Priority: Allergic reaction or toxicity?

Katie71275 · Jul 12, 2012

Hmm, I would have chosen the rash too...and this is why:

Seek medical attention right away if any of these SEVERE side effects occur when using Gentamicin/Prednisolone

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in vision; eye pain, itching, redness, swelling, irritation, or sores not present when you began using Gentamicin/Prednisolone.

Obviously the changes in hearing is important b/c the med is ototoxic, but I would assume they were having a reaction to the drug that could become anaphylaxis..

ashleyisawesome, BSN, RN · Jul 12, 2012

exactly what i thought. hmf. :confused:

Katie71275 · Jul 12, 2012

I'd bring it to your instructor and see if they can tell you why that is the correct answer...or if they would have chosen the other....To me, an allergic reaction is the priority as if you go into anaphylaxis and quit breathing...will it really matter if you can't hear?

decembergrad2011, BSN, RN · Jul 12, 2012

Ototoxicity can be permanent, and the patient is currently experiencing hearing changes. Without any other symptoms noted, you are making an unnecessary leap with thinking that the patient may experience compromised airway. Do not read deeper into the question and make assumptions. The scenario at hand does not described dyspnea. You are on the right track with thinking that it could potentially lead into a problem, but you're not quite there yet.

Although this is more of my real life experience coming into play, a red rash is common with antibiotics.

windowrn · Jul 12, 2012

Hmm, I would have chosen the rash too...and this is why:
Seek medical attention right away if any of these SEVERE side effects occur when using Gentamicin/Prednisolone
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in vision; eye pain, itching, redness, swelling, irritation, or sores not present when you began using Gentamicin/Prednisolone.
Obviously the changes in hearing is important b/c the med is ototoxic, but I would assume they were having a reaction to the drug that could become anaphylaxis..

Absolutely those are all possible signs of a severe allergic reaction, but just because you have itching or a red rash does not mean that the patient is in the middle of a severe allergic reaction. At this point, this patient has a potential problem. On the other hand, patient with hearing changes is experiencing an actual problem - ototoxicity.

Actual problems trump potential problems. One thing that my NCLEX prep class instilled in me was that when doing prioritization questions do not think about what might happen in the future. Read the question for what is happening right now. Absolutely, if that patient develops respiratory distress, etc., they would become the priority.

ashleyisawesome, BSN, RN · Jul 12, 2012

Absolutely those are all possible signs of a severe allergic reaction, but just because you have itching or a red rash does not mean that the patient is in the middle of a severe allergic reaction. At this point, this patient has a potential problem. On the other hand, patient with hearing changes is experiencing an actual problem - ototoxicity.
Actual problems trump potential problems. One thing that my NCLEX prep class instilled in me was that when doing prioritization questions do not think about what might happen in the future. Read the question for what is happening right now. Absolutely, if that patient develops respiratory distress, etc., they would become the priority.

that actually really helped. thanks!

windowrn · Jul 13, 2012

You are welcome. We spent a lot of time on prioritization questions.

Stable v. unstable

Acute v. chronic

actual v. potential

newly diagnosed v. diagnosed 24+ hours ago

fresh surgical v. old surgical or medical

unexpected symptoms v expected symptoms

It is important to look for those things. Looking at it this way (I made this up myself and I'm not a test writer, so it's entirely possible that the answer is arguable. But, I was trying to illustrate a point in prioritization questions)

55 year old COPD patient with pulse ox of 89%

60 year old stable after MI last night

20 year old back from PACU after appendectomy

30 year old newly diagnosed with diabetes

who do you see first?

Answer

.

fresh appendectomy

questions says the MI is stable. Sure, he could deteriorate at any moment, but at the time of the question, he was stable, so he is low priority

COPD patient is chronic and 89% is not unexpected in a COPD patient. Therefore, he is stable and low priority

New diabetic - he is unstable because he is newly diagnosed, but per the surgical beats medical, the appendectomy is higher priority than the diabetic.

Katie71275 · Jul 13, 2012

Very helpful thanks!

I would have chosen the appendectomy on that one as well since it's a fresh surgical wound and you have risk for bleeding, etc.

Sun0408, ASN, RN · Jul 13, 2012

Windowrn and decembergrad said it best.. Actual problem will trump potential every time..

metal_m0nk, BSN, RN · Jul 13, 2012

It depends on the severity of symptoms. If the question had said that the pt was developing shortness of breath as part of the allergic reaction, then the allergic reaction would have been correct.

nurseprnRN, BSN, RN · Jul 13, 2012

no airway sx/sx? but a fried eighth nerve is forever.

allergic reactions, no matter how they start, are progressive and will generally give you time to react, and unless they are very exceptional, are treatable. and-- he doesn't have any sx/sx of anaphylaxis. lots of people get drug rashes.

this guy has already lost some hearing-- let's fix it so he doesn't lose more.