Initial Grading Reminder
Grade 1: Asymptomatic; clinical or diagnostic observations only; intervention not indicated
Grade 2: Moderate symptoms; medical intervention indicated; limiting instrumental ADLs
Grade 3: Symptomatic, associated with hypotension and/or tachycardia; limiting self-care ADLs
Assessment and Grading
Characterize the symptom (onset, pace)
Ask the patient:
Do you have any pre-existing conditions that lead to flushing (e.g., rosacea)? 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:
How bad is your flushing? Do you feel like your heart is racing?
Patient Query Regarding Other Symptoms/Red Flags
Ask the patient:
Do you have any back pain, itching, difficulty breathing? Are you feeling faint? Do you have a fever?
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 moderate or worse flushing should be seen.
The presence of any of the red-flag 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.
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Nursing Assessment of Potential Causes
Highly suggestive of infusion reaction outside of other causes
Differential Diagnosis
What do you suspect is the cause of the flushing?
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