Ms. B is a 73-year-old woman who worked in the local traffic tunnel for about 25 years and has had chronic obstructive pulmonary disease (COPD) for ten years, caused by exposure to environmental pollutants while on the job and by cigarette smoking. She is now retired and is frequently admitted to the hospital for treatment of her condition. She quit smoking about eight years ago. Ms. B is now in the hospital for treatment of an acute exacerbation of her COPD and an upper respiratory tract infection. The physician has ordered the following:
oxygen per nasal cannula at 2 L/min; methylprednisolone (Solu-Medrol) 125 mg IV push, then 80 mg IVPB every 6 hours; Advair 250 mcg/50 mcg, one dose every 12 hours; albuterol 2.5 mg by nebulizer every 4 hours for two days, then every 4 hours as needed; piperacillin/tazobactam (Zosyn) antibiotic therapy, 3.375 g IV every 6 hours; measurement of intake and output; daily weight measurement; assessment of vital signs with breath sounds and pulse oximetry every 2 hours until stable; and chest physiotherapy twice a day and as needed.Ms. B's condition stabilizes within two days, and the methylprednisolone dose is gradually reduced. After one week, the intravenous corticosteroid is discontinued, and she is started on oral prednisone (generic) 40 mg daily. Her discharge medications include the following: prednisone (generic) 40 mg PO daily for three days, then taper and discontinue by reducing the dose by 5 mg daily (prescription calls for 5-mg tablets); Advair 250 mcg/50 mcg, one dose every 12 hours; albuterol (Proventil HFA) metered-dose inhaler, 90 mcg/spray, every 4 hours as needed. Ms. B states, "This is confusing! How do I know how many tablets to take?