I start clinicals in a few weeks. I'm in my first semester of nursing school.
I'm so scared of my pts going into anaphylactic shock.
How do you know it's happening?
What do you do?
What do you tell the staff around you during this time?
What happens if you freak out and step away? Can you do that as a student since you don't know what exactly to do yet? (We weren't taught anything except that it's an emergency crisis reaction to whatever they're allergic to)
Also, what is "code"? My professors say it a lot saying either they never had a pt who codes or they had one who codes.
What does code mean and what is it?
What do you do in the event?
Please tell me all of the codes. Please tell me what type of emergency situations can happen and what you need to do (in details and explain why).
I'd like to know to be safe than sorry and make sure my pts lives are not at risk because of my lack of knowledge and me being so scared freezing up.
Patients reporting iodine or seafood allergy should be questioned as to the exact nature and severity of the reaction. If possible, seafood allergy should be distinguished from other causes of seafood intolerance. The presence of a seafood allergy places the patient at a threefold risk of an adverse reaction to contrast material.
there is other literature out there that says the exact opposite - and you left out the second part of that which essentially agrees that seafood allergy is not a contraindication to contrast.
Deep breaths OP. Nobody expects you to handle it well (much less at all really) as a student! The biggest thing you can do as a student is obtain help! If the patient has no pulse - you do have an obligation to begin CPR. I've been in nine facilities (six as a student), one as an assistant (also where one of my clinical rotations was) and three as an RN. Each place handles codes differently but the gist is the same. Some places have buttons on the wall, others have numbers to call, some places you have to hit the button on the wall AND call, etc. Your instructor and/or the nurses you are working with will help you know what to do. Especially as a first rotation student the answer will probably be "find help and start CPR / bagging with an ambu bag if needed". A trick from when I worked the floor - if you're by yourself and have to start CPR but can't run for help or others wouldn't hear you - you can use the call light/button and whoever answers the lights on the unit (often at the nurses' station) will be able to send you help and take care of any call that needs made.
If you find the patient you will be expected to give the information you have - what did you find, what did you assess, and what did you do to others. This happened to me my senior year during my ICU placement. My instructor and I realized that the patient I was working with was seizing. The patient's primary nurse handled up drawing up/giving the ativan, and the intensivist came in - asked what happened - *I* the student, had the most complete account of what we found and what had been done. It's intimidating as a student, the first time they ask *you* for your account - but sometimes you may have the most complete picture.
As you progress through school, you will learn more about how to handle emergency situations. In general you are going to look for the big problems first - airway, breathing, circulation. Nursing is a team sport, you will never not have help. You just have to ask for it sometimes. Even as an RN, your first several emergency situations you may take a lesser role than the situations you face after gaining some experience. My first code as an RN? We coded the visitor who was visiting one of my patients.
For anaphylactic reactions, often patients need epinephrine, and/or other pharmacologic intervention, and they are at risk (depending on severity) for airway compromise and/or circulatory collapse. If I suspected my patient was having an anaphylactic reaction, my question is - are they experiencing facial/airway swelling, what is the reaction exactly (symptoms they are having)? With my own anaphylactic reaction I never experienced airway swelling, but I did down a loading dose of benadryl when I noticed the hives. For good measure my neighbor took me to work to the ED (this was the only time I've considered calling 911 on myself and I probably should have). If I was ever exposed to the causative agents again my reaction would probably be worse...
It would depend on how emergency codes (rapid response, code blue, etc) are handled in a facility how I'd handle it. If folks are slow to respond, I'd probably just call it in as a code blue anticipating it could progress to that before I have orders for anything to give my patient. If I were working as a floor nurse where I work now, I'd probably call it as an adult or pediatric rapid response as we often have a very quick response. Sometimes they convert the calls from a RRT call to a code...and that's sometimes before they finish overhead paging the first call.
And be sure to ask your patients if they have any allergies before you administer medications. You can study things that aren't so obvious, such as an allergy to shellfish means watch out for contrast dye. As the PP said, you'll have help if anything happens.
That's probably not going to help much since that is a well-debunked myth. It used to be assumed that the reason someone would be allergic to shellfish is that it contains higher levels of iodine, this was before we understood that not all meat proteins are the same; some can trigger an allergic response while others don't, it had nothing to do with the iodine. This is further debunked by the fact that you can't be truly allergic to iodine. It's an element which is incapable of triggering an antibody mediated reaction, and in modern societies is completely unavoidable.
Patients reporting iodine or seafood allergy should be questioned as to the exact nature and severity of the reaction. If possible, seafood allergy should be distinguished from other causes of seafood intolerance. The presence of a seafood allergy places the patient at a threefold risk of an adverse reaction to contrast material.
What this reflects is that those prone to any antibody mediated reaction have an increased potential for having other antibody mediated responses. Someone who's immune system is prone to antibody mediated reactions is at higher risk for all types of reactions.
@muno so why did some hospitals switch from iodine to chorhexidine skin cleansers?
Never mind you answered while I was posting, thanks muno.
Sorry to go way off topic, but there's actually a really interesting answer to that question. The recommendation to switch was supposedly based on evidence that CHG was more effective than iodine based prep (not to mention cheaper), although as it turns out that recommendation may have come as the result of kickbacks from the main manufacturer of CHG prep to those who made the recommendations.
I find it really interesting (as a pre-nursing student) that so few people have dealt with anaphylaxis or have done so only very rarely. I actually had an "exciting" episode of it myself about a year ago in an out-patient surgical center, and my nurse panicked. Eventually a team came and took care of me, but not until I was in a pretty bad state... :-/
That's probably not going to help much since that is a well-debunked myth. It used to be assumed that the reason someone would be allergic to shellfish is that it contains higher levels of iodine, this was before we understood that not all meat proteins are the same; some can trigger an allergic response while others don't, it had nothing to do with the iodine. This is further debunked by the fact that you can't be truly allergic to iodine. It's an element which is incapable of triggering an antibody mediated reaction, and in modern societies is completely unavoidable.
It may be debunked but it's still "fact" in nclex world
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VANurse2010
1,526 Posts
there is other literature out there that says the exact opposite - and you left out the second part of that which essentially agrees that seafood allergy is not a contraindication to contrast.