Presented by Julie Gray, Kate Balagety,

Nazia Arif, Christine, Gemma,

 Oral Prednisolone
Is One of the drugs used in management of Rheumatoid Arthritis. Mainly
because;
•It can be used in low doses to decrease the
symptom of inflammation.
•Reduces swelling in the joints
•Prednisolone reduces symptoms of pain,
•Reduces stiffness, and maintains mobility
•Prevent deformity as the process of disease
makes the individual rigid.
 3 SIDE EFFECTS
• Peptic ulceration; A GI effect, caused by
long term use of predisolone.
• Osteoporosis; Muscloskeletal effect.
• Papiloedema; Opthalmic effect.
 Nursing Care Issues
Regarding Patients on Predisolone

Wean Patient off from dosage, as it may lead to sudden collapse.

Monitor blood glucose levels, Pre and post meals because prolonged use of
steroids could lead to possible diabetes.
Predisolone is a glucocorticoid, which increases blood glucose levels due to the
breakdown of proteins and fats by the process of gluconeogenesis.
Glucocorticoids suppress WBC e.g. lymphocytes; part immune/inflammatory
response, therefore risk of infection.
Use aseptic techniques, whilst caring for wounds and invasive procedure, to
reduce risk of infection as patients become more suseptable whilst on
predisolone.
This can be achieved by; maintaining a clean environment, using PPE and hand
washing. [infection control techniques]
 A nursing colleague says to you that her patient has asked for more
painkillers but she is not going to rush to get them because she does
not believe that the patient is in that much pain.

In this situation, the first priority would be the

patient in pain. There are many ways
around ensuring the patient receives
analgesia.
 Legal & Ethical Issues around Pain
Seers 1987, found that nurses recorded pain to be less severe then the patients
own assessment very often.

Patients maybe stereotyped as being a nuisance or dramatic over expressing

their pain.

Equally patients in pain may not express as well (introvert personalities) and
receive less analgesia.
This situation can be brought on by the nurses own culture and beliefs on the
concept of care and pain. Such has strong personalities can endure pain, and
weaker people are demanding analgesia in fear of pain.
The NMC code of conduct and ethics of nursing;
Nurses must:
Attend to every report of pain by clients or their families
Regard the personal privacy of clients as they deal with pain.
Respect the lifestyle and belief systems of clients.
Strive to sustain human life and dignity while relieving pain and suffering.
 Advocacy
• Although not specifically your patient, as a nurse
you must take on the role of advocate for all
patients and make it your responsibility to look
after their interests and health. You would
therefore be in breach of the NMC Code of
Conduct which states:
• “You must act as an advocate for those in your
care, helping them to access relevant health and
social care....” Also:
• “You must listen to the people in your care and
respond to their concerns and preferences”.
 Ethics:
• McCaffrey (1968) proposed a definition of
pain that reminds nurses of the subjectivity
of pain:
• “Pain is what the patient says it is and
exists when he/she says it does”.
 Effects of unrelieved pain:

• Unrelieved pain increases a patient’s

susceptibility to develop detrimental physical,
psychological, spiritual and social effects. Good
management of pain enables mobility and deep
breathing, and reduces the risk of physiological
events such as deep vein thrombosis,
hypertension and tachycardia.
• Preventing these complications avoids
prolonged hospital stays which has cost
implications for the NHS.
 1
You could ask your colleague what the
patient is prescribed, and offer to provide
the medication as a staff member, or
under supervision as a student.

Making it very difficult for nurses to say no,

because legally and ethically they know
they have a duty of care.
 2
You could question the effectiveness of the
drug the patient is receiving, as they need
more analgesia.

Highlighting the fact that the patient must be

in pain, and its better to give them the
analgesia now, and evaluate the results. It
might be the medical team need to
prescribe an alternative.
 3
Communicating with your colleague is
important, you may take them aside for a
moment, and remind them that if the
patient says they are in pain, they are in
pain.
Ethically as nurses we are obliged to
manage that pain as much as possible. It
will help to build a good nurse patient
relationship and maintain ‘trust’ by
providing the patient with prescribed pain
relief.
 4
As a last resort, if your colleague doesn’t
recognise and acknowledge the non
maleficence; to report the pain to another
member of staff, and later discuss with a
senior member of staff how a patients pain
should be managed and how nursing
attitudes effect this on the ward.
 Legal:
There are additional legal and financial
considerations for health care providers who do
not treat serious pain appropriately. In the USA,
a health care provider was held liable for failure
to treat serious pain in terminal illness
appropriately and the family were awarded
substantial damages, (Estate of H. James vs
Hillhaven Corp. 1991). Although this case
involved terminal illness, there are implications
for all health care staff and managers.