Glucocorticoids - prednisone (Rayos) & Mineralocorticoids - fludrocortisone

to determine baseline status before beginning therapy and for any potential adverse effects.

Assess weight; temperature; orientation and affect; grip strength; eye examination; blood pressure, pulse, peripheral perfusion, and vessel evaluation; respiration and adventitious breath sounds; glucose tolerance, renal function, serum electrolytes, and endocrine function tests as appropriate, to determine baseline status before beginning therapy and for any potential adverse effects.

Glucocorticoids (i.e.prednisone) treat many conditions that are caused by inflammation, such as:

Asthma. Chronic obstructive pulmonary disease (COPD) Allergies. Rheumatoid arthritis. Osteoarthritis. Crohn's disease and other types of inflammatory bowel disease. Eczema and other skin conditions. Multiple sclerosis.

The nurse is teaching a client who is receiving prednisone about possible adverse effects. The client demonstrates understanding of the teaching when the client identifies what possible effect? Abdominal distention Weight loss Hypoglycemia Anorexia

Abdominal distention All of these are associated w/ prednisone use. Abdominal distention Weight gain Hyperglycemia Increased appetite

Nursing Considerations for Patients Receiving Glucocorticoids are:

Administer drug daily at 8 to 9 AM to mimic normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. Space multiple doses evenly throughout the day to try to achieve homeostasis. Use the minimal dose for the minimal amount of time to minimize adverse effects. Taper doses when discontinuing from high doses or from long-term therapy to give the adrenal glands a chance to recover and produce adrenocorticoids. Arrange for increased dose when the patient is under stress to supply the increased demand for corticosteroids associated with the stress reaction. Use alternate day maintenance therapy with short-acting drugs whenever possible to decrease the risk of adrenal suppression. Do not give live virus vaccines when the patient is immunosuppressed because there is an increased risk of infection. Protect the patient from unnecessary exposure to infection and invasive procedures because the steroids suppress the immune system and the patient is at increased risk for infection. Assess the patient carefully for any potential drug-drug interactions to avoid adverse effects.

Some adverse affects of using prednisone is?

Adverse Effects: Vertigo, headache, hypotension, shock, sodium and fluid retention, amenorrhea, increased appetite, weight gain, immunosuppression, aggravation or masking of infections, impaired wound healing.

When a patient is taking Glucocorticoids what are some assessments you as a nurse need to do?

Assess for: hx of allergy to any steroid preparations acute infections peptic ulcer disease pregnancy & lactation endocrine disturbances renal dysfunction which could be cautions or contraindications to use of the drug.

Glucocorticoids are cautioned in the presence of?

Caution should be used in patients with: Diabetes b/c the glucose-elevating effects disrupt glucose control With acute peptic ulcers, b/c steroid use is associated with the development of ulcers With other endocrine disorders, which could be sent into imbalance In pregnancy, b/c of the potential for adverse effects on the fetus

Glucocorticoids (i.e.prednisone) are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. How do glucocorticoids do this?

Blocking the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. --> Without these chemicals the normal inflammatory reaction is blocked. They also impair the ability of phagocytes to leave the bloodstream and move to injured tissues, and they inhibit the ability of lymphocytes to act within the immune system, including a blocking of the production of antibodies.

What is the therapeutic action of Glucocorticoids and Mineralocorticoids?

Glucocorticoids (anti-inflammatory) suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins, or as. Mineralocorticoids (salt retaining) that regulate the balance of salt and water in the body. Glucocorticoids enter target cells and bind to cytoplasmic receptors, initiating many complex reactions that are responsible for anti-inflammatory and immunosuppressive effects.

Glucocorticoids are contraindicated in the presence of?

Glucocorticoids are contraindicated in the presence of: Acute infection, which could become serious or even fatal if the immune and inflammatory responses are blocked; With lactation, because the anti-inflammatory and immunosuppressive actions could be passed to the baby.

What action do glucocorticoids (i.e. prednisone) have on protein and fat?

Glucocorticoids increase the rate of protein breakdown & decrease the rate of protein formation from amino acids, another way of preserving energy. Glucocorticoids also cause lipogenesis, or the formation and storage of fat in the body.

What action do glucocorticoids have on glucose?

Glucocorticoids stimulate an increase in glucose levels for energy.

Prednisone is used for what?

Inflammation, autoimmune disorders, ulcerative colitis, glomerulonephritis, allergies, drug reactions, anaphylaxis, and to prevent organ rejection

Glucocorticoids: Prednisone (-sone) Short term use ONLY Immunosuppression (masks infection) Taper when discontinue to allow the body to refresh Electrolyte imbalance (Na and K+)

Nursing Process: Goal: reduce inflammation of chronic conditions Hold: Low K+, Edema, HTN Baseline data specific to this drug: Sleep patterns, Na+/K+ levels, condition, glucose levels, weight, immune status (WBC), edema, calcium (bone density) Nursing Diagnoses: Chronic Inflammation, Addison's Disease, Adrenal Fx (???) Teaching: stay away from sick people, get vaccines (avoid live virus), reduce Na intake, notify provider for sudden weight gain/edema/fever, long term use leads to osteoporosis, TAPER off Antidote: Fuk Nope ← lol

What are some nursing processes for patients taking Glucocorticoids such as prednisone (-sone)?

Nursing Process: Goal: reduce inflammation of chronic conditions Hold: Low K+, Edema, HTN Baseline data specific to this drug: Sleep patterns, Na+/K+ levels, condition, glucose levels, weight, immune status (WBC), edema, calcium (bone density) Nursing Diagnoses: Chronic Inflammation, Addison's Disease, Adrenal Fx (???) Teaching: stay away from sick people, get vaccines (avoid live virus), reduce Na intake, notify provider for sudden weight gain/edema/fever, long term use leads to osteoporosis, TAPER off Antidote: Fuk Nope ← lol

Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease? Osteoporosis Swelling in the brain and spinal cord Bronchoconstriction Cryptorchism

Osteoporosis The client who is on long-term glucocorticoid therapy is at risk for osteoporosis due to the reduction in new bone synthesis. Glucocorticoids are used to reduce swelling in the brain and spinal column and to promote bronchodilation.

Prednisone (Rayos) Oral Adult: 0.1-0.15 mg/kg/d PO Pediatric: Base dose on severity and response Replacement therapy for adrenal insufficiency, treatment of allergic and inflammatory disorders

The Glucocorticoid --> Prednisone is available only as an oral agent.

True or False? Not all adrenocortical agents are classified as only glucocorticoids or mineralocorticoids?

True

True or False? Some steroids have both glucocorticoid and mineralocorticoid effects.

True Hydrocortisone, cortisone, and prednisone all have both glucocorticoid and mineralocorticoid effects.

What important teaching is needed for patients taking Glucocorticoids?

Ways to avoid adverse effects Warning signs of problems Importance of regular evaluation (including blood tests) Explain the need to protect the patient from exposure to infections to prevent serious adverse effects.

Hydrocortisone, cortisone, and prednisone have glucocorticoid and some mineralocorticoid activity and affect what electrolytes in the body when present at high levels?

potassium (K+) sodium (Na+) water levels