I'm allergic to.....(laundry list)!

[AOx1]

I just had a patient who listed about a million allergies. Among them was "oxygen" lol! When asked about this "allergy" she reported "it dries my nose." Here lately, it seems every must have multiple "allergies" many of which are just side effects. It makes me worry that those with true allergies might not have them taken as seriously. For example, a frequent flier boy's mom listed a zillion allergies, and her son actually had an anaphylactic reaction to nuts. But I fear this gets lost in all the other "allergies" he has. Anyone else worry about this?

[Esme12, ASN, BSN, RN]

So, with the Versed there was nothing else given at all that way you absolutely know it was the Versed and not another drug or a combination of drugs?.... IMO it often isn't so much the drug but the patients personality that causes the problems. Many anesthetic drugs actually work on the same receptor(s) so what you are seeing most of the time is what happens to that particular patient when they become disinhibited. The same thing can happen with propofol, valium, ativan, ketamine, thiopental or any drug that is used for sedation.

If it isn't an IgE mediated reaction then it isn't an allergy, and I take it off the patients allergy list. I list meds/food that the patient has had side-effects below the allergies with an explanation of what the reaction was, and note usually the patient requests not to be given these medications/foods.

Listing allergies that aren't true allergies is poor practice and can lead to all sorts of problems.

I get what you are saying but aren't you being a little bold? I have seen patients with an idiosyncratic reaction and become agitated, hyper, or combative. Like hyperactivity and benadryl with children or ketamine emersion hallucinations......side effect yes.........give again? NO! I always ask the patient what the reaction was and note accordingly.

My Mom,77, is allergic to Morphine (hives),demerol (tongue swelled), and codine (face/lips swelled) and she is not a drug seeker. We found all she was alergic to when having a TEE they perforated her esophagus which developed almost complete airway obstruction requiring emergency conscious tracheotomy, ventilator support for 2 months. The only pain rx for whatever reason (preservatives in drugs ect) that she can take is Dilaudid!

She had minimally invasive knee replacemant several months later at another facility and until my sisters and I got involved, coluld get nothing stronger for pain that Tylenol!!!!!!!!!!!!!!!! Not all narcotic allergies are drug seekers. I thought I would spit nails if I saw that all knowing "Ah HA" look on one more nurse. I no longer give that look myself.:)

[happy2learn]

People just need to be honest and explain why they absolutely do not want a certain medication, instead of saying it's an allergy.

I would hope, that like in the instance mamamerlee described, that the request would be taken seriously, especially if there are other options.

[wtbcrna, MSN, DNP, CRNA]

WBTCRNA - - I was given Versed just before having an outpatient bunion reduction. I never even dozed, I can tell you everything that happened, and, even worse, I cried uncontrollably through the entire procedure. People in the waiting area could hear me, including my husband. He became very nervous and upset that I was crying so hard.

Even if it is not an allergy, I do not ever want to have it again. NEVER.

Then you just tell the anesthesia provider and surgeon that you don't want versed.

There is still no guarantee that this won't happen with any other sedation drug since they mostly work on the same receptor, and it also doesn't mean it would happen the next time versed is taken either.

When patients become disinhibited to the point that they are no longer calm then they should be allowed to either fully wake up or the sedation should be deepened.

[wtbcrna, MSN, DNP, CRNA]

I get what you are saying but aren't you being a little bold? I have seen patients with an idiosyncratic reaction and become agitated, hyper, or combative. Like hyperactivity and benadryl with children or ketamine emersion hallucinations......side effect yes.........give again? NO! I always ask the patient what the reaction was and note accordingly.

My Mom,77, is allergic to Morphine (hives),demerol (tongue swelled), and codine (face/lips swelled) and she is not a drug seeker. We found all she was alergic to when having a TEE they perforated her esophagus which developed almost complete airway obstruction requiring emergency conscious tracheotomy, ventilator support for 2 months. The only pain rx for whatever reason (preservatives in drugs ect) that she can take is Dilaudid!

