Unique Plan Description: GYNONC EMA CO Day 1_2 INPT (MH)
Plan Selection Display: GYNONC EMA CO Day 1_2 INPT (MH)
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2018-05-15 08:39:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-02-19 10:59:36
Available at all facilities: No

Day 1
Admit/Discharge/Transfer
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		T;N, Routine
			Comment: Routine
Activity
	Activity-As Tolerated
		T;N
Diet
	Regular Diet
		T;N
IV Solutions
Chemotherapy PreHydration
	Sodium Chloride 0.9% with KCl 20mEq
		1,000 mL, IV, 100 ml/hr
Premeds
	Ativan
		0.5 mg, Tab, By Mouth, Once, PRN for nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
		1 mg, Tab, By Mouth, Once, PRN for nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
	ondansetron IVPB (MH/WH)
		0.15 mg/kg, Injection-Premix, IVPB, Q4H
			Comment: Give 30 minutes prior to chemotherapy
Chemotherapy Agent
	etoposide/NS 500 mL
		100 mg/m2, IVPB, Once, T;N, 1 Dose(s)/Time(s), Infuse Over 60 min(s)
			Comment: On Admission
		50 mL, EVERY BAG
		500 mL, EVERY BAG
	methotrexate
		100 mg/m2, Injection, IV Push, Once
			Comment: Follow with methotrexate 200 mg/m2Extremely Hazardous Drug | Antineoplastic |  PPE Requirements: Dispensed From Pharmacy In Rx Crush Bag, Double Gloves, Gown, Face Shield If Tube Admin Or Splashing Risk.
	methotrexate/sodium bicarb/D5W 1000mL
		200 mg/m2, IVPB, Once, T;N, Infuse Over 4 hr
			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.
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
	Cosmegen
		0.5 mg, Injection, IV Push, Once
			Comment: On Admission
Medications

Patient Care
	Resuscitation Status
		T;N, Full Code
		T;N, No Code

Day 2
IV Solutions
Premeds
	Ativan
		0.5 mg, Tab, By Mouth, Once, PRN for nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
		1 mg, Tab, By Mouth, Once, PRN for nausea, duration: 1 Dose(s)/Time(s)
			Comment: and/or anxiety
Chemotherapy Agent
	leucovorin
		15 mg, Tab, BY MOUTH, Q12H, T+1;N, duration: 4 Dose(s)/Time(s)
			Comment: Start 24 hours after start of methotrexate, send patient home with RX.
	Cosmegen
		0.5 mg, Injection, IV Push, Once, T+1;0900
			Comment: Give on Day 2
	etoposide/NS 500 mL
		100 mg/m2, IVPB, Once, T+1;0900, Infuse Over 30 min(s)
			Comment: Give on Day 2
		50 mL, EVERY BAG
		500 mL, EVERY BAG
Patient Care

	Patient Education
		Instructions: Educate patient to continue taking leucovorin as prescribed X 3 more doses

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