Once a patient enters custody and begins consistent medication adherence, side effects or adverse reactions can surface quickly. Correctional nurses are often the first to recognize and respond to these unintended effects. Below are several high-risk categories every nurse working in corrections should be prepared to identify and address.

Allergic Reactions and Anaphylaxis

Medications commonly associated with allergic reactions include:

• Penicillins and sulfa antibiotics
• Insulin (especially animal-derived)
• Anticonvulsants
• Vaccines and contrast dyes

Anaphylaxis is a medical emergency. Facilities must have a written protocol and access to emergency treatment like epinephrine. Nurses should be able to recognize early signs: rash, swelling, respiratory distress, and hypotension.

Heat-Related Illnesses

Patients taking psychotropics, anticholinergics, diuretics, amphetamines, or beta-blockers are at increased risk for heat exhaustion and heat stroke. This is especially concerning in facilities where environmental temperature is not controlled by those who live in the unit.

Watch for signs such as confusion, weakness, flushed skin, or absence of sweating in hot environments. If your facility lacks a heat-illness policy, advocate for one or adapt one from a reputable source.

Photosensitivity

Many incarcerated persons are unable to avoid prolonged sunlight exposure due to facility design or work assignments. Certain medications, like some antibiotics, diuretics, and psychotropics, can cause photosensitivity, resulting in severe sunburns or rashes.

Prevention includes:

• Education about sun exposure risks
• Encouraging use of sunscreen and protective clothing when available
• Prompt treatment of skin reactions

Refer to the Institute for Safe Medication Practices (ISMP) for detailed medication lists and management tips of medications with the potential for photosensitivity.

Hyponatremia

Low sodium levels can occur from medications like SSRIs, MAO inhibitors, or diuretics, as well as from excessive water intake. Symptoms include nausea, confusion, headaches, and seizures. Nurses should monitor fluid intake, electrolytes, and report changes in mental status immediately.

Psychotropic Medication Complications

Correctional nurses must recognize:

• Extrapyramidal symptoms; dystonia
• Tardive dyskinesia
• Serotonin syndrome
• Lithium toxicity
• Neuroleptic malignant syndrome
• Metabolic syndrome

These reactions can be subtle at first. If psychiatric nursing is outside your comfort zone, seek education from your facility’s mental health provider. Understanding these complications can significantly impact patient safety and outcomes.

Medication safety behind the wall depends on you. Correctional Nurses are in position to be the first to identify unintended medication effects. From persons just arriving in intake to patients that have been incarcerated for some time, your vigilance, clinical insight, and communication with providers can prevent harm and improve outcomes.

Please share your experiences with unintended effects of medication in your practice below.