Unique Plan Description: ONC R-CHOP
Plan Selection Display: ONC R-CHOP
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2022-02-07 13:17:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-05-27 15:49:29
Available at all facilities: Yes

ONC R-CHOP
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
		T;N, Routine, Q24H, spec type = Blood
	Comprehensive Metabolic Panel
		T+1;0400, Routine, Q24H, spec type = Blood
		T;N, Stat, spec type = Blood
	Hepatitis B Surface Antigen
		T;N, Stat, spec type = Blood
	Pregnancy Test Urine
		T;N, Stat, Stat, spec type = Urine
Diagnostic Tests
	Echo w Doppler resting
		Stat, Indication: Chemotherapy/follow-up exam, Stat if not previously done, prior to administration of doxorubicin
IV Solutions
	Sodium Chloride 0.9%
		250 mL, IV, T;N+30, 25 ml/hr
			Comment: use as primary/flush with rituximab-abbs, doxorubicin and vincristine
	Dextrose 5% in water Chemo flush
		250 mL, IV, Once, 25 ml/hr, T;N+270
			Comment: use as primary/flush with cyclophosphamide
Premeds
	acetaminophen
		1,000 mg, Tab, By Mouth, Once
			Comment: give 30 minutes prior to rituximab-abbs
		650 mg, Tab, By Mouth, Once
			Comment: give 30 minutes prior to rituximab-abbs
	diphenhydrAMINE
		50 mg, Injection, IV Push, Once
			Comment: give 30 minutes prior to rituximab-abbs
		25 mg, Injection, IV Push, Once
			Comment: give 30 minutes prior to rituximab-abbs
	ondansetron
		0.15 mg/kg, INT, IVPB, Once, T;N+270
			Comment: give 30 minutes prior to cyclophosphamide
	palonosetron
		0.25 mg, Injection, IV Push, Once, T;N+270
			Comment: give 30 minutes prior to cyclophosphamide
	Emend for Injection
		150 mg, INT, IVPB, Once, infuse over 30 min(s), T;N+270
			Comment: give 30 minutes prior to cyclophosphamide
Chemotherapy Agent
		Day 1(NOTE)*
	riTUXimab-abbs/NS 500mL
		500 mL, IV, T;N+30, 1 Dose(s)/Time(s)
			Comment: Initial infusion: Start an infusion rate of 50 mg/hour; if there is no infusion-related reaction, increase the rate by 50 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour.
		375 mg/m2, EVERY BAG, 50 mg/hr
		500 mL, IV, Routine, T;N+30, 1 Dose(s)/Time(s)
			Comment: Initial infusion: Start an infusion rate of 50 mg/hour; if there is no infusion-related reaction, increase the rate by 50 mg/hour increments every 30 minutes, to a maximum rate of 400 mg/hour
		500 mg/m2, EVERY BAG, 50 mg/hr
	cyclophosphamide/D5W 250mL
		750 mg/m2, IVPB, Once, T;N+300, Infuse Over 30 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.
		25 mL, EVERY BAG
		250 mL, EVERY BAG
	DOXOrubicin/NS 100 mL
		50 mg/m2, IVPB, Once, Routine, infuse over 20 min(s), T;N+330
			Comment: Vesicant.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
	vinCRIStine/NS 50 mL
		1.4 mg/m2, IVPB, Once, T;N+350, Infuse Over 15 min(s)
			Comment: Vesicant. MAX DOSE 2mg.
		5 mL, EVERY BAG
		50 mL, EVERY BAG
		Days 1-5(NOTE)*
	predniSONE
		100 mg, Tab, By Mouth, DAILY, duration: 5 Dose(s)/Time(s)
Medications

	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, BID, T+1;0900, duration: 4 Dose(s)/Time(s)
	prochlorperazine
		10 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: For nausea refractory to zofran
		10 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: For nausea refractory to ondansetron, if unable to take PO
	LORazepam
		0.5 mg, Injection, IV Push, Q6H, PRN anxiety
			Comment: related to anticipatory nausea/vomiting
Patient Care
	Obtain Consent/Permit for:
		T;N, or verify Consent for Chemotherapy
	Hazardous Drug Precautions
		T;N
	IV-Maintain
		T;N
			Comment: insure 2 vascular access devices
	Oral Care
		BID, Strict oral care
	Vital Signs
		T;N, Prior to beginning rituximab-abbs infusion, then with each rate change and PRN
	Notify MD
		T;N, Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.  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