September 26, 2007 · Leave a Comment
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.