Systemic Effects of Excess Steroids – NCLEX Review (Nursing)

by Prof. Lawes

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    00:00 Now, we can give you a big, old long list of those but I'm gonna do something goofy with you and let's see if it helps you remember things better.

    00:07 So I'm gonna give you some hand motions that go along with this.

    00:11 If you put your pencil down for just a minute and do them with me, it's gonna make it simpler for you to follow along.

    00:16 Alright, so I'm thinking of systemic effects of excess corticosteroids.

    00:21 So whether the patient is taking them by mouth or by IV, those are the 2 routes that are gonna give us the most significant systemic effects.

    00:29 So moon face, facial hair, mood swings, buffalo hump. Got that? Alright, we're gonna do it a few more times because for this kind of stuff, repetition is the first step in laying your groundwork.

    00:43 So moon face, facial hair, mood swings, buffalo hump.

    00:49 Good, now we've got 3 or 4 more times coming so stick with us.

    00:53 Moon face, facial hair, mood swings, buffalo hump. You got it.

    00:59 Moon face, facial hair, mood swings, buffalo hump.

    01:04 Good, if we've done it enough to annoy you, then your brain is like, yeah, I got this. Good job.

    01:09 Now, do something that makes these list be particular for you.

    01:14 They stand out for you. That's why we -- I use hand motions, a different tone to my voice, a weird name.

    01:20 Those are things that will help you remember.

    01:22 You've gotta realize you can't remember everything but what you do know, you need to know very well. That's the key.

    01:32 So we're talking about excess corticosteroids.

    01:36 You know, you've got excess ACTH, excess cortisol, and excess aldosterone.

    01:41 Remember, that one can vary based on the medication we looked at that previous chart.

    01:47 So our goal is to suppress inflammation.

    01:53 That's usually why we're giving excess corticosteroids.

    01:56 So now let's look at this list.

    01:59 Remember, moon face, facial hair, mood swings, buffalo hump.

    02:05 Patients on excess corticosteroids, whether it's a medication or Cushing's disease, can have these crazy mood swings, euphoria, depression, psychosis, panic attacks.

    02:15 It's not normal for them. It can definitely be exacerbated when a patient's taking corticosteroids.

    02:22 Moon face is a very full face. It looks like they've gained a lot of weight.

    02:27 Now, the facial hair might be okay for you if you're a guy but most females are a little down on having beards.

    02:35 No one wants to sell tickets for them to see the bearded lady.

    02:38 So we're looking at these rather than just see a list and look at them.

    02:43 Thinking moon face, facial hair, mood swings, buffalo hump.

    02:49 Do that a few more times. I know it sounds silly but it's gonna help encode it in your brain.

    02:55 Now, in moving on down, I know I've already talked about the fullness in my face, I know the females are gonna grow facial hair that they do not appreciate, you're gonna end up with this kind of fat distribution back there.

    03:08 That's the buffalo hump. But if I think about cardiovascular, I know if there's an aldosterone component, that's gonna impact my sodium level so I'm gonna keep hanging onto more water. That means I have excess volume.

    03:23 What normally happens when I have a higher volume? How does that impact my blood pressure? Well, it's gonna be up. More volume means hypertension or an elevated blood pressure.

    03:35 Now, I'm talking about electrolytes if I'm having -- hanging onto more sodium, I'm gonna have an increase in my sodium. What happens to my potassium? Good, you remembered. You have a decrease in your potassium.

    03:51 So moon face, facial hair, mood swings, buffalo hump.

    03:55 Moving down to cardiovascular, why do I have elevated blood pressure? Good, because I have more volume. Why do I have lower potassium? Because I have increased sodium.

    04:08 Okay, those are the kind of games you wanna play with yourself.

    04:11 You wanna keep quizzing and asking yourself questions and looking at it from all different kinds of perspectives.

    04:16 Now, we get down, you see the diagram there.

    04:19 We're talking about that this buffalo hump back here is fat distribution.

    04:24 Yeah, it's this weird fat distribution but you also have it in your trunk.

    04:29 So they kinda look like a martini olive on toothpicks.

    04:33 Their arms and legs don't gain weight but they put weight right around the middle and in their face.

    04:40 No one appreciates this side effect of excess corticosteroids.

    04:45 But that's -- they're gonna have a look.

    04:47 You can Google it, look at pictures, even had celebrities have to deal with that.

    04:51 All of a sudden looks like they've gained a lot of weight but really, they haven't.

    04:55 So you're gonna see rapid weight gain, some other things that go along with that are insulin resistance.

