The most important nursing intervention on a patient receiving prednisolone?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Pharmacology

Medium

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Prednisolone is a corticosteroid that has significant metabolic effects.
One of the most common and immediate side effects is hyperglycemia (elevated blood sugar).
Corticosteroids increase glucose production in the liver and cause peripheral insulin resistance.
Therefore, monitoring blood sugar levels is a critical safety intervention to detect and manage corticosteroid-induced hyperglycemia.
Failure to monitor can lead to severe hyperglycemia, which can be dangerous, especially in patients with pre-existing diabetes.

Option A: While prednisolone can cause sodium and water retention, leading to changes in fluid balance, hourly urine output monitoring is generally reserved for critically ill patients or those with acute renal failure. It is not the primary intervention for routine prednisolone administration.
Option B: Checking urine specific gravity assesses the concentration of urine and is related to fluid balance. However, it is an indirect and less precise measure compared to directly monitoring blood glucose for the most common metabolic side effect.
Option D: Routine monitoring of prednisolone blood levels is not standard nursing practice. The dosage is adjusted based on the patient's clinical response and the management of side effects, not on achieving a specific serum drug concentration.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing interventions and side effect management for corticosteroid therapy to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate patients on long-term corticosteroid therapy about the signs and symptoms of hyperglycemia, such as increased thirst, frequent urination, and blurred vision.
Patients should be taught to report these symptoms immediately.
It is crucial to assess for a history of diabetes mellitus before starting corticosteroid therapy, as these drugs can significantly worsen glycemic control.

How to Approach the Question

First, identify the drug mentioned in the question: Prednisolone.
Recall the drug class: Prednisolone is a corticosteroid (glucocorticoid).
Think about the major side effects associated with this drug class. Key side effects include hyperglycemia, fluid retention, immunosuppression, and adrenal suppression.
Analyze the options provided. Each option relates to a potential side effect or monitoring parameter.
Prioritize the interventions. Ask which side effect is most common, immediate, and potentially dangerous. Corticosteroid-induced hyperglycemia is a very common and significant metabolic effect.
Select the option that directly addresses this high-priority issue. Checking blood sugar is the direct way to monitor for hyperglycemia.

Concept Tested & Keywords

Concept Tested: Nursing interventions and side effect management for corticosteroid therapy.
Stem keywords: nursing intervention, prednisolone
Lead-in keywords: most important

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