Pharmacology & Dosage Calculation
patient who is admitted denies any medication allergies medical records state, "No known drug allergies." A…
patient who is admitted denies any medication allergies medical records state, "No known drug allergies." A medication been sent to the pharmacy for gentamicin. The pharmacist record in the pharmacy of an allergy to the medication. Which of the following is the best way for the nurse to proceed?
Explanation
Core Concept: Patient safety is the paramount concern when there is a discrepancy between the patient's reported allergy history, the medical record, and the pharmacy's records. The nurse must never administer a medication with a potential allergy flag without first investigating the discrepancy (e.g., asking the patient specifically about the reaction to gentamicin) and clarifying with the prescribing physician.
Clinical Presentation:
- N/A (Medication safety concept).
- Allergic reaction: Urticaria, pruritus, angioedema, anaphylaxis (hypotension, wheezing).
Diagnosis:
- First-line diagnostic plan: Detailed allergy history interview with the patient to differentiate between a true allergy (IgE-mediated) and an adverse side effect (e.g., GI upset).
- Gold standard test: Allergy skin testing or specific IgE blood testing if the history is unclear and the medication is essential.
Management:
- Acute management: Hold the medication. Investigate the discrepancy, consult the pharmacist, and contact the physician for clarification or an alternative order.
- Gold standard long-term/definitive management: Accurately update the electronic health record (EHR) with the specific drug, reaction type, and severity. Provide the patient with an allergy bracelet.