Download File

CHAPTER 38
CORTICOSTEROIDS
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-1
FUNCTIONS OF ADRENAL GLANDS
(WHERE ARE THEY LOCATED?)
• The adrenal cortex secretes two types of
corticosteroids (hormones)
• Mineralocorticoids (Addison’s disease & F&L balance)
• Fludrocortisone (Addison’s)
• Aldosterone (increases Na reabsorption, thus inc B/P)
• Glucocorticoids (antiinflammatory, metabolism of CHO, Pro,
&Fat)
• Cortisone
• Hydrocortisone
• Prednisone
•
BTW….Adrenal Medulla secretes Epinephrine (F/F)
Mosby, Inc., an affiliate of Elsevier Inc.
38-2
PREMEDICATION ASSESSMENT
• Check for electrolyte imbalance:
•
KNOW NORMAL VALUES
• Record intake and output, vital signs
• Check for signs of infection (may be masked, low temp)
• Perform baseline assessment of patient’s degree of
alertness WHY? Steroids can cause Psychosis, esp pt with
mental disorder (quickie: AOX4, ABC’s)
• Previous treatment for ulcer, heartburn, stomach pain
• Taking NSAIDS, ASA…..Why?
• Taking herbs? (ginko, ginsing, garlic)
• Test stools for occult blood
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-3
NURSING PROCESS: IMPLEMENTATION
• Monitor glucose levels for elevation; insulin may be
required
• Follow body’s normal circadian rhythm
• Corticosteroids: 2/3 of dose before 9 AM, 1/3 of dose late
afternoon
• Mineralocorticoids: once daily in evening
• Monitor daily weight, I&O
• Additional doses may be needed if patient
experiences stress, accidental injury; wear ID
bracelet
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-4
DRUG CLASS: MINERALOCORTICOIDS
• Drug: fludrocortisone (Florinef) The only true
mineralocorticoid drug
• Actions
• Affect fluid and electrolyte balance causing sodium and
water retention
• Uses
• Treat adrenal insufficiency, Addison’s disease (you need to
ADD mineralocorticoids to this pt)
• Therapeutic outcomes
• Control of blood pressure, restore fluid and electrolyte
balance
• Adverse effects: sodium accumulation, potassium
depletion
• Remember ….. H20 follows Na
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-5
AUDIENCE RESPONSE QUESTION 1
• Which laboratory test result is the nurse especially
aware of for a patient who is taking fludrocortisone
(Florinef) for the treatment of Addison’s disease?
A.
B.
C.
D.
Potassium depletion
Sodium loss
Calcium loss
Hydrogen increase
A- Causes sodium retention and potassium loss
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-6
AUDIENCE RESPONSE QUESTION 2
• The nurse instructs a patient taking fludrocortisone
(Florinef) that he should notify the health care
provider of the occurrence of which adverse
effect?
A.
B.
C.
D.
Fatigue
Weight loss
Edema of feet and ankles
Nausea
• C Na & H2O retention, K loss also check daily wt
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-7
DRUG CLASS: GLUCOCORTICOIDS
• Actions
• Antiinflammatory, antiallergenic (2nd choice after antihistamines)
immunosuppression (autoimmune disorders/ transplants/ cancer)
• Uses
• Certain cancers, organ transplantation, autoimmune diseases,
allergies, shock
• Common and serious adverse effects
• Electrolyte imbalance, fluid accumulation; susceptibility to
infection; behavioral changes; hyperglycemia; peptic ulcer
formation; delayed wound healing; visual disturbances;
osteoporosis
• Long term may use every other day dosing always use the
smallest dose for the shortest length of time to avoid neg SE
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-8
CORTICOSTEROID THERAPY:
DRUG INTERACTIONS
• Diuretics
• Corticosteroids may enhance the loss of potassium
• Warfarin
• Corticosteroids may enhance or decrease the
anticoagulant effects of warfarin
• Oral hypoglycemic agents or insulin
• Diabetic/prediabetic patients must be monitored for
hyperglycemia
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-9
STEROID TAPER
• Abrupt discontinuation of therapy may result in
adrenal insufficiency. Adrenals shut down BC there
are steroids in bloodstream
• Symptoms
• Fever, malaise, fatigue, weakness, dizziness, fainting, anorexia,
nausea, hypotension, dyspnea, hypoglycemia, muscle and
joint pain
• Gradual withdrawal of steroid use prevents symptoms
of adrenal insufficiency and allows adrenal glands to
start functioning again
• That is why QOD dosing works well
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-10
CORTICOSTEROID THERAPY:
USE WITH CAUTION
• Carefully monitor patients with
•
•
•
•
•
•
Diabetes mellitus (hyperglycemia)
Heart failure
Hypertension
Peptic ulcer disease (check stool for OB)
Mental disturbance (neuro base line, psych Hx)
Suspected infections (may mask S&S)
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-11
PATIENT EDUCATION
FOR CORTICOSTEROID THERAPY
• Know when to contact health care provider (increased
physical or mental stress, signs of infection, edema)
• Perform appropriate skin care
• Cope with stress
• Avoid infections
• Ensure proper nutrition
• Ensure regular exercise
• Foster health maintenance
• Maintain a written record Pt self assessment record vs,
wt, mood changes, response to Tx)
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-12
AUDIENCE RESPONSE QUESTION 3
• What is a common adverse effect of
glucocorticoids?
A.
B.
C.
D.
Weight loss
Hypoglycemia
Appetite suppression
Delayed wound healing
E.
D especially significant if pt is diabetic
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-13
AUDIENCE RESPONSE QUESTION 4
The nurse is teaching a patient about a
glucocorticoid medication to treat an adrenal
disorder. Which statement made by the patient
indicates a need for further teaching?
A. “I take my medications with breakfast.”
B. “I’ll be careful not to be in crowds of people.”
C. “My prescription ran out, but I’ll refill it next week.”
D. “I’ll follow up with my physician in 1 week.”
 c Titrate off to allow adrenal glands to return to normal, do
not stop suddenly
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-14
AUDIENCE RESPONSE QUESTION 5
• A patient has been taking an oral corticosteroid to
treat inflammation of the respiratory tract. The
patient questions the nurse who is administering a
dose of insulin. The nurse should respond:
A. “Your physician wants you to take this to prevent
diabetes.”
B. “Your pancreas is no longer functioning and you need
insulin.”
C. “Your respiratory tract inflammation has caused you to be
diabetic.”
D. “Corticosteroids frequently cause your blood sugar to
increase.”
E. D/ hyperglycemia
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-15
STEROID MEN
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-16
STEROID FEMALE
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-17
MOON FACE BEFORE & AFTER
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-18
MOON FACE BABY
Mosby items and derived items © 2013,
2010, 2007, 2004 by Mosby, Inc., an
affiliate of Elsevier Inc.
38-19