A patient is taking high doses of prednisone to control the symptoms of acute exacerbation of systemic lupus erythematosus. When teaching the patient about the use of prednisone, which information is important for the nurse to include?
A.
Check your temperature daily because prednisone can hide signs of an infection.
B.
Do not stop taking the prednisone suddenly, it should be decreased gradually.
C.
Call the doctor if you experience any mood alterations with the prednisone.
D.
Weigh yourself daily to monitor for weight gain caused by water or increased fat.
The Correct Answer and Explanation is:
The correct answer is B. Do not stop taking the prednisone suddenly; it should be decreased gradually.
Explanation:
Prednisone is a corticosteroid commonly prescribed for its potent anti-inflammatory and immunosuppressive effects. It is often used in managing autoimmune diseases like systemic lupus erythematosus (SLE), especially during acute exacerbations. While prednisone is effective, it has a significant impact on the body, particularly when used in high doses or over extended periods.
Key Points about Prednisone:
- Gradual Tapering: The most critical piece of information to convey to a patient on high-dose prednisone is the need for gradual tapering when discontinuing the medication. The adrenal glands produce cortisol, a natural steroid hormone. When a person takes prednisone, the body’s production of cortisol decreases because the external supply meets the body’s needs. If prednisone is stopped abruptly, the body may not be able to produce enough cortisol quickly enough to meet physiological needs, leading to adrenal insufficiency, a potentially life-threatening condition. Tapering the dose allows the adrenal glands to gradually resume normal cortisol production.
- Infection Risk: Prednisone suppresses the immune system, which can increase the risk of infections and mask typical signs such as fever. While monitoring temperature is important, it is secondary to understanding the necessity of tapering the dose (Option A).
- Mood Alterations: Corticosteroids like prednisone can cause mood swings, irritability, or even more severe psychiatric symptoms. It is crucial to inform patients to report any mood changes (Option C), but again, this is not as immediately critical as the risk of adrenal insufficiency.
- Weight Gain: Prednisone can cause significant weight gain due to fluid retention and fat redistribution. Daily weight monitoring (Option D) can be useful, especially in patients with cardiovascular risks, but it is not as urgent as understanding the need to taper the medication.
Conclusion: Educating the patient about the importance of not stopping prednisone suddenly and understanding the need for gradual tapering is the most critical aspect of managing their treatment. This helps prevent serious complications such as adrenal insufficiency, making Option B the correct answer.