Inhaled Steroids Nursing Implications
Nursing Pharmacology Study Guide on Inhaled Steroids
Inhaled steroids are a class of drugs that are administered to facilitate the reduction of inflammation in the lungs. They are often prescribed to patients with asthma and other respiratory problems, such as chronic obstruction pulmonary disease (COPD).
Inhaled steroids are under the group called corticosteroids but specifically involve the inhalation or breathing in of the medicine slowly through the mouth using an inhaler.
The medicine then travels directly into the lungs. An inhaled steroid medication is ideally taken on the same time each day. It may need to be taken once or twice throughout the day, depending on the physician’s prescription.
Inhaled steroids are indicated for long-term treatment of asthma and prevention of acute exacerbation of asthma. They are sometimes given in combination with oral steroids.
Indications for Inhaled Steroids
Inhaled steroids are prescribed due to several reasons. One is to reduce the frequency of the symptoms of the respiratory illness. This can help slow down the damage in the lungs and consequently promote a better quality of life.
Patients on inhaled steroids experience fewer hospital admission and have the benefit of a lower risk of death due to asthma attacks. Inhaled steroids are indicated for the following medical conditions:
- Persistent or chronic asthma – treated with inhaled steroids which is sometimes in combination with oral corticosteroids
- Acute asthma in exacerbation
- COPD – often managed with a combination of inhaled steroids and long-acting bronchodilators
Actions of Inhaled Steroids
Inhaled steroids mimic the action of the naturally produced hormone called cortisol. The adrenal glands secrete cortisol in the morning into the bloodstream.
Cortisol helps the body generate energy to deal with stressors by means of using the process of glucogenesis in the liver to tap the protein stores. Cortisol is also a potent anti-inflammatory hormone and partly regulates the body’s inflammatory process by means of blocking inflammatory cells and cutting off the signals.
Inhaled steroids work like cortisol in terms of anti-inflammatory capabilities.
Many of the inhaled steroids last for about 12 hours to 24 hours in the body; thus, they can be taken either once or twice during the day depending on the prescription of the physician. A patient may have a PRN or “as needed” inhaler to be used during asthma attacks.
Inhaled steroids differ from other types of corticosteroids in terms of route, which is inhalation. This route allows the medicine to directly enter the airways and reach the lungs within seconds.
Inhaled steroids are one of the most common treatments of choice for asthma and COPD because they can be administered in low dosages compared to oral or intravenous corticosteroids.
They also exhibit fewer side effects and adverse responses; thus, they are often regarded as a safer treatment option than oral steroids.
Side Effects and Adverse Effects of Inhaled Steroids
The common side effects of inhaled steroids include:
- Oral thrush and store throat– happen when yeast infection grows in the oropharyngeal area and is evidenced by a white film on the tongue and a bad taste in the mouth; use of spacers with some inhaled steroids and proper oral hygiene can help prevent oral thrush; oral antifungal treatment is started when oral thrush is noted
- Increased blood glucose levels – patients on steroids are on a daily blood glucose monitoring usually done once or twice a day.
- Increased appetite
- Weight gain, especially if they have been taken for a long time
- High blood pressure or hypertension
- Increased bruising
- Hypothalamic-pituitary-adrenal (HPA) axis suppression – this can result to an impaired response to stressors
The following adverse effects of inhaled steroids should alert the patient to stop the medication and seek immediate medical attention:
- Pneumonia or other infections
- Blurry vision or other eye problems
- Signs of allergic reaction or anaphylaxis such as shortness of breath, swelling, hives, and rashes – it is rare for inhaled steroids to cause an allergy
Contraindications and Cautions for Inhaled Steroids
The long-term use of inhaled steroids puts a patient at a higher risk of developing pneumonia or any other infection. Patients on inhaled steroids should avoid exposure to highly communicable diseases, such as measles and chickenpox.
Inhaled steroids’ effect may be more potent in patients with liver cirrhosis and hypothyroidism. Inhaled steroids should also be used with caution in children as they can affect their linear growth, depending on the dosages, the specific inhaler used, and the duration of usage.
