A client with diabetes mellitus is being admitted to the hospital for surgery. The client has been taking Glucocorticoids (Prednisone) long-term for uncontrolled COPD. Which of the following must the nurse consider when she is obtaining a health history? (Select All that Apply.)
Due to the use of long-term glucocorticoids her medication must not be abruptly discontinued to avoid adrenal suppression
The client may develop low blood pressure
The use of long-term glucocorticoids places the client at risk for increased susceptibility to infection
The use of long-term glucocorticoids may have contributed to a spike in blood glucose levels
The client will most likely experience more pain
Correct Answer : A,C,D
The nurse must consider the following when obtaining a health history for a client with diabetes mellitus who has been taking glucocorticoids (prednisone) long-term for uncontrolled COPD:
- Due to the use of long-term glucocorticoids, the medication must not be abruptly discontinued to avoid adrenal suppression. Abruptly stopping glucocorticoids can lead to adrenal insufficiency and a potentially life-threatening condition. Gradual tapering of the medication is necessary under medical supervision.
- The use of long-term glucocorticoids may contribute to a spike in blood glucose levels. Glucocorticoids can cause insulin resistance and increase blood sugar levels, which can be problematic for individuals with diabetes mellitus.
- The use of long-term glucocorticoids places the client at risk for increased susceptibility to infection. Glucocorticoids can suppress the immune system, making the client more susceptible to infections. This is important to consider, especially in a hospital setting where the risk of acquiring infections may be higher.
Regarding the other options:
The client may develop low blood pressure: While glucocorticoids can cause fluid retention and increased blood pressure, they are not typically associated with low blood pressure.
The client will most likely experience more pain: The use of glucocorticoids is not directly related to increased pain perception. Pain management may be influenced by various factors, but it is not specifically attributed to long-term glucocorticoid use.
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Correct Answer is D
Explanation
Diphenhydramine is an antihistamine medication that can cause sedation as a side effect. Taking most of the daily dose at bedtime can help minimize daytime sedation. By taking the medication closer to bedtime, the sedative effects are more likely to occur during sleep, reducing the impact of sedation during waking hours.
The other options mentioned are not effective strategies to minimize daytime sedation caused by diphenhydramine:
A. "Distribute the doses evenly throughout the day": This approach may lead to a consistent level of sedation throughout the day and may not effectively minimize daytime sedation.
B. "Gradually decrease the dose once tolerance to the effect is reached": Gradually decreasing the dose of diphenhydramine is not a recommended strategy for minimizing daytime sedation. It is important to follow the prescribed dose and consult with a healthcare provider before making any changes to the medication regimen.
C. "Take the medication with meals": Taking diphenhydramine with meals may help reduce the risk of stomach upset but does not directly address the issue of daytime sedation.
Correct Answer is D
Explanation
Albuterol is a short-acting beta-agonist bronchodilator, commonly used as a rescue medication for acute asthma symptoms. It works quickly to open up the airways and relieve bronchospasm, helping to alleviate the symptoms of an asthma attack. Beclomethasone, formoterol, and salmeterol are long-acting medications used for maintenance therapy in asthma management, not for immediate relief during an acute attack.
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