs/symptoms of
hyperglycemia are polyuria,
polydipsia, polyphagia,
lethargy, malaise, blurred
vision, and headache (Sparks
& Taylor, 2014, p.136).
Nurse will perform and teach
client how to finger stick
herself with a glucometer.
Nurse will teach client that
poor medication management
of glucocorticoids can result in
hyperglycemia (Sparks &
Taylor, 2014, p.137).
Nurse will teach the client and
family members to report
6
Client states that she
...To prevent future episodes
understands that the
and develop treatment
underlying causes of changes
strategies such as changes in
in glucose are familial history,
lifestyle (Sparks & Taylor,
Prednisone, inadequate
2014, p.136).
dietary intake, and illness.
Assess the patients
knowledge of
hypo/hyperglycemia to ensure Client accurately states at
adequate management and least two signs/symptoms of
prevent future episodes both hypo/hyperglycemia.
(Sparks & Taylor, 2014,
p.136).
To prevent and develop
strategies to decrease the risk
of client becoming diabetic.
Results of high dosages or
Client will monitor her blood
prolonged usage of prednisone
sugar with finger stick to
increase blood sugar (Hayes &
maintain and prevent
McCuistion, 2014, p. 753).
hyperglycemia.
Increase in blood sugar can put
the client at an advantage of
becoming diabetic due to the
family history.
To ensure an adequate Client states if glucose levels
understanding to prevent future below or above 60-100 mg/dL
STERIOD TEACHING PLAN
NUR 314 Pharmacology
glucose management of both
hypo/hyperglycemia (Sparks &
Taylor, 2014, p.137). (4)
Client will consult physician
after discharge to evaluate
serum electrolyte levels of
potassium, as prescribed
(Sparks & Taylor, 2014, p.137)
(5)
Nursing Diagnosis: Acute pain related to physical, biological, or chemical agents as evidence by
communication of pain and autoimmune disorder (Sparks & Taylor, 2014, p.238).
Long Term Goal: Client will experience decreased overall pain related to Rheumatoid Arthritis.
Short Term Goals
Client will be established
goals and develop plan for
pain control (Sparks &
Taylor, 2014, p.238). (1)
Client will articulate
possibility of physical pain
being associated with
emotional stressors (Sparks &
Taylor, 2014, p.238). (2)
abnormal glucose sugars levels
that are below or above 60-100
mg/dL (Hayes & McCuistion,
2014, p.770).
Nurse will give discharge
instructions and teach client
and caregiver about consulting
with physician for serum
electrolyte levels of potassium,
as prescribed.
Nursing Interventions:
Nurse will meet with client and
physician to discuss goals and
plan for pain control.
Nurse will teach patient that
there is a correlation between
physical and emotion pain.
Other factors can be influences
the feeling of pain.
events hypo/ hyperglycemia.
Prednisone side effects
increase blood sugar, decrease
potassium, and effect sodium
and water retention. With
increase blood glucose levels,
potassium and sodium levels
may be low or high (Sparks &
Taylor, 2014, p.137)
Scientific Principles:
This gives the patient a sense
of control (Sparks & Taylor,
2014, p.238).
This helps the patient explore
exacerbating emotional or
environmental factors that may
influence pain (Sparks &
Taylor, 2014, p.238).
7
to contact healthcare provider.
Client states she understands
discharge order and will
consult physician to continue
her labs.
Evaluation
Client states specific and
timely goals for pain along
with a specific plan.
Client shows she understands
what factors can influence
pain such as emotional and
environmental.
STERIOD TEACHING PLAN
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Client will be able to identify
specific characteristics of pain
(Sparks & Taylor, 2014,
p.238). (3)
Client will state satisfaction
with prescribed medication
(Sparks & Taylor, 2014,
p.238). (4)
Client will use relaxation
techniques to relieve pain
(Sparks & Taylor, 2014,
p.238). (5)
Nursing Diagnosis: Knowledge deficient related to difficulty understanding disease process and its effect
on self-care as evidence by medication noncompliance and exacerbated symptoms due to lack of consistent
Long Term Goal: Patient will understand all aspects of the medication and disease process.
Short Term Goals
Nurse will teach the patient
about the 1-10 pain scale in
addition to specific terms that
can be used to accurately
describe the characteristics of
pain.
Nurse will teach the patient
about the prescribed
medication and frequently
check the patient for
satisfaction.
Nurse will teach patient about
guided imagery, massage, and
music therapy to assist in pain
management.
treatment.
Nursing Interventions:
8
Continuous reassessment
documents patients subjective
complaints and behavior with
organic pathology. While pain
Client repeatedly and
is subjective, when using the
specifically describes the
scale you can compare the
characteristics of pain.
patients perception of pain
from one assessment to
another (Sparks & Taylor,
2014, p.238).
Teaching patient about his
medication may help to Client states satisfaction
increase the accuracy of regarding prescribed
dosage necessary to provide medication related to pain
pain relief (Sparks & Taylor, relief.
2014, p.240).
These methods work as an
adjunct to medications, Client uses multiple methods
increase self-help, and foster of relaxation techniques to
independence (Sparks & assist in pain management.
Taylor, 2014, p.240).
Scientific Principles: Evaluation
STERIOD TEACHING PLAN 9
NUR 314 Pharmacology

