should i have questioned it??

[kell1566]

Hey everyone!! im a student nurse who is graduatin in may 07. I have a question about a med that i was concerned about administering, any advice would be great!~~

My last clinical day I was team leader and overlooked 3 students with a total of 6 ortho/trauma patients. As team leader, my instructor allowed me to check the po meds, while she had to check the injections, IV etc. Anyway, this one patient was getting cozaar for her BP. As i was looking at her kardex, it noted an allergy to Lisinopril in one section, then further down it said allergy to ACE inhibitors. I was concerned about the allergy and wanted clarification....was she allergic to ALL ACE inhibitors or just lisinopril??

And if she was allergic to ACE(angeiotensin converting enzyme) inhibitors....was it risky to be giving her a angiotensisn II receptor antagonist? I understand that angiotensin is already present in the body but there was no documentation about what she was allergic to within the ACE inhibitor or what S/S she had to call it an allergy? So who knows if whatever she was allergic to could also be present in cozaar.

As a student nurse, we learn to always check and this rang a bell in my head and I said that I wasnt comfortable giving the student the "OK" to give it so we talked to the instructor that was thankful i caught it and advised me to contact the pharmacist, which I was already in the process of doing. The Pharmacist said if she is allergic to ACE inhibitors ----no way do not give Cozaar...tell MD to clarify allergy.....then another said that as long as she was having a cough and not angioedema it was fine to give it.....esp since she had been gettin it everyday while at this hospital....for me i dont care how long she was gettin it it doesnt mean im givin it unles I know its ok....

I was just confused could anyone shine any light on it?? Overall.....if the pt was allergic to ACE inhibitors.....would they give Cozaar instead??Thanks ...sorry for the long post~~:monkeydance:

[jill48, ASN, RN]

Awesome catch! :yelclap: :yelclap: :yelclap: :yelclap: :yelclap:

[AnnieOaklyRN, BSN, RN, EMT-P]

It is very imporant to clarify ALLERGIES versus SIDE EFFECTS, as a lot of paitents claim to be allergic to medication when really they are just having a side effect. If the patient had been getting this medication every day I would say it is fine. ACE inhibitors can cause coughing but that may resolve with time, but they also cause angioedema which of course can be dangerous and that would be a denfinite contraindication to giving the med. Sounds like to me this patient was getting this drug everyday already and it wasnt a problem. I am a student about to graduate and I would have given it provided it was not a new medication for her.

Sweetooth

[jill48, ASN, RN]

It is very imporant to clarify ALLERGIES versus SIDE EFFECTS, as a lot of paitents claim to be allergic to medication when really they are just having a side effect. If the patient had been getting this medication every day I would say it is fine. ACE inhibitors can cause coughing but that may resolve with time, but they also cause angioedema which of course can be dangerous and that would be a denfinite contraindication to giving the med. Sounds like to me this patient was getting this drug everyday already and it wasnt a problem. I am a student about to graduate and I would have given it provided it was not a new medication for her.

Sweetooth

I'm an LPN with almost 12 years experience and I would not have given it UNLESS the physician clarified and amended the allergy status. And I would chart every single call I made; to the pharmacist, to the physician, speaking to my supervisor, to the patient, etc. Cover your butt. My favorite rule for myself: IF YOU DIDN'T CHART IT, YOU DIDN'T DO IT.

[rachelaleanRN2B]

Good job questioning this. It is your job to do so, so you did the right thing by going to your instructor. Never question yourself for questioning. When a pt says they are allergic to something always ask what the reaction was because lots of times it is just a mere known side effect of the drug and not a true reaction. Great job!!

Rachel

[kmoonshine, RN]

Here's a good article on the subject:

http://www.uspharmacist.com/index.asp?show=article&page=8_1962.htm

I've seen a patient once with angioedema - he had just started taking lisinopril and his mouth and lips were very swollen. I swear, his lips looked as big as a hotdog. Pt denied SOB and his oxygen sats were at 100%; we gave him lots of IV meds (benadryl, pepcid, etc) and kept a close watch on him, ready to intubate if needed.

[kell1566]

thanks everyone for the replies!!! i am so glad to be able to use this site and ask questions....we learn something new everyday!! well overall im glad i questioned it bc ive always learned in nursing school that dont jus give it bc somoene else did the day before....i kno this may not apply in the real world...but im going to try and uphold it!!

congrats to everyone else graduating.....its been a long haul~~~ but the learning is gonna continue!! good luck in the future!! thanks to everyone for your posts!! nothing wrong with takin a few mins to call and ask the MD and pharmacist so Ill keep that in mind!!

[MB37]

A thought I had while reading this - I have prehypertension, and my NP tried a few types of drugs to bring it down. We tried Lisinopril, and I got horribly dizzy, to the point of barely being able to walk across the room. This was a side effect and not an allergy, but she told me she was going to chart it as an allergy so that no one would ever prescribe it to me again. I'll explain that to any future GPs that I see for this, but what if I had been 86 and not fully oriented? I'm only a very new student, so I don't know how standard that is. Now, I'd also mention it to anyone else I saw who prescribed an ACE inhibitor, so we'd know what to watch for.