Managing the side effects of corticosteroids therapy discussion post

I am submitting three discussion post and i need you to respond to them individually. In your responses to the posts provide constructive and insightful comments that go beyond that of agree or disagree. 1) This post is from Marita: Long term use of corticosteroids can lead to Cushing's syndrome. There are several things the nurse should teach a patient. The skin may become fragile and the patient should avoid injury due to impaired wound healing and risk for infection. A diet low in salt is recommended due to sodium and water retention and increase foods high in potassium, protein, calcium and vitamin D. The nurse can teach the patient or family member how to check blood pressure regularly since prolonged use of these medications can cause hypertension. Patients should be warned about development of moon face, buffalo hump and weight gain. Encourage a low calorie diet. The patient could develop hyperglycemia so the patient should have their blood sugar and glycosuria checked at each doctor visit. Encourage frequent eye exams since prolonged use of corticosteroids could cause glaucoma and/or cataract formation. Teach the patient about the risk for osteoporosis and compression fractures of the spine. Caution the patient to never abruptly stop taking the medication because this may cause an adrenal crisis (Smeltzer, et al, 2010). Some clients may not adhere to the prescribed medication due to the side effects/manifestations that can occur with long term use of corticosteroids. Obesity, moon face, buffalo hump, hypertension, hyperglycemia, impaired wound healing and risk for infection, muscle weakness, mood alterations, osteoporosis, cataracts and/or glaucoma, menstrual irregularities, impotence and adrenal suppression are reasons a client may be unwilling to go along with the prescribed plan of care (Smeltzer, et al, 2010). The nurse could recommend a nutritionist to assist the patient in planning meals that are low sodium, low calorie, high in potassium, protein, calcium and vitamin D. This could decrease the chance of weight gain, hypertension, hyperglycemia, osteoporosis, muscle wasting and water retention. The nurse can teach the patient and/or family how to monitor blood pressure, blood glucose levels and weight. The nurse should encourage moderate activity to prevent complications of immobility and promote increased self-esteem. Encourage hand washing and to avoid exposure to others with respiratory infection to prevent the client from infection since their immune system is compromised. Teach the client to prevent falls and other trauma because they are at risk for osteoporosis which increases their risk for fractures (Smeltzer, et al, 2010). If a client considers the information provided and takes action, the likelihood of complications from prolonged use of corticosteroids will decrease. 2)This post is from Paula: In a patient with Cushing's syndrome, the first thing that I would advise as the RN is to keep a daily health log. In this health log, I would tell them they need to document their weight each morning, monitor their intake and output daily, monitor activity with frequent rest periods daily, verbalize their feelings about the condition, and perform morning blood glucose testing-and document (Interactive Tutorial, week 5). There are several factors that are important to adhere by when taking corticosteroids that the RN can initiate during the nursing assessment. They are: check for allergies before taking any steroid, obtain baseline vital signs before beginning an endocrine drug, including weight and urinary output, check serum levels, including blood glucose, check current medications that the patient is taking, and check for drug interactions to other medication (Kee, Hayes, & McCuiston, 2011). The RN can teach the patient many important factors in regards to corticosteroid use. When a patient is taking meds for their thyroid gland, they need to be instructed on several key factors for use. The med should be tapered, not stopped abruptly. Advise the patient to adhere to the drug regimen. They should decrease salt intake to decrease or avoid edema. Instruct the patient to report side effects such as: muscle weakness, edema, petechiae, ecchymosis, decrease in growth, decreased wound healing, and mentrual irregularities (Kee, Hayes, & McCuiston, 2001). If a patient has been diagnosed with diabetes prior to taking corticosteroids, they should monitor their blood sugar levels closely. Patients should be advised to take their meds at the same time each day, preferably before breakfast. Food will hamper the absorption rate. Teaching the client to check warning labels on OTC drug labels is very important. Suggest that the patient carry a MedicAlert card, tag, or bracelet with the health condition and thyroid drug used with them at all times. When talking to a patient who has hypothyroidism, inform them that they should avoid foods that can inhibit thyroid secretion (strawberries, peaches, pears, cabbage, turnips, spinach, kale, Brussels sprouts, cauliflower, radishes, and peas). For a patient who has hyperthyroidism, instruct the patient to take their med with meals to decrease GI symptoms. Educate