Transcript Cortico-Steroids and Gonadal Hormonesx

CHAPTER 28
CORTICO-STEROIDS AND
GONADAL HORMONES
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cortico-steroids are hormones secreted by the adrenal cortex of the
adrenal glands (fig 27-1)
mineralo-corticoids: maintain fluid and electrolyte balance, used to
treat adrenal insufficiency caused by hypo-function of the
pituitary or adrenal glands (Addison’s Disease)
gluco-corticoids: regulate carbohydrate, protein, and fat
metabolism, have anti-inflammatory, anti-allergic, and
immuno-suppressant activity
gonads: reproductive glands, the testes of the male and the
ovaries of females
testes produce sperm and testosterone (male hormone), it controls
development of the male sex organs
androgens: other steroid hormones that produce masculine effects
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ovaries produce estrogen and progesterone, these stimulate the
development of female sex organs
estrogen: female hormone, responsible for most of the changes
progesterone is the hormone needed for body changes that favor
pregnancy and lactation
Delegation Guidelines
Cortico-Steroids and Gonadal Hormones:
Some cortico-steroids and gonadal hormones are
given parenterally- by intramuscular or intravenous
injection. Because you do NOT give parenteral dose
forms, they are NOT included in this chapter. Should
a nurse delegate the administration of such to you,
you must:
- remember that parenteral dosages are often very
different from dosages other routes
-Refuse the delegation. Make sure to explain why. Do
NOT just ignore the request. Make sure the nurse
knows that you cannot give drug and why
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Mineralo-Corticoids
ie: fludrocortisone (Florinef)
 mineralo-corticoid with gluco-corticoid effects
 affects fluid and electrolyte balance by causing:
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 sodium
and water retention
 potassium and hydrogen excretion
drug is used with gluco-corticoids
 goals of therapy:
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 control
BP
 restore fluid and electrolyte balance
Assisting With the Nursing Process
mineralo-corticoids:
ASSESSMENT: measure vitals, weight, intake/output, observe for
signs/symptoms of infection, observe level of alertness and
orientation to person, time and place. Test stools for occult blood
PLANNING: Oral Dose Form is 0.1mg tablets
IMPLEMENTATION: adult dose is 0.1mg daily
EVALUATION: see “Drug Class: Gluco-Corticoids”
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Gluco-Corticoids:
given for anti-inflammatory, anti-allergenic, immunosuppressant
effects
relieve symptoms of inflammation, but do not cure disease
drugs used in treatment of:
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cancers
organ transplants
auto-immune diseases
rheumatoid arthritis
allergy signs/symptoms
shock
nausea and vomiting from chemotherapy
goals of treatment:
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reduce pain and inflammation
minimize shock and hasten recovery
reduce nausea and vomiting from chemotherapy
Assisting With the Nursing Process
gluco-corticoids:
ASSESSMENT: measure vitals, weight, intake/output, observe for
signs/symptoms of infection, observe level of alertness and orientation
to person, time and place. Test stools for occult blood
PLANNING: see table 28-1 (p. 350) for “Oral Dose Form”
IMPLEMENTATION: persons taking these for at least 1 week must not
abruptly stop therapy, otherwise, the following may occur:
-fever
-anorexia
-nausea
-dyspnea
-malaise/fatigue
-hypotension
-fainting
-muscle and joint pain
-weakness
-dizziness
-hypoglycemia
-return of disease process
follow manufacturer’s instructions to apply topical dose
 alternate-day therapy may be used for chronic conditions
 give oral dose forms with meals to lessen stomach irritation
continued on next slide………..
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Assisting With the Nursing Process gluco-corticoids:
continued……
EVALUATION: many side effects are related to dosage and duration,
report and record:
 changes in alertness/orientation etc: may signal electrolyte
imbalance
 sore throat, fever, malaise, nausea, vomiting and other
signs/symptoms of infection
 behavior changes: psychotic behaviors are more likely in persons
with history of mental illness (ch 15)
 signs/symptoms of hypoglycemia (ch 27)
 vision problems: drugs may cause cataracts
 delayed wound healing: observe surgical patients for dehiscence
(separation of wound layers)
 Estrogens
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estrogens are used:
 to
relieve hot flash symptoms of menopause
 for contraception
 hormone replacement therapy after surgical removal
of ovaries
 as part of treatment for osteoporosis
 to treat severe acne in females
 to slow the progress of advanced prostate cancers
 to slow progress of some types of breast cancer
Assisting With the Nursing Process
estrogen:
ASSESSMENT: measure vitals and weight
PLANNING: see table 28-2 of p. 352-353 for “Dose Forms”
IMPLEMENTATION: see table 28-2 of p. 352-353 for “Adult Doses”
EVALUATION: report and record:
 weight gain, edema, breast tenderness, nausea: tend to be mild
and resolve
 hypertension, signs/symptoms of hyperglycemia (ch 27), breakthrough uterine bleeding, signs/symptoms of thrombo-embolic
diseases (ch 23): complications of estrogen therapy
Progestin
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progesterone and progestins inhibit ovulation
used to treat amenorrhea (no menstruation), break-through uterine
bleeding, endometriosis
endometriosis: condition in which tissues that line the inside of
uterus grows outside the uterus, usually tissues grow on
organs in the pelvic and abdominal areas. Symptoms include:
painful (severe) menstrual cramps, lower back and pelvic pain,
heavy periods, spotting between periods, pain during or after
sex
progestins may be used with estrogens as contraceptives (ch 29)
goals of progestin therapy:
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contraception
relief of endometriosis symptoms
hormone balance to relive amenorrhea or abnormal uterine bleeding
Assisting With the Nursing Process
progestins:
ASSESSMENT: measure vitals and weight
PLANNING: see table 28-3 of p.353 for “Dose Forms”
IMPLEMENTATION: see table 28-3 of p.353 for “Adult Doses”
EVALUATION: report and record:
 weight gain, edema, nausea, vomiting, diarrhea, tiredness, oily
scalp, acne: tend to be mild and resolve
 break-through uterine bleeding, amenorrhea, continuing headache,
jaundice, depression: complications of progestin therapy
 pregnancy: birth defects are possible
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Androgens
used to treat:
hypogonadism: condition in which body does NOT produce enough
testosterone, affects the development of the male sex
hormones and growth and development
eunuchism: condition in which the male lacks male hormones,
testicles were destroyed or removed. If this occurs before
puberty, secondary sex characteristics do NOT develop
androgen deficiency: lower than normal amounts of testosterone
breast cancer in post-menopausal women: goal is to suppress
cancer growth and reduce discomfort
Assisting With the Nursing Process
androgens:
ASSESSMENT: measure vitals, weight, blood glucose (can cause
hypoglycemia in persons with diabetes)
PLANNING: see table 28-4 of p.354-355 for “Dose Forms”
IMPLEMENTATION: see table 28-4 of p.354-355 for “Adult Doses”
EVALUATION: report and record:
 stomach irritation: give drug with food/milk
 changes in alertness and orientation to person, time and place;
confusion; muscle cramps; nausea; edema: may signal electrolyte
imbalance
 women: masculine characteristics such as deepening voice, hoarseness,
growth of facial hair, menstrual irregularities: may NOT reverse when
therapy is discontinued
 men: excessive sexual stimulation, priapism (prolonged or constant
erection), breast enlargement: signal androgen overdose
 nausea, vomiting, constipation, poor muscle tone, lethargy: signal
hypercalcemia (high blood calcium levels)
 anorexia, nausea, vomiting, jaundice: signal liver toxicity