Fundamentals of Nursing Q 311
A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:
A. Withhold the moderation and notify the physician.
B. Administer the medication and notify the physician.
C. Administer the medication with an antihistamine.
D. Apply cornstarch soaks to the rash.
Correct Answer: A. Withhold the moderation and notify the physician
Initial sensitivity to penicillin is commonly manifested by a skin rash, even in individuals who have not been allergic to it previously. Because of the danger of anaphylactic shock, the nurse should withhold the drug and notify the physician, who may choose to substitute another drug.
Option B: To determine if a patient has an IgE mediated penicillin allergy, the only validated test currently available in the united states is penicillin skin testing. A board-certified allergist should perform the test. It involves a skin-prick with the application of the major and minor determinants as well as a control. The area of skin is examined 15 minutes later. If a wheel of at least 3 mm and concomitant erythema develop, the test is positive. The test should not be performed if the reaction to penicillin was a severe non-IgE mediated reaction.
Option C: Administering an antihistamine is a dependent nursing intervention that requires a written physician’s order. Treatment for acute IgE mediated reaction to penicillin depends on severity. Patients presenting in acute anaphylaxis need to have immediate treatment with IM epinephrine (1 mg/ml) 0.3 mg to 0.5 mg every 5 to 15 minutes until resolution of symptoms. Adjunctive therapies include H1 and H2 antihistamines including diphenhydramine 25 mg to 50 mg intravenously (IV) and ranitidine 50 mg IV, respectively.
Option D: Although applying cornstarch to the rash may relieve discomfort, it is not the nurse’s top priority in such a potentially life-threatening situation. Cutaneous symptoms are often the first and most common finding of an allergic reaction, however, are absent in 10% to 20% of patients experiencing an allergic reaction. Common cutaneous symptoms are generalized urticaria, flushing, pruritus, and angioedema.