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Download 51038 CHEMO RICE Orders QM0811-080911
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attach patient label here Physician Orders ADULT Order Set: RICE Diagnosis : Non- Hodgkin's Lymphoma Chemotherapy Height: ___________cm Weight: __________kg Cycle: _____ Of :________ Actual BSA:_____________m2 Treatment BSA:______________m2 Day/Wk:______ Freq: ______ [ ] No known allergies Allergies: [ ]Medication allergy(s):_____________________________________________________________________ [ ] Latex allergy [ ]Other:__________________________________________________________________ Patient Care [ ] Nursing Communication T;N, Do not exceed a treatment BSA of ________ m2 [ ] Nursing Communication [ ] Normal Saline T;N, May hold hydration during chemotherapy infusion Continuous Infusions Pre Hydration 1,000 mL, IV, Routine, ____mL/hr Medications Pre Medication Administer the below before Rituximab : [X] [X] acetaminophen 650 mg, Tab, PO, Once,Comment: to be given prior to rituximab infusion diphenhydrAMINE 25 mg, Injection, PO, Once, Comment: to be given prior to rituximab infusion CHEMOTHERAPY Drug (generic) & solution (optional) Intended Dose [X] rituximab 375 mg/m2 [X] etoposide 100 mg/m2 [X] carboplatin AUC 5 [X] ifosfamide 5000 mg/m2 [X] MESNA 5000 mg/m2 Actual Dose Route, Infusion, Frequency and total doses IV Piggyback, Infuse using Rituximab flowsheet, ONCE on DAY 1 IV Piggyback, Infuse over 90 min, q24h on DAYS 1- 3 IV Piggyback, Infuse over 1 hour, ONCE on DAY 2 Continuous Infusion, Infuse over 24 hours, ONCE on DAY 2 Continuous Infusion, Infuse over 24 hours, ONCE on DAY 2 NOTE: Mix ifosfamide and MESNA together in 1 L bag Acute Emesis Prophylaxis ( may undergo therapeutic interchange) NOTE: Administer intial doses at least 30-60 minutes prior to chemotherapy [X] ondansetron 12 mg, Injection, IV Piggyback, qDay, on DAYS 1-3 10 mg, Tab, PO, q6h, PRN Nausea/Vomiting [X] prochlorperazine 10 mg, Injection, IV Push, q6h, PRN Nausea/Vomiting , Comment : if unable to [X] take PO prochlorperazine [X] dexamethasone [ ] Notify Physician- Once __________________ __________________ Date Time 8 mg, Injection, IV Push, Q Day , on DAYS 2 and 3 Consults/Notifications T;N, Who: _____________________, For: if BSA exceeds 2 m 2 _________________________________________________ Physician's Signature __________________ MD Number *111* 51038-CHEMO RICE Orders- QM0811-080911 Page 1 of 1
