NURSING PROCESS

PATIENT RECEIVING VASOPRESSIN

ASSESSMENT

Preadministration Assessment

Assessment of the patient receiving an androgen or anabolic steroid depends on the drug, the patient, and the reason for administration.

ANDROGENS. In most instances, androgens are administered to the man on an outpatient basis. Before and during therapy, the primary health care provider may order electrolyte studies, because use of these drugs can result in fluid and electrolyte imbalances.

When these drugs are given to the female patient with advanced breast carcinoma, evaluate the patient’s current status (physical, emotional, and nutritional) carefully and record the findings in the patient’s chart. Problem areas such as pain, any limitation of motion, and the ability to participate in the activities of daily living are carefully evaluated and recorded in the patient’s record. You should take and document vital signs and weight. Baseline laboratory tests may include a complete blood count, hepatic function tests, serum electrolytes, and serum and urinary calcium levels. Review these tests and note any abnormalities.

ANABOLIC STEROIDS. Evaluate and document the patient’s physical and nutritional status before starting therapy with anabolic steroids. Note the patient’s weight, blood pressure, pulse, and respiratory rate. Baseline laboratory studies may include a complete blood count, hepatic function tests, and serum electrolytes and serum lipid levels. Review these studies and note any abnormalities.

Ongoing Assessment

The ongoing assessment depends on the reason the drug was prescribed and the condition of the patient. Men receiving an androgen or anabolic steroid are questioned regarding the effectiveness of drug therapy.

Track the weight of the patient with advanced breast carcinoma daily or as ordered by the primary health care provider. Contact the primary health care provider if there is a significant (5-lb) increase or decrease in the weight. Check the lower extremities frequently for signs of edema.

Teach the patient or caregiver to observe for adverse drug reactions, especially signs of fluid and electrolyte imbalance, jaundice (which may indicate hepatotoxicity), and virilization. The primary health care provider must be alerted to any signs of fluid and electrolyte imbalance or jaundice.

When the patient is hospitalized, review vital signs every 4 to 8 hours, depending on the patient’s condition, and then evaluate the patient’s response to drug therapy based on original assessment findings. Possible responses include a decrease in pain, an increase in appetite, and a feeling of well-being.

LIFESPAN CONSIDERATIONS

Chronic Care

When the androgens are administered to a patient with diabetes, blood glucose levels should be measured frequently because glucose tolerance may be altered. Adjustments may need to be made in insulin dosage, oral antidiabetic drugs, or diet.

When anabolic steroids are used for weight gain, the patient is weighed at intervals ranging from daily to weekly. A good dietary regimen is necessary to promote weight gain. Consult the dietitian if the patient eats poorly.

NURSING DIAGNOSES

Drug-specific nursing diagnoses include the following:

  Excess Fluid Volume related to adverse reactions (sodium and water retention)

  Disturbed Body Image (in the female) related to adverse reactions (virilization)

Nursing diagnoses related to drug administration are discussed in Chapter 4.

PLANNING

The expected outcomes of the patient may include an optimal response to therapy, support of patient needs related to the management of adverse reactions, and confidence in an understanding of the medication regimen.

IMPLEMENTATION

Promoting an Optimal Response to Therapy

If the androgen is to be administered as a buccal tablet, show the patient how to place the tablet and warn the patient not to swallow the tablet but to allow it to dissolve in the mouth. Remind the patient not to smoke or drink water until the tablet is dissolved. Oral and parenteral androgens are often taken or given by injection on an outpatient basis. When given by injection, the injection is administered deep intramuscularly (IM) into the gluteal muscle. Alternatively, a pellet dose is placed under the skin and repeated every 3 to 6 months. Oral testosterone is given with or before meals to decrease gastrointestinal (GI) upset.