Open discussion helps

Client will be able identify the
disease process and
medication regimen for her
disease (Sparks & Taylor,
2014, p.623) (1)
Client will address the
importance of self-care and
making informed choices of
taking her medication with a
caregiver (Sparks & Taylor,
2014, p.623). (2)
Nurse will teach addition
information about rheumatoid
arthritis to client in a learning
environment and assist with
identifying the medical
regimen of Prednisone
Nurse will contact a close
family member, caregiver, or
social worker to address self-
care of hygiene, diet, and
medications.
identify barriers to learning
and determines if these barriers process of rheumatoid arthritis
may be eliminated. Discussion
also promotes
acceptance(Sparks & Taylor,
2014, p.623)
Improving self-care of clients
disease with a caregiver will
provided the client to perform
ADLs and open medication
bottles.
Client identifies the disease
and identifies the correct
dosage, time, duration, and
drug.
Client receives help from
caregiver and continues to
improve self- care.

Nurse teaches client to use

Client will provide memory memory skills such as aids, Helps with memory lapses and Client uses an alarm to
skills to help assist on taking alarms, or a calendar for taken helps notifies client to take remember when she should
medication. (3) medications. medication take her medications.

New information is easier to

Client will demonstrate
ability to effectively
implement chosen health care
strategy (Sparks & Taylor,
2014, p.623). (4)
Client will join a support
group (Sparks & Taylor,
Nurse will provide a quiet,
assimilate if its built on
calm environment for learning,
existing knowledge (Sparks &
limit the length of each Client demonstrates ongoing
Taylor, 2014, p.623). ...(A)
teaching session to prevent ability to implement chosen
calm learning environment for
overload, and consider the health care strategies (Sparks
learning to enable the patient
clients existing knowledge & Taylor, 2014, p.624).
to process information without
(Sparks & Taylor, 2014,
distraction from background
p.623).
noise or stress (Sparks &
Taylor, 2014, p.623).
Nurse will provide patient with Encourage the patient to join Client gains continuous
the necessary resources, a support groupto reinforce education and support from
STERIOD TEACHING PLAN 10
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2014, p.624). (5) encouragement, and education education and promote contact groups recommended to her
to join a support group that with others in the same by the nurse.
meets her needs. situation (Sparks & Taylor,
2014, p.624).

Nursing Diagnosis: Risk for disuse syndrome as evidence by her hands are beginning to show signs of
deformity and her distal phalanges (knuckles) are warm, tender to touch and spongy on palpation (Sparks &
Taylor, 2015, p. 102).
Long Term Goal: Deterioration of the body will slow with medication, dietary alterations, and exercise.

Short Term Goals Nursing Interventions: Scientific Principles: Evaluation

Client will maintain adequate To maintain urine output
dietary intake, hydration, and and aid bowel elimination
weight (Sparks & Taylor, (Sparks & Taylor, 2015,
2015, p.103). (1) p.104).
Client will maintain muscle These measures prevent joint
strength and tone and joint contractures, muscle atrophy,
ROM (Sparks & Taylor, and other complications of
2015, p.103). (2) prolonged inactivity (Sparks
& Taylor, 2015, p.103).
Nurse will teach client that
Client will understand the Provide or help with daily
signs of infection can be
importance of infection hygiene; keep skin dry and
abnormal temperature, blood
control (Sparks & Taylor, lubricated to prevent cracking
pressure, pulse, and
2015, p.104). (3) and possible infection (Sparks
respirations (Sparks & Taylor,
& Taylor, 2015, p.104).
2015, p.103).
Client will openly express Allow open expression of all
frustration, anger, feelings associated with
despondency, and other prolonged inactivity to help
feelings associated with patient and family cope with
STERIOD TEACHING PLAN 11
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prolonged inactivity (Sparks treatment (Sparks & Taylor,

& Taylor, 2015, p.105). (4) 2015, p.104).

Nurse will teach client that

extended pressure on joint with
Client will avoid positions
arthritis can cause more pain or
that put extended pressure on
discomfort. Client should
specific body part (Sparks &
change position every two
Taylor, 2014, p.103). (5)
hours (Sparks & Taylor, 2014,
p.103).
These measures enhance
Client will state that she
circulation and help prevent
fulfills movement
tissue or skin breakdown
requirements to avoid
(Sparks & Taylor, 2014,
prolonged pressure.
p.103).
STERIOD TEACHING PLAN 12
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References

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2015). Pharmacoloy: A patient-centered nursing process approach (8th ed.). St. Louis,

MI: Elsevier Saunders.

Sparks, S., & Taylor, C. M. (2014). Nursing diagnosis: Reference manual (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Treas, L. S., & Wilkinson, J. M. (2014). Basic nursing: Concepts, skills & reasoning. Philadelphia, PA: F.A. Davis Company.

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2015). Davis's drug guide for nurses (14th ed.). Philadelphia, PA: F.A. Davis

Company.