Fluid retention is common and presents as periorbital and lower extremity oedema in at least 50-60% of individuals treated with imatinib. Serious effects of fluid retention include:25, 28
- pleural effusion
- rapid weight gain
- pulmonary oedema.
Fluid retention and oedema has also been reported in the second generation TKI dasatinib. Management includes monitoring for signs of fluid retention and oedema during therapy. Individuals need to be educated to weigh themselves daily at home and to report weight gains of 1 kg in one week and symptoms of dyspnoea.12 Symptom management strategies may include diuretics for periorbital and lower extremity oedema and ice packs or haemorrhoid preparations for periorbital oedema.28
A group of rare but significant side effects has been associated with the use of bevacizumab including:10, 12, 34
- development of potentially fatal gastrointestinal perforations
- complicated wound healing and tissue repair such as wound dehiscence, tracheoesophageal fistula, and perforation of nasal septum
- haemorrhage - epistaxis, haematemesis, haemoptysis, bleeding at tumour sites, subarachnoid, and haemorrhagic stroke.
This has led to black box warnings being listed with the use of this agent. Although rare, at times these serious adverse events can be fatal and require the SCN to develop skills in assessing for alterations and educating individuals on the importance of reporting symptoms early. The following management strategies should be considered:12, 34
- assess baseline bowel and skin integrity and signs of delayed wound healing each visit
- assess for conditions that place the individual at risk for bleeding
- assess baseline mental status and neurological signs and monitor during therapy for CNS haemorrhage, reversible posterior leukoencephalopathy and fatal encephalopathy
- educate individuals on signs to report immediately - wound dehiscence, bleeding tendencies such as epistaxis, haematemesis, and haemoptysis, abdominal pain associated with nausea, vomiting and constipation
- treatment should be interrupted prior to surgical procedures, although the exact time interval required is not known.
Identify an agent from each of the following categories:
- Monoclonal antibodies
- Molecular targeted therapies
- Angiogenesis inhibitors
- Miscellaneous agents
and complete the following activities:
- Identify adverse effects of these agents
- Select one adverse effect of each agent and discuss the evidence based nursing interventions required to prevent, detect and manage the effect.