NURBN2012 Case Study: Budesonide Treatment and Patient Education

This case study presents a dialogue between a nurse practitioner and a patient, Mary, regarding the treatment of her son, Joseph, with budesonide for his respiratory condition. The conversation covers various aspects of Joseph's medication, including dosage, administration methods, and potential side effects. The nurse provides detailed instructions on how to administer the medication, emphasizing the importance of taking it with food or without food depending on the doctor's instructions. She also addresses potential drug interactions, dietary supplements, and food restrictions, specifically warning against grapefruit consumption. Furthermore, the nurse discusses the importance of medical compliance, the potential risks associated with improper medication use, and the need for regular follow-up. The case highlights the significance of patient education, medication adherence, and the role of healthcare professionals in managing patients' health conditions. The discussion also touches on the impact of Joseph's condition on his lifestyle, including limitations on physical activities like cycling, and the importance of addressing these concerns.

Running head: HEALTHCARE
Topic: HEALTHCARE
Name of the Student:
Name of the University:
Author Note:

1HEALTHCARE
Nurse practitioner- Good morning Mary! How is Joseph’s health condition now? Has there
been any improvement after replacement of earlier doses of beclomethasone with
budesonide?
Mary- Good Morning! He is fine now as there has been improvement after the change of the
drug. But still he suffers from shortness of breaths very often and cannot pursue cycling as he
often need his nebulizer after cycling for 15 minutes.
NP- The last time we had discussed about his medications it has been changed from
bethclomethasone to budesonide (Bassler et al., 2015). The dose of his medications is 0.5 mg
once daily or twice daily of 0.25 mg when you would take only bronchodilators. Moreover, if
you take inhaled corticosteroids it would 0.5once daily as well as 0.25 twice daily or 0.5 mg
twice daily. For oral corticosteroids 0.5 mg would be taken daily or 1 mg daily. Have you
understood the timing of budesonide or you want me to repeat it?
Mary: Yes I have been following the dosage and the medications as per your instructions.
However his doctor has instructed me to strictly adhere to the dosage and get help form you if
any side effects are shown. I still don’t whether I would continue with his cycling exercises
as he likes to ride bicycles.
NP- Mary you should know this new drug budesonide requires the consumption of the
medicine along with food or without food as per the directions of your doctor (Peterson et
al., 2015). You should take this through mouth (Sherlock et al., 2015). He should not sill the
tablets out of your mouth till they have a score line. Heu should take the medicine with a full
glass of water. Moreover, always remember to make him shallow the tablet and do not crush
or chew it.

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Mary- Oh great he would not have to taste the medicine then. Earlier one was bitter in taste
and made his mouth distasteful as I had to chew it.
NP- Well then it is a great relief regarding the medicine! However always remember that
drugs have all possible drug interactions. Thus always consult your healthcare professional
and your general practitioner before taking the medicine (Bateman et al., 2015). The
supplements for the diet would be folic acid, garlic, oolong tea along potassium along with
incorporation of astralagus in your diet.
Mary: Oh nice ! I love garlic and Joseph loves it too as his grandma always makes tasty
dishes with garlic. He would like to take all the supplements in my diet. However will there
be any reaction of any food after taking the drug? Do I have to consider about any particular
food item?
NP: Oh yes absolutely! You should be careful while making dishes with grapefruit and
consume or make him eat only after you have consulted your doctor.
Mary: Oh really! This is sad because Joseph love grapefruit and often eat it with my family
as I always cook good dishes with grapefruit.
NP: Yes but do not worry. You only have to discontinue it for a short span only. However
Joseph should always be careful about your increased chance of alcohol along with you and
family on weekends. Because if the dose is high he will never get rid of your breathing
problems, they will worsen on the contrary (Zheng et al., 2016). Keep his as well yours
consumption within permissible limits and ask his doctor before consuming the drug
alongside alcohol. Always ask his general pracationer before taking alcohol.

3HEALTHCARE
Mary: Oh! I did not know that. I will never drink it again. Joseph also want to get rid of his
cough and short breaths. He does not like it. He cannot cycle because of it. He gets tired very
soon while most of his friends still continue to play and this saddens me.
NP: Mary, always remember that there are various medical compliances with the drug you
are taking. Be careful about whatever I say as they are important. Medical compliance is an
advice which you would be following form the doctors and the nurses. Often you would
suffer from problems and the quality of care you receive will be compromised. The areas of
medical compliance are the proper maintenance of the prescriptions along with the
medications and the doses which you should regularly follow.
Mary: Is that something to worry about? I am scared about whatever you are saying. I would
tell Joseph to be careful and give me the medicines in correct doses and on time. Will I suffer
from anything else?
NP: Nothing to worry about Mary. Always note that you can use this drug as an inhaler or
pill. Always show your doctor and you family about the dose of the drug as you might suffer
from liver diseases if they are taken improper and cause diseases along with tuberculosis
apart from high blood pressure (Nieuweboer et al., 2015). Always measure the dose. Update
me about the improvements every week. For any kind of problem, come to me. Have a nice
day Mary. Thank you!

4HEALTHCARE
References
Bassler, D., Plavka, R., Shinwell, E. S., Hallman, M., Jarreau, P. H., Carnielli, V., ... &
Halliday, H. L. (2015). Early inhaled budesonide for the prevention of
bronchopulmonary dysplasia. New England Journal of Medicine, 373(16), 1497-1506.
Bateman, E. D., Reddel, H. K., O’byrne, P. M., Barnes, P. J., Zhong, N., Keen, C., ... &
FitzGerald, J. M. (2018). As-needed budesonide–formoterol versus maintenance
budesonide in mild asthma. New England Journal of Medicine, 378(20), 1877-1887.
Nieuweboer, A. J., de Graan, A. J. M., Hamberg, P., Bins, S., van Soest, R. J., van Alphen, R.
J., ... & Zuetenhorst, H. (2017). Effects of budesonide on cabazitaxel
pharmacokinetics and cabazitaxel-induced diarrhea: a randomized, open-label
multicenter phase II study. Clinical Cancer Research, 23(7), 1679-1683.
Peters, S. P., Bleecker, E. R., Canonica, G. W., Park, Y. B., Ramirez, R., Hollis, S., ... &
Martin, U. J. (2016). Serious asthma events with budesonide plus formoterol vs.
budesonide alone. New England Journal of Medicine, 375(9), 850-860.
Sherlock, M. E., MacDonald, J. K., Griffiths, A. M., Steinhart, A. H., & Seow, C. H. (2015).
Oral budesonide for induction of remission in ulcerative colitis. Cochrane database of
systematic reviews, (10).
Zheng, C.R., Chen, G.Z., Yu, J., Qin, J., Song, P., Bian, S.Z., Xu, B.D., Tang, X.G., Huang,
Y.T., Liang, X. and Yang, J., 2014. Inhaled budesonide and oral dexamethasone
prevent acute mountain sickness. The American journal of medicine, 127(10),
pp.1001-1009.

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