Unique Plan Description: GYNONC Cisplatin/Etoposide (small cell)(MH)
Plan Selection Display: GYNONC Cisplatin/Etoposide (small cell)(MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2018-05-15 07:02:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-10-08 08:59:42
Available at all facilities: Yes

GYNONC Cisplatin/Etoposide (small cell)(MH)
IV Solutions
Chemotherapy PreHydration
		DAY 1(NOTE)*
	Dextrose 5% with 0.9% NaCl w/KCl 20 mEq
		1,000 mL, IV, Routine, T;N, 1 Dose(s)/Time(s), 500 ml/hr
			Comment: Administer 500 mL at 500 mL/hr 1 hrs prior to chemotherapy and 1 hours after chemo
	Sodium Chloride 0.9%
		500 mL, IV, T;N, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: To flush line between medications
		DAY 2 and 3(NOTE)*
		500 mL, IV, T+1;N, 1 Dose(s)/Time(s), 250 ml/hr
		500 mL, IV, T+2;N, 1 Dose(s)/Time(s), 250 ml/hr
Premeds
		DAY 1(NOTE)*
	potassium chloride Oral
		20 mEq, Tablet-Extended-Release, By Mouth, Once, T;N
	Ativan
		0.5 mg, Tab, By Mouth, Q4H, PRN, anxiety, 3 Day(s)
			Comment: Give 30 minutes prior to chemotherapy.
	Emend for Injection
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+120
			Comment: Infuse over 30 minutes; give 30 minutes prior to chemotherapy.
	Pepcid
		20 mg, Injection, IV Push, Once, T;N+180
	Aloxi/Decadron/NS 50mL
		12 mg, EVERY BAG
		50 mL, EVERY BAG
		0.25 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+180
			Comment: 30 min prior to chemotherapy
	magnesium sulfate IVPB
		2 gm, INT, IVPB, Once, T;N
		DAY 2(NOTE)*
	Pepcid
		20 mg, Injection, IV Push, Q24H, T+1;N+180, duration: 2 Dose(s)/Time(s)
	Decadron injectable
		10 mg, Injection, IV Push, Q24H, Routine, T+1;N+180, duration: 2 Dose(s)/Time(s)
			Comment: 30 min prior to chemotherapy
Chemotherapy Agent
	etoposide/NS 500 mL
		100 mg/m2, IVPB, Q24H, T;N+210, 3 Dose(s)/Time(s), Infuse Over 60 min(s)
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	CISplatin/NS 500mL
		50 mg/m2, IVPB, Once, T;N+150, Infuse Over 60 min(s)
			Comment: Administer 500 mL at 500 mL/hr 1 hrs prior to chemotherapy and 1 hours after.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
Medications

	potassium chloride Oral
		20 mEq, Tab, By Mouth, Once, T+1;N+60
Patient Care
	Notify MD
		T;N, Contact Provider for further orders if allergic reaction protocol initiated
	Initiate MD Plan for:
		T;N, Allergy Reaction protocol if patient experiences reaction to treatment

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: for moderate to severe reaction to chemotherapy
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 1st choice steroid
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 2nd choice steroid
	Solu-CORTEF
		100 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 3rd choice steroid
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, 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