Unique Plan Description: GYNONC Intraperitoneal Regime Inpt (MH)
Plan Selection Display: GYNONC Intraperitoneal Regime Inpt (MH)
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: 2024-11-15 15:45:11
Available at all facilities: Yes

Day 1
Admit/Discharge/Transfer
	Admit to Inpatient Status
		T;N, Anticipated LOS 2 midnight or more
	Admit to Observation Status
		T;N
Vital Signs
	Vital Signs
		Record BP prior to and on completion of infusion
Activity
	Bedrest
		T;N
			Comment: Continuously once IP port until Huber needle removed.
	Elevate head of bed
		Elevate head of bed 30 degrees
			Comment: No greater than 30 degrees while port is accessed
Diet
	Regular Diet
		
IV Solutions
Premeds
	Decadron IVPB
		20 mg, IVPB, Once
			Comment: Administer prior to Taxol; give over 15 minutes
	Pepcid
		20 mg, Injection, IV PUSH, Once
			Comment: Administer 30 min prior to Taxol
	Benadryl
		50 mg, Injection, IV PUSH, Once
			Comment: Administer 30 min prior to Taxol
	Ativan
		1 mg, Tab, BY MOUTH, Q4H, PRN, anxiety, 2 Dose(s)/Time(s)
			Comment: nausea or vomiting
Chemotherapy Agent
	PACLitaxel/NS 1000 mL
		135 mg/m2, IVPB, Once, T;N, Infuse Over 24 hr
			Comment:  Infuse over 24 hours.  Verify patient has taken Dexamethasone 20mg po at HS and AM prior to chemotherapy as directed. Verify patient has Emend 125mg PO 1hr prior to start of cisplatin. Place Anaphylaxis kit at bedside. Enter Allergic Reaction Protocol if reaction occurs.
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
Medications

Patient Care
	Resuscitation Status
		No Code
		Full Code
	Intake and Output
		
			Comment: Hourly during infusion
	Notify MD
		T;N, STAT for any reaction
		T;N, If output less than 100 mL x 2 hrs
		T;N, If patient requires pain medication

Day 2
Admit/Discharge/Transfer
	Discharge Conditional
		Conditions to be met: Patient to be dismissed post Cisplatin when vital signs stable and no complaints of uncontrolled pain or nausea
Activity
	Position Patient
		T+1;0900
			Comment: After Huber needle removed, reposition every 15 minutes for 1 hour
IV Solutions
Chemotherapy PreHydration
	Dextrose 5% with 0.9% NaCl
		1,000 mL, IV, PRN, see comment, T+1;0700, 1 Day(s)
			Comment: Give 500 mL bolus and continue at 250 mL/hr for remainder of stay
Premeds
	ondansetron IVPB (MH/WH)
		32 mg, Injection-Premix, IVPB, Once, T+1;0700, 1 Day(s)
			Comment: Administer 30 min prior to cisplatin
	Decadron IVPB
		12 mg, IVPB, Once, T+1;0700
			Comment: Administer 30 min prior to cisplatin; give over 15 minutes
	NF - medication from home
		Emernd 125 mg oral tablet, 1 TAB, By Mouth, Once, T+1;0630
			Comment: Give one hour prior to cisplatin
	Sodium Chloride 0.9%
		250 mL, IntraPeritoneal, T+1;0700, 1 Dose(s)/Time(s)
			Comment: Infuse 50-100 mL of NS to flush port and verify patency prior to pharmacy mixing bag of cisplatin
Chemotherapy Agent
	CISplatin/NS 1000mL
		75 mg/m2, IntraPeritoneal, Once, T+1;0730, Infuse Over 5 min(s)
			Comment: Infuse warmed NS wide open as rapidly as possible.  Upon completion of Cisplatin, flush IP catheter and remove IP needle
		40 mL, EVERY BAG
		1,000 mL, EVERY BAG
Chemotherapy PostMedications
	Sodium Chloride 0.9%
		1,000 mL, IntraPeritoneal, T+1;0700, 1 Dose(s)/Time(s)
			Comment: Infuse 500-1000 mL as rapidly as possible following cisplatin per patient comfort.  Amount to depend on patient's comfort.  Upon completion of Cisplatin, flush IP catheter and remove IP needle

Allergy Reaction Protocol
Activity

	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in trendelenberg
IV Solutions
	Sodium Chloride 0.9%
		500 mL, IV, Routine, Bolus
		1,000 mL, IV, Routine, 30 ml/hr
Medications
	Benadryl
		50 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
		25 mg, Injection, IV Push, Once, PRN, allergic reaction, NOW
	Decadron (MH/WH)
		20 mg, Injection, IV PUSH, Once, PRN, allergic reaction
	SOLU-Medrol
		125 mg, Injection, IV Push, Once
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, Once
		0.5 mg, Injection, IM-Intramuscular, Once
		0.5 mg, Injection, SUBCUTANEOUS, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.5 mg, Injection, IM-Intramuscular, Q10MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 < 30kg(NOTE)*
		0.01 mg/kg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.01 mg/kg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		For infants and children up to age 12 > or equal to 30kg(NOTE)*
		0.3 mg, Injection, SUBCUTANEOUS, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
		0.3 mg, Injection, IM-Intramuscular, Q5MIN, PRN, anaphylaxis, 3 Dose(s)/Time(s)
Patient Care
	Pharmacy Consult
		T;N, Allergy Reaction Protocol was entered on this patient, please verify allergy, and add allergen to patient allergies in medical record
	Discontinue Medication
		T;N, Discontinue IV medication or infusion and remove tubing
	Notify MD
		T;N, Contact PCP for additional orders

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
		<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"><HTML><HEAD><META content="text/html; charset=windows-1252" http-equiv=Content-Type><STYLE> BODY background-color: rgb(128,255,255);margin:0; P margin:0 </STYLE><META name=GENERAT(NOTE)*
		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