1. Chapter 28 Cortico-steroids and gonadal Hormones

2. 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

3. 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

4. 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

5. 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

6. 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”

7. 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

8. 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………..

9. 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)

10. 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

11. Assisting With the Nursing Process
estrogen:
ASSESSMENT: measure vitals and weight
PLANNING: see table 28-2 of p for “Dose Forms”
IMPLEMENTATION: see table 28-2 of p 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

12. 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

13. 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

14. 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

15. 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 for “Dose Forms”
IMPLEMENTATION: see table 28-4 of p 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