Chapter 28 Cortico-steroids and gonadal Hormones

cortico-steroids are hormones secreted by the adrenal cortex of the 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

ovaries produce estrogen and progesterone, these stimulate the 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

ie: fludrocortisone (Florinef) Mineralo-Corticoids ie: fludrocortisone (Florinef) mineralo-corticoid with gluco-corticoid effects affects fluid and electrolyte balance by causing: sodium and water retention potassium and hydrogen excretion drug is used with gluco-corticoids goals of therapy: 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”

Gluco-Corticoids: given for anti-inflammatory, anti-allergenic, immunosuppressant effects relieve symptoms of inflammation, but do not cure disease drugs used in treatment of: cancers organ transplants auto-immune diseases rheumatoid arthritis allergy signs/symptoms shock nausea and vomiting from chemotherapy goals of treatment: 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 -malaise/fatigue -weakness -anorexia -hypotension -dizziness -nausea -fainting -hypoglycemia -dyspnea -muscle and joint pain -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………..

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 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), break- through uterine bleeding, signs/symptoms of thrombo-embolic diseases (ch 23): complications of estrogen therapy

Progestin 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: 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

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