# A nurse is caring for a patient with a known latex allergy who is scheduled for surgery. Which action should the nurse take first to ensure patient safety? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540836 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a patient with a known latex allergy who is scheduled for surgery. Which action should the nurse take first to ensure patient safety? ## 보기 1. Create a latex-free environment and ensure all staff are aware of the allergy **✔ 정답** 2. Administer prophylactic antihistamines before the procedure 3. Place the patient in isolation to prevent cross-contamination 4. Schedule the surgery for the end of the day to minimize exposure **정답: 1** ## 해설 Creating a latex-free environment is the priority to prevent life-threatening anaphylaxis during surgery. Other actions like medication or scheduling are secondary to this primary prevention. ## 심화 해설 Understanding Latex Allergy and Perioperative Safety Latex allergy is a hypersensitivity reaction to proteins found in natural rubber latex. In susceptible individuals, exposure can trigger a spectrum of responses, ranging from contact dermatitis to life-threatening anaphylaxis. The cornerstone of safe care for a patient with a known latex allergy is complete avoidance of all latex-containing products. This principle is supported by the position paper on occupational anaphylaxis, which identifies natural rubber latex as a significant trigger for systemic allergic reactions in the workplace, including healthcare settings [3]. The goal is to prevent the initiation of an allergic cascade, which can occur not only through direct skin or mucous membrane contact but also via inhalation of latex proteins that bind to the powder inside gloves and become aerosolized. Analysis of Answer Choices - Option 1: Scheduling the patient as the first case of the day can reduce exposure to airborne latex particles that may have accumulated from previous procedures. However, this measure is insufficient on its own. An operating room that has not been thoroughly cleaned of latex dust or is still stocked with latex-containing equipment does not constitute a safe environment. Complete avoidance is the standard, not merely a reduction in potential aerosolized particles. - Option 2: Ensuring staff wear powder-free latex gloves is contraindicated. While powder-free gloves release fewer aerosolized latex proteins than powdered ones, they still contain the allergenic latex proteins. A study on glove integrity highlights that even powder-free latex gloves are a source of latex exposure [1]. This action would place the patient at significant risk for a hypersensitivity reaction. The correct intervention is to use non-latex alternatives, such as nitrile or neoprene gloves. - Option 3 (Correct Answer): Creating a latex-free environment is the definitive and most appropriate safety measure. This involves a comprehensive approach: using non-latex gloves, latex-free tourniquets, stethoscopes, blood pressure cuffs, IV tubing ports, and syringes. A practical review of surgical glove materials confirms that synthetic alternatives like nitrile and neoprene provide effective barrier protection without the allergy risk associated with latex [2]. This action directly aligns with the preventive management strategies for latex-induced anaphylaxis by eliminating the trigger entirely [3]. - Option 4: Administering prophylactic antihistamines is not a substitute for allergen avoidance. While antihistamines may blunt the early cutaneous signs of a mild allergic reaction, they are unreliable in preventing anaphylaxis, which is a multi-system, mast-cell mediated event involving more than just histamine release. Relying on premedication without establishing a latex-free environment creates a false sense of security and leaves the patient vulnerable to a severe, potentially fatal reaction. Clinical Safety Rationale The pathophysiology of IgE-mediated latex allergy involves sensitization and subsequent mast cell degranulation upon re-exposure. The most effective preventive strategy is complete antigen avoidance. A "latex-free" protocol is a system-based safety measure that requires meticulous attention to the entire perioperative environment, from the gloves the surgical team wears to the materials in the anesthesia circuit. The evidence clearly indicates that synthetic glove materials provide a safe and effective alternative, eliminating the risk of triggering a life-threatening allergic event [2,3].References (research sources) - [1]Assessment of glove integrity across various dental