Unique Plan Description: CARBOplatin/ Etoposide
Plan Selection Display: CARBOplatin/ Etoposide
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2025-10-28 12:09:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-10-28 12:09:00
Available at all facilities: Yes

CARBOplatin/ Etoposide
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Routine, Q24H, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, spec type = Urine
IV Solutions
	Sodium chloride 0.9% Chemo Flush
		25 mL, IVPB, Q1H, PRN IV line flush, 200 ml/hr
Medications
	prochlorperazine
		10 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: first line treatment for nausea/vomiting
		10 mg, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: first line treatment for nausea/vomiting, if unable to take PO
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting not relieved by prochlorperazine.
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting not relieved by prochlorperazine and patient unable to take PO
	LORazepam
		0.5 mg, Injection, IV Push, Q6H, PRN anxiety
			Comment: Related to anticipatory nausea/vomiting
Premeds
	Emend for Injection
		150 mg, INT, IVPB, Once, T;N+60
			Comment: Give on day 1, 30 minutes prior to chemotherapy
	Aloxi/Decadron/NS 50mL
		0.25 mg, IVPB, Once, infuse over 15 min(s), 200 ml/hr, T;N+60
			Comment: Give on day 1, 30 minutes prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	dexamethasone Injectable
		8 mg, Injection, IV Push, Q24H, T+1;N+60, duration: 2 Dose(s)/Time(s)
			Comment: Give on days 2 and 3, 30 minutes prior to chemotherapy
	ondansetron
		8 mg, Injection, IV Push, Once, T+2:N+60
			Comment: Give on Day 3, 30 minutes prior to chemotherapy
	OLANZapine
		5 mg, By Mouth, QHS, duration: 4 Dose(s)/Time(s)
			Comment: Give on days 1 through 4.
Chemotherapy Agent
	CARBOplatin/NS 250 mL
		5 AUC(Carboplatin), IVPB, Once, T;N+150, Infuse Over 30 min(s)
			Comment: On day 1. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		25 mL, EVERY BAG
		250 mL, EVERY BAG
		6 AUC(Carboplatin), IVPB, Once, T;N+150, Infuse Over 30 min(s)
			Comment: On day 1. Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection.
		25 mL, EVERY BAG
		250 mL, EVERY BAG
	etoposide/NS 500 mL
		100 mg/m2, IVPB, Q24H, T;N+90, 3 Dose(s)/Time(s), Infuse Over 60 min(s)
			Comment: Chemotherapy gown, double gloves, face mask, eye protection.
		500 mL, EVERY BAG
		50 mL, EVERY BAG
Patient Care

	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: ensure 2 means of vascular access
	Oral Care
		BID, strict oral care
	Notify MD
		Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
	Initiate MD Plan for:
		T;N, CHEMO Allergy Reaction protocol if patient experiences reaction to treatment.
	Notify MD
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.
Consults/Follow-up
	Pharmacy Consult
		Pharmacist allowed to round doses to nearest measurable volume (0.1 mL) and/or vial size if dose change is not greater than 5% of original calculated dose.

CHEMO Reaction Protocol
Vital Signs
	Vital Signs
		Assess vital signs every 2 to 5 minutes until the patient is stable. Place patient into a recumbent position with elevation of the lower extremities if hypotensive
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		Reassess vital signs every 15 minutes x 2, then q30min x 2, or more frequently as needed, I&O, etc until stable
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in Trendelenburg.
IV Solutions
	Sodium Chloride 0.9% IVPB
		500 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give 1-2 minutes after diphenhydramine if no improvement or if symptoms worsen to include: hypotension, shortness of breath, facial/lip/tongue swelling, and/or any other signs /symptoms of a severe allergic reaction.
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give if dexamethasone unavailable or ineffective and additional steroids are needed, per provider.
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, PRN for see comment
			Comment: For chills and rigors
Patient Care
	Notify MD
		T;N, Contact the oncologist if any of the reaction protocol medications are administered to the patient.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase