A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecys-tectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning
The patient's surgery is scheduled for the next morning. The nurse will expect an order to: a. administer the usual morning dose of hy-drocortisone 25 mg PO.
b. administer hydrocortisone 50 mg PO in the morning.
c. administer hydrocortisone 50 mg IV be-fore surgery.
d. withhold the morning dose of hydrocorti-sone and give it after surgery.
C
Patients who take steroids need extra steroid before situations that cause stress, such as surgery. Failure to administer the increased dose can prove fatal. For surgeries that cause moderate stress, such as a cholecystectomy, patients should be given 50 mg of hydrocortisone intravenously the day of the procedure, followed by a taper over 1 to 2 days to the usual replacement dose. Giving the usual dose or giving an increased oral dose is not indicated.
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