Question

1. A second-year nursing student has to prepare medication cards for clinical on adrenocortical agents. The specific medication cards that have to be prepared are for prednisone (Deltasone) and fludrocortisone (Florinef). Additionally, the student nurse has to prepare a patient teaching plan for mineralocorticoids.

a. What are the key nursing implementation teaching points that need to be reviewed with a patient receiving an adrenocortical agent?

2. A Diabetes registered nurse educator is preparing an in-service presentation for student nurses on agents to control blood glucose levels for diabetes mellitus. The in-service will include a brief review of the pathophysiology of diabetes mellitus. Drugs to be included in the presentation will include insulin, chlorpropamide (Diabinese), glyburide (Micronase), and metformin (Glucophage).

i. What alterations in metabolic pathways and changes to basement membranes occur with diabetes mellitus?

3. A second-year nursing student is tutoring a first-year nursing student about the cardiovascular system, which is responsible for delivering oxygen and nutrients to all the cells of the body and for removing waste products for excretion.

1. What is the capillary fluid shift, including factors that influence the movement of fluid?
2. What are the therapeutic actions and most common adverse reactions for aspirin, heparin, and urokinase?

Answer 1

1a .Adrenocorticoid agents are drugs used as short term treatment to suppress immune system in patients with inflammatory disorders. They are used for replacement therapy to maintain hormone levels when adrenal glands are not functioning adequately . These agents are categorised into :-

- glucocorticoid

- mineralocorticoid

- androgen

Nursing interventions for a patient recieving adrenocorticoid are :-

- Administer drug daily at 8am to 9am to mimic peak diurnal concentration levels and thereby minimise suppression of hypothalamic pituitary axis .

- space multiple doses evenly throughout the day to try to maintain balance .

- taper doses when discontinuing to give the adrenal glands chance to recover and produce adrenocorticoid

- protect patient from unnecessary exposure to infection and invasive procedures because steroids suppress immunity and cause infection.

- provide comfort measures

- provide patient education about drugs ,its side effects ,and warning signs ,when to reach the hospital and ,compliance

- mineralocorticoid should be used only in conjugation with glucocorticoids to maintain electrolyte balance

- monitor for hypokalemia and take actions

- discontinue ,if signs of overdose occur to prevent the development of toxicity .

2 (I). Diabetis Mellitus cause sorbitol accumulation , formation of advanced glycation end products , PKC activation , oxidative stress and angiogenic factors all these lead to endothelial and metabolic dysfunction results in retinopathy , neuropathy , nephropathy .

3.a) Capillary fluid shift is the movement of fluid across the capillary membrane between the blood and interstitial fluid compartment . Factors influencing the movement of fluid shift are hydrostatic pressure and oncotic pressure.

b) Aspirin inhibits the production of prostaglandin and hence relieve pain and it also act as anticoagulant as it prevents the platelets aggregation . Its most common side effects is ringing in ears , nausea and vomiting called salisylism and bleeding.

Heparin is an anticoagulant , prevention of blood clotting . Its most common adverse action is bleeding .

Urokinase is a thrombolytic ,it dissolves the clot or thrombus . Its main adverse effects is bruising , bleeding ,bloody or tarry stools , vomiting or coughing blood .