CORTICOSTEROIDS

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NURSING IMPLICATIONS

Assessment & Drug Effects

• Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood glucose.
• Lab tests: Periodic serum electrolytes blood glucose, Hct and Hgb, platelet count, and WBC with differential.
• Monitor for adverse effects. Older adults and patients with low serum albumin are especially susceptible to adverse effects.
• Be alert to signs of hypocalcemia (see Appendix F).
• Ophthalmoscopic examinations are recommended every 2–3 mo, especially if patient is receiving ophthalmic steroid therapy.
• Monitor for persistent backache or chest pain; compression and spontaneous fractures of long bones and vertebrae present hazards.
• Monitor for and report changes in mood and behavior, emotional instability, or psychomotor activity, especially with long-term therapy.
• Be alert to possibility of masked infection and delayed healing (antiinflammatory and immunosuppressive actions).
• Note: Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury).
• Note: Single doses of corticosteroids or use for a short period (<1 wk) do not produce withdrawal symptoms when discontinued, even with moderately large doses.

Patient & Family Education

• Expect a slight weight gain with improved appetite. After dosage is stabilized, notify physician of a sudden slow but steady weight increase [2 kg (5 lb)/wk].
• Avoid alcohol and caffeine; may contribute to steroid-ulcer development in long-term therapy.
• Do not ignore dyspepsia with hyperacidity. Report symptoms to physician and do NOT self-medicate to find relief.
• Do NOT use aspirin or other OTC drugs unless prescribed specifically by the physician.
• Note: A high protein, calcium, and vitamin D diet is advisable to reduce risk of corticosteroid-induced osteoporosis.
• Notify physician of slow healing, any vague feeling of being sick, or return to pretreatment symptoms.
• Do not abruptly discontinue drug; doses are gradually reduced to prevent withdrawal symptoms.
• Report exacerbation of disease during drug withdrawal.
• Carry medical identification at all times. It needs to indicate medical diagnosis, drug therapy, and name of physician.
• Apply topical preparations sparingly in small children. The hazard of systemic toxicity is higher because of the greater ratio of skin surface area to body weight.
• Check shelf-life date on topical corticosterone during long-term use.
• Do not breast feed while taking/using this drug without consulting physician.

Other Nursing Articles you may want to look at:

• HYDROCORTISONE (hye-droe-kor’ti-sone) Aeroseb-HC, Alphaderm, Cetacort, Cortaid, Cort-Dome, Cortenema, Cortril, Dermacort, Dermolate, Hydrocortone, Hytone, Proctocort, Rectocort , Synacort HYDROCORTISONE ACETATE Anusol HC, CaldeCort, Carmol HC, Colifoam, Cortaid, Cortamed, Cort-Dome, Cortef Acetate, Corticaine, Cortifoam, Cortiment , Epifoam, Hydrocortone Acetate HYDROCORTISONE CYPIONATE Cortef Fluid HYDROCORTISONE SODIUM PHOSPHATE Hydrocortone Phosphate HYDROCORTISONE SODIUM SUCCINATE A-Hydrocort, Solu-Cortef HYDROCORTISONE VALERATE Westcort Classifications: skin and mucous membrane agent; antiinflammatory; synthetic hormone; adrenal corticosteroids; glucocorticoid; mineralocorticoid Pregnancy Category: C NURSING IMPLICATIONS Assessment
• PREDNISONE (pred’ni-sone) Apo-Prednisone , Deltasone, Meticorten, Orasone, Panasol, Prednicen-M, Sterapred, Winpred  Classifications: hormones and synthetic substitutes; adrenal corticosteroid; glucocorticoid Pregnancy Category: C   NURSING IMPLICATIONS Assessment & Drug Effects Establish baseline and continuing data regarding BP, I&O ratio and pattern, weight, and sleep pattern. Start flow chart as reference for planning individualized
• CEPHALEXIN (sef-a-lex’in) Cefanex, Ceporex_A, Keflet, Keflex, Keftab, Novolexin_A Classifications: antiinfective; antibiotic; first-generation cephalosporin Prototype: Cefazolin Pregnancy Category: B NURSING IMPLICATIONS Assessment & Drug Effects Determine history of hypersensitivity reactions to cephalosporins and penicillin and history of other drug allergies before therapy is initiated. Lab tests: Evaluate renal and hepatic
• DOBUTAMINE HYDROCHLORIDE (doe-byoo’ta-meen) Dobutrex Classifications: autonomic nervous system agent; beta-adrenergic agonist; catecholamine Prototype: Isoproterenol Pregnancy Category: C NURSING IMPLICATIONS Assessment & Drug Effects Correct hypovolemia by administration of appropriate volume expanders prior to initiation of therapy. Monitor therapeutic effectiveness. At any given dosage level, drug takes 10–20 min to produce
• CLOXACILLIN, SODIUM (klox-a-sill’in) Apo-Cloxi , Cloxapen, Cloxilean, Novocloxin , Orbenin, Tegopen Classifications: antiinfective; antibiotic, natural penicillin; beta-lactam Prototype: Penicillin G Pregnancy Category: B NURSING IMPLICATIONS Assessment & Drug Effects Determine previous exposure and sensitivity to penicillins and cephalosporins and other allergic reactions of any kind before treatment is initiated. Monitor for S&S of