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The Caring for the Nguyens

The case study presented an issue connected to the prescription of asthma treatments to a 3-year-old Kim Phan. The child was diagnosed with the disease after evaluating presenting symptoms such as tiredness, fatigue, coughing, wheezing, shortness of breath, and nasal congestion. He was prescribed a five-day tapering course of prednisone, a Singulair 4 mg orally daily at bedtime, and periodic treatments with albuterol, administered through a nebulizer. Mai Nguyen, the child’s great-grandmother, raised a concern on the prednisone’s safety, and the family needs a consultation.

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Theoretical Knowledge for Addressing the Concern

Addressing patients and their family members’ concerns on the necessity and safety of prescribed medicines is one of the most frequent responsibilities that nurses have to perform. To do this, it is essential “to understand the benefits of the medications you administer, as well as their potential to cause harm” (Treas et al., 2018, p. 772). This means that medical personnel need to have the necessary knowledge of pharmacology and practical skills of administering medications.

The Reliable Sources of the Needed Information

It is important to realize that nursing personnel is advised to consult with reliable sources that can provide necessary information on drugs, regulations of their use, safety, and possible complications upon necessity. The most trustworthy references are The United States Pharmacopeia and National Formulary, which contains descriptions of drugs approved to be marketed in the USA. Moreover, it is advised to use nursing drug books, Physician’s Desk Reference, medication package inserts, and reliable Internet-based databases, such as Drugs.com, MedlinePlus, and WebMD.

The Rationale for the Prednisone Prescription

Prednisolone has been widely used for asthma treatment in children. This steroid has been used for battling inflammation associated with asthma for decades. Although any medication should be used with precaution, the clinical trials have not shown any connection between prednisone and growth problems (“Prednisolone side effects”, 2020). The reported musculoskeletal issues caused by the increased urinary calcium excretion are characteristic for postmenopausal females and elderly patients (“Prednisolone side effects”, 2020). Therefore, the prescription of prednisone can be considered as safe.

Moreover, in the case of Kim, who presented both wheezing and cold symptoms (coughing and nasal congestion), the use of prednisone can be backed up by recent studies. For instance, a 2017 study showed that prednisone “may be beneficial in first-time wheezing children whose episode was severe and associated with high rhinovirus load” (Koistinen et al., 2017, p. 557). This explanation can potentially help with addressing Yen’s concern.

Finally, it is also essential to answer the grandparent’s question on why prednisolone was administered both orally and through the injection. Due to Kim’s serious condition, the nurse might want to explain that it was essential to provide the rapid delivery of the drug through the intramuscular route to ensure its absorption into the bloodstream and the systemic effect. The further use of tablets was advised due to their convenience for self-administration.

The Oral Administration of Singulair and Albuterol Nebulizer Administration

Due to the pharmacokinetics of Singulair and Albuterol, different administration methods have been prescribed. Singulair, a leukotriene inhibitor, is used to prevent and control asthma attacks and taken orally in the evening (“Singulair”, 2020). The oral character of the administration is explained by its effect, which is supposed to build up over time. However, for albuterol, which is also used to treat Kim’s symptoms, including difficulty breathing, wheezing, and coughing, a nebulizer was chosen due to the patient’s age (“Albuterol oral inhalation”, 2016). Other forms of the medicine – aerosol and powder for oral inhalation – can be prescribed to children of four years of age and older.

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References

Albuterol oral inhalation. (2016). MedlinePlus. Web.

Koistinen, A., Lukkarinen, M., Turunen, R., Vuorinen, T., Vahlberg, T., Camargo, C. A., Jr., Gern, J., & Ruuskanen, O. (2017). Prednisolone for the first rhinovirus-induced wheezing and 4-year asthma risk: A randomized trial. Pediatric Allergy and Immunology, 28(6), 557-563. Web.

Prednisolone side effects. (2020). Drugs.com. Web.

Singulair. (2020). Drugs.com. Web.

Treas, L.S., Wilkinson, J. M., Barnett, K. L., & Smith, M. H. (2018). Basic nursing: Thinking, doing, and caring. F.A. Davis Company.

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