Corticosteroids Nursing Implications
Corticosteroids Nursing Pharmacology
Corticosteroids are a class of drug that are used to reduce inflammation in the body as well as to control overactive immune system activity and hormonal imbalances.
Corticosteroids mimics cortisol, a hormone that is naturally produced in the adrenal glands.
Cortisol plays an important role in metabolism, as well as in immune and stress response.
There are two classifications of corticosteroids – glucocorticoids and mineralocorticoids.
- Glucocorticoids – a subclass of corticosteroids that are potent inhibitors of inflammation. They prevent the release of chemicals associated with inflammation.
- Mineralocorticoids – these drugs act on the water and electrolyte balance in the body.
Corticosteroids can also be categorized as systemic and localized corticosteroids.
Systemic corticosteroids are commonly given orally or through injection and their effects are multi-systemic.
On the other hand, localized steroids are given topically, as drops, or inhaled to particularly act on an organ or organ system.
Indications for Corticosteroids
Corticosteroids are widely used in different medical conditions. Most of their uses are related to inflammatory regulation.
However, there are also other indications for its use.
- Addison’s disease – Addison’s disease is a condition of the adrenal gland where the gland does not produce enough cortisol and/or aldosterone hence supplementary sources in the form of corticosteroids are needed to fill the gaps in supply.
- Organ transplant – corticosteroids is a standard treatment after an organ transplant to reduce inflammation and lessen the likelihood of organ rejection.
- Inflammation – Although inflammation is a normal response to protect the body, it sometimes causes more harm than good. In cases where inflammation causes damage to the other organs or to the patient’s condition, corticosteroids are given to counteract the inflammation process.
- Autoimmune disease – autoimmune disease involves the self-destruction of organs in the body though an overactive inflammatory response. Corticosteroid works by counteracting and managing the inflammatory effect.
The following are the common conditions where corticosteroids are used.
- Hay fever
- Chronic obstructive pulmonary disease (COPD)
- Inflammatory bowel disease
- Multiple sclerosis
Actions of Corticosteroids
Corticosteroids work through several mechanisms. Corticosteroid molecules diffuse to cell membranes and bind to glucocorticoid receptors.
The binding causes a series of effects in the body cells which leads to the suppression in the synthesis of pro-inflammatory mediators which include macrophages, eosinophils, lymphocytes, mast cells, and dendritic cells.
Also, corticosteroids inhibit the action of phospholipase A2 which produces other inflammatory mediators.
Side Effects and Adverse Effects of Corticosteroids
The side effects and adverse effects of corticosteroids vary from person to person.
They may not occur all the time, although the likelihood of having such side effects may change depending on the dose and time the drug is taken.
The side effects and adverse effects may include the following:
- Oral Corticosteroids
- Weight gain or edema – may occur due to water retention
- High blood pressure
- Loss of potassium
- Muscle weakness
- “moon face” or puffiness of the face
- Growth of facial hair
- Easy bruising of the skin
- Slow wound healing
- Stomach and duodenal ulcers
- High blood sugar levels
- Menstrual irregularities
- “buffalo hump” or rounding of the upper neck
- Topical Corticosteroids
- Loss of skin color
- Facial flushing
- High blood sugar
- Inhaled Corticosteroids
- Sore throat
- Difficulty speaking
- Nose bleeds
- Oral thrush
Corticosteroids are highly associated with obesity and growth retardation in children.
They can also predispose the person taking it to infections due to the suppression of immune system function.
They is also associated with osteoporosis hence bone fractures can be expected.
Sudden discontinuation of the medication can cause adrenal crisis which is the inability of the adrenal glands to cope with the supply due to sudden withdrawal.
Contraindications and Cautions for Corticosteroids
An increased risk of hypokalemia may occur when corticosteroids are administered with other medications that reduce potassium levels like diuretics, laxatives, high doses of certain antibiotics and insulin.
Caution is highly warranted as hypokalemia is greatly associated with dysrhythmia and heart failure.
Also, corticosteroids given with anticholinesterase can cause severe weakness in individuals diagnosed with myasthenia gravis.
Other medical conditions require caution when a person is prescribed with corticosteroids such as the following:
- Peptic ulcer
- Diabetes mellitus
- Viral and fungal infections
- Herpes simplex keratitis
- Renal failure
Drug Interactions with Corticosteroids
Corticosteroids are effective in treating and managing certain medical conditions.
However, these drugs also interact with other medications which changes effectiveness of corticosteroids.
The following are the medications that interact with corticosteroids:
- Troleandomycin, erythromycin, ketoconazole, clarithromycin – these drugs reduce the metabolism of corticosteroids in the liver. This metabolism increases the side effects of corticosteroids as well as the drug levels in the blood.