She had minimally invasive knee replacemant several months later at another facility and until my sisters and I got involved, coluld get nothing stronger for pain that Tylenol!!!!!!!!!!!!!!!! Not all narcotic allergies are drug seekers. I thought I would spit nails if I saw that all knowing "Ah HA" look on one more nurse. I no longer give that look myself.:)

No, I am not being bold. An allergy is an allergy and a side effect is a side effect. One allows me the comfort to pick another a drug in the same class with less of a side effect profile and the other usually requires me to pick another class of medications.

IMO people with multiple allergies need to have allergy testing done to find out what exactly they are allergic to. Maybe they are just allergic to a preservative, and possibly I can use a preservative free form of the medication instead. It makes their care a lot safer for them and helps providers choose the most appropriate meds without just using an educated guess.

[mmm cdiff]

Well, there's a difference between an allergy and an intolerance. A true allergy must involve IgE. Intolerance is the inability to withstand or consume a medication.

Also, say a patient gives you a laundry list of "allergies" (ie: allergy to oxygen - it dries my nose... allergy to cabbage - gives me gas), would you still chart it, but write the "reaction"?

[happy2learn]

Well, there's a difference between an allergy and an intolerance. A true allergy does involve IgE. Intolerance is the inability to withstand or consume a medication.

Also, say a patient gives you a laundry list of "false allergies" (ie: the allergy to oxygen - it dries my nose), would you still chart it, but write the "reaction"?

I apologize, but I'm going to go completely off topic. Your name is hilarious. :igtsyt:

Sorry bout that, carry on..... lol

[Asystole RN]

It was IV.

Unless she was allergic to D5 1/2...................................well.............you know.

The theory was it burned no matter what was done (run it slow, ice, even pain meds) and she hated it so (like saying you are allergic to tomatoes at Denny's I guess) she just said she was allergic in hopes of the doctor finding a different way to solve the problem. She half heartedly admitted this.

I am sure your patient was just all poo poo about the IV but remember that the pharmacy mixes up (sometimes depending upon the dose it is just premixed from the manufacturer) the additive whether it be potassium or bicarb.

Different additives may or may not have preservatives, anti-caking agents, binders or the like.

What I was attempting to illustrate is it is not always the medication itself but maybe the packaging and manufacturing by-products used in the med that illicit the reaction.

[eriksoln, BSN, RN]

I am sure your patient was just all poo poo about the IV but remember that the pharmacy mixes up (sometimes depending upon the dose it is just premixed from the manufacturer) the additive whether it be potassium or bicarb.

Different additives may or may not have preservatives, anti-caking agents, binders or the like.

What I was attempting to illustrate is it is not always the medication itself but maybe the packaging and manufacturing by-products used in the med that illicit the reaction.

I know.

I was just having fun remembering her and how she claimed it as an allergy when it was really just a preference. That lady and the doctor order made me laugh.

[happy2learn]

I know.

I was just having fun remembering her and how she claimed it as an allergy when it was really just a preference. That lady and the doctor order made me laugh.

Curious, what did she say when she was told there was no such thing as a potassium allergy? I bet that was an interesting conversation....

[iNurseUK, RN]

I once had a patient refuse a normal saline infusion "because it has salt in it and I'm allergic to salt"

[eriksoln, BSN, RN]

Curious, what did she say when she was told there was no such thing as a potassium allergy? I bet that was an interesting conversation....

Thats when the half hearted admission came about:

"Well, if you're going to split hairs about it, my reaction was burning, in the IV. It wont kill me but, I might refuse it anyway."

We fixed it.....................but not nicely. My solution, which the nurse assigned to her like that worked was simple. I stood outside her door and pretended to be talking to her nurse, but I was really talking at the pt.

"Remember that other pt. you had with a low potassium? Did they make it? I remember him saying he felt like his chest was going to implode!!!!! How long was he in the ICU anyway? YOU MEAN HE IS STILL THERE? I hope he makes it."

She agreed to allow for the infusion.

:chair: Yes, I know, I'm a horrible nurse. I know. Not therapeutic communication at all.

[AgentBeast, MSN, RN]

I once had a patient refuse a normal saline infusion "because it has salt in it and I'm allergic to salt"

That would be impressive if she actually was.