Nursing Considerations for Patients Receiving Glucocorticoids
糖皮质激素使用者的护理考虑
Assessment: History and Examination
评估：病史与体检
l Assess for history of allergy to any steroid preparations, acute infections, peptic ulcer disease, pregnancy, lactation, endocrine disturbances, and renal dysfunction, which could be cautions or contraindications to use of the drug.
l Assess weight; temperature; orientation and affect; grip strength; eye examination; blood pressure, pulse, peripheral perfusion, and vessel evaluation; respiration and adventitious breath sounds; glucose tolerance, renal function, serum electrolytes, and endocrine function tests as appropriate, to determine baseline status before beginning therapy and for any potential adverse effects.
Nursing diagnoses related to drug therapy might include the following:
与药物疗法有关的护理诊断可能包括如下：
l Altered cardiac output related to fluid retention
心排血量改变，与液体潴留有关
l Excess fluid volume related to water retention
液体容量过剩，与水潴留有关
l Disturbed sensory perception (visual, kinesthetic)
感官知觉紊乱（视觉、动觉）
l Risk for infection related to immunosuppression
感染危险，与免疫抑制有关
l Ineffective coping related to body changes caused by the drug
应对无效：与药物引起的身体变化有关
l Deficient knowledge regarding drug therapy
知识缺乏，与药物疗法有关
l Imbalanced nutrition: More than body requirements related to metabolic changes
营养失调：多于身体需要，与代谢变化有关
Planning 护理计划
l The patient will receive the best therapeutic effect from the drug therapy.
患者将获得药物疗法的最佳治疗效果
l The patient will have limited adverse effects to the drug therapy.
患者出现有限的药物疗法不良效应
l The patient will have an understanding of the drug therapy, adverse effects to anticipate, and measures to relieve discomfort and improve safety
患者了解药物疗法、预期的不良效应及缓解不适提高安全性的措施
Implementation with Rationale 实施及说明
l Administer drug daily at 8 to 9 AM to mimic normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic–pituitary axis.
每天0800 - 0900给药，模仿正常的昼间峰值浓度，从而最大限度降低下丘脑-垂体轴抑制
l Space multiple doses evenly throughout the day to try to achieve homeostasis.
均匀分隔每日多次剂量，努力达到内环境稳定
l Use the minimal dose for the minimal amount of time to minimize adverse effects.
用最少的次数给最小的剂量，降低不良效应
l Taper doses when discontinuing from high doses or from long-term therapy to give the adrenal glands a chance to recover and produce adrenocorticoids.
停药时从大剂量逐渐减至小剂量或从长期疗法逐渐减少用药，为肾上腺恢复和生产肾上腺类皮质激素提供机会
l Arrange for increased dose when the patient is under stress to supply the increased demand for corticosteroids associated with the stress reaction.
患者应激时安排增加剂量，为与应激反应相关的皮质类固醇需求增加提供补充
l Use alternate day maintenance therapy with short-acting drugs whenever possible to decrease the risk of adrenal suppression.
尽可能使用短效药物提供隔日维持疗法，降低肾上腺抑制风险
l Do not give live virus vaccines when the patient is immunosuppressed because there is an increased risk of infection.
患者免疫抑制时不要使用活病毒疫苗，因此此时感染危险增加
l Protect the patient from unnecessary exposure to infection and invasive procedures because the steroids suppress the immune system and the patient is at increased risk for infection.
保护患者，不要暴露感染和进行侵入性操作，因为类固醇抑制免疫系统，患者感染风险增加
l Assess the patient carefully for any potential drug–drug interactions to avoid adverse effects.
仔细评估患者是否出现任何药药相互作用，避免不良效应
l Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of problems, and the need for regular evaluation, including blood tests, to enhance patient knowledge of drug therapy and promote compliance.
进行彻底的患者宣教，包括避免不良效应的措施、问题警示讯号和定期评价需要，包括血液试验，强化患者药物疗法知识，促进治疗依从性
l Explain the need to protect the patient from exposure to infections to prevent serious adverse effects.
说明保护患者不暴露感染的必要性，防止类固醇不良效应
Evaluation 评价
l Monitor patient response to the drug (relief of signs and symptoms of inflammation, return of adrenal function to within normal limits).
监测患者的药物反应（炎症症状体征的缓解、肾上腺功能恢复至正常限度内）
l Monitor for adverse effects (increased susceptibility to infections, skin changes, endocrine dysfunctions, fatigue, fluid retention, peptic ulcer, psychological changes).
监测有无不良效应（感染易感性增加、皮肤变化、内分泌功能障碍、疲劳、液体潴留、消化性溃疡、心理变化）
l Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, and specific measures to avoid them)
评价宣教计划效果（患者可以说出药名、剂量、需要留意的不良效应及具体的避免措施）
★Video ★
Glucocorticoid Hormone Excess
★Test ★
1. A patient with adrenal insufficiency is to be discharged and is given Prednisone as a home medication. The nurse instructs the patient the following, except?
A. To avoid aspirin-containing products.
B. To avoid foods rich in potassium.
C. To avoid caffeinated drinks.
D. To avoid individuals with respiratory infections.
2. A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find?
A. HTN, peripheral edema, and petechiae
B. Weight loss, buffalo hump, and moon face with acne
C. Abdominal and buttock striae, truncal obesity, and hypotension
D. Anorexia, signs of dehydration, and hyper pigmentation of the skin
奥医教育“在线自测”题库
ISPN/RN复习练习、效果检验一站完成。
答案 Answers
1. B. To avoid foods rich in potassium. Rationale: One of the side effects of taking prednisone is hypokalemia so a potassium rich food should be included in the diet. 2. A. HTN, peripheral edema, and petechiae Rationale: The effects of glucocorticoid excess include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility. Clinical manifestations of corticosteroid deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.)
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