McKenna's Pharmacology for Nursing, 2e

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P A R T 6  Drugs acting on the endocrine system

Because steroids interfere with the normal inflammatory and immune response to infection, the lesion could progress to a very serious problem. The lesion should be cultured, cleansed and dressed. M.W. should be instructed in how to care for her hand and how to protect it from water or further injury. An antibiotic might be prescribed and then evaluated for its appropriateness when the culture report comes back. The real challenge with M.W. will be helping her to cope with and understand the need to taper her prednisone. The drug-teaching information for prednisone should be thoroughly reviewed with M.W., pointing out the side effects of drug therapy that she is already experiencing and explaining, again, the effect that prednisone has on her body. A calendar should be prepared for M.W. to help her schedule the tapering of the drug. It usually progresses from 5 mg twice daily for 2 weeks to 5 mg/day. M.W. will need a great deal of encouragement and support to cope with the decrease in therapeutic benefit caused by the need to reduce the prednisone dose. She has felt so good and done so much better while receiving the drug that she may have a real dread of losing those benefits. She should be encouraged to discuss her feelings and to call in for support if she needs it. M.W. should be given an appointment for a return visit in 2 weeks to evaluate the lesion on her hand and to check her progress in the tapering of the drug. She should be urged to call if the lesion looks worse to her or if she has any difficulties with her drug therapy. M.W.’s case is a common example of the clinical problems that are encountered with a chronic inflammatory condition requiring steroid therapy. These people require strong support and continual teaching. CARE GUIDE FOR M.W.: ADRENOCORTICAL AGENTS Assessment: History and examination Assess for allergies to any steroids and for heart failure, pregnancy, hypertension, acute infection, peptic ulcer, vaccination with a live virus, or endocrine disorders. Also assess for concurrent use of ketoconazole, troleandomycin, oestrogens, barbiturates, phenytoin, rifampicin or salicylates. Focus the physical examination on the following: Neurological: orientation, reflexes, affect General: temperature, weight, site of hand infection CV: pulse, cardiac auscultation, blood pressure, oedema Respiratory: respiratory rate, adventitious sounds Laboratory tests: urinalysis, blood glucose level, stool guaiac test, renal function tests, culture and sensitivity of wound specimen Implementation Administer around 9 a.m. to mimic normal diurnal rhythm. Use the minimal dose for the minimal period of time that the dose is needed.

Arrange for increased doses during times of stress. Taper gradually to allow adrenal glands to recover and produce their own steroids. Protect the person from unnecessary exposure to infection. Provide support and reassurance to deal with drug therapy. Provide teaching regarding drug name, dosage, adverse effects, precautions and warning signs to report. Evaluation Evaluate drug effects: relief of signs and symptoms of inflammation. Monitor for adverse effects: infection, peptic ulcer, fluid retention, hypertension, electrolyte imbalance or endocrine changes. Monitor for drug–drug interactions as listed. Evaluate the effectiveness of the teaching program. Evaluate the effectiveness of comfort and safety measures and support offered. TEACHING FOR M.W. • The drug that has been prescribed for you is called prednisone. Prednisone is from a class of drugs called corticosteroids, which are similar to steroids produced naturally in your body. They affect a number of bodily functions, including your body’s glucose levels, blocking your body’s inflammatory and immune responses and slowing the healing process. • You should never stop taking your drug suddenly. If your prescription is low or you are unable to take the medication for any reason, notify your healthcare provider. • Some of the following adverse effects may occur: • Increased appetite: This may be a welcome change, but if you notice a continual weight gain, you may want to watch your kilojoules. • Restlessness, trouble sleeping: Some people experience elation and a feeling of new energy; take frequent rest periods. • Increased susceptibility to infection: Because your body’s normal defenses will be decreased, you should avoid crowded places and people with known infections. If you notice any signs of illness or infection, notify your healthcare provider at once. • Report any of the following to your healthcare provider: sudden weight gain; fever or sore throat; black, tarry stools; swelling of the hands or feet; any signs of infection; or easy bruising. • If you are taking this drug for a prolonged period, limit your intake of salt and salted products and add proteins to your diet. • Avoid the use of any over-the-counter medication without first checking with your healthcare provider. Several of these medications can interfere with the effectiveness of this drug. • Tell any doctor, nurse or other healthcare provider involved in your care that you are taking this drug.