Unique Plan Description: GYNONC Doxil Every 28 Days (MH)
Plan Selection Display: GYNONC Doxil Every 28 Days (MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2018-05-15 08:40:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-01-14 13:12:12
Available at all facilities: No

GYNONC Doxil Every 28 Days (MH)
IV Solutions
Chemotherapy PreHydration
	Dextrose 5% in Water IVPB
		100 mL, IVPB, Once, 20 ml/hr
			Comment: Infuse at a rate of 20ml/hr. In Infusion Center
	Sodium Chloride 0.9% IVPB
		100 mL, Solution-Injection, IVPB, Once, 20 ml/hr
			Comment: infuse at 20 mL/hr in Infusion Center
Premeds
	Ativan
		0.5 mg, Tab, BY MOUTH, Once, PRN for anxiety, duration: 1 Dose(s)/Time(s)
			Comment: Give prior to chemotherapy.
		1 mg, Tab, BY MOUTH, Once, PRN for anxiety, duration: 1 Dose(s)/Time(s)
			Comment: Give prior to chemotherapy.
	ondansetron/dexamethasone/NS 50mL
		12 mg, EVERY BAG
		16 mg, IVPB, Once, Routine, infuse over 15 min(s), 200 ml/hr, T;N+120
			Comment: 30 min prior to chemotherapy
		50 mL, EVERY BAG
Chemotherapy Agent
	DOXOrubicin liposomal/D5W 250mL
		30 mg/m2, IVPB, Once, T;N+90, Infuse Over 60 min(s)
			Comment: Infuse initial cycle over 90 minutes, Infuse following cycles over 60 minutes.
		25 mL, EVERY BAG
		250 mL, EVERY BAG
		40 mg/m2, IVPB, Once, T;N+90, Infuse Over 60 min(s)
			Comment: Infuse initial cycle over 90 minutes, Infuse following cycles over 60 minutes.
		25 mL, EVERY BAG
		250 mL, EVERY BAG
	Mvasi/NS 100 mL
		100 mL, EVERY BAG
		10 mg/kg, IVPB, Once, T;N+30, Infuse Over 60 min(s)
			Comment: Infuse initial dose over 90  (+/- 15) minutes.Second dose: Infuse over 60  (+/- 10) minutes if no adverse reaction with first dose (includes fever/chills). Third and subsequent doses: Infuse over 30  (+/- 10) minutes if no adverse reaction with first dose (includes fever/chills).
		10 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: 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