A client on high-dose inhaled fluticasone 1000 mcg/day plus … | MyMerci
Adverse Effects/Contraindications/InteractionsPPT
Question
A client on high-dose inhaled fluticasone 1000 mcg/day plus daily prednisone 7.5 mg for severe asthma develops fever, vomiting, and hypotension after a flu-like illness. Which is the priority nursing action?
1Administer IV potassium replacement
2Anticipate IV hydrocortisone, IV normal saline, and dextrose — adrenal crisis is suspected✓ Correct answer
3Hold all asthma medications and reassess in 4 hours
4Encourage oral fluids and recheck BP in 30 minutes
Explanation
Correct (2): Long-term high-dose ICS plus chronic systemic steroids cause HPA axis suppression; an acute stressor (illness, vomiting, surgery) without stress-dose steroids precipitates adrenal crisis — hypotension, hypoglycemia, hyponatremia, hyperkalemia, weakness. Treatment: IV hydrocortisone 100 mg STAT, IV saline with dextrose, and supportive care. (1) Delay can be fatal. (3) Adrenal crisis is hypoNa/hyperK — extra K worsens. (4) Inadequate.
In-depth explanation
Memory Tip Long-term steroid use + acute stress = "Stress dose or Crash." Sick-day rules: triple steroid for fever, surgery, or illness. CPG All chronic steroid users wear a MedicAlert; carry emergency hydrocortisone.
Clinical scenario
Scenario 48-year-old female on high-dose ICS + prednisone 7.5 mg/day × 2 years for severe asthma. Presents with fever, vomiting, BP 86/52, weak, confused, fingerstick glucose 62.