Side Effects	Assessment Parameters	Nursing Interventions
Cardiovascular: Fluid and Electrolytes     Renal toxicity	Serum creatinine, BUN Creatinine clearance Urine output Peripheral edema	Restrict fluids Administer diuretics Decrease dosage
Gastrointestinal    Nausea, vomiting    Anorexia    Diarrhea    Hepatotoxicity    Pancreatitis	Appetite, elimination pattern, bilirubin, serum transaminases and phosphatases, coagulation factors, serum amylase and lipase, serum calcium	Administer oral dose with meals Consult dietician Institute enteral or parenteral nutrition
Hematologic    Leukopenia    Thrombocytopenia    Macrocytic anemia	WBC count with differential and platelet count RBC count Bleeding (oozing, hemorrhage) Signs, symptoms of infection Inspect mucous membranes	Increase attention to infection control measures Administer platelets Administer packed RBCs Administer oral anti-infectives Decrease dosage
Dermatologic    Stomatitis	Inspect mucous membranes	Maintain good oral hygiene Administer analgesics

BUN, blood urea nitrogen; RBC, red blood cell; WBC, white blood cell

Drug	Anti-inflammatory Potency	Equivalent Dosage* (mg)	Mineralocorticoid Activity
Hydrocortisone	1.0	20.00	2+
Cortisone	0.8	25.00	2+
Prednisone	4.0	5.00	1+
Prednisolone	4.0	5.00	1+
Methylprednisolone	5.0	4.00	0
Triamcinolone	5.0	4.00	0
Betamethasone	20-30	0.60	0
Dexamethasone	20-30	0.75	0

*For example, prednisone is 4 times more potent than hydrocortisone (eg, 5 mg of prednisone is equivalent to 20 mg of hydrocortisone).

Side Effects	Assessment Parameters	Nursing Interventions
Cardiovascular: Fluid and Electrolytes    Sodium retention    Potassium wasting    Calcium and phosphorous        wasting    Metabolic alkalosis    Fluid retention    Arterial hypertension	Serum electrolytes, calcium,    phosphorus, albumin Intake and output Acid-base status Peripheral edema Blood pressure	Low-sodium, high-    potassium diet Oral electrolytes Calcium, phosphorous Instruct patient about side    effects Decrease dosage
Gastrointestinal    Peptic ulcers (esophagus,       stomach, duodenum)    Pancreatitis    Hepatitis    Increased appetite    Diarrhea	Guaiac stools and vomitus Serum amylase, lipase,    calcium, transaminases,    phosphatases, bilirubin Coagulation factors Peritoneal signs	Administer oral corticosteroids with food Antacids, H2 receptor    blocker Consult dietician Decrease dosage
Endocrine    Impaired glucose tolerance    Diabetes mellitus    Cushing's syndrome    Hypothyroidism    Impaired carbohydrate       tolerance    Adrenopituitary       suppression Osteoporosis	Serum glucose Polydipsia, polyuria Cushingoid signs - moon    face, truncal obesity,    buffalo hump, striae T3, T4 During period of steroid    withdrawal or stress:    headache, lethargy, weakness, hypotension Complaints of back or limb    pain	Insulin Thyroid hormones Instruct patients about    consequences of sudden steroid withdrawal Avoid sudden steroid    withdrawal Calcium, vitamin D
Hematologic    Neutrophilia, eosinophilia,       basophilia    Lymphocytopenia    Opportunistic infection,       impaired wound healing    Aseptic necrosis of femoral       and humoral heads	WBC count with differential Inspect mucous membranes Signs and symptoms of    infection Wound healing	Increase attention to    infection control Oral anti-infectives
Neurologic    Headache    Insomnia    Vertigo    Seizures Muscle weakness	Neurologic status Sleep pattern	Analgesics Administer dose in    morning if possible Facilitate environment    for proper sleep Seizure precautions in    susceptible patients Consult physical therapist Decrease dosage
Psychological    Psychosis    Euphoria    Depression	Mental status	Consult psychiatrist if    indicated Instruct patient about    side effects Decrease dosage
Dermatologic    Thin, fragile skin    Petechiae, ecchymoses    Erythema    Acne    Hirsutism    Stomatitis	Inspect skin Inspect mucous    membranes	Topical anti-acne medication Avoid adhesive tape Avoid skin trauma Counsel regarding    hirsutism
Other    Blurred vision    Cataracts	Patient complaints about    alteration in vision	Consult ophthalmologist