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2 ● Rect: Assess symptoms of ulcerative colitis (diarrhea, bleeding, weight loss, ano-
rexia, fever, leukocytosis) periodically during therapy.
suppress adrenal function, maypantibody response to andqrisk of adverse reac- ● Lab Test Considerations: Systemic— Monitor serum electrolytes and glu- PDF Page #2
tions from live-virus vaccines. cose. May cause hyperglycemia, especially in persons with diabetes. May cause hy-
pokalemia. Monitor hematologic values, serum electrolytes, and serum and urine
Route/Dosage glucose routinely in patients on prolonged therapy. May causepWBC counts. May
PO (Adults and Children ⬎ 12 yr): 20– 240 mg/day in 1– 4 divided doses. causepserum potassium and calcium andqserum sodium concentrations.
PO (Children): Physiologic replacement— 0.5– 0.75 mg/kg/day or 20– 25 mg/ ● Guaiac test stools. Promptly report presence of guaiac-positive stools.
m2/day divided q 6 hr. Anti-inflammatory or immunosuppressive— 2.5– 10 mg/ ● May cause elevated serum cholesterol and lipid values. May causepuptake of thy-
kg/day or 75– 300 mg/m2/dayin 3– 4 divided doses. roid 123I or 131I.
PO (Neonates): Congenital adrenal hyperplasia— 10– 20 mg/m2/day in 3 di- ● Suppresses reactions to allergy skin tests.
vided doses. ● Periodic adrenal function tests may be ordered to assess degree of hypothalamic-
PO, IV (Neonates): Refractory hypoglycemia— 5 mg/kg/day divided q 8– 12 hr pituitary-adrenal axis suppression in systemic and chronic topical therapy.
or 1– 2 mg/kg/dose q 6 hr.
Rect (Adults): Retention enema— 100 mg nightly for 21 days or until remission Potential Nursing Diagnoses
Risk for infection (Side Effects)
occurs.
Disturbed body image (Side Effects)
IM, IV (Adults): 100– 500 mg q 2– 6 hr (range 100– 8000 mg/day).
IM, IV (Children and Infants): Adrenocortical insufficiency— 1– 2 mg/kg/ Implementation
dose bolus, then 25– 250 mg/day in divided doses q 6– 8 hr. Anti-inflammatory or ● Do not confuse hydrocortisone with hydrocodone. Do not confuse Solu-
immunosuppressive— 1– 5 mg/kg/day or 30– 150 mg/m2/day divided q 12– 24 Cortef with Solu-Medrol (methylprednisolone).
hr; Physiologic replacement— 0.25– 0.35 mg/kg/day or 12– 15 mg/m2/day once ● If dose is ordered daily or every other day, administer in the morning to coincide
daily; Shock— 50 mg/kg bolus then 50 mg/kg as a 24 hr infusion. with the body’s normal secretion of cortisol.
IV (Neonates): Bronchopulmonary dysplasia prevention in preterm neonates ● Periods of stress, such as surgery, may require supplemental systemic corticoste-
with prenatal inflammatory exposure— 1 mg/kg/day divided q 12 hr during the roids.
first 2 weeks of life; Refractory hypotension— 3 mg/kg/day divided q 8 hr x 5 days. ● PO: Administer with meals to minimize GI irritation.
● Tablets may be crushed and administered with food or fluids for patients with diffi-
NURSING IMPLICATIONS culty swallowing.
Assessment ● IM: IM doses should not be administered when rapid effect is desirable. Do not
● Indicated for many conditions. Assess involved systems prior to and periodically dilute with other solution or admix.
during therapy. IV Administration
● Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weak- ● pH: 7.0– 8.0.
ness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) prior to and ● Direct IV: Reconstitute with provided solution (i.e., Act-O-Vials) or 2 mL of bac-
periodically during therapy. teriostatic water or saline for injection. Rate: Administer each 100 mg over at
● Monitor intake and output ratios and daily weights. Observe patient for peripheral least 30 sec. Doses ⱖ500 mg should be infused over at least 10 min.
edema, steady weight gain, rales/crackles, or dyspnea. Notify health care profes- ● Intermittent Infusion: Diluent: May be added to 50– 1000 mL of D5W or
sional should these occur. 0.9% NaCl. Concentration: Usual 1– 5 mg/mL. Adults who are fluid restricted
● Children should have periodic evaluations of growth. may received up to 60 mg/mL. Rate: Administer over 20– 30 min.
䉷 2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/hydrocortisone 02/14/2014 02:24PM Plate # 0-Composite pg 3 # 3
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● If rectal dose used ⬎21 days, decrease to every other night for 2– 3 weeks to de- PDF Page #4
crease gradually.
Evaluation/Desired Outcomes
● Decrease in presenting symptoms with minimal systemic side effects.
● Suppression of the inflammatory and immune responses in autoimmune disor-
ders, allergic reactions, and neoplasms.
● Management of symptoms in adrenal insufficiency.
● Improvement in symptoms of ulcerative colitis. Clinical symptoms usually improve
in 3– 5 days. Mucosal appearance may require 2– 3 mo to improve.
Why was this drug prescribed for your patient?