Nursing Dx

Definition: A hypersensitive reaction to natural latex rubber products

RELATED FACTORS
Hypersensitivity to natural latex rubber protein

DEFINING CHARACTERISTICS
Subjective
Life-threatening reactions occurring <1 hour after exposure to latex proteins:
Tightness in chest; [feeling breathless]
Gastrointestinal characteristics: Abdominal pain; nausea
Orofacial characteristics: Itching of the eyes; nasal/facial/oral itching; nasal  congestion
Generalized characteristics: Generalized discomfort; increasing complaints of total body warmth
Type IV reactions occurring >1 hour after exposure to latex protein:
Discomfort reaction to additives such as thiurams and carbamates
Objective
Life-threatening reactions occurring <1 hour after exposure to latex proteins:
Contact urticaria progressing to generalized symptoms
Edema of the lips/tongue/uvula/throat
Dyspnea; wheezing; bronchospasm; respiratory arrest
Hypotension; syncope; cardiac arrest
Orofacial characteristics: Edema of sclera/eyelids; erythema/tearing of the eyes; nasal facial/erythema; rhinorrhea
Generalized characteristics: Flushing; generalized edema; restlessness
Type IV reactions occurring >1 hour after exposure to latex protein:
Eczema; irritation; redness

Sample Clinical Applications:Multiple allergies, neural tube defects (e.g., spina bifida,
myelomeningoceles), multiple surgeries at early age, chronic urological conditions (e.g.,
neurogenic bladder, exstrophy of bladder), spinal cord trauma

Client Will (Include Specific Time Frame)
• Be free of signs of hypersensitive response.
• Verbalize understanding of individual risks/responsibilities in avoiding exposure.
• Identify signs/symptoms requiring prompt intervention.

NURSING PRIORITY NO.1 To assess contributing factors:
• Identify persons in high-risk categories such as those with history of certain food allergies (e.g., banana, avocado, chestnut, kiwi, papaya, peach, nectarine), prior allergies, asthma, and skin conditions (e.g., eczema and other dermatitis), those occupationally exposed to latex products (e.g., healthcare workers, police/firefighters, emergency medical technicians [EMTs], food handlers, hairdressers, cleaning staff, factory workers in plants that manufacture latex-containing products), those with neural tube defects (e.g., spina bifida) or congenital urological conditions requiring frequent surgeries and/or catheterizations (e.g., extrophy of the bladder). Note: The most severe reactions tend to occur with latex proteins contacting internal tissues during invasive procedures and when they touch mucous membranes of the mouth, vagina, urethra, or rectum.
• Question new client regarding latex allergy upon admission to healthcare facility, especially when procedures are anticipated (e.g., laboratory, emergency department, operating room, wound care management, one-day surgery, dentist). Basic safety information to help healthcare providers prevent/prepare for safe environment for client and themselves while providing care.
• Discuss history of exposure: client works in environment where latex is manufactured or latex gloves are used frequently; child was blowing up balloons (may be an acute reaction to the powder); use of condoms (may affect either partner); individual requires frequent catheterizations. Finding cause of reaction may be simple or complex but often requires diligent investigation and history-taking from multiple sources.
• Administer or note presence of positive skin-prick test (SPT), when performed. Sensitive, specific, and rapid test but should be used with caution in persons with suspected sensitivity, as it carries risk of anaphylaxis.
• Perform challenge/patch test, if appropriate, to identify specific allergens in client with known type IV hypersensitivity.
• Note response to radioallergosorbent test (RAST) or enzyme-linked latex-specific IgE (ELISA). Performed to measure the quantity of IgE antibodies in serum after exposure to specific antigens and has generally replaced skin tests and provocation tests, which are inconvenient, often painful, and/or hazardous to the client.

NURSING PRIORITY NO.2 To take measures to reduce/limit allergic response/avoid exposure to allergens:
• Ascertain client’s current symptoms, noting rash, hives, itching, eye symptoms, edema, diarrhea, nausea, and feeling of faintness. Baseline for determining where the client is along a continuum of symptoms so that appropriate treatments can be initiated.
• Determine time since exposure (e.g., immediate or delayed onset such as 24 to 48 hours).
• Assess skin (usually hands but may be anywhere) for dry, crusty, hard bumps, horizontal cracks caused by irritation from chemicals used in/on the latex item (e.g., latex or powder used in latex gloves, condoms, etc.). Dry itchy rash (contact irritation) is the most common response and is not a true allergic reaction but can progress to a delayed type of allergic contact dermatitis with oozing blisters and spread in a way similar to poison ivy.
• Assist with treatment of contact dermatitis/type IV reaction:
Wash affected skin with mild soap and water.
Wash hands between glove changes and after each glove removal.
Avoid oil-based salves or lotions when using latex gloves.
Consider application of topical steroid ointment.
Inform client that the most common cause is latex gloves but that many other products contain latex and could aggravate condition.
• Monitor closely for signs of systemic reactions (e.g., difficulty breathing or swallowing; wheezing; hoarseness; stridor; hypotension; tremors; chest pain; tachycardia; dysrhythmias; edema of face, eyelids, lips, tongue, and mucous membranes). Type IV response can progress to type I anaphylaxis.
• Note behavior such as agitation, restlessness, and expressions of fearfulness, in the presence of above listed symptoms. Indicative of severe allergic response that can result in anaphylactic reaction and lead to respiratory/cardiac arrest.
• Administer treatment, as appropriate, if severe/life-threatening reaction occurs:
Stop treatment or procedure, if needed.
Support airway and administer 100% oxygen or mechanical ventilation, if needed.
Administer emergency medications and treatments per protocol (e.g., antihistamines, epinephrine, corticosteroids, and IV fluids).
• Educate care providers in ways to prevent inadvertent exposure (e.g., post latex precaution signs in client’s room, document allergy to latex in chart, routinely monitor client’s environment for latex-containing products and remove them promptly) and in emergency treatment measures should they be needed.
• Ascertain that latex-safe environment (e.g., surgery/hospital room) and products are available according to recommended facility guidelines and standards, including equipment and supplies, (e.g., powder-free, low-protein latex products) and latex-free items (e.g., gloves, syringes, catheters, tubings, tape, thermometers, electrodes, oxygen cannulas, underpads, storage bags, diapers, feeding nipples, etc.), as appropriate.
• Notify physicians, colleagues, and medical products suppliers of condition (e.g., pharmacy so that medications can be prepared in latex-free environment, home-care oxygen company to provide latex-free cannulas).
• Encourage client to wear medical ID bracelet to alert providers to condition if client is unresponsive.

NURSING PRIORITY NO.3 To promote wellness (Teaching/Learning):
• Instruct in signs of reaction and emergency treatment needs. Reactions range from skin irritation to anaphylaxis. Reaction may be gradual but progressive, affecting multiple body systems, or may be sudden, requiring lifesaving treatment. Allergy can result in chronic illness, disability, career loss, hardship, and death. There is no cure except complete avoidance of latex
• Emphasize the critical importance of taking immediate action for type I reaction to limit life-threatening symptoms.
• Demonstrate procedure and recommend client carry auto-injectable epinephrine to provide timely emergency treatment, as needed.
• Emphasize necessity of informing all new care providers of hypersensitivity to reduce preventable exposures.

• Instruct client/family/SO that latex exposure occurs through contact with skin or mucous membrane, by inhalation, parenteral injection, or wound inoculation.
• Instuct client/SO(s) to survey and routinely monitor environment for latex-containing products, and replace as needed.
• Provide printed lists or Web sites for identifying common household products that may contain latex (e.g, carpet backing, hoses, rubber grip utensils, diapers, undergarments, shoes, toys, pacifiers, computer mouse pad, erasers, rubber bands, and much more) and where to obtain latex-free products and supplies.
• Provide resource and assistance numbers for emergencies. When allergy is suspected or the potential for allergy exists, protection must begin with identification and removal of possible sources of latex.
• Provide worksite review/recommendations to prevent exposure. Latex allergy can be a disabling occupational disease. Education about the problem promotes prevention of allergic reaction, facilitates timely intervention, and helps nurse to protect clients, latex-sensitive colleagues, and themselves.
• Recommend full medical workup for client presenting with hand dermatitis, especially if job tasks include use of latex.
• Contact suppliers to verify that latex-free equipment, products, and supplies are available, including (but not limited to) low-allergen/powder-free synthetic gloves, airways, masks, stethoscope tubings, IV tubing, tape, thermometers, urinary catheters, stomach and intestinal tubes, electrodes, oxygen cannulas, pencil erasers, wrist name bands, and rubber bands.
• Ascertain that procedures are in place to identify and resolve problems with medical devices relevant to allergic reactions or glove performance.
• Refer to resources, including but not limited to ALERT (Allergy to Latex Education & Resource Team, Inc.), Latex Allergy News, Spina Bifida Association, National Institute for Occupational Safety and Health (NIOSH), Kendall’s Healthcare Products [Web site], Hudson RCI [Web site]), for further information about common latex products in the home, latex-free products, and assistance.

DOCUMENTATION FOCUS
Assessment/Reassessment
• Assessment findings/pertinent history of contact with latex products/frequency of exposure.
• Type/extent of symptoms.
Planning
• Plan of care and interventions and who is involved in planning.
• Teaching plan.
Implementation/Evaluation
• Response to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
Discharge Planning
• Discharge needs/referrals made, additional resources available.