A 65-year-old client with type 2 diabetes is starting prednisone 40 mg PO daily for a polymyalgia rheumatica flare. Which monitoring parameter does the nurse instruct the client to track at home and report to the prescriber?

Systemic corticosteroids cause steroid-induced hyperglycemia by increasing hepatic gluconeogenesis and peripheral insulin resistance. In a patient with pre-existing diabetes the rise is often dramatic, requires more frequent fingerstick monitoring (often four times daily during initiation), and may necessitate a temporary insulin or oral agent dose increase. Steroids also blunt the febrile and inflammatory response, so classic infection signs are masked: fever may be low or absent, tachycardia and malaise may be the only clue, and wound healing is delayed. Patients are taught to report subtle infection signs (sore throat, dysuria, redness or drainage from any wound, persistent fatigue, low-grade fever) immediately. While BP, eye exams, and weight are also relevant in long-term follow-up, the immediate at-home monitoring priority during initiation is glucose and infection surveillance.

Steroid + diabetes + infection susceptibility is the daily home monitoring trio. The phrase "infection signs may be masked" is the NCLEX trigger for unusual surveillance.