Oncology Nurse Advisor Forum – July 2010

URINALYSIS IN PATIENTS RECEIVING ALKYLATING AGENTS

Why are ketones present in urinalysis results when patients are receiving ifosfamide or cyclophosphamide?

These drugs are alkylating agents that increase the risk of hemorrhagic cystitis. Acrolein, the metabolized byproduct of these agents, is excreted by the kidneys into the urine. If allowed to remain in contact with the bladder mucosa, acrolein can cause irritation, inflammation, and bleeding. A urinalysis is performed to look for blood in the urine and to assess hydration status. Mesna (Mesnex) is a uroprotective agent that helps to prevent hemorrhagic cystitis. When given IV, it can be mixed with ifosfamide or cyclophosphamide and given after as IVPB. If given PO, the dose is higher and the drug is foul-tasting. Mesna is a free-sulfhydryl compound. It is these compounds that react to the ketone pad on the urine dipstick and cause the false-positive reading. Careful attention to the urinalysis is needed to check for the presence of blood and the specific gravity reading to assess the patient’s hydration status. — Karen MacDonald, RN, BSN, CPON

COPING WITH COMPASSION FATIGUE

Oncology nurses are exposed every day to so much pain and suffering. Sometimes I feel overwhelmed and drained. Any suggestions? — Kerstin L. McSteen, BSN, MSN, ACHPN, CNS-BC, Minneapolis, MN

Compassion fatigue is very real. It is important to develop strategies to help yourself cope. Do particular patients trigger fatigue? Or is the fatigue generalized – an overall reaction to accumulated stress from caring for oncology patients? If particular patients are more draining, can you take a break from their care, maybe switching assignments? Activate the same coping strategies we offer to oncology patients: Comfort measures—carving out “me time.” Relaxation—music, meditation, etc. Distraction—activities that allow you to forget. Draw on past experiences: what worked for you in the past? Does your hospital offer caregiver support? — Ann Brady, RN, BSN ONA

From the July 01, 2010 Issue of Oncology Nurse Advisor