- Monitor vital signs before and frequently during therapy.
- Assess mucous membranes, number and consistency of stools, and frequency of vomiting. Assess for signs of infection (fever, chills, sore throat, cough, hoarseness, pain in lower back or side, difficult or painful urination). Assess for bleeding (bleeding gums; bruising; petechiae; and guaiac test stools, urine, and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to venipuncture sites for 10 min. Notify health care professional if symptoms of toxicity (stomatitis or esophagopharyngitis, uncontrollable vomiting, diarrhea, GI bleeding, myocardial ischemia, leukocyte count <3500/mm3, platelet count <100,000/mm3, or hemorrhage from any site) occur; drug will need to be discontinued. May be reinitiated at a lower dose when side effects have subsided.
- Assess IV site frequently for inflammation or infiltration. Patient should notify nurse if pain or irritation at injection site occurs. May cause thrombophlebitis. If extravasation occurs, infusion must be stopped and restarted in another vein to avoid damage to subcut tissue. Report immediately. Standard treatment includes application of ice compresses.
- Assess skin for palmar-plantar erythrodysesthesia (tingling of hands and feet followed by pain, erythema, and swelling) throughout therapy.
- Monitor intake and output, appetite, and nutritional intake. GI effects usually occur on 4th day of therapy. Adjusting diet as tolerated may help maintain fluid and electrolyte balance and nutritional status.
- Monitor patient for cerebellar dysfunction (weakness, ataxia, dizziness). This may persist after discontinuation of therapy.
- Topical: Inspect involved skin before and throughout therapy.
Lab Test Considerations:
May cause ↓ in plasma albumin.
- Monitor hepatic (AST, ALT, LDH, and serum bilirubin), renal, and hematologic (hematocrit, hemoglobin, leukocyte, platelet count) functions before and periodically during therapy. Monitor CBC daily during IV therapy. Report WBC of <3500/mm3 or platelets <100,000/mm3 immediately; they are criteria for discontinuation. Nadir of leukopenia usually occurs in 9–14 days, with recovery by day 30. May also cause thrombocytopenia.
- May cause ↑ in urine excretion of 5-hydroxyindoleacetic acid (5-HIAA).