Unique Plan Description: GYNONC Cytoxan Every 3 Wk (MH)
Plan Selection Display: GYNONC Cytoxan Every 3 Wk (MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2018-05-15 08:38:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-02-19 10:56:37
Available at all facilities: No

GYNONC Cytoxan Every 3 Wk (MH)
IV Solutions
Chemotherapy PreHydration
	Sodium Chloride 0.9% IVPB
		100 mL, Solution-Injection, IVPB, Once
			Comment: Infuse at 20 mL/hr
Premeds
	ondansetron/dexamethasone/NS 50mL
		16 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+120
			Comment: 30 min prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
	Ativan
		0.5 mg, Tab, BY MOUTH, Once, PRN, anxiety, 1 Day(s)
			Comment: nausea or vomiting
		1 mg, Tab, BY MOUTH, Once, PRN, anxiety, 1 Day(s)
			Comment: nausea or vomiting
Chemotherapy Agent
	cyclophosphamide/D5W 500mL
		500 mg/m2, IVPB, Once, T;N+90, Infuse Over 60 min(s)
			Comment: Extremely Hazardous Drug | Antineoplastic |  PPE Requirements: Dispensed From Pharmacy In Rx Crush Bag, Double Gloves, Gown, Face Shield If Tube Admin Or Splashing Risk.
		50 mL, EVERY BAG
		500 mL, EVERY BAG
Medications

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