Understanding rationale for med ordered against patient allergies

[WorkingCAmom]

Hi everyone, this is my first post. I learn so much from everyone's topics, and now here I am asking for help.

My patient has an acetaminophen (from Norco) allergy yet her mild to moderate pain med ordered is acetaminophen.

Is the reason that this is ordered is because it's not a part of Norco? Is there a difference between acetaminophen allergy when it's from Norco compared to an overall allergy of acetaminophen?

Thank you for your time and any help given. I didn't have any computer access to see the meds listed and the nurse printed off the list for me right before we left for the day, so I didn't notice this during the shift.

[JustBeachyNurse, LPN]

What is the "allergic reaction" to acetaminophen? It's very rare to have an acetaminophen (APAP) allergy. Many claim APAP (and NSAID like ibuprofen) allergy in a quest secure narcotic pain relievers even Norco or Percocet (not realizing APAP is part of the combination analgesic)

[RainMom]

It could be a default in the way allergies are listed in the software used. Where I work, if a combination drug (like Norco - hydrocodone/acetaminophen) is listed as an allergy, both drugs will be listed individually as an allergy even if it is only one component that causes the pt problems. So if a pt says Norco causes severe nausea/vomiting (I know, adverse effect; not true allergy, but I digress), & the nurses picks "Norco" in the system, both hydrocodone & acetaminophen will show up on the allergy/adverse drug effect list unless someone takes the time to delete out the tylenol.

[WorkingCAmom]

Thank you for the responses. I'm thinking that it must be that the allergy was to Norco and so that it flagged both meds in it seeing as it shows allergy to hydrocodone and acetaminophen.

Thank you for the help!

[applesxoranges, BSN, RN]

Most people who report an allergy to norco is because they want something else or norco made them nauseated. Many people will say they are allergic to Tylenol in an attempt to get pain meds. This is usually followed by a "oh, I can take norco/percocet."

[KelRN215, BSN, RN]

A true acetaminophen allergy would be extremely rare. And how would anyone (other than an allergist) go about determining that it was the acetaminophen vs the hydrocodone that caused the person to be "allergic" to Norco?

You may frequently see Vancomycin ordered in someone who has a documented Vancomycin "allergy". But if you dig a little deeper, you will find out that it not an allergy but an adverse (Redman's) reaction, that the benefits outweigh the risks and that you can simply give it slower in this situation.

[elkpark]

A client allergy list isn't an automatic dictum that the individual can never be given any of those medications again -- it's a flag for the provider to consider the risks and benefits before ordering a medication on the list. There's a lot more to life than anaphylaxis -- some "allergic" reactions aren't true allergic reactions, just unpleasant side effects; some allergic reactions are mild and the benefits of using the medication in a particular situation outweigh the risks. A lot of things to be considered in each, individual situation.