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/clinical/cckm-tools/content/beacon-protocols/head-and-neck/name-96783-en.cckm

201711317

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CSC HEAD/NECK Cabozantinib(28D:1-28) VER 11-10-17 (HL 5099)

CSC HEAD/NECK Cabozantinib(28D:1-28) VER 11-10-17 (HL 5099) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Head and Neck


CSC HEAD/NECK CABOZANTINIB (28D:1-28) VER: 11/10/17 –  Properties
Pre-Cycle –  11/6/2017 through 11/12/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 11/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S Approximate, Expires: S+397, Routine
BUN
Expected: S Approximate, Expires: S+397, Routine
CREATININE
Expected: S Approximate, Expires: S+397, Routine
CALCIUM
Expected: S Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+397, Routine
PHOSPHATE
Expected: S Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S Approximate, Expires: S+365, Routine
URINALYSIS, NO MICROSCOPY
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 1 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Expected: S Approximate, Expires: S+365, Normal, Routine
Pre-Labs (delete all that do not apply)
HCG, QUALITATIVE, URINE
Expected: S Approximate, Expires: S+365, Routine
Cycle 1 –  11/13/2017 through 12/10/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 11/13/2017
Treatment Plan Information
Reference Information (1)
MEDULLARY THYROID CANCER: Kurzrock R, et al. J Clin Oncol 2011;29:2660-6.
Reference Information (2)
MEDULLARY THYROID CANCER: Schoffski P, et al. Proceedings ASCO 2012, abstract #5508.
Treatment Plan Summary
DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Sodium, Potassium, Magnesium, Calcium, Phosphate, AST,
ALT, Total Bilirubin, Alkaline Phosphatase, Urinalysis without Microscopy
Treatment Parameters
Hold treatment and notify authorizing prescriber for: ANC less than 1500/µL or Sodium less than 135 mmol/L or
Potassium less than 3.5 mmol/L or Magnesium less than 1.7 mg/dL or Phosphate less than 2.5 mg/dL or Calcium less
than 8.5 mg/dL or AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline Phosphatase greater than 2.5 x
ULN or Total Bilirubin greater than 1.5 x ULN or Urine Protein greater than or equal to 100 mg/dL
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 2 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): cabozantinib (dispensed Day 1 of
Cycle 1 only - subsequent refills will be ordered through the medication activity).
Take Home Medications
Cabozantinib S-Malate 1 X 80 & 3 X 20 MG KIT
Take 1x80mg cap and 3x20mg cap orally 1x daily with 8oz water. No food 2h before or 1h after dose, Disp-1 Kit, R-0,
starting S, Local Printer
1 kit = 1 box = 28 day supply
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate,
Magnesium, Urinalysis without Microscopy
Cycle 2 –  12/11/2017 through 1/7/2018 (28 days), Planned
Day 1, Cycle 2 –  Planned for 12/11/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 3 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline
Phosphatase greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 4 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate,
Magnesium, Urinalysis without Microscopy
Cycle 3 –  1/8/2018 through 2/4/2018 (28 days), Planned
Day 1, Cycle 3 –  Planned for 1/8/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