Question

Due to a severe asthma attack, a client has been on corticosteroids for more than 2 weeks. Which information should the nurse give the client about when the time comes to stop the medication? A. Fluid intake will need to be limited. B. The dose of medication will be tapered down slowly. C. Extra calcium will be needed for a week to ten days, D. Vitamin supplements will be needed to prevent bone loss.

Short answer

The nurse should inform the client that the dose of corticosteroids will need to be tapered down slowly when stopping the medication.

Step-by-step solution

Understand Corticosteroids and Their Withdrawal Process

Patients on corticosteroids for a significant duration, such as more than 2 weeks, generally cannot stop the medication abruptly due to the risk of adrenal insufficiency. The body needs time to resume natural steroid production, and a sudden stop in the external steroid supply can lead to acute health issues.

Eliminate Incorrect Options

Options A, C, and D involve managing side effects or essential nutrients but do not address the withdrawal process of corticosteroids. Limiting fluid intake, and adding calcium for a short term, or vitamin supplements, although possibly relevant to overall treatment, do not pertain to the immediate concern of stopping the medication.

Identify the Correct Answer

The correct answer is that the dose of corticosteroids will need to be tapered down slowly. This process avoids potential complications and allows the body to adjust to decreased levels of the medication.

Key concepts

Adrenal Insufficiency

When the human body has been exposed to corticosteroids for an extended period, usually more than a couple of weeks, the adrenal glands reduce their natural production of cortisol. This is because these synthetic steroids can mimic the action of cortisol, which is an essential hormone released by the adrenal glands in response to stress. When a patient suddenly stops taking corticosteroids, the body may experience a Phase of adrenal insufficiency.

Adrenal insufficiency is a condition where the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol, which can lead to symptoms like fatigue, dizziness, muscle weakness, and abdominal pain. One of the essential roles of cortisol is to help the body respond to stress, and without this hormone, the body can go into a state of shock, which can be life-threatening.

Therefore, educating patients undergoing steroid therapy about the risks of adrenal insufficiency is crucial, as it underscores the importance of proper medication management and cessation practices.

Medication Tapering

Medication tapering refers to the gradual reduction of the dosage of drugs rather than stopping them abruptly. The tapering process allows the body to adjust to decreasing amounts of the medication, minimizing withdrawal symptoms or adverse effects associated with sudden discontinuation.

In the context of corticosteroids, tapering is vital to prevent adrenal insufficiency.

Steps for Tapering Down Corticosteroids:

• Determine the starting dose: The taper generally begins from the dose at which the patient has been stable.
• Reduce the dose: The reduction can be a specific percentage of the current dose or a fixed amount, commonly between 10% to 20% reductions, over a scheduled period, often weekly or bi-weekly.
• Monitor the patient: The patient's response to the taper should be monitored clinically and, if necessary, biochemically through tests such as the ACTH (Adrenocorticotropic Hormone) stimulation test.
• Adjust the tapering schedule: Depending on how the patient is responding, the tapering schedule may need to be adjusted either to accelerate or decelerate the process.

Tapering strategies can vary based on the corticosteroid potency, the duration of therapy, and the patient's medical history. A slow taper facilitates adrenal recovery and lowers the risk of withdrawal symptoms.

NCLEX-RN Pharmacology

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) includes pharmacology as a central component, ensuring that nurses have a comprehensive understanding of medications and their management. A nurse's expertise in pharmacology should not only include the mechanisms and effects of medications but also safe administration practices and patient education strategies.

In regard to corticosteroid withdrawal, NCLEX-RN candidates are expected to know the importance of medication tapering, recognize the symptoms of adrenal insufficiency, and advise accordingly on medication management. Nurses play a pivotal role in patient education, helping patients understand

Why Tapering is Necessary:

• To prevent potential adverse reactions associated with abrupt discontinuation.
• To support the resumption of endogenous hormone production.
• To adjust to the physiologic changes at lower medication dosages.

Through understanding these pharmacological principles, nurses can better guide patients undergoing corticosteroid therapy, ensuring safe and effective treatment withdrawal.