Patient Care and Monitoring Urologic Complications

1. Assess the patient receiving ifosfamide or cyclophosph-amide at least daily for development of hematuria.

2. Ensure administration of adequate hydration and proper doses of mesna.

3. Counsel patient receiving oral mesna on the importance of compliance, when to take doses, and to immediately report any episodes of vomiting for IV readministration.

4. Assess the quantity of urinary bleeding and promptly refer to urologist for local or surgical management.

5. Patients receiving systemic treatment should be monitored every 4 hours for resolution of hematuria. Promptly refer to urologist for refractory hematuria.

6. Evaluate the patient for drug interactions, allergies, and adverse effects with chemotherapy, mesna, or systemic therapies for management.

Monitor the patient for resolution of hematuria after each successive therapeutic intervention. Frequency of monitoring is based on the severity of hemorrhaging. Monitor urinary output and serum chemistries (including sodium, potassium, chloride, blood urea nitrogen, and serum creatinine) daily for renal dysfunction. Check the CBC at least daily to monitor hemoglobin and platelet count.

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