Which of the following client education points about ibuprofen and acetaminophen should the nurse include? Select all that apply.

Rationale:

A. Glucocorticoids do not improve muscle strength. In fact, long-term corticosteroid use can cause steroid-induced myopathy, which leads to muscle weakness, particularly in the proximal muscles of the thighs and shoulders. This side effect can reduce the patient’s overall physical function and mobility rather than enhancing it. Therefore, this is not an expected or beneficial effect of corticosteroid therapy.

B. Glucocorticoids are immunosuppressive, meaning they reduce the body’s ability to mount an immune response. This places the patient at increased risk of infections, including opportunistic infections. Patients should be educated to monitor for signs of infection such as fever, cough, sore throat, or unusual fatigue, and seek medical attention promptly if symptoms occur.

C. Corticosteroids affect carbohydrate, protein, and fat metabolism, which can lead to elevated blood glucose levels, particularly in patients with pre-existing diabetes or impaired glucose tolerance. They also cause fluid retention and increased vascular sensitivity to catecholamines, which can elevate blood pressure. Patients should monitor for symptoms such as increased thirst, frequent urination, fatigue, headaches, or swelling, and regularly check their blood pressure and glucose levels as recommended by their healthcare provider. This monitoring is essential to detect and manage complications early.

D. While glucocorticoids can reduce inflammation and alleviate pain during a flare-up, they do not directly improve joint mobility. Improvements in mobility are usually achieved through physical therapy, exercise, and long-term disease-modifying antirheumatic drugs (DMARDs) rather than corticosteroid therapy alone

Rationale:

A. Gastrointestinal upset is a common side effect of pyridostigmine, not an indicator of treatment effectiveness. While monitoring for adverse effects is important, diarrhea does not reflect whether the medication is improving muscle function.

B. Pyridostigmine enhances neuromuscular transmission, leading to reduced muscle fatigue. A patient reporting less fatigue during daily activities indicates the medication is working effectively.

C. Injection site discomfort is not related to the efficacy of pyridostigmine; it is a local adverse effect. Monitoring for pain is important for patient comfort, but it does not indicate treatment success.

D. Ptosis, dysarthria, and difficulty speaking are common symptoms in myasthenia gravis due to weak facial and respiratory muscles. Improvement in speech endurance reflects enhanced neuromuscular function, signaling effective therapy.

E. Pyridostigmine increases acetylcholine availability at the neuromuscular junction, improving skeletal muscle strength. Observable improvements in mobility or exercise tolerance indicate treatment effectiveness.

F. Respiratory muscles may be affected in myasthenia gravis, and pyridostigmine can enhance respiratory muscle strength, reducing dyspnea or respiratory compromise. This is a critical indicator of therapeutic effectiveness, especially to prevent myasthenic crisis.

G. While pyridostigmine can cause cholinergic side effects such as bradycardia, changes in heart rate are not an indicator of effectiveness. Heart rate monitoring is for safety and side effect management, not therapeutic assessment.