Languha Ngati

Pharmacology discussion Question

Chapter 36, adrenocortical agents

Instructor: CarolAnn Marchand

3-12-2020
WRITTEN ASSIGNMENTS

1. Describe the diurnal rhythm of the release of corticosteroids. Glucocorticoids, hormones

produced by the adrenal gland cortex, perform numerous functions in body homeostasis and the

response of the organism to external stressors. One striking feature of their regulation is a diurnal

release pattern, with peak levels linked to the start of the activity phase. This release is under

control of the circadian clock, an endogenous biological timekeeper that acts to prepare the

organism for daily changes in its environment. Circadian control of glucocorticoid production

and secretion involves a central pacemaker in the hypothalamus, the suprachiasmatic nucleus, as

well as a circadian clock in the adrenal gland itself.

2. Why must corticostweroids be tapered when discontinued after long term use?

Prednisone is similar to cortisol, a hormone naturally made by your adrenal glands. If you take

prednisone for more than a few weeks, your adrenal glands decrease cortisol production. A

gradual reduction in prednisone dosage gives your adrenal glands time to resume their normal

function. If you abruptly stop taking prednisone or taper off too quickly, you might experience

prednisone withdrawal symptoms: Severe fatigue, weakness, body aches, joint pain, nausea, loss

of appetite and lightheadedness.

3. You are caring for a 7-year-old child who has been prescribed a beclomethasone

(Beclovent) inhaler for an exacerbation of asthma. What essential nursing considerations

are required for this child? Why are these essential? Nursing considerations

Assessment
History: Acute asthmatic attack, status asthmaticus; systemic fungal infections; allergy to any

ingredient; lactation; untreated local infections, nasal septal ulcers, recurrent epistaxis, nasal

surgery or trauma

Physical: Weight, T; P, BP, auscultation; R, adventitious sounds; chest radiograph before

respiratory inhalant therapy; examination of nares before intranasal therapy

Interventions

BLACK BOX WARNING: Taper systemic steroids carefully during transfer to inhalational

steroids; deaths resulting from adrenal insufficiency have occurred during and after transfer from

systemic to aerosol steroids.

Use decongestant nose drops to facilitate penetration of intranasal steroids if edema or excessive

secretions are present.

Teaching points

This respiratory inhalant has been prescribed to prevent asthmatic attacks, not for use during an

attack.

Allow at least 1 minute between puffs (respiratory inhalant); if you also are using an inhalational

bronchodilator (isoproterenol, albuterol, metaproterenol, epinephrine), use it several minutes

before using the steroid aerosol.

Rinse your mouth after using the respiratory inhalant aerosol.

Use a decongestant before the intranasal steroid and clear your nose of all secretions if nasal

passages are blocked; intranasal steroids may take several days to produce full benefit.
Use this product exactly as prescribed; do not take more than prescribed, and do not stop taking

the drug without consulting your health care provider. The drug must not be stopped abruptly but

must be slowly tapered.

You may experience these side effects: Local irritation (use the device correctly), headache

(consult your health care provider for treatment).

Report sore throat or sore mouth.

4. You are caring for a 41-year-old adult who has been prescribed Decadron for a severe

allergic reaction. What essential nursing considerations are required for this adult? Why

are these essential?

Nursing considerations

Assessment

History for systemic administration: Active infections; renal or hepatic disease; hypothyroidism,

ulcerative colitis; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF,

hypertension, thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus;

lactation

History for ophthalmic preparations: Acute superficial herpes simplex keratitis, fungal infections

of ocular structures; vaccinia, varicella, and other viral diseases of the cornea and conjunctiva;

ocular TB

Physical for systemic administration: Baseline body weight, T; reflexes, and grip strength, affect,

and orientation; P, BP, peripheral perfusion, prominence of superficial veins; R and adventitious

sounds; serum electrolytes, blood glucose

Physical for topical dermatologic preparations: Affected area for infections, skin injury

Interventions

For systemic administration, do not give drug to nursing mothers; drug is secreted in breast milk.

WARNING: Give daily doses before 9 AM to mimic normal peak corticosteroid blood levels.

Increase dosage when patient is subject to stress.

Taper doses when discontinuing high-dose or long-term therapy.

Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

For respiratory inhalant, intranasal preparation, do not use respiratory inhalant during an acute

asthmatic attack or to manage status asthmaticus.

Do not use intranasal product with untreated local nasal infections, epistaxis, nasal trauma, septal

ulcers, or recent nasal surgery.

WARNING: Taper systemic steroids carefully during transfer to inhalational steroids; adrenal

insufficiency deaths have occurred.

