# A nurse is caring for a patient with a known latex allergy who is scheduled for surgery. Which intervention should the nurse implement first to prevent an allergic reaction? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540838 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a patient with a known latex allergy who is scheduled for surgery. Which intervention should the nurse implement first to prevent an allergic reaction? ## 보기 1. Administer prophylactic antihistamines 30 minutes before the procedure 2. Ensure the operating room is prepared as a latex-free environment **✔ 정답** 3. Place an allergy alert bracelet on the patient's wrist 4. Obtain an order for emergency epinephrine to be available **정답: 2** ## 해설 The priority intervention is ensuring a latex-free operating room environment to prevent allergen exposure entirely. Prophylactic medications, allergy alerts, and emergency preparations are secondary supportive measures. ## 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 Latex-Safe Surgical Environment: A Clinical Guide For patients with a known latex allergy, primary prevention through strict allergen avoidance is the definitive standard of care. The following steps outline the creation and maintenance of a latex-free surgical field. 1. Identification and Communication - Verify the allergy type and severity (e.g., contact dermatitis vs. anaphylaxis) during the preoperative assessment. - Document the allergy prominently in the electronic health record and apply a red allergy alert bracelet. - Notify the entire perioperative team, including surgeons, anesthesia providers, and scrub personnel, during the surgical time-out. 2. Environmental Preparation - Schedule the patient as the first case of the day to minimize airborne latex particles from previous procedures. - Remove all latex-containing items from the operating room, including gloves, tourniquets, catheters, stethoscope tubing, and blood pressure cuffs. - Use latex-free alternatives such as vinyl or nitrile gloves and silicone-based medical devices. - Cover any latex-containing surfaces that cannot be removed (e.g., some anesthesia machine parts) with a protective barrier drape. 3. Medication and Fluid Safety - Inspect all medication vials for latex-containing stoppers; if unavoidable, puncture the stopper once and use the medication immediately to minimize contact time. - Use latex-free syringes and intravenous tubing with injection ports that do not contain latex. - Ensure all intravenous fluids are in latex-free packaging. 4. Emergency Preparedness - Ensure a latex-free emergency cart is readily available, stocked with latex-free airway devices, resuscitation bags, and non-latex gloves. - Have epinephrine, antihistamines, and corticosteroids immediately accessible as per institutional anaphylaxis protocol. - Clearly label the room as a "Latex-Safe Environment" to alert all incoming staff. ## 핵심 개념 - **Type I Hypersensitivity** — An IgE-mediated immediate allergic reaction where exposure to an antigen triggers mast cell degranulation and release of histamine, leading to symptoms ranging from urticaria to anaphylaxis. - **Latex Allergy** — An allergic response to proteins in natural rubber latex, commonly seen in healthcare settings, which can cause contact dermatitis, urticaria, asthma, or life-threatening anaphylaxis upon mucosal or parenteral exposure. - **Anaphylaxis** — A severe, rapid-onset systemic hypersensitivity reaction characterized by airway swelling, hypotension, and shock, requiring immediate administration of intramuscular epinephrine. - **Allergen Avoidance** — The primary and most effective strategy for managing allergies by completely removing the offending substance from the patient's environment to prevent the initiation of an immune response. ## 같은 주제 문제 - [A nurse is caring for a patient with a known latex allergy who is scheduled for surgery. 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