Open Resources for Nursing (Open RN) Show
Corticosteroids can be prescribed in a variety of routes. Fluticasone is an example of a commonly used inhaled corticosteroid; prednisone is an example of a commonly used oral corticosteroid; and methylprednisolone is a commonly used IV corticosteroid. Additional information about corticosteroids and potential adrenal effects is located in the “Endocrine” chapter. Mechanism of Action Fluticasone is a locally acting anti-inflammatory and immune modifier. The nasal spray is used for allergies, and the oral inhaler is used for long-term control of asthma. Fluticasone is also used in a combination product with salmeterol. It decreases the frequency and severity of asthma attacks and improves overall asthma symptoms. See Figures 5.14-16[1],[2],[3] for images of different formulations of fluticasone. Oral prednisone prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Methylprednisolone IV prevents the release of substances in the body that cause inflammation. It also suppresses the immune system. Methylprednisolone requires reconstitution before administration. See Figure 5.17[4] for an image of methylprednisolone. Indications for Use Fluticasone inhalers are used to prevent asthma attacks. In respiratory conditions, oral prednisone is used to control severe or incapacitating allergic conditions that are unresponsive to adequate trials of conventional treatment for seasonal or perennial allergic rhinitis, bronchial asthma, contact dermatitis, atopic dermatitis, serum sickness, and drug hypersensitivity reactions. Methylprednisolone IV is used to rapidly control these same conditions. Nursing Considerations Across the Lifespan Fluticasone is safe for 4 years and older. Prednisone and methylprednisolone are safe for all ages. Adverse/Side Effects Fluticasone can cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis. Patients should rinse their mouths after use to prevent candidiasis (thrush). Prednisone and methylprednisolone: See more information about adverse effects of corticosteroids in the “Endocrine” chapter. Cardiovascular symptoms can include fluid retention, edema, and hypertension. Imbalances such as hypernatremia (↑Na), hypokalemia (↓ K+), and increased blood glucose with associated weight gain can occur. CNS symptoms include mood swings and euphoria. GI symptoms can include nausea, vomiting, and GI bleed. In long- term therapy, bone resorption occurs, which increases the risk for fractures; the skin may bruise easily and become paper thin; wound healing is delayed; infections can be masked; and the risk for infection increases. Long-term corticosteroid therapy should never be stopped abruptly because adrenal insufficiency may occur.[5]  Patient Teaching & Education Patients should be advised that corticosteroids are not used to treat an acute asthma attack. They can cause immunosuppression and suppress signs of infection. Corticosteroids can also cause an increase in blood glucose levels. Patients may experience weight gain, swelling, increased fatigue, bruising, and behavioral changes. These occurrences should be reported to one’s healthcare provider.[6] Now let’s take a closer look at the medication grid for fluticasone, prednisone, and methylprednisolone in Table 5.12.[7],[8],[9] Table 5.12 Fluticasone, Prednisone, and Methylprednisolone Medication Grid
Which process causes Hypoxemic respiratory failure?Type 1 respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia, and can be caused by alveolar hypoventilation, low atmospheric pressure/fraction of inspired oxygen, diffusion defect, ventilation/perfusion mismatch, and right-to-left shunt.
Which intervention will the nurse anticipate when a patient is diagnosed with ARDS?Mechanical ventilation (a ventilator) is often used in caring for patients with ARDS. For milder cases of ARDS, oxygen may be given through a fitted face mask or a cannula fitted over the nose.
In which condition will the nurse expect to hear fine and coarse crackles during lung auscultation?They are caused by mucous in larger bronchioles, as heard in COPD. Fine crackles are heard during late inspiration and may sound like hair rubbing together. These sounds originate in the small airways/alveoli and may be heard in interstitial pneumonia or pulmonary fibrosis.
Which patient information is obtained through the use of pulse oximetry?Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of the blood. It is an easy, painless measure of how well oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs.
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