546
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.