Inhaled steroids are not recommended for people with low or reduced bone density, such as those who have osteoporosis or frequent fractures.
Patients on inhaled steroids also require regular eye checkups because of the possibility of adverse effects on eyesight such as blurry vision or glaucoma.
As with other corticosteroids, inhaled steroids may cause hypokalemia, although this adverse event is more common in steroids administered orally or intravenously.
Some inhaled steroids are contraindicated with patients who have milk allergy. Pregnant women with asthma can continue taking their inhaled steroids daily but will be closely monitored by their physician. Inhaled steroids are generally considered safe for breastfeeding women.
Drug Interactions with Inhaled Steroids
Inhaled steroids have rare adverse interactions with other drugs because of their low dosages, as well as their direct action to the lungs instead of systemic action. It is important to note that cytochrome P450 or CYP inhibitors may increase the systemic effect of beclomethasone, an inhaled steroid which is their substrate.
Nursing Care Plans for Patients on Inhaled steroids
Possible Nursing Diagnoses
- Risk for Fluid Retention
- Disturbed Body Image
- Risk for Hyperglycemia
- Risk for Electrolyte Imbalance (Hypokalemia)
- Risk for Disturbed Sensory Perception (Visual)
- Risk for Infection related to due to impaired stress response due to long-term use of high dose inhaled steroids
|Assess the patient for signs and symptoms of asthma or COPD.||To confirm the indication for administering inhaled steroids.|
|Check the patient’s allergy status.||Previous allergic reaction to any type of corticosteroids may render the patient unable to take inhaled steroids. Alternatives to inhaled steroids should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Pregnant women with asthma can continue taking their inhaled steroids daily but will be closely monitored by their physician.|
|Assess the patient’s ability to self-administer the inhaled steroid.||To check for any potential problems with administration.|
To ensure that the right form of inhaled steroids is given through the right route.
|Check the patient’s blood glucose and 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 inhaled steroids.||An increased risk of hyperglycemia and hypokalemia may occur when inhaled steroids 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.||Inhaled steroids can increase serum glucose levels.|
Nursing Planning and Intervention
|Administer inhaled steroids at the same time each day, usually one dose in the morning and a second dose at night as prescribed.||Inhaled steroids taken in the morning can mimic the time of the body’s production of the hormone cortisol.|
|Use spacers with some inhaled steroids and teach proper oral hygiene.||To ensure optimal absorption and therapeutic action by inhaled steroids.|
To avoid oral thrush.
|Administer oral antifungal treatment||To manage oral thrush which is a common side effect of long-term inhaled steroid use.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking inhaled steroids. Instruct the patient on how to self-administer inhaled steroids.||To inform the patient on the basics of inhaled steroids, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s input and output.||Long-term or potent inhaled steroids may cause fluid retention as evidenced by edema/ swelling.|
|Inform the patient not to have any live vaccine within 3 months after the course. Advise to avoid people with measles, chickenpox, pneumonia or other communicable diseases.||Inhaled steroids may weaken the immune system. Taking a live vaccine while having an|
|of inhaled steroids.||immunocompromised body may increase the patient’s risk for infection.|
|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 inhaled steroids, especially when taking it for a long time.||Taking inhaled steroids 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 inhaled steroids, inform the patient if the dosage of inhaled steroids needs to be tapered down.||Abruptly stopping some types of steroids 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.||Inhaled steroids can increase serum glucose levels.|
|Ask the patient to repeat the information about inhaled steroids.||To evaluate the effectiveness of health teaching on inhaled steroids.|
|Monitor the patient’s serum electrolyte levels, liver and renal function.||To ensure that the inhaled steroids did not cause any electrolyte imbalance (particularly hypokalemia), liver or renal dysfunction.|
|Monitor the patient’s response to inhaled steroids.||To check if the inhaled steroids are effective or if the dose needs to be adjusted.|
|Advise the patient to undergo regular eye checkups and to report any changes in vision or discomfort/ pain due to increased pressure in the eyes.||Inhaled steroids’ adverse reactions include blurry vision, glaucoma, or other eye problems.|
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