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dexamethasone Nursing Considerations & Management

Drug Name
Generic Name : dexamethasone,dexamethasone acetate , dexamethasone sodium phosphate Brand Name:
  • Oral, persomal dermatologic aerosol and gel, ophthalmic deprivation: Aeroseb-Dex, Decadron, Hexadrol, Maxidex Ophthalmic, ratio-Dexanamethasone (CAN)
  • IM, intra-articular, or sleek-tissue introduction: Cortastat LA, Dalalone L.A., Decaject LA, Dexasone-L.A., Dexone LA, Solurex LA
  • IV, IM, intra-articular, intralesional introduction; respiratory inhalant; intranasal steroid; ophthalmic disentanglement and ointment; persomal dermatologic cream: Cortastat, Dalalone, Decadron Phosphate, Decaject, Dexasone, Hexadrol Phosphate, Solurex
Classification: Corticosteroid, Glucocorticoid, Hormone Pregnancy Category C
Dosage & Route
ADULTS Systemic administration
  • Individualize dosage installed on injustice of proviso and apology. Yield daily dose precedently 9 AM to minimize adrenal reservation. If long-term therapy is needed, alternate-day therapy following a conjuncture a short-acting steroid should be considered. Following long-term therapy, following a conjuncturedraw refuse reluctantly to abandon adrenal shortness. For means-of-support therapy, convert moderate dose in paltry increments at intervals until the last clinically agreeable dose is reached.
Oral (dexamethasone)
  • 0.75–9 mg/day.
  • Suppression reachstone for Cushing’s syndrome: 1 mg at 11 AM; prove plasma cortisol at 8 AM the present day. For greater truthfulness, yield 0.5 mg q 6 hr for 48 hr, and garner 24-hr urine to state 17-hydroxycorticosteroid (17-OHCS) exudation.
  • Suppression reachstone to descry Cushing’s syndrome due to ACTH abundance from that resulting from other causes: 2 mg q 6 hr for 48 hr. Garner 24-hr urine to state 17-OHCS exudation.
IM (dexamethasone acetate)
  • 8–16 mg; may cite in 1–3 wk.
IV or IM (dexamethasone sodium phosphate)
  • 0.5–9 mg/day.
  • Cerebral edema: 10 mg IV and then 4 mg IM q 6 hr until cerebral edema symptoms subside; exexchange to spoken therapy, 1–3 mg tid, as shortly as likely and taper aggravate 5–7 days.
PEDIATRIC PATIENTS
  • Individualize dosage installed on injustice of proviso and apology, rather than by precise supply to formulas that redress adult doses for age or assemblage burden. Carefully perceive-keep enlargement and fruit in infants and effect on long-term therapy.
IV
  • Unresponsive shock: 1–6 mg/kg as a uncombined IV introduction (as greatly as 40 mg moderately followed by citeed introductions q 2–6 hr has been reported).
Intralesional (dexamethasone acetate) ADULTS AND PEDIATRIC PATIENTS
  • 4–16 mg intra-articular, sleek tissue; 0.8–1.6 mg intralesional.
(dexamethasone sodium phosphate)
  • 0.4–6 mg (depending on junction or sleek-tissue introduction position).
  • Respiratory inhalant (dexamethasone sodium phosphate)
  • 84 mcg liberated following a conjuncture each actuation.
ADULTS
  • 3 inhalations tid–qid, not to achieve 12 inhalations/day.
PEDIATRIC PATIENTS
  • 2 inhalations tid–qid, not to achieve 8 inhalations/day.
  • Intranasal (dexamethasone sodium phosphate)
  • Each spray delivers 84 mcg dexamethasone.
ADULTS
  • 2 sprays (168 mcg) into each nostril bid–tid, not to achieve 12 sprays (1,008 mcg)/day.
PEDIATRIC PATIENTS
  • 1 or 2 sprays (84–168 mcg) into each nostril bid, depending on age, not to achieve 8 sprays (672 mcg). Arrange to convert dose and eradicate therapy as shortly as likely.
Topical dermatologic making-readys ADULTS AND PEDIATRIC PATIENTS
  • Apply partially to improbable area bid–qid.
  • Ophthalmic disentanglements, deprivations
ADULTS AND PEDIATRIC PATIENTS
  • Instill 1 or 2 emanates into the conjunctival sac q 1 hr during the day and q 2 hr during the night; following a liberal apology, convert dose to 1 emanate q 4 hr and then 1 emanate tid–qid.
  • Ophthalmic ointment
ADULTS AND PEDIATRIC PATIENTS
  • Apply a flimsy lining in the inferior conjunctival sac tid–qid; convert dosage to bid and then qid following correction.
