In the past history enquire;
If a patient with intestinal obstruction, gives a past history of
abdominal surgery, there are three possibilities;
Most patients fall into the adhesions category.
Always take a drug allergy history, do not just write allergic to Penicillin. Ensure that you document when the `allergy' occurred and what happened. Was this a tummy upset with loose bowel motions? Or did the patient have a rash? Or did their lips swell up as they got wheezy? The worst crime is to document that there are no allergies when a history has not been taken. It is nearly as bad to document that the patient is allergic to a drug when they are not. If you are in doubt, document that in the patients notes. If the patient is allergic to a drug then this should be prominently displayed on their notes (usual to see a section on the front cover) and in the medications chart. Ensure when you are charting a drug or giving a drug that a history of allergies has been taken and that the patient is not allergic to the drug you are going to give. If the patient is allergic to penicillin then they will most likely be allergic to all penicillins such as ampicillin, pipercillin, phenoxy-methyl penicillin, benzyl penicillin etc. Many drugs contain a penicillin drug in combination with another drug such as Co-amoxiclav Augmentin which contains amoxicillin with clauvelinic acid. These should not be given if the patient is allergic to Penicillin. Cephalosprorins are somewhat similar to Penicillin in their structure and there is a significant chance that if the patient is allergic to one they will be allergic to the other. About 15% of patients that are allergic to Penicillin will be allergic to cephalosporins. It would be foolish to risk an anaphylactic reaction in a patient allergic to Penicillin by administering a cephalosporin.
If you are administering the first dose of an antibiotic, check for allergies, with the patient, with the patient's notes and with the drug chart. Ensure you remember the emergency treatment for anaphylaxis and check where the emergency drugs are.
Rarely there will be a problem with anaesthetics in the patient or in the family history, these should be documented and discussed with the anaesthetic staff.