For topical dermatologic preparations, use caution when occlusive dressings, tight diapers cover

affected area; these can increase systemic absorption.

Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases.

Teaching points

Systemic administration
Do not stop taking the oral drug without consulting your health care provider.

Avoid exposure to infection.

Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools,

fever, prolonged sore throat, colds or other infections, worsening of this disorder.

Intra-articular administration

Do not overuse joint after therapy, even if pain is gone.

Respiratory inhalant, intranasal preparation

Do not use more often than prescribed.

Do not stop using this drug without consulting health care provider.

Use the inhalational bronchodilator drug before using the oral inhalant product when using both.

Administer decongestant nose drops first if nasal passages are blocked.

Topical

Apply the drug sparingly.

Avoid contact with eyes.

Report any irritation or infection at the site of application.

Ophthalmic

Administer as follows: Lie down or tilt head backward and look at ceiling. Warm tube of

ointment in hand for several minutes. Apply one-fourth to one-half inch of ointment, or drop
suspension inside lower eyelid while looking up. After applying ointment, close eyelids and roll

eyeball in all directions. After instilling eye drops, release lower lid, but do not blink for at least

30 seconds; apply gentle pressure to the inside corner of the eye for 1 minute. Do not close eyes

tightly, and try not to blink more often than usual; do not touch ointment tube or dropper to eye,

fingers, or any surface.

Wait at least 10 minutes before using any other eye preparations.

Eyes will become more sensitive to light (use sunglasses).

Report worsening of the condition, pain, itching, swelling of the eye, failure of the condition to

improve after 1 week

5. You are caring for a 72-year-old adult who has been prescribed predisone for

exacerbation of COPD. What essential nursing considerations are required for this older

adult? Why are these essential? Nursing Interventions

Patient and family teaching is an important nursing intervention to enhance self-management in

patients with any chronic pulmonary disorder.

To achieve airway clearance:

The nurse must appropriately administer bronchodilators and corticosteroids and become alert

for potential side effects.

Direct or controlled coughing. The nurse instructs the patient in direct or controlled coughing,

which is more effective and reduces fatigue associated with undirected forceful coughing.

To improve breathing pattern:

Inspiratory muscle training. This may help improve the breathing pattern.

Diaphragmatic breathing. Diaphragmatic breathing reduces respiratory rate, increases alveolar

ventilation, and sometimes helps expel as much air as possible during expiration.

Pursed lip breathing. Pursed lip breathing helps slow expiration, prevents collapse of small

airways, and control the rate and depth of respiration.

To improve activity intolerance:

Manage daily activities. Daily activities must be paced throughout the day and support devices

can be also used to decrease energy expenditure.

Exercise training. Exercise training can help strengthen muscles of the upper and lower

extremities and improve exercise tolerance and endurance.

Walking aids. Use of walking aids may be recommended to improve activity levels and

ambulation.

To monitor and manage potential complications:

Monitor cognitive changes. The nurse should monitor for cognitive changes such as personality

and behavior changes and memory impairment.

Monitor pulse oximetry values. Pulse oximetry values are used to assess the patient’s need for

oxygen and administer supplemental oxygen as prescribed.

Prevent infection. The nurse should encourage the patient to be immunized against influenza and

S. pneumonia because the patient is prone to respiratory infection.

GROUP ASSIGNMENTS

1. Corticosteriods have many adverse reactions. Prepare a list of adverse reaction,

determine nursing assessments or nursing measures essential to monitoring the adverse

reaction or to treating the adverse reaction. What is the rationale for each assessment or

nursing measure? Nursing considerations

Assessment

History: Infections; renal or liver disease, hypothyroidism, ulcerative colitis with impending

perforation, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF,

hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus;

hepatic disease; lactation

Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral

perfusion, prominence of superficial veins, R, adventitious sounds, serum electrolytes, blood

glucose

Interventions

Administer once-a-day doses before 9AM to mimic normal peak corticosteroid blood levels.

Increase dosage when patient is subject to stress.

WARNING: Taper doses when discontinuing high-dose or long-term therapy to avoid adrenal

insufficiency.

Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Teaching points
Do not stop taking the drug without consulting your health care provider; take once-daily doses

at about 9 AM.

Avoid exposure to infections.

Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools,

fever, prolonged sore throat, colds or other infections, worsening of the disorder for which the

drug is being taken.

 Citation

RNpedia. 2020. Adrenocortical Drugs Nursing Considerations & Management - Rnpedia.

[online] Available at: <https://www.rnpedia.com/practice-exams/pharmacology-and-drug-

calculation-exams/adrenocortical-drugs/> [Accessed 12 March 2020].