Androderm is a transdermal system that is applied nightly to clean, dry skin on the abdomen, thigh, back, or upper arm. This system is not applied to the scrotum. Sites are rotated, with 7 days between applications to any specific site. The system is applied immediately after opening the pouch and removing the protective covering. If the patient has not exhibited a therapeutic response after 8 weeks of therapy, another form of testosterone replacement therapy should be considered. When the system is removed it should be folded in half on itself to prevent accidental dosing if touched.

Testosterone gel (AndroGel) is applied once daily (preferably in the morning) to clean, dry, intact skin of the shoulders and upper arms or abdomen. After the packet is opened, the contents are squeezed into the palm of the hand and immediately applied to the application sites. The application sites are allowed to dry before the patient gets dressed. The gel is not applied to the genitals. Wear gloves if applying to another person; wash hands well with soap and water for self-applications.

Axiron is a liquid preparation that is sprayed into the axillae daily. It is a fast-drying liquid being tested for ease of use.

Monitoring and Managing Patient Needs

Observe the patient receiving an androgen or anabolic steroid for signs of adverse drug reactions.

EXCESS FLUID VOLUME. Sodium and water retention may also occur with androgen or anabolic steroid administration, causing the patient to become edematous. In addition, other electrolyte imbalances, such as hypercalcemia, may occur. Monitor the patient for fluid and electrolyte disturbances.

LIFESPAN CONSIDERATIONS

Gerontology

Older adults with cardiac problems or kidney disease are at increased risk for sodium and water retention when taking androgens or anabolic steroids.

To monitor for fluid retention, make a daily comparison of the patient’s preadministration weight with current weights and make sure to note the appearance of puffy eyelids and dependent swelling of the hands or feet (if the patient is ambulatory) or the sacral area (if the patient is nonambulatory), and report any findings to the primary health care provider. Daily fluid intake and output should be used to calculate fluid balance, too.

DISTURBED BODY IMAGE. With long-term administration of a male hormone, the female patient may experience mild to moderate masculine changes (virilization), namely, facial hair, a deepening of the voice, and enlargement of the clitoris. Male-pattern baldness, patchy hair loss, skin pigmentation, and acne may also result. Although these adverse effects are not life-threatening, they often are distressing and only add to the patient’s discomfort and anxiety. These problems may be easy to identify, but they are not always easy to solve. If hair loss occurs, suggest wearing head coverings such as hats, scarves, or a wig; mild skin pigmentation may be covered with makeup, but severe and widespread pigmented areas and acne are often difficult to conceal. Each patient is different, and the emotional responses to these outward changes may range from severe depression to a positive attitude and acceptance. Work with the patient as an individual, first identifying the problems, and then helping the patient, when possible, to deal with these changes.

Educating the Patient and the Family

Explain the dosage regimen and possible adverse drug reactions to the patient and family and develop a teaching plan to include the following points:

ANDROGENS

  Notify the primary health care provider if any of the following occurs: nausea, vomiting, swelling of the legs, or jaundice. Women should report any signs of virilization to the primary health care provider.

  Oral tablets—Take with food or a snack to avoid GI upset.

  Buccal tablets—Place the tablet between the cheek and molars and allow it to dissolve in the mouth. Do not smoke or drink water until the tablet is dissolved.

  Testosterone transdermal system—Apply according to the directions supplied with the product. Be sure the skin is clean and dry and the placement area is free of hair. Do not store outside the pouch or use damaged systems. Discard systems in household trash in a safe manner to prevent ingestion by children or pets.

ANABOLIC STEROIDS

  Anabolic steroids may cause nausea and GI upset. Take this drug with food or meals.

  Keep all primary health care provider or clinic visits, because close monitoring of therapy is essential.

  Female patients: Notify the primary health care provider if signs of virilization occur.

EVALUATION

  Therapeutic response is achieved.

  Adverse reactions are identified, reported to the primary health care provider, and managed successfully with appropriate nursing interventions:

•  Adequate fluid volume is maintained.

•  Perceptions of body changes are managed successfully.

  Patient and family express confidence and demonstrate an understanding of the drug regimen.