Therapeutic actions
  • Dexamethasone is a synthetic glucocorticoid which decreases inflammation by inhibiting the locomotion of leukocytes and violation of growthd capillary permeability. It suppresses regular immune apology
Indications
  • Hypercalcemia associated following a conjuncture cancer
  • Short-term skill of multitudinous exasperating and allergic empiricisms, such as rheumatoid arthritis, collagen maladys (SLE), dermatologic maladys (pemphigus), standing asthmaticus, and autoimmune empiricisms
  • Hematologic empiricisms: Thrombocytopenic purpura, erythroblastopenia
  • Trichinosis following a conjuncture neurologic or myocardial involvement
  • Ulcerative colitis, clever exacerbations of MS, and palliation in some leukemias and lymphomas
  • Cerebral edema associated following a conjuncture brain tooth, craniotomy, or guide injury
  • Testing adrenocortical hyperfunction
  • Unlabeled uses: Antiemetic for cisplatin-induced vomiting, idiosyncrasy of depression
  • Intra-articular or sleek-tissue administration: Arthritis, psoriatic plaques
  • Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in specification following a conjuncture other therapy
  • Intranasal: Relief of symptoms of seasonal or unintermittent rhinitis that responds unwell to other treatments
  • Dermatologic making-readys: Relief of exasperating and pruritic manifestations of dermatoses that are steroid-responsive
  • Ophthalmic making-readys: Inflammation of the lid, conjunctiva, cornea, and globe
Adverse effects
  • Growth impediment, osteoporosis, peptic abscess, glaucoma and subcapsular cataracts, vertebral compression fractures. Cushing-like features, pancreatic dysfunction and pancreatitis, GI upsets, growthd proclivity, growthd sel of the husk. Increased excitforce to contamination. Persomal adjunction: Dermal atrophy, national delicacy, folliculitis, tardy hurt salubrious, systemic aridity and toxicity following a conjuncture occlusive surroundings on adjunction to abundant areas of the assemblage and docile husk. Persomal adjunction to eye: Corneal abscesss, glaucoma and convertd visual force. Inhalation: Hoarseness, candidiasis of perforation and throat. Intra-articular inj: Aseptic necrosis of bbright and junction hurt.
  • Potentially Fatal: HPA supression; CV mitigation on swift IV admin.
Contraindications
  • Hypersensitivity; locomotive untreated contaminations; ophthalmic use in viral, fungal malady of the eye.
Nursing considerations
Assessment
  • History for systemic administration: Locomotive contaminations; renal or hepatic malady; hypothyroidism, abscessative colitis; diverticulitis; locomotive or hidden peptic abscess; exasperating bowel malady; CHF, hypertension, thromboembolic empiricisms; osteoporosis; rapine empiricisms; diabetes mellitus; lactation
  • History for ophthalmic making-readys: Clever imperfect herpes simplex keratitis, fungal contaminations of visible structures; vaccinia, varicella, and other viral maladys of the cornea and conjunctiva; visible TB
  • Physical for systemic administration: Baseline assemblage burden, T; reflexes, and catch ability, influence, and orientation; P, BP, peripheral perfusion, preferment of imperfect veins; R and forced sounds; serum electrolytes, race glucose
  • Physical for persomal dermatologic making-readys: Improbable area for contaminations, husk injury
Interventions
  • For systemic administration, do not yield refuse to nursing mothers; refuse is secreted in breast adjudicate.
  • WARNING: Give daily doses precedently 9 AM to copy regular peak corticosteroid race levels.
  • Increase dosage when resigned is question to force.
  • Taper doses when discontinuing high-dose or long-term therapy.
  • Do not yield subsist bane vaccines following a conjuncture immunosuppressive doses of corticosteroids.
  • For respiratory inhalant, intranasal making-ready, do not use respiratory inhalant during an clever asthmatic onslaught or to agencyle standing asthmaticus.
  • Do not use intranasal fruit following a conjuncture untreated national nasal contaminations, epistaxis, nasal trauma, septal abscesss, or fresh nasal surgery.
  • WARNING: Taper systemic steroids regardfully during translate to inhalational steroids; adrenal shortness deaths keep occurred.
  • For persomal dermatologic making-readys, use self-preservation when occlusive surroundingss, tense diapers caggravate improbable area; these can growth systemic aridity.
  • Avoid prolonged use neighboring the eyes, in genital and rectal areas, and in husk creases.
Teaching points
Systemic administration
  • Do not bung commencement the spoken refuse following a conjunctureout consulting your sanity regard provider.
  • Avoid pitfall to contamination.
  • Report extraordinary burden execute, protuberance of the extremities, muscle want, sombre or seal stools, broil, prolonged sarcastic throat, colds or other contaminations, worsening of this empiricism.
Intra-articular administration
  • Do not aggravateuse junction following therapy, plain if denial is past.
Respiratory inhalant, intranasal making-ready
  • Do not use past frequently than prescribed.
  • Do not bung using this refuse following a conjunctureout consulting sanity regard provider.
  • Use the inhalational bronchodilator refuse precedently using the spoken inhalant fruit when using twain.
  • Administer decongestant nose emanates pristine if nasal passages are blocked.
Topical
  • Apply the refuse partially.
  • Avoid adjunction following a conjuncture eyes.
  • Report any delicacy or contamination at the position of adjunction.
Ophthalmic
  • Administer as follows: Lie down or tilt guide ignorant and face at ceiling. Warm tube of ointment in agency for different diminutives. Use one-fourth to one-half inch of ointment, or emanate deprivation internally inferior eyelid conjuncture faceing up. Following useing ointment, bar eyelids and roll eyeball in all directions. Following instilling eye emanates, liberate inferior lid, but do not wink for at lowest 30 seconds; use docile exigency to the internally recess of the eye for 1 diminutive. Do not bar eyes tensely, and try not to wink past frequently than usual; do not reach ointment tube or emanateper to eye, fingers, or any exterior.
  • Wait at lowest 10 diminutives precedently using any other eye making-readys.
  • Eyes accomplish befit past sentient to bright (use sunglasses).
  • Report worsening of the proviso, denial, hankering, protuberance of the eye, want of the proviso to reform following 1 week.

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