Chemotherapy: High-Risk Complications - Research Paper Example

Chemotherapy-related Nephrotoxicity Studies indicate that chemotherapeutic drugs may damage glomerulus, renal tubules, or microvasculature and thereby lead to renal problems. Adverse reactions can be mild or fatal. Some commonly used nephrotoxic antineoplastic agents like Cisplatin may develop proximal and distal tubule damages. The injury level may vary in accordance with the dosage. High dose cisplatin therapy would result in acute tubular necrosis, which is a condition limiting tubules’ sodium, magnesium, and water reabsorption capabilities.

This condition in turn may lead to chronic electrolyte abnormalities too. “Even when aggressive pre and posthydration with mannitol induced diuresis are part of the cisplatin regimen, the patient may develop nephrotoxicity” (Held-Warmkessel, 2011) In order to reduce those risks, it is necessary to closely monitor renal activities following the drug administration. Similarly, methotrexate causes damage to renal tubules and collecting ducts and ultimately results in acute tubular necrosis. While giving high dose therapy, drug precipitates out of the solution and is accumulated in tubules ducts; this condition may worsen the injury.

Acute kidney injury is more likely to occur at any time during this treatment. To minimize the renal risk chances associated with high dose therapy, patients are given sodium bicarbonate containing I.V. fluids (Sodium Bicarbonate, n.d). Through this hydration technique, it can also alkalinize urine. The urine pH testing begins prior to hydration and lasts until the methotrexate is eliminated from the body. Over the treatment period, it is essential to closely monitor the methotrexate drug levels periodically.

Major signs and symptoms of chemotherapy related nephrotoxicity may include excess or deficit fluid volume, electrolyte abnormalities such as hyperkalemia and hypocalcemia. Sometimes, nausea and vomiting are observed as major symptoms of this condition. According to Held-Warmkessel, nursing interventions mainly focus on collecting patient history, physical assessment performance, identification of nephrotoxicity risk factors, and lab results review. In addition, it would be better to pay specific attention to potential nephrotoxic medications the patient takes regularly, like nonsteroidal anti-inflammatory drugs.

Checking the patient for signs and symptoms of excess or deficit fluid volume and drug toxicity is also important. Febrile Neutropenia Febrile neutropenia is the most potential high risk complication of chemotherapy because this condition may cause even stable patients to develop hemodynamic instability and critical illness. The victim may die unless prompt monitoring and interventions are conducted. As Bolyard., Cottle., Edwards., Kinsey., Schwinzer & Zeidler (n.d) point out, neutropenia is diagnosed when the patient’s absolute neutrophil count falls below 500 cells/mm3.

In patients having a hematologic malignancy, neutrophils are inactive and unable to effectively fight infection even though the absolute neutrophil count lies within the normal range. Likewise, white blood cells including neutrophils play a key role in maintaining body’s cellular immunity. According to Held-Warmkessel (2011), neutrophils are the first respondents in an infection site and they prevent progressive infection. The chemotherapy procedure kills bone