A nurse is caring for a 35-year-old client with newly diagnosed pulmonary sarcoidosis after presenting with persistent cough, shortness of breath, and bilateral hilar lymphadenopathy on chest X-ray. The physician has prescribed prednisone 40 mg daily. The client asks about long-term management and expresses concern about medication side effects. Which nursing intervention is most important to include in the client's care plan?
1Encourage increased fluid intake to thin respiratory secretions
2Administer bronchodilators as needed for wheezing
3Provide supplemental oxygen to maintain oxygen saturation above 95%
4Monitor for signs of infection and teach infection prevention measures✓ 정답
해설
Monitoring for infection is critical because corticosteroids suppress the immune system, increasing infection risk. Other interventions are supportive but less priority for immunosuppressed clients.
Clinical Judgment
The core of this question is to identify the most dangerous side effect of corticosteroid therapy and select the priority nursing intervention for it. While Sarcoidosis itself involves inflammation due to granuloma formation, the prescribed Prednisone acts as an immunosuppressant. Therefore, the greatest risk to the patient is infection. Other options may be symptomatic management for the patient's symptoms (cough, dyspnea), but preventing the systemic risk from the drug therapy is more critical. Infection prevention education and monitoring are fundamental preventive measures for managing drug side effects.
Memory Tip:
A mnemonic to remember the major side effect of corticosteroids: Steroid Is Immunosuppressive → Susceptible to Infection!
KR vs US:
While the importance of managing steroid side effects is also emphasized in Korea, in NGN/US exams, Patient Safety and Preventive Education are always evaluated as the top priority. For "Most Important" questions, the intervention chosen is the one that prevents potentially life-threatening complications (infection).
Clinical Practice Guide
When starting high-dose steroids in a patient with sarcoidosis, prepare the following:
1. Assess baseline vital signs and signs of infection: Check fever pattern and white blood cell count.
2. Check vaccination status: Live vaccines are contraindicated; administer inactivated vaccines if needed.
3. Patient education: Educate on handwashing, avoiding crowds, wound care, and immediately reporting fever or chills.
Caution:
In SATA (Select All That Apply) questions asking about "corticosteroid patient education," important answers may include infection prevention along with not abruptly stopping the medication, regular eye exams (glaucoma, cataracts), and calcium/vitamin D intake to prevent osteoporosis. Since this question asks for the "most important" single intervention, focus on infection control.
Sarcoidosis — A multisystem inflammatory disease in which non-infectious granulomas of unknown cause form in organs, especially the lungs and lymph nodes.
Corticosteroids — A drug with potent anti-inflammatory and immunosuppressive effects. It is used as a first-line treatment for sarcoidosis, but has various side effects such as increased risk of infection, hyperglycemia, and osteoporosis.
Immunosuppression — A state in which the immune system's function is suppressed. It is the main mechanism of action of corticosteroid therapy and its most dangerous side effect, significantly increasing vulnerability to infection.
Hilar Lymphadenopathy — Enlargement of lymph nodes around the hilum (Hilum). One of the chest X-ray findings commonly observed in sarcoidosis.
Infection Prevention — All measures to prevent infection. For immunocompromised patients, hand hygiene, environmental management, vaccination, and education on early symptom recognition are essential.