them about the effects of iodine and its presence in iodized salt, shellfish, and OTC cough meds. Stressing the importance of drug compliance is critical because if the patient should stop their meds abruptly, they could bring on a thyroid crisis. Advise the patient about side effects that need to be reported to the physician during the use of the antithyroid meds such as: sore throat and fever (Kee, Hayes, & McCuiston, 2011). A patient with hypoparathyroidism should be advised to report any symptoms of tetany in hypocalcemia which include: twitching of mouth, tingling and numbness of fingers, carpopedal spasm, spasmodic contractions, and laryngeals spasms. The patient should also report signs and symptoms of hypercalcemia such as: bone pain, anorexia, nausea, vomiting, thirst, constipation, lethargy, bradycardia, and poyuria (Kee, Hayes, & McCuiston, 2011). In a patient with adrenal disorders the patient should be advised not to abruptly stop their medication and take the med as prescribed. Advise them not to take cortisone preparations during pregnancy unless necessary and prescribed by the physician. Inform the patient that taking certain herbal laxatives and diuretics may interact with their prescribed drug and cause a severity of hypokalemia. Patients should also report any eye issues or problems that they may experience. Glaucoma and cataracts may occur from long term corticosteroid use. If a patient should go out around others during flu season, they may want to wear a mask because of the increase of infection. Patients should be educated on signs and symptoms of adrenal hormone overdose or Cushing syndrome. The signs are: moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding, and menstrual irregularity. The patient should be instructed to take cortisone meds at mealtime or with food. Instruct them on adding foods rich in potassium to their diet such as: fresh and dried fruits, vegetables, meats, and nuts (Kee, Hayes, & McCuiston, 2011). There are several things that may prevent a patient from adhering to the medication regimen. The patient may forget to obtain their weight first thing in the morning. They may or may not take their meds with food, as prescribed. Some may forget to obtain a blood sugar first thing of the morning because they ate their meal before they remembered It is very important that the patient be educated on how to take the meds and all of the signs and symptoms to look for when taking any corticosteroid. They may be experiencing certain side effects and fail to report them because they can mimic other health issues. This is why the RN needs to remain educated themself to provide the most accurate information to their patient. The RN is the advocate for the patient who is in their care. The RN can stress the importance of keeping a daily health log to right down any and all daily symptoms that they are having. It would not be a bad idea for the RN to help the patient get a heatlh log started. The RN can write down the name and dosage of the medication, the time that the med should be taken, the physicians name and number, and any/all signs and symptoms that need to be reported for the patient, specific to the prescribed medication they are taking. 3)This post is from Nash: Corticosteroids are frequently used as anti-inflammatory agents. This group of drugs controls inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site (Kee, Hayes, McCuistion & et al, 2012). Patient education is the most important responsibility Registered Nurses (RN) have. When it comes to corticosteroids it is important to educate the patient on the medication, possible side effects, route for administration, duration of use and nursing considerations. I believe the most important item for this therapeutic class is that corticosteroids are the doses are suppose to be tapered over a period of 5-10 days (Kee, Hayes, McCuistion & et al, 2012). Of course noted medication allergies should be noted and verified prior to any prescription. Pregnancy Risk - Most corticosteroids are Class C - Animal studies have shown an adverse effect on the fetus, but adequate studies haven't been conducted in humans. The benefits from use in pregnant women may be acceptable despite potential risks. Common adverse reactions are insomnia, vertigo, headache, hypertension, arrhythmias, nausea, vomiting, acne (Lippincott Williams and Wilkins, 2012). With abrupt withdrawal, the patient could experience rebound inflammation, fatigue, weakness, arthralgia, fever, dizziness, lethargy, depression, fainting, orthostatic hypotension, dyspnea, anorexia, and hypoglycemia. *After prolonged use, sudden withdrawal may be fatal (Lippincott Williams and Wilkins, 2012).* Drug - Drug interactions - Verify other medications the patient is currently taking. Noted Drug - Drug interactions are with NSAIDs, carbamazepine, phenytoin, cyclosporine, oral anticoagulants, potassium-depleting drugs, salicylates, skin-test antigens, vaccines and ketoconazole (Lippincott Williams and Wilkins, 2012). The adverse reactions, notably nausea, can cause patients to cease their prescription. Compliance can be ensured by education and explaination about why the medication is absolutely needed and how to properly take it.