    05:02 So this is going to have an effect on the patient's glucose.

    05:06 Something else you're gonna wanna keep track of.

    05:09 So even if they're not diabetic, you might see a bump in their serum glucose but if they are diabetic, you're definitely gonna see an increase in their serum glucose.

    05:18 So the health care provider will need to work together with the patients.

    05:21 We need to find maybe some adjustments to dosing or the plan that need to occur depending on how long this patient is gonna have to be on the excess corticosteroids.

    05:31 Okay, try it one more time. Moon face, facial hair, mood swings, buffalo hump.

    05:37 Elevated -- yes, elevated hypertension. You've got it. Gain wait.

    05:43 You're gonna gain weight right around the middle and full in the face.

    05:48 Blood sugar's going to be up because of insulin resistance.

    05:53 Now, it also has some sexual side effects.

    05:55 Remember, you think back to what aldosterone did and what cortisol does.

    05:59 That's why you have decreased libido, impotence, amenorrhea, and infertility.

    06:05 Really messes up with the sexual effects so excess corticosteroids can cause problems in these 4 specific areas.

    06:14 Now finally, I wanna talk about -- I know we've got buffalo hump on the back, right? We've got that. We've talked about the weird fat distribution but I wanna talk about some things like skin and bones.

    06:24 Acne, muscle wasting, they have excessive sweating, purple or red striae, they've got this steroid skin that can bruise very easily.

    06:33 And I found with elderly clients, if they're on corticosteroids, it almost tears if you brush up against their skin.

    06:39 Very, very fragile skin. But these are the 2 I want you to really focus on.

    06:45 The other ones are important. We already talked about the buffalo hump, that weird fat distribution, but these 2 have significant impact.

    06:53 If it's a child, we avoid giving corticosteroids if possible.

    06:58 If we do have to give them, we try to give them delivered directly to the site like as in asthma.

    07:03 We want an inhaler to go directly to the lung but if it's in a child, we wanna try to avoid oral or IV. Can you remember why? Good, because if we give it oral or IV, you have an increased chance of getting the systemic side effects.

    07:21 One of those most significant for children is gonna be suppression of their growth.

    07:25 Now, for all ages, corticosteroids are difficult on the bones.

    07:29 So I've got an elderly female client who already has osteoporosis.

    07:33 This is gonna be a tricky balance. So keep that in mind.

    07:36 Of this slide, the 2 on the bottom are the most important so if you just wanna memorize 2, those are the 2 I want you to make sure that you have solid in your mind.

    07:47 Now's your chance. Engaging with the content, so without looking at your notes, I want you to see if you can list the items you think you should teach your patient about corticosteroids.

    07:59 We got some bullet points for you there.

    08:00 Just pause the video, list as many as you can.

    08:08 This is another way to remember things.

    08:10 You may or may not like it but that's the beauty of our system is you choose what works the best for you.

    08:16 So we took the word Cushing's and we added some things to U.

    08:19 It stands for unhappy or "U"phoric for mood swings.

    08:23 We use the H for hump and hypertension.

    08:26 The I for insulin resistance, the G for gut, and the S for skin and sex.

    08:33 Now, please keep in mind there's only so many of these you can keep in your brain so be wise about the ones where you need them.

    08:42 Use this type of tool only in places where you really need it.

    08:46 Most often, understanding the why and how behind it, knowing how things work in your body, is the best method for remembering it rather than trying to remember a group of letters or a name.

    08:58 So use them judiciously but they really do have their place but you have to be careful about which one works best for your brain.

    About the Lecture

    The lecture Systemic Effects of Excess Steroids – NCLEX Review (Nursing) by Prof. Lawes is from the course NCLEX Pharmacology Review (Nursing).

    Included Quiz Questions

    1. Moon face
    2. Night sweats
    3. Low-grade fever
    4. Slurred speech
    1. Increased irritability
    2. Auditory hallucinations
    3. Tactile disturbances
    4. Visual hallucinations
    1. Aldosterone
    2. Calcitonin
    3. Thyroxine
    4. Progesterone
    1. Decrease in potassium levels
    2. Decrease in chloride levels
    3. Decrease in sodium levels
    4. Decrease in calcium levels
    1. Decreased libido
    2. Impotence
    3. Amenorrhea
    4. Infertility
    5. Menorrhagia

    Author of lecture Systemic Effects of Excess Steroids – NCLEX Review (Nursing)

     Prof. Lawes

    Prof. Lawes

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