examethasone is a corticosteroid (steroid hormone) used to treat inflammation, allergies, autoimmune
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disorders, cerebral edema, and severe COVID-19 cases.
It helps by reducing swelling, redness, pain, and allergic reactions through blocking inflammatory chemicals
released in the body.
Dosage (Adults):
1. Inflammation: Start with 0.75 mg/day, may increase up to 9 mg/day depending on the condition (can be
given IV, IM, or Oral).
2. Multiple Sclerosis: 30 mg orally for 7 days, then reduce to 4–12 mg/day for about a month.
3. Cerebral Edema: 10 mg IV, followed by 4 mg IM every 4 hours.
4. Severe COVID-19: 6 mg daily for 10 days (reduces lung inflammation and improves recovery).
Indications (Uses):
1. Treats acute attacks of multiple sclerosis, allergies, cerebral edema, inflammation, and shock.
2. Used in skin allergies, asthma, and drug hypersensitivity.
3. Helps in diagnosing Cushing’s syndrome.
4. Prevents nausea and vomiting caused by chemotherapy.
5. Used to prevent altitude sickness in travelers.
Contraindications (When Not to Use):
Hypersensitivity to the drug.
Untreated active infections (especially bacterial, viral, or fungal).
Eye infections caused by viruses or fungi.
Adverse Effects (Side Effects):
Allergic: Anaphylaxis, angioedema.
Heart: Irregular heartbeat, high BP, heart failure, swelling.
Skin: Acne, thin skin, delayed wound healing, itching (urticaria).
Endocrine: High blood sugar, Cushing’s syndrome (moon face, obesity), irregular periods, stunted growth in
children.
GIT: Stomach bloating, pancreatitis, increased appetite.
Bones/Muscles: Weakness, muscle loss, osteoporosis, fractures.
Nervous System: Headache, mood swings, depression, seizures.
Eyes: Glaucoma (high eye pressure), cataract.
Others: Weight gain, hiccups, tiredness (malaise).
Role of Nurse
1. Assessment:
Check history of infection, diabetes, heart, liver, or kidney problems before giving the drug.
For eye use, make sure there are no viral or fungal eye infections.
Record vital signs, weight, blood glucose, and electrolytes before and during treatment.
For topical (skin) use, inspect the area for infection, irritation, or injury.
2. Implementation:
Administer the drug as prescribed, preferably in the morning to match natural hormone rhythm.
Do not stop suddenly — taper dose slowly to prevent adrenal crisis.
Avoid live vaccines during treatment (due to suppressed immunity).
Monitor for signs of infection, mood changes, and swelling.
3. Patient Education:
Inform the patient to take medication with food or milk to prevent stomach irritation.
Do not stop abruptly; always consult a doctor before discontinuing.
Avoid contact with people having infections (e.g., chickenpox, measles).
Report unusual weight gain, swelling, black stools, vision changes, or mood swings.
For eye or topical forms, follow correct application techniques and hygiene.
Interventions
1. Do not give to nursing mothers – drug can pass through breast milk and affect the baby.
2. Give the daily dose before 9 AM – this matches the body’s natural cortisol rhythm and reduces side effects.
3. Increase dose during stress or illness – because the body needs more steroids under stress.
4. Taper the dose gradually – never stop suddenly, as it can cause adrenal insufficiency (shock or collapse).
5. Avoid live vaccines (e.g., MMR, varicella) during treatment – dexamethasone suppresses the immune
system.
6. Do not use inhalers during acute asthma attack – they are for maintenance, not emergency relief.
7. Avoid nasal use if the patient has nasal infection, trauma, or recent nasal surgery.
8. Taper systemic steroids carefully when shifting to inhalers to avoid adrenal gland failure.
9. Topical use: avoid tight bandages or diapers on treated skin areas, as this increases absorption and side
effects.
10. Avoid prolonged use near eyes, genital, or rectal areas, or in skin folds, as the skin there is thinner and
absorbs more drug.
11. Teaching Points
1. Systemic Administration (Oral/IV/IM)
Do not stop suddenly – always consult your doctor before discontinuing.
Avoid people with infections (measles, chickenpox, etc.) as your immunity is lower.
Report immediately if you notice rapid weight gain, swelling, muscle weakness, fever, black/tarry stools, sore
throat, or infection signs.
Take the medicine with food or milk to reduce stomach irritation.
Take it in the morning to minimize adrenal suppression.
2. Intra-articular (Joint Injection)
Do not overuse the joint after pain relief – the drug only removes pain, not the underlying cause.
Watch for infection or swelling at the injection site.
3. Respiratory / Intranasal Use
Use only as prescribed – excessive use can damage nasal tissues or cause dependence.
Do not stop abruptly – reduce gradually under doctor’s advice.
Use bronchodilator (inhaler) before the steroid inhaler to open the airways for better absorption.
If nasal passages are blocked, use decongestant drops first.
Rinse mouth after inhalation to prevent fungal infection (oral thrush).
4. Topical (Skin Use)
Apply a thin layer gently over the affected area.
Avoid contact with eyes, mouth, and broken skin.
Do not cover with tight dressings unless advised by a doctor.
Report irritation, redness, or infection at the site immediately.
5. Ophthalmic (Eye Use)
How to apply:
Tilt head back or lie down.
Pull down lower eyelid and apply a small amount of ointment or drops.
Avoid touching the dropper/tube to the eye or fingers.
Wait at least 10 minutes before applying another eye medication.
Eyes may become sensitive to light – wear sunglasses outdoors.
Report if symptoms worsen or do not improve after 1 week, or if there is pain, swelling, or itching.
Next Topic – Intravenous (IV) Fluids & Electrolyte Replacement
Definition:
IV fluids are sterile solutions given directly into the vein to rehydrate the body, maintain fluid balance, and
correct electrolyte imbalances (like sodium, potassium).
They are especially useful in dehydration, vomiting, diarrhea, shock, and surgery.
Classification of IV Fluids
1. Crystalloids –
Contain small dissolved substances (salts, minerals, sugars).
Move easily through cell membranes.
Used for dehydration, shock, electrolyte imbalance.
Examples: Normal Saline (0.9% NaCl), Ringer’s Lactate, Dextrose solutions (D5W, D10W).
2. Colloids –
Contain large molecules (gelatin, dextran, albumin) that stay longer in blood vessels.
Used to expand blood volume in shock, burns, and major blood loss.
3. Blood and Blood Products –
Includes whole blood, plasma, packed red cells, platelets
Used for anemia, hemorrhage, and major trauma.
4. Lipids (Fat Emulsions)
Provide essential fatty acids and calories for patients on long-term IV nutrition.
Given as part of parenteral nutrition.