What will you do?

[MissRN7]

Hi all!!

I am a new nurse and was faced with this problem:

A MD orders ceftriaxone for a pt. However the pt does not know if they are allegeric to lidocaine (NKA, no dental procedures ever in the past ). Do you reconstitute this medication with normal saline or lidocaine?

What are the consequences of giving a medication to a pt if they have NKA and they end up having a major allergry reaction?

Thanks!

[jadelpn, LPN, EMT-B]

They do not know they are allergic as they have gotten it before they think? Or that they are allergic to lots of things and just nervous? Have they ever had a med reaction? if so, what was it? Anaphalaxis? I would get this information, (even if it is patient is declining lidocane) get an order to either give it IV, or without lidocaine. Lido is an MD option, not the only way to mix rocephin, but I gather the shot can be more painful when you don't use lidocaine. I have given rocephin IM both ways, just be sure you discuss with the patient and the MD allergy reactions in the past, and document same, and then get an order to proceed IV or IM without lido.

[sauconyrunner]

You will give the medication with lidocaine. The patient will wait for 30 minutes (or whatever your policy is) and then be discharged. If they have a major allergic reaction, you will treat it, and then discuss with the physician....what may have caused the allergic reaction- the Lidocaine or the ceftriaxone.

Consequences? There are no consequences for giving a medication as ordered (following all 5 rights etc) for which the patient does not have a documented allergy. The patient has an allergic reaction...it is an unexpected negative event, but not one you could have prepared for. You would still fill out an event report, though an event report is not always punative. It is simply an event which bears looking into. If you sent the patient home 5 minutes after giving the injection....that is failure to follow policy, and common sense, and you would be responsible for not observing for the proper amount of time. (But NOT for the allergic reaction.)

Without this, we would give no patients any medications ever. Remember, patients who have successfully taken some medications for years can suddenly develop severe allergic reactions- example, lisinopril.

[Double-Helix, BSN, RN]

You could ask this question with any medication. If the patient has never had ceftriaxone before, are you still going to give the medication? The answer is yes, you are. But just like with any first time medication administration, you would monitor the patient for signs of an allergic reaction.

So in this case, you would give the medication with lidocaine, according to your facility's policy. Then you would monitor the patient for signs of an allergic reaction, as you would any time you've given the first dose of a medication.

[lumbarpain, ADN, RN]

a very good PMH will suffice just fine or contacting close family members to see if there were any other reactions the patient may have had that maybe the patient doesnt recall thats if you feel that anxious about it. But NKA means of course No known allergies. and remember ANYONE at any age can acquire an allergy to anything at any point of their lifespan. If a reaction does occur, you know you followed up properly and documented correctly. So to alleviate your anxiety and feel comfortable and if you dont mind doing extra work in calling significant others by all means do it. Let your Nurse manager know this too, Always good to inform a higher up just in case. So you are covered. Dont forget to document that you called relatives or significant others and notified the Nurse Manager.. this is all you can do.

[Double-Helix, BSN, RN]

Just remember that you can't call the family members or friends unless you have the patient's consent to release medical information.

[Galaxy1]

the patient was NKA.

[Galaxy1]

give the med with lidocaine. patient could be allergic to dust on Mars. patient is NKA.

[RNmtbiker89]

I agree with the consensus on here. I understand your anxiety but there's not much you can do, other than what was ordered and what is technically safe because you have no other concrete info to prove otherwise. I'd definitely keep an eye on them after admin and I wouldnt rush discharge but to be even safer you could document your teaching on having the pt watch out for specific adverse reactions.

[wooh, BSN, RN]

They have NKA. If it turns out they're allergic to lidocaine, I'd do the same thing that I'd do if it turns out they're allergic to the rocephin.