- Phenobarbital, ephedrine, phenytoin, rifampicin – these drugs increase metabolism of corticosteroids in the liver leading to reduced blood.
- Estrogen – decreases liver metabolism of corticosteroids leading to an increase in blood levels.
- Warfarin – interacts with corticosteroids which brings the need for a more frequent monitoring of blood coagulation.
- Cholestyramine – this drug reduces the absorption of oral corticosteroids.
Nursing Care Plans for Patients on Corticosteroids
- Possible Nursing Diagnoses
- Risk for Electrolyte Imbalance (Hypokalemia)
- Risk for Fluid Retention
- Disturbed Body Image
- Risk for Hyperglycemia
- Risk for Sleep Deprivation
- Risk forInfection related to slow wound healing as a side effect of corticosteroids
|Nursing Interventions for Corticosteroids||Rationales|
|Assess the patient for signs and symptoms of||To confirm the indication for administering corticosteroids.|
|Check the patient’s allergy status.||Previous allergic reaction to corticosteroids may render the patient unable to take them. Alternatives to corticosteroids should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Very potent corticosteroids should be prescribed in caution to a pregnant woman or lactating mother as these drugs can potentially harm the fetus or newborn.|
|Assess the patient’s mucous membranes and his/her ability to swallow.||To check for any potential problems with administration, hydration, and absorption.|
To ensure that the right form of corticosteroids is given through the right route.
|Check the patient’s serum potassium levels. Check for current medications that include diuretics, laxatives, high doses of certain antibiotics and insulin as these should be used cautiously with corticosteroids. An increased risk of hypokalemia may occur when corticosteroids are administered with other medications that reduce potassium levels like diuretics, laxatives, high doses of certain antibiotics and insulin. Caution is highly warranted as hypokalemia is greatly associated with dysrhythmia and heart failure.|
|Check medical history for diabetes or myasthenia gravis.||Corticosteroids can increase serum glucose levels. Corticosteroids given with anticholinesterase can cause severe weakness in individuals diagnosed with myasthenia gravis.|
Nursing Planning and Intervention
|Nursing Interventions for Corticosteroids||Rationales|
|Administer corticosteroids in the morning with breakfast.||Corticosteroids taken in the morning can mimic the time of the body’s production of the hormone cortisone.|
|Administer corticosteroids with meals.||To ensure optimal absorption and therapeutic action by corticosteroids.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking corticosteroids. Instruct the patient on how to self-administer corticosteroids.||To inform the patient on the basics of corticosteroids, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s input and output.||Corticosteroids may cause fluid retention as evidenced by edema/ swelling.|
|For topical steroids, advise the lactating mother to wash off any steroid cream from the skin prior to feeding the baby.||To ensure that the steroid is not ingested by the baby during breastfeeding.|
|Inform the patient not to have any live vaccine within 3 months after the course of corticosteroids.||Corticosteroids may weaken the immune system. Taking a live vaccine while having an immunocompromised body may increase the patient’s risk for infection.|
|Ensure that the patient has a proton-pump inhibitor (PPI) drug if he/she is required to take both corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs).||Taking NSAIDs and steroids may increase the risk for internal gastrointestinal bleeding and stomach ulcers. A PPI cover needs to be considered prior to combining these drugs, otherwise an alternative to the NSAID needs to be prescribed.|
|Advise the patient to rinse the mouth with water after using steroid inhalers.||To reduce the risk of developing oral thrush.|
|Advise the patient to eat moderately while on steroids, especially when taking it for more than 3 weeks.||Taking corticosteroids for less than 3 weeks poses little to no side effects. However, taking steroids for more than 3 weeks may increase appetite, leading to weight gain.|
|Towards the end of the course of corticosteroids, inform the patient if the steroids need to be tapered down.||Abruptly stopping some types of steroids such as prednisone may cause withdrawal symptoms such as fatigue, joint pain, lightheadedness, and dizziness.|
|Routinely check for the blood glucose level of the patient, especially if they are diabetic.||Corticosteroids can increase serum glucose levels.|
|Nursing Interventions for Corticosteroids||Rationale|
|Ask the patient to repeat the information about corticosteroids.||To evaluate the effectiveness of health teaching on corticosteroids.|
|Monitor the patient’s serum electrolyte levels and renal function.||To ensure that the corticosteroids did not cause any electrolyte imbalance (particularly hypokalemia) or renal dysfunction.|
|Monitor the patient’s response to corticosteroids.||To check if the corticosteroids are effective or if the dose needs to be adjusted.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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