So we are switching to a new computer system at work. Not everything will carry over and we have to do some manual entry of certain things. Allergies is one of the items that falls onto that list. We are able to print out that info from the old system so we can put in onto the new, so the information has all been verified at some point by nursing staff or physicians. Which also means at one point it was all ENTERED by someone with a license or someone who is supposed to have enough medical knowledge to do such things.
Some of the "allergies" (complete with reaction, since it's a required field):
Nitroglycerin---"it makes my ears ring"
Tetnaus shot---"my arm hurts after I get one"
E-mycin---"diarrhea"
iron supplements---"makes my BM dark"
and my favorite:
Epinephrine---"makes my heart race"
Seriously?! I can shrug and say "meh" to many things, but truly?! WHY do trained professionals DO this? Go ahead and put some of these things down and attribute the poops after an ABX to a side effect, but not an ALLERGY. Yes, side effects, intolerances and allergies are all options to choose from.
I am not even entering the epinephrine "allergies", nope, not doing it.
I wish there were other fields for adverse reactions, but on my pharmacy profile I have put down demerol as an allergy. I didn't stop breathing, but I hallucinated and puked for 3 hours straight. I don't remember much, I thought I was at home with my mom taking care of me (she wasn't even in the hospital), but I was told by the nurses that even after my stomach was empty I continued to heave. I'd really rather not ever go through that again!
I wish there were other fields for adverse reactions, but on my pharmacy profile I have put down demerol as an allergy. I didn't stop breathing, but I hallucinated and puked for 3 hours straight. I don't remember much, I thought I was at home with my mom taking care of me (she wasn't even in the hospital), but I was told by the nurses that even after my stomach was empty I continued to heave. I'd really rather not ever go through that again!
I am not allergic to opioids but always had severe side effects like vomiting for hours. In my pharm profile, allergy card and MediAlert it goes like:
"h/o severe prolonged vomiting. Please prescribe and administer opioids such as (...) ONLY when absolutely necessary. Please administer ondasentron, diphenhydramine and dexamethasone or equivalents per your facility PONV protocol with every opioid administration"
The only one problem is to get people reading it but after it happens things become much easier for everyone. I was told many times how clear instructions about what to do and not fooling around with "perceived" vs. "real" allergies are appreciated.
Question to those who think that "an allergy is always an allergy":
- what would you do if patient claims an "allergy" to a drug or even a group of drugs, with questionable symptoms, and this very drug is required with potentially life-saving benefits? Say, a person had postoperative psychosis several years ago after being given Ativan, was told by those ubiquitous "them" ("they told me"... ) that he is "allergic" to all benzos and to Ativan in particular and now in DT with seizures and unstable circulation?
I had similar case before, and intensivist MD had to personally draw and inject Valium, with gloomy smile and words "he probably just didn't get enough of it then". I also saw a particularly advanced Pixes refusing to release "code pack" for patient who claimed to be "allergic" on Epinephrine because, surely, the drug was there.
We all know that. Now, what would you do if patient claims allergy to epi with typucal stuff "it makes my head hurt, my pressure up and my heart beating crazy", full code and very much clearly is about to go right south? He is not potential "slow code", his life very well might be saved.
I once went to the ER by ambulance for an allergic reaction that caused tachycardia and chest pain. In the ER I was placed on a monitor, the paramedics had started an IV, and I received 2L of 02. Both the nurse and the ER physician questioned me very carefully about allergies/sensitivities to medications and other substances. When I mentioned that I am sensitive to cardiovascular side effects of epinephrine, and that my dentist avoids using it on me unless really necessary, the nurse said: "That's very important for us to know", and the physician said the same. As Anna Flaxis mentioned in her post above, every single drug has the potential for adverse reactions. I didn't need to receive epinephrine, as my symptoms didn't progress further, but I appreciated the physician factoring in the information I told him about my sensitivity to epinephrine into his treatment decisions. It really is important to pay attention to what the patient says they experience allergic or adverse reactions to, including sensitivities, and to note this information on the patient's medical record.
My mouth will start to get tingly, then it will be very itchy and sore for a while. With fresh pineapple the reaction stays mostly in my mouth, but with nuts I'll get an upset stomach and cramps if I eat enough of it.
To me, the pineapple seems like a "true" allergy OR a reaction to the acids, and the nuts seems like a digestive issue...just my opinion.
That happened to me for years until I started breaking out in giant welts. Took me a while to make the connection. Either way, why would you want to take a pain medication that puts you in pain?
I think we're all way too Tylenol-happy, and I wish people would consider aspirin more often. I think most people think of it a a heart drug and don't know that it's also a good painkiller at the right dose, and is less likely to mess you up than other NSAIDs unless you're allergic. Tylenol is hailed as this great analgesic that doesn't interact with most medications, but the cost is that it will trash your liver over time.
I wonder how many of these people who have issues with tylenol are poor metabolizers for CYP450? If there are a bunch of allergies/"allergies" listed from this chart, I'd be more likely to think there's something metabolic rather than something psychological going on.
I have a true allergy to Tylenol. And it's my worst allergy on a growing list, having had angioedema a few times! UGH
The things the OP listed make sense. They are not allergies, but might be reasons patients don't want to take the drug. I am not allergic to Cipro. But, Cipro causes severe abdominal pain. I throw up and have diarrhea to the point that I am just expelling mucus. My temperature goes up and I get extremely dizzy, to the point that I cannot walk. I also hallucinate. It is not an allergy, but I would not take Cipro unless it was a life or death situation.
The last time I took Cipro was at work. Everyone who took care of a certain patient got a prescription because of whatever he had. My reaction was witnessed by coworkers and a doctor. The doctor turned it in to MedWatch.
In your case, I would suspect you could turn on a dime and have seriously allergic symptoms or adverse effects with it. I have heard of blood dyscrasias with it.
On our intake form, we have a space for "allergies and sensitivities." We are instructed to put the drug the patient states are allergies there with their reaction in quotation marks so that it is obvious that it is a patient perception rather than an official declaration of allergy. So if a patient states he has a codeine allergy, I have noted "causes stomach pain." And that's fine, codeine is not an emergency drug, so there is no reason to give that drug and we are glad to know that we need to take that drug out of the equation if pain becomes an issue.
) that he is "allergic" to all benzos and to Ativan in particular and now in DT with seizures and unstable circulation?
BuckyBadgerRN, ASN, RN
3,520 Posts
I had a patient recently tell me he's "a little" allergic to Tylenol, so he can only take one at a time, not the two I was offering