Nursing Considerations
Educate patients and their families about the prevention and management of TLS, including the signs and symptoms of hyperuricemia and information about prescribed medications. For example, make sure they understand each drug's purpose, dosage, expected effects, and possible adverse reactions. Also make sure they know how to recognize serious adverse reactions or signs and symptoms they should notify the health care provider about at once. Complete a nursing admission assessment, including a risk-factor assessment. Notify the health care provider of any abnormal lab results that may indicate TLS. Administer IV hydration as prescribed and monitor fluid balance by weighing the patient daily and documenting intake and output accurately. Urine output should be in balance with the intake. If fluid intake exceeds output, notify the health care provider, because the patient may be developing renal complications from TLS. To assess a patient's renal function, follow these guidelines:
* Assess urine output, including pH, color, odor, volume, and clarity, and test for the presence of red blood cells and hemoglobin. Notify the health care provider of oliguria or other abnormalities, which may indicate acute renal failure. Educate the patient about the need to save all urine for measurement and testing.
* Insert an indwelling urinary catheter if prescribed, but avoid catheters in patients with low neutrophil or platelet counts due to the risk of infection and bleeding, and remove urinary catheters as soon as they are no longer needed to prevent catheter-associated urinary tract infections.
* Assess breath sounds (pulmonary crackles) and heart sounds (S3) for signs of fluid overload.
* Weigh the patient daily.
* Monitor BUN, serum uric acid, and creatinine levels.
* Perform medication reconciliation, and collaborate with the prescriber and pharmacist to stop or hold any medications that may adversely affect renal function or serum electrolyte and uric acid levels.
To assess a patient for signs and symptoms of hyperkalemia, hyperphosphatemia, and hypocalcemia, closely monitor electrolyte, phosphorus, and calcium levels, and monitor ECG results. As prescribed, administer phosphate binding agents, medications to reduce serum potassium and uric acid levels, and increase serum calcium levels.
