34
P A R T 1
Introduction to nursing pharmacology
cardiac arrhythmias, caused in many people a charac
teristic skin rash that appeared like a bright red blood
vessel pattern under the skin. Although people may
report that they are allergic to a drug because they
develop a skin rash when taking the drug, it is important
to determine whether a rash is a commonly associated
adverse effect of the drug.
Assessment
Hives, rashes and other dermatological lesions may be
seen. Severe reactions may include exfoliative derma
titis, which is characterised by rash and scaling,
fever, enlarged lymph nodes, enlarged liver and the
potentially fatal erythema multiforme exudativum
(Stevens–Johnson syndrome), which is characterised by
dark red papules appearing on the extremities with no
pain or itching, often in rings or disc-shaped patches.
Interventions
In mild cases, or when the benefit of the drug outweighs
the discomfort of the skin lesion, provide frequent skin
care; instruct the person to avoid rubbing, wearing tight
or rough clothing and using harsh soaps or perfumed
lotions; and administer antihistamines, as appropriate.
In severe cases, discontinue the drug and notify the
prescriber and/or primary caregiver. Be aware that, in
addition to these interventions, topical corticosteroids,
antihistamines and emollients are frequently used.
Stomatitis
Stomatitis
,
or inflammation of the mucous membranes,
can occur because of a direct toxic reaction to the drug
or because the drug deposits in the end capillaries in the
mucous membranes, leading to inflammation. Many
drugs are known to cause stomatitis. The antineoplastic
drugs commonly cause these problems because they are
toxic to rapidly turning-over cells, like those found in
the gastrointestinal (GI) tract. People receiving antineo
plastic drugs are usually given instructions for proper
mouth care when the drugs are started.
Assessment
Symptoms can include swollen gums, inflamed gums
(gingivitis), and a swollen and red tongue (glossitis).
■■
TABLE 3.1 Interventions for types of drug allergies
Allergy type
Assessment
Interventions
Anaphylactic reaction
This allergy involves an antibody that
reacts with specific sites in the body
to cause the release of chemicals,
including histamine, that produce
immediate reactions (mucous
membrane swelling and constricting
bronchi) that can lead to respiratory
distress and even respiratory arrest.
Hives, rash, difficulty breathing,
increased BP, dilated pupils,
diaphoresis, “panic” feeling,
increased heart rate, respiratory
arrest
Administer adrenaline, 0.3 mL of
a 1:1000 solution, IM for adults
or 0.01 mg/kg of 1:1000 IM for
children. Massage the site to
speed absorption rate. Repeat
the dose every 15–20 minutes, as
appropriate. Notify the prescriber
and/or primary caregiver and
discontinue the drug. Be aware that
prevention is the best treatment.
Counsel the people with known
allergies to wear Medic-Alert
identification and, if appropriate, to
carry an emergency adrenaline kit.
Cytotoxic reaction
This allergy involves antibodies that
circulate in the blood and attack
antigens (the drug) on cell sites,
causing death of that cell.This
reaction is not immediate but may
be seen over a few days.
Full blood count showing damage
to blood-forming cells (decreased
haematocrit, white blood cell count
and platelets); liver function tests
show elevated liver enzymes; renal
function test shows decreased renal
function
Notify the prescriber and/or primary
caregiver and discontinue the drug.
Support the person to prevent
infection and conserve energy until
the allergic response is over.
Serum sickness reaction
This allergy involves antibodies that
circulate in the blood and cause
damage to various tissues by
depositing in blood vessels.This
reaction may occur up to 1 week or
more after exposure to the drug.
Itchy rash, high fever, swollen lymph
nodes, swollen and painful joints,
oedema of the face and limbs
Notify the prescriber and/or primary
caregiver and discontinue the drug.
Provide comfort measures to help
the person cope with the signs
and symptoms (cool environment,
skin care, positioning, ice to joints,
administer antipyretics or anti-
inflammatory agents, as appropriate).
Delayed allergic reaction
This reaction occurs several hours
after exposure and involves
antibodies that are bound to specific
white blood cells.
Rash, hives, swollen joints
Notify the prescriber and/or primary
caregiver and discontinue drug. Provide
skin care and comfort measures that
may include antihistamines or topical
corticosteroids.
