A client is getting prednisolone injection as continuous infusion. The important nursing management is

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Medical & Surgical Nursing

Medium

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Explanation

Prednisolone is a corticosteroid medication, a class of drugs known to cause hyperglycemia (high blood sugar) as a primary metabolic side effect.
Corticosteroids increase glucose production in the liver and promote insulin resistance, leading to elevated blood glucose levels.
A continuous infusion delivers a steady, high dose of the medication, making the risk of rapid and severe hyperglycemia particularly high.
Therefore, frequent (hourly) monitoring of blood sugar is the most critical nursing intervention to ensure patient safety and allow for timely management with insulin if needed.

Option A: This measures urine concentration to assess fluid balance. While steroids can cause fluid shifts, this is not the most immediate or critical metabolic effect to monitor hourly.
Option C: This is used to monitor for ascites or bowel distension, which are not direct or acute complications of a prednisolone infusion.
Option D: This is a pediatric assessment used to monitor brain growth in infants and is completely irrelevant for an adult patient.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management for corticosteroid therapy to guide bedside assessment, documentation, and the next nursing action.
Nurses must anticipate hyperglycemia as a common side effect in any patient receiving moderate to high-dose corticosteroid therapy and advocate for a blood glucose monitoring protocol.
Failure to monitor and manage steroid-induced hyperglycemia can lead to severe complications, including hyperglycemic hyperosmolar state (HHS), poor wound healing, and increased risk of infection.
What if? If the patient was taking a single, low oral dose of prednisolone daily for a chronic condition, blood sugar monitoring might be less frequent (e.g., once daily or a few times per week) rather than hourly, as the risk of acute, severe hyperglycemia is lower.

How to Approach the Question

First, identify the drug mentioned in the question: Prednisolone.
Recall the drug class: Prednisolone is a corticosteroid.
Think about the most common and immediate side effects of corticosteroids. The primary metabolic side effect is hyperglycemia (increased blood sugar).
Consider the route of administration: 'Continuous infusion' signifies a constant, high level of the drug in the body, which amplifies the risk of side effects.
Evaluate the options based on this knowledge. 'Hourly blood sugar' directly addresses the most significant and immediate risk associated with a continuous corticosteroid infusion.
Eliminate the other options as they are not relevant to the primary, acute effects of the drug in this context.

Concept Tested & Keywords

Concept Tested: Nursing management for corticosteroid therapy
Stem keywords: prednisolone injection, continuous infusion, nursing management
Lead-in keywords: important
Clinical cues: The phrase 'continuous infusion' is a key clinical cue, as it implies a sustained and potent drug effect that requires more frequent and vigilant monitoring compared to intermittent or oral dosing.