Symptom: Faint, feeling

Initial Grading Reminder

CTCAE Grading of Faint, Feeling:

Grade 2 (Moderate): Present (e.g., near fainting)
Grade 3 (Severe): Fainting; orthostatic collapse

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any issues like this in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

Do you just feel faint or have you actually fainted? What makes you feel faint (e.g., rising quickly)? Does it come and go? Is it affecting your ability to take care of yourself?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

How much fluid are you drinking per day? Do you have any change in your bowel function? Do you have a stiff neck or headache? Do you have any swelling in your legs? Have you had experienced any seizures or hallucinations? Is your breath fruity? Have you seen a change in your urination (either increased or decreased)? Do you have any severe abdominal (belly) pain?

Do you have any back pain, itching, flushing, difficulty breathing? Do you have a fever?

(Suggestive of an allergic reaction).

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new-onset moderate or worse (or worsening) symptoms should be seen.

    Patients with any of the red-flag symptoms need to be seen immediately and should not drive (they need someone to drive them).

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    Nursing Assessment of Potential Causes

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    Allergic Reaction to Infusion

    Does the patient have any back pain, itching, flushing, difficulty breathing? Is he/she feeling faint? Does he or she have a fever?

    These symptoms are suggestive of an allergic reaction and the patient should be seen immediately. For patients who had an infusion reaction during the actual infusion, hospitalization is indicated for clinical sequelae