VN 201 Chapter 27 Review

CH 37: Corticosteroids


 Corticosteroids: are hormones secreted by the adrenal cortex of the adrenal glands as regulated by
pituitary glands. Divided into two categories:
o Mineralocorticoid: is aldosterone, secreted by adrenal cortex to act on the kidney to maintain
fluids and electrolyte balance. Ex: Fludrocortisone, Aldosterone.
o Glucocorticoids: regulate carbohydrate, protein, and fat metabolism. It is used in treatment of
inflammatory, antiallergenic, and immunosuppressive activity. Ex: Cortisone, Hydrocortisone,
Prednisone.


 Nursing implication for corticosteroid Therapy:
o Assessment: The minimum data includes wt, BP, results of electrolyte and glucose. Monitoring all
aspects of intake, output, diet, electrolyte balance and hydration, and history of pain experience.
 Medication use: Prescribed and OTC meds history (including herbal meds)
 Physical assessment: BP, Tem, Wt and fat distribution, Pulse, Heart and lung sounds,
Skin color, and Neck veins.
 Neurologic: Mental state and Anxiety. Pt can be susceptible to psychotic behavior
change.
 Status of hydration: Dehydration, Skin turgor, Oral mucous membrane, Lab changes look
for values of BUN, nitrogen, hematocrit, and electrolytes. Overhydration causes
abdominal grit and weight gain. and look for edema,
 Presence of ulcer disease: previous treatments for ulcer, heartburn, and stomach pain.
Check stool for occult blood.
 Lab test: corticosteroids cause sodium retention (hypernatremia) and potassium
excretion (hypokalemia); hyperglycemia may be observed with high dose of it.
 Nutrition: history of pt’s diet. Nausea, vomiting, Anorexia are the signs of corticosteroids
insufÏciency.
 Hyperglycemia: it induces hyperglycemia, with pt with diabetes or prediabetes.
 Activity and Exercise: effect of exercise on pt’s function.
o Implementation:
 Presence of illness: infectious diseases, and TB testing is needed.
 Medication use: Review all meds
 Medication administration: Monitor BG level, if elevated insulin may be needed. Follow
the body's normal circadian rhythm. Glucocorticoids ordered 2x daily, ⅔ administered
before 9am. Take all meds with food and monitor for hyperglycemia.
 Neurological: Plan for stress reduction education.
 Fluid volume status: Monitor daily I&O
 Nutrition: examine dietary history
 Pain Management: Comfort measures for decreasing pain.
 Vital Signs and Hydration: Monitor VS, and hydration status regularly.
 Laboratory test: check for abnormal lab values. (hypo/hyperkalemia,
hypo/hyperglycemia, hypo/hyperkalemia)
o Pt education:
 Contact with healthcare provider: assess pt’s understanding
 Skin Care: change position every 2 hrs, inspect the ankle, feel and abdomen for edema
daily.
 Coping with stress: explore mechanism to deal with stress
 Avoidance of infection: advise pt to avoid crowds or people known to have infection.
Report any signs of infection.

,  Nutritional status: Assess pt to develop a specific schedule for daily I&O. If weight gain is
a problem, try calorie restriction.
 Activity and exercise: participate in regular exercise. Encourage weight bearing
measures to prevent calcium loss, and to maintain mobility try ROM, and joining and
muscle integrity.
 Fostering health maintenance: discuss how the meds are beneficial, pt with steroids
therapy should carry identification cards or bracelets. Provide pt info containing drug
monographs for the drug prescribed.
 Pt self-assessment: enlist pt’s help in developing and maintaining a written record of
monitoring parameters.


 Drug Class: Mineralocorticoid
o Fludrocortisone
o Action: is adrenal corticosteroid with potent mineralocorticoid and glucocorticoid effects. It
affects fluid and electrolyte balance by acting on renal tubules, causing sodium and water
retention and potassium and hydrogen excretion.
o Uses: in combination of glucocorticoids to replace mineralocorticoids activity in pt who suffer
adrenocortical insufÏciency, and to treat salt losing adrenogenital syndrome.
o Therapeutic outcomes: Control BP and restore fluid and electrolyte balance.
o Nursing implication:
 Check the electrolyte
 Record I&O, weight, and VS
 Ask pt for any signs of infection
 Perform baseline assessment
 Ask for previous treatment for heartburn or stomach pain.
o Dosage and Administration:
 PO 0.1mg tab daily
o Adverse effect: Sodium accumulation and potassium depletion.




 Drug Class: Glucocorticoids
o Action: anti-inflammatory and anti-allergenic and immunosuppression
o Uses: they don't cure disease, but relief symptoms. Use for certain cancer, organ transplantation,
autoimmune disease, allergies and shock.
o Therapeutic Outcomes: reduce pain and inflammation, minimize shock syndrome and faster
recovery. Reduce nausea and vomiting associated with chemotherapy.
o Nursing Implication:
 Check the electrolyte and glucose
 Keep record of I&O, VS, and weights.
 Ask about signs of infection: vomiting, nausea, fever, sore throat
 Perform baseline assessment
 Ask about previous treatment for ulcer, heartburn, and test stool for blood.
o Dosage and Administration: administer for 3 weeks or longer, 2mg, 20mg, for 21 days.
o Common serious and adverse effects: electrolyte imbalance, fluid accumulation, susceptibility to
infection, behavior changes, hyperglycemia, peptic ulcer formation, delayed wound healing,
visual disturbances, and osteoporosis.
o Drug Interaction:
 Diuretics: Furosemide, Bumetanide, Thiazides: corticosteroids may enhance the loss of
potassium.
 Warfarin: steroids may enhance or decrease the anticoagulant effects.