Assessment

• Monitor ECG continuously during infusion. Cardiac function, including thallium stress testing, should be determined prior to initiation of therapy. Supraventricular arrhythmias may respond to digoxin or verapamil and usually resolve after completion of therapy

• Monitor vital signs at least daily throughout therapy. Fever, chills, rigors, and malaise usually occur within hours of administration. Acetaminophen and an NSAID, such as indomethacin, should be administered prior to initiation of aldesleukin therapy to reduce fever. Meperidine may be given to control rigors associated with fever

• Assess patient for the development of capillary leak syndrome (hypotension, hypovolemia, edema, ascites, pleural effusions). This initially manifests as a drop in arterial blood pressure beginning 2–12 hr from start of administration. If blood pressure decreases to <90 mmHg, constant ECG monitoring, hourly vital signs, and CVP monitoring are recommended

• Monitor respiratory status and pulse oximetry frequently. Pulmonary function tests, including arterial blood gases, and chest x-ray should be monitored prior to and periodically throughout therapy. Pulmonary toxicity (respiratory failure, tachypnea, wheezing) and pulmonary infiltration may become apparent by the 4th day of therapy and usually resolve within a few weeks after therapy. Respiratory failure may require intubation

• Monitor weight daily. Weight gain during therapy may be more than 10% of pretreatment weight. Reversal of weight gain, via diuresis of fluid, may take up to 1–2 wk after therapy

• Monitor for changes in mental status. Hold administration if patient develops moderate-to-severe lethargy or somnolence. Low doses of haloperidol have been used for debilitating mental status changes

• Assess frequently for signs of infection, particularly sepsis and bacterial endocarditis. Antibiotic prophylaxis directed against Staphylococcus aureus may be used for patients with central lines. Any intercurrent infections should be managed aggressively. Aldesleukin impairs the function of WBCs

• Assess for signs of anemia (increased fatigue, dyspnea, orthostatic hypotension) and bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis). Ranitidine or cimetidine may be given for prophylaxis of GI irritation and bleeding. Transfusions of RBCs and/or platelets may be required

• Assess nutrition and bowel status. Stomatitis may require a liquid diet or initiation of parenteral nutrition. Nausea, vomiting, and diarrhea occur in most patients and may lead to hypokalemia and acidosis. Antiemetics and antidiarrheals may be given as needed and are usually discontinued 12 hr after last dose

• Assess skin daily for rash or blisters on skin. Notify physician if these occur; exfoliative dermatitis can be fatal

• Monitor CBC, differential, platelet count, blood chemistries including electrolytes, and renal and hepatic function prior to and daily throughout therapy. May cause elevated bilirubin, BUN, serum creatinine, transaminase, and alkaline phosphatase levels. May cause anemia, thrombocytopenia, hypomagnesemia, acidosis, hypocalcemia, hypophosphatemia, hypokalemia, hyperuricemia, hypoalbuminemia, and hypoproteinemia

» Monitor thyroid function periodically during therapy

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