specialties in a dental school setting.Research articleAlsaegh MA, AlSiraj MF, Alsadoon AN, Soufi O, Mahmoud O, Varma SR. (2024) · DOI: 10.3389/froh.2024.1496918 - [2]Gloving the Surgeon: <i>A Practical Review of Surgical Glove Material Properties, Safety, and Waste</i>.Research articlePatel JJ, Fine KS, O'Shea AW, Wirth PJ, Shaffrey EC, Attaluri PK, Rao VK. (2025) · DOI: 10.1097/as9.0000000000000600 - [3]Occupational anaphylaxis: A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI).Research articleTreudler R, Worm M, Bauer A, Dickel H, Heine G, Jappe U, Klimek L, Raulf M, Wedi B, Wieczorek D, Francuzik W, Jakob T, Pfaar O, Ring J, Rueff F, Schnadt S, Werfel T, Wurpts G, Zarnowski J, Zuberbier T, Brockow K. (2024) · DOI: 10.5414/alx02543e ## 임상 시나리오 Clinical Practice Guide: Latex Allergy in the Perioperative Setting 1. Preoperative Identification and Communication - Screen all patients for latex allergy using a targeted history (e.g., reactions to balloons, gloves, or condoms; history of multiple surgeries or spina bifida). - Document the allergy prominently in the electronic health record (EHR) and flag the patient's chart. - Notify the entire perioperative team (surgeon, anesthesiologist, scrub nurse, circulating nurse) during the preoperative briefing or huddle. - Apply a latex allergy identification band to the patient on admission. 2. Creating a Latex-Free Environment - Schedule the patient as the first case of the day to minimize exposure to airborne latex particles from previous procedures. - Thoroughly clean the operating room according to protocol, ensuring all surfaces are wiped down to remove latex dust. - Remove all latex-containing items from the room. This includes gloves, tourniquets, stethoscope tubing, IV injection ports, catheters, and adhesive tapes. - Use a latex-free cart or kit stocked with synthetic alternatives (e.g., nitrile or neoprene gloves, silicone catheters, plastic syringes). - Place a clearly visible sign on the operating room door stating "Latex Allergy" to prevent staff from inadvertently introducing latex products. 3. Pharmacological Considerations - Do not rely on prophylactic antihistamines or corticosteroids as a primary preventive strategy; they do not reliably prevent anaphylaxis from parenteral or mucosal exposure. - Ensure emergency medications (epinephrine, antihistamines, corticosteroids, albuterol) are readily available and doses are pre-calculated based on the patient's weight. - Review the medication list to ensure all drugs are drawn from latex-free vials; many medication vial stoppers contain latex. 4. Intraoperative Monitoring and Emergency Response - Continuously monitor for signs of an allergic reaction, including sudden hypotension, tachycardia, bronchospasm, urticaria, or angioedema. - If anaphylaxis is suspected, immediately stop the procedure, call for help, administer intramuscular epinephrine into the anterolateral thigh, and initiate supportive care (oxygen, IV fluids). - Be aware that reactions can be delayed; maintain vigilance throughout the entire perioperative period, including the post-anesthesia care unit (PACU). 5. Postoperative Care and Discharge Education - Continue monitoring in the PACU for any biphasic or delayed allergic reactions. - Reinforce education on latex avoidance in daily life and healthcare settings. - Advise the patient to wear a medical alert bracelet and inform all future healthcare providers of the latex allergy. - Document the event and the successful use of a latex-free protocol in the patient's record. ## 핵심 개념 - **Latex Allergy** — An IgE-mediated hypersensitivity reaction to proteins in natural rubber latex, capable of causing contact urticaria to life-threatening anaphylaxis. - **Anaphylaxis** — A severe, systemic allergic reaction that is rapid in onset and may cause death, triggered by mediator release from mast cells and basophils. - **Aerosolized Latex Particles** — Latex allergens that bind to cornstarch powder on gloves and become airborne, potentially causing respiratory or systemic reactions upon inhalation. - **Primary Prevention** — Interventions aimed at preventing the onset of disease or injury by reducing exposure to risk factors, such as creating a latex-free environment. - **IgE-mediated Hypersensitivity** — A type I hypersensitivity reaction where allergens cross-link IgE antibodies on mast cells, triggering degranulation and release of inflammatory mediators. ## 같은 주제 문제 - [A nurse is caring for a patient with a known latex allergy who is scheduled for surgery. 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