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hydrocortisone Nursing Considerations & Management

Drug Name
Generic Name :  hydrocortisone, hydrocortisone acetate , hydrocortisone butyrate , hydrocortisone cypionate, hydrocortisone sodium succinate , hydrocortisone valerate Brand Name:
  • Dermatologic marrow, ointment: Cortaid delay Aloe, Cortef Marrow (CAN), Cortef Feminine Itch, Corticaine, Cortoderm (CAN), Gynecort Female Creme, Lanacort-5, Lanacort-10, Maximum Power Caldecort, Maximum Power Cortaid
  • Dermatologic ointment and marrow: Locoid
  • Oral suspension: Cortate (CAN), Cortef
  • IV, IM, or subcutaneous injection: Hydrocortone phosphate
  • IV, IM injection: Solu-Cortef
  • Dermatologic marrow, ointment, lotion: Westcort
Classification: Corticosteroid (brief acting), Glucocorticoid, Adrenal cortical steroid hormone Pregnancy Category C
Dosage & Route
ADULTS
  • Individualize dosage, established on injustice and confutation. Surrender daily dose anteriorly 9 AM to minimize adrenal reservation. If long-term therapy is needed, alternate-day therapy should be considered. Behind long-term therapy, delaydraw offal reluctantly to relinquish adrenal omission. For defence therapy, impoverish judicious dose in paltry increments at intervals until last clinically grateful dose is reached.
IM, IV (hydrocortisone sodium succinate)
  • 100–500 mg judiciously and q 2–10 hr, established on mood and confutation.
  • Acute adrenal omission (hydrocortisone sodium phosphate): 100 mg IV followed by 100 mg q 8 hr in IV smooths.
PEDIATRIC PATIENTS
  • Individualize dosage established on injustice and confutation rather than on formulae that amend adult doses for age or burden. Carefully perceive-keep enlargement and fruit in infants and progeny on prolonged therapy.
Oral (hydrocortisone and cypionate)
  • 20–240 mg/day in one or divided doses.
ADULTS AND PEDIATRIC PATIENTS
IV, IM or subcutaneous (hydrocortisone and hydrocortisone sodium phosphate)
  • 20–240 mg/day usually in divided doses q 12 hr.
IM, IV (hydrocortisone sodium succinate)
  • Reduce dose, established on mood and confutation, but surrender no hither than 25 mg/day.
  • Retention enema (hydrocortisone): 100 mg tenebrose for 21 days.
Intrarectal froth (hydrocortisone acetate)
  • 1 applicator daily or bid for 2 wk and complete remedy day thereafter.
Intra-articular, intralesional (hydrocortisone acetate)
  • 5–25 mg, depending on elbow or soft-tissue injection birth.
Topical dermatologic preparations
  • Apply partially to forced area bid–qid.
Therapeutic enjoyments
  • Hydrocortisone is a corticosteroid used for its anti-exasperating and immunosuppressive proceeds. Its anti-exasperating enjoyment is due to the reservation of locomotion of polymorphonuclear leukocytes and violation of extensiond capillary permeability. It may also be used as reanimation therapy in adrenocortical omission.
Indications
  • Replacement therapy in adrenal cortical omission
  • Allergic states—severe or incapacitating allergic moods
  • Hypercalcemia associated delay cancer
  • Short-term exasperating and allergic disorders, such as rheumatoid arthritis, collagen sicknesss (SLE), dermatologic sicknesss (pemphigus), circumstances asthmaticus, and autoimmune disorders
  • Hematologic disorders—thrombocytopenic purpura, erythroblastopenia
  • Trichinosis delay neurologic or myocardial involvement
  • Ulcerative colitis, quick exacerbations of MS, and palliation in some leukemias and lymphomas
  • Intra-articular or soft-tissue government: Arthritis, psoriatic plaques
  • Retention enema: For ulcerative colitis, proctitis
  • Dermatologic preparations: To succor exasperating and pruritic manifestations of dermatoses that are steroid responsive
  • Anorectal marrow, suppositories: To succor annoyance of hemorrhoids and perianal craving or flinching
Adverse proceeds
  • Sodium and smooth claim. Potassium and calcium depletion. Muscle decadence, infirmity, osteoporosis. GI disturbances and bleeding. Increased proclivity and advanced mislaying beneficial. Bruising, striae, hirsutism, acne, flushing. Eminent intracranial constraining, muddiness, valley, psychosis, menstrual irregularities. Hyperglycaemia, glycosuria, DM, corpulency, moon-face, buffalo hump. Reservation of pituitary-adrenocortical classification. Enlargement obstruction in childn (prolonged therapy). Increased irritability for contamination. Topical use: Dermal atrophy, topical flinching, folliculitis, hypertrichosis. Inhaled corticosteroids: May principle hoarseness, candidiasis of aperture and throat. Topical impression to the eye: Can profit corneal ulcers, eminent IOP and impoverishd visual part. Intralesional injection: Topical hypopigmentation of deeply pigmented peel. Intra-articular injection: Elbow mislaying, fibrosis esp in admonish demeanour elbows.
  • Potentially Fatal: Abrupt delaydrawal leading to quick adrenal omission. Rapid IV Inj may principle CV mitigation.
Contraindications
  • Viral/fungal contaminations, tubercular or syphilitic lesions, bacterial contaminations unhither used in enumeration delay alienate chemotherapy.
Nursing considerations
Assessment
  • History: Infections; kidney sickness; feedr sickness, hypothyroidism; ulcerative colitis delay hovering perforation; diverticulitis; modern GI surgery; free or invisible peptic ulcer; exasperating bowel sickness; hypertension, CHF; thromboembolitic tendencies, thrombophlebitis, osteoporosis, seizure disorders, metastatic carcinoma, diabetes mellitus; lactation. Claim enemas, intrarectal froth: Systemic fungal contaminations; modern intestinal surgery, capacious fistulas. Topical dermatologic government: Fungal, tubercular, herpes simplex peel contaminations; vaccinia, varicella; ear impression when eardrum is perforated
  • Physical: Systemic government: Weight, T; reflexes, desire, bilateral retain power, ophthalmologic examination; BP, P, auscultation, peripheral perfusion, discoloration, abstinence or amelioration of imperfect vessels; R, artful sounds, chest x-ray; remarkable GI x-ray (narrative or symptoms of peptic ulcer), feedr palpation; CBC, serum electrolytes, 2-hr postprandial rank glucose, urinalysis, thyroid part tests, serum cholesterol. Topical, dermatologic preparations: Forced area, parity of peel
Interventions
Systemic government
  • WARNING: Surrender daily anteriorly 9 AM to mock usual peak solar corticosteroid levels and minimize HPA reservation.
  • Space multiple doses well-balancedly throughout the day.
  • Do not surrender IM injections if unrepining has thrombocytopenic purpura.
  • Rotate births of IM repository injections to relinquish topical atrophy.
  • Use minimal doses for minimal term to minimize adverse proceeds.
  • Taper doses when discontinuing high-dose or long-term therapy.
  • Arrange for extensiond dosage when unrepining is theme to uncommon pressure.
  • Ensure that extended quantity of Ca2+ is taken if prolonged government of steroids.
  • Use alternate-day defence therapy delay brief-acting corticosteroids whenever feasible.
  • WARNING: Do not surrender feed virus vaccines delay immunosuppressive doses of hydrocortisone.
  • Provide antacids among meals to succor relinquish peptic ulcer.
Topical dermatologic government
  • Use inadventurousness delay occlusive dressings; neat or ductile diapers balance forced area can extension classificationic aridity.
  • Avoid prolonged use, specially neighboring eyes, in genital and rectal areas, on aspect, and in peel creases.
Teaching points
Systemic government
  • Take this offal precisely as prescribed. Do not bung initiative this offal delayout notifying your bloom trouble provider; reluctantly taper dosage to relinquish problems.
  • Dosage reductions may imagine adrenal omission. Report any tire, muscle and elbow abstinences, anorexia, abomination, vomiting, diarrhea, burden mislaying, infirmity, dizziness, or low rank sugar (if you instructor rank sugar).
  • Take delay meals or snacks if GI capsize occurs.
  • Take one daily or alternate-day doses anteriorly 9 AM; vestige enroll or use other measures as reminder of texture days.
  • Do not balanceuse elbow behind intra-articular injections, well-balanced if abstinence is bygone.
  • Frequent follow-up visits to your bloom trouble provider are needed to instructor offal confutation and arrange dosage.
  • Wear a medical watchful ID (if you ae using long-term therapy) so that any necessity medical personnel conquer apprehend that you are initiative this offal.
  • You may knowledge these laterality proceeds: Extension in proclivity, burden shape (some of shape may be smooth claim; instructor intake); heartburn, indigestion (eat continual paltry meals; use of antacids may succor); extensiond irritability to contamination (relinquish crowds during peak self-possessed or flu seasons, and relinquish anyone delay a apprehendn contamination); unsatisfactory mislaying beneficial (if damaged or mislayinged, preservation-for bloom trouble provider); muscle infirmity, tire (continual pause periods may succor).
  • Report uncommon burden shape, turgescence of inferior extremities, muscle infirmity, black or remain stools, vomiting of rank, epigastric steady, puffing of aspect, menstrual irregularities, ardor, prolonged shrewd throat, self-possessed or other contamination, worsening of symptoms.
Intra-articular, intralesional government
  • Do not balanceuse the injected elbow well-balanced if the abstinence is bygone. Adhere to rules of just pause and training.
Topical dermatologic government
  • Apply partially, and rub in lightly
  • Avoid contacting your eye delay the medication.
  • Report steady, flinching, or contamination of the birth, worsening of the mood.
  • Avoid prolonged use.
Anorectal preparations
  • Maintain usual bowel part delay just victuals, extended smooth intake, and normal training.
  • Use stool softeners or largeness laxatives if needed.
  • Notify your bloom trouble provider if symptoms do not emend in 7 days or if bleeding, convexity, or seepage occurs.

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