Fluticasone (Flonase) a nasal glucocorticoid has been prescribed for a client with allergic rhinitis. The nurse teaches the client which is the most common side effect of continuous use.

Montelukast is a medicine used to treat and prevent asthma and allergic rhinitis. It can cause some side effects, such as stomach pain, headache, cough, or fever. However, some side effects are more serious and need to be reported to the provider.

According to the sources I found, the most serious side effect of montelukast that should be reported to the provider is depression. Depression is a mental health condition that can affect your mood, thoughts, and behavior. It can cause symptoms such as feeling sad, hopeless, or worthless; losing interest in activities you used to enjoy; having trouble sleeping or concentrating; or having thoughts of harming yourself or others.

Montelukast has been linked to neuropsychiatric events, such as agitation, aggression, sleep disturbances, suicidal thoughts and behavior (including suicide). The mechanisms underlying these events are not well understood, but they can occur at any time during treatment. Therefore, patients and caregivers should be alert for changes in behavior or new neuropsychiatric symptoms when taking montelukast. If these occur, they should discontinue montelukast and contact a healthcare provider immediately.

The other options are not listed as serious side effects of montelukast that need to be reported to the provider. Constipation, blurred vision, and palpitations are possible side effects of other medicines used to treat asthma or allergic rhinitis, such as corticosteroids, antihistamines, or beta-agonists. However, they are not specific to montelukast and may not be related to its use.

The nurse must consider the following when obtaining a health history for a client with diabetes mellitus who has been taking glucocorticoids (prednisone) long-term for uncontrolled COPD:

1. Due to the use of long-term glucocorticoids, the medication must not be abruptly discontinued to avoid adrenal suppression. Abruptly stopping glucocorticoids can lead to adrenal insufficiency and a potentially life-threatening condition. Gradual tapering of the medication is necessary under medical supervision.
2. The use of long-term glucocorticoids may contribute to a spike in blood glucose levels. Glucocorticoids can cause insulin resistance and increase blood sugar levels, which can be problematic for individuals with diabetes mellitus.
3. The use of long-term glucocorticoids places the client at risk for increased susceptibility to infection. Glucocorticoids can suppress the immune system, making the client more susceptible to infections. This is important to consider, especially in a hospital setting where the risk of acquiring infections may be higher.

Regarding the other options:

The client may develop low blood pressure: While glucocorticoids can cause fluid retention and increased blood pressure, they are not typically associated with low blood pressure.

The client will most likely experience more pain: The use of glucocorticoids is not directly related to increased pain perception. Pain management may be influenced by various factors, but it is not specifically attributed to long-term glucocorticoid use.