Saturday, March 9, 2013

A Valuable Lesson in Allergies!

Working at two different hospitals (one outpatient based and one acute care based) I have a lot of opportunity for diversity in the patients I get to see!

Today I worked at my second job! At this job I work in acute care and today they needed me mostly on the "Neuro Floor" this floor is for our patients that have experienced a "neurological event" such as a traumatic brain injury or stroke. Working with anyone in an altered medical state it's important to stay on your toes! I find though that my patients on the neuro floor will acquire a little bit more of my attention - usually due to impulsivity.

Onto my story! Today I went in for a clinical swallow evaluation with one of our patients. One of the consistencies I use within the assessment is pudding, this happened to be chocolate pudding!

The patient brought the spoon full of chocolate pudding up to their mouth and stated "I usually don't eat chocolate." Of course I asked... "oh? why?" the patient then stated the words that no body ever wants to hear! "I'm Allergic!" Within a heart beat I snatched the spoon away before it could touch her lips! I'm sure I startled the patient!

I asked the patient why they were going to eat the chocolate if they were allergic. The response was not great... "well I'm sometimes allergic...sometimes I break out in hives and sometimes I don't." Oh my goodbye chocolate pudding! After a bit more conversation I found out a few more allergies that had not been reported to the patient's doctor or were not in the patient's medical record - which now are! I have a feeling that this patient may also be a great candidate for therapy targeting judgement and safety! :-)

So what did we learn today? Most allergies that are reported are medicine based - they do not always have food allergies included so ask ask ask! In the case of your patients that have had a neurological event occur try to get family input. If you are not getting a clear answer maybe ask if they have had any of the below symptoms with the food you are going to try with them.

Skin: irritation, redness, itching, swelling, blistering, weeping, crusting, rask, eruptions, or hives.

Lungs: wheezing, tightness, cough, or shortness of breath.

Head: swelling or bumps on the face, neck, eyelids, lips, tongue, throat, or hoarseness of voice or headache.

Nose: stuffy nose, runny nose, sneezing.

Eyes: red (bloodshot), itchy, swollen, or watery or swelling of the area around the face and eyes.

Stomach: pain, nausea, vomiting, or diarrhea.

Other: fatigue, sore throat.

What is the strangest thing that has happened during one of your own clinical swallow assessments?

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