Nursing Dx

Definition: Risk of hypersenitivity to natural latex rubber products

RISK FACTORS
History of reactions to latex
Allergies to bananas, avocados, tropical fruits, kiwi, chestnuts, poinsettia plants
History of allergies and asthma
Professions with daily exposure to latex
Multiple surgical procedures, especially from infancy
NOTE: A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

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

DESIRED OUTCOMES/EVALUATION CRITERIA

Client Will (Include Specific Time Frame)
• Identify and correct potential risk factors in the environment.
• Demonstrate appropriate lifestyle changes to reduce risk of exposure.
• Identify resources to assist in promoting a safe environment.
• Recognize need for/seek assistance to limit response/complications.

ACTIONS/INTERVENTIONS

NURSING PRIORITY NO.1 To assess causative/contributing factors:
• Identify persons in high-risk categories such as those with history of certain food allergies (e.g., banana, avocado, chestnut, kiwi, papya, peach, nectarine); asthma; skin conditions (e.g., eczema); 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 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). Current information indicates that natural latex is found in thousands of medical supplies; however, many manufacturers are now using synthetic SB latex. These products have not been associated with allergic reactions, even among individuals that are sensitive to natural latex.

NURSING PRIORITY NO.2 To assist in correcting factors that could lead to latex allergy:
• Ascertain that facilities have established policies and procedures. Promotes awareness in the workplace to address safety and reduce risk to workers and client.
• Create latex-safe environments in care setting (e.g., substitute nonlatex products, such as natural rubber gloves, PCV IV tubing, latex-free tape, thermometers, electrodes, oxygen cannulas, etc.). Reduces risk of exposure.
• Promote good skin care when latex gloves may be preferred/required for barrier protection (e.g., in specific disease conditions such as HIV or during surgery). Use powder-free gloves, wash hands immediately after glove removal; refrain from use of oil-based hand cream. Reduces dermal and respiratory exposure to latex proteins that bind to the powder in gloves.
• Discuss necessity of avoiding latex exposure. Recommend/assist client/family to survey environment and remove any medical or household products containing latex. Avoidance of latex is the only way to prevent the allergy.
• 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.

NURSING PRIORITY NO.3 To promote wellness (Teaching/Discharge Considerations):
• Instruct client/care providers about types of potential reactions. Reaction may be gradual and progressive (e.g., irritant contact rash with gloves); can be progressive, affecting multiple body systems; or may be sudden and anaphylactic requiring lifesaving treatment.
• Identify measures to take if reactions occur and ways to avoid exposure to latex products to reduce risk of injury. (Refer to ND latex Allergy Response.)
• Refer to allergist for testing as appropriate. Testing may include challenge test with latex gloves, skin patch test, or blood test for IgE.
• Encourage client to wear medical ID bracelet and emphasize importance of informing all new care providers of hypersensitivity to reduce preventable exposures.
• Refer to resources (e.g., Latex Allergy News, 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, and frequency of exposure.

Planning
• Plan of care 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
• Long-term needs and who is responsible for actions to be taken.
• Specific referrals made.