Corticosteroids Chapter 37

Glucocorticoids

____________ produce many adverse effects, including delayed wound healing, hyperglycemia, weight gain, fluid retention, increased fat deposition, increased appetite, mood swings, and gastric ulcer formation.

Fludrocortisone

________________ causes sodium and water retention and potassium excretion, which can then result in fluid leaking out of capillary beds and accumulating in feet and ankles. Weight will also increase due to fluid retention.

hyperglycemia

Oral hypoglycemic agents or insulin: Diabetics/prediabetic patients must be monitored for ____________

d

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 healthcare provider 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 increase."

Glucocorticoids

Actions: Antiinflammatory, antiallergenic, immunosuppression 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

Glucocorticoids

Adrenal glands Secrete two types of corticosteroids (hormones) one is _________________; which are Cortisone, Hydrocortisone, Prednisone

Mineralocorticoids

Adrenal glands Secrete two types of corticosteroids (hormones) one is ___________________; which are Fludrocortisone, Aldosterone

increase

Corticosteroids do cause an ________ in blood sugar, requiring insulin to lower the blood sugar level.

warfarin

Corticosteroids may enhance or decrease the anticoagulant effects of ________

potassium

Corticosteroids may enhance the loss of _______

k

Fludrocortisone's mineralocorticoid and glucocorticoid effects can disrupt fluid and electrolyte balance by acting on the distal renal tubules, causing sodium and water retention and potassium and hydrogen excretion.

Adrenal glads

Lab values to check for electrolyte imbalance: K+, Ca+, Na+, Cl-. Signs of infection to look for in a patient taking steroids: General malaise, sore throat, low-grade fever.

Mineralocorticoids

Maintain fluid and electrolyte balance and are used to treat adrenal insufficiency caused by hypopituitarism or Addison's disease

m

Monitor glucose levels for elevation; insulin may be required Follow body's normal circadian rhythm Corticosteroids: ⅔ of dose before 9 am, ⅓ 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

Glucocorticoids

Regulate carbohydrate, protein, and fat metabolism and have antiinflammatory, antiallergenic, and immunosuppressant activity.

steroids

Symptoms: Fever, malaise, fatigue, weakness, dizziness, fainting, anorexia, nausea, hypotension, dyspnea, hypoglycemia, muscle and joint pain

c

The nurse instructs a patient taking fludrocortisone (Florinef) that she should notify the healthcare provider of the occurrence of which adverse effect? a)Fatigue b)Weight loss c)Edema of feet and ankles d)Nausea

c

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 healthcare provider in 1 week."

potassium

The nurse should be especially aware of decreased ________ levels, which can cause muscle weakness and increase the risk of cardiac rhythm abnormalities.

adrenal glands

These are located on the top of each kidney; they also regulate sex hormones.

Fludrocortisone (Florinef)

This is a Mineralocorticoids Action: Affects fluid and electrolyte balance, causing sodium and water retention Uses: Treatment of adrenal insufficiency, Addison's disease Therapeutic outcomes: Control of blood pressure, restoration of fluid and electrolyte balance Adverse effects: Sodium accumulation, potassium depletion

Fludrocortisone

Used in combination with glucocorticoids. _____________ is the only drug that has true mineralocorticoid effects.

d

What is common adverse effect of glucocorticoids? a)Weight loss b)Hypoglycemia c)Appetite suppression d)Delayed wound healing

Corticosteroids

What may cause: Cause hyperglycemia in diabetic patients. Mask symptoms of infection. Induce hypertension. Induce psychotic behavioral changes in a patient with a history of mental instability.

a

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)Potassium depletion b)Sodium loss c)Calcium loss d)Hydrogen increase

adrenal

steroid taper- Abrupt discontinuation of therapy may result in ________ insufficiency