• Look

    Does the patient look uncomfortable? Does the patient look ill?

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  • Listen

    Does the patient report headache, fever, tiredness, sleepiness, hallucinations, stiff neck?

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  • Recognize

    Signs of infectious cause (lumbar puncture); Obtain brain MRI; Consult neurologist

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  • Recognize

    Determine specific toxicity and related grade (if applicable) Other related symptoms: hypotension, syncope, chest pain, DOE, SOB, palpitations, edema, etc. Impact of symptoms on QOL/performance status Changes in cardiac function: ECG changes, decreased EF, elevated cardiac enzymes (troponin, CK) Assess other changes in oxygen saturation, BP, lung function

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  • Listen

    Change in energy level? SOB or DOE? Leg edema? Palpitations? Changes in BP? Dizziness or syncope? What exacerbates or improves symptoms? Any new prescribed or OTC meds? Illicit substances? Any underlying cardiac disease (CAD, MI, or other)? What exacerbates or improves symptoms? Prior radiation therapy?

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  • Look

    Does the patient look unwell? Fatigued? Diaphoretic? SOB or in respiratory distress? Is there leg edema?

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  • Recognize

    Laboratory abnormalities (elevated creatinine, electrolyte abnormalities) Urinalysis abnormalities (casts) Abdominal or pelvic disease that could be causing symptoms Prior history of renal compromise? Other immune-related adverse effects? Presence of current or prior immune-mediated toxicities, including rhabdomyolysis Is patient volume depleted?

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  • Look

    Does the patient appear uncomfortable? Does the patient look ill?

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  • Listen

    Has there been change in urination? Urine color? Frequency? How much fluid is the patient taking in? Are associated symptoms present? Nausea? Headache? Malaise? Lung edema? Are there symptoms indicative of: Urinary tract infection? Pyelonephritis? Worsening CHF? Are symptoms limiting ADLs? Current or recent use of nephrotoxic medications (prescribed and OTC), other agents? NSAIDs Antibiotics

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  • Listen

    Does the patient report weakness (unilateral or bilateral)? Does the patient report new or worsened pain, numbness, or tingling? Does the patient report difficulty walking or holding items?

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