Unique Plan Description: GYNONC Intraperitoneal Regime Day 1_2
Plan Selection Display: GYNONC Intraperitoneal Regime Day 1_2
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2018-05-15 08:36:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 11:59:35
Available at all facilities: Yes

GYNONC Intraperitoneal Regime Day 1_2
IV Solutions
Chemotherapy PreHydration
		Day 1(NOTE)*
	Sodium Chloride 0.9% IVPB
		100 mL, Solution-Injection, IVPB, Once
			Comment: Run at 20 mL/hr in infusion Center
		Day 2(NOTE)*
	Sodium Chloride 0.9% with KCl 20mEq
		1,000 mL, IV, T+1;N, 1 Dose(s)/Time(s), 250 ml/hr
	Sodium Chloride 0.9%
		500 mL, IV, T+1;N, 1 Dose(s)/Time(s), 20 ml/hr
			Comment: To be used for flushing line between medications
Premeds
		Day 1(NOTE)*
	Ativan
		0.5 mg, Tab, By Mouth, Q4H, PRN, anxiety, 2 Day(s)
			Comment: nausea or vomiting.
	Benadryl
		50 mg, Capsule, BY MOUTH, Once, T;N+60
		25 mg, Capsule, BY MOUTH, Once, T;N+60
	Pepcid
		20 mg, Injection, IV Push, Once, T;N+120
	Decadron injectable
		10 mg, Injection, IV Push, Once, Routine, T;N+120
			Comment: 30 min prior to chemotherapy
	ondansetron
		8 mg, Injection, IV Push, Once, T;N+60
		Day 2(NOTE)*
	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+1;N+120
			Comment: 30 min prior to chemotherapy
	Emend for Injection
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T+1;N+30, duration: 1 Dose(s)/Time(s)
			Comment: IF patient has NOT taken oral Emend.  Infuse over 30 minutes; give 30 minutes prior to chemotherapy.
	Sodium Chloride 0.9% IntraPERITONEAL
		1,000 mL, IntraPeritoneal, Once, T+1;N, 1 Dose(s)/Time(s)
			Comment: Administer 500-1000mL as rapidly as possible dependent on patient comfort
Chemotherapy Agent
		Day 1(NOTE)*
	PACLitaxel/NS 500 mL
		135 mg/m2, IVPB, Once, T;N+90, Infuse Over 3 hr
		50 mL, EVERY BAG
		500 mL, EVERY BAG
		Day 2(NOTE)*
	CISplatin/NS 1000mL
		75 mg/m2, IntraPeritoneal, Once, T+1;N+90, Infuse Over 5 min(s)
			Comment: Verify patient has taken home Emend 125mg po 1hr prior to start of cisplatin.
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
Medications

Patient Care
	Bedrest
		T+1;N
			Comment: Once IP port is accessed until Huber needle removed
	Elevate head of bed
		T+1;N
			Comment: No greater than 30 degrees while port is accessed
	Position Patient
		T+1;N
			Comment: After Huber needle removed, reposition every 15 minutes for 1 hour
	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