The nurse prepares a client for the first cycle of cisplatin. Which plan is appropriate?
1Provide prescribed hydration and antiemetic prophylaxis and monitor creatinine, magnesium, potassium, and hearing.✓ Correct answer
2Restrict fluids during treatment and monitor blood urea nitrogen without checking magnesium or hearing.
3Delay antiemetics until nausea begins and assess liver enzymes and visual acuity as the priority tests.
4Give mannitol without hydration and postpone renal and electrolyte testing until the treatment cycle is complete.
Explanation
Cisplatin can cause cumulative nephrotoxicity, renal electrolyte wasting, severe nausea and vomiting, and ototoxicity. Adequate hydration, highly effective antiemetic prophylaxis, and baseline and serial monitoring of renal function, magnesium, potassium, and hearing are appropriate. Fluid restriction, delayed antiemetics, and osmotic diuresis without hydration increase risk.
Clinical reasoning Cisplatin injury commonly affects the renal tubules and cochlea and can cause substantial magnesium and potassium losses. It is also highly emetogenic.
Decision rule Before and during cisplatin, protect renal perfusion with the prescribed hydration plan, prevent nausea before it starts, and trend renal function, electrolytes, and hearing.
Scenario 38-year-old male starting cisplatin for testicular cancer.
Cisplatin — Platinum chemotherapy; nephro-, oto-, and neurotoxic; severely emetogenic.
Aggressive hydration — Pre-, during, and post-cisplatin to reduce nephrotoxicity.
Audiometry — Baseline and serial hearing test for cisplatin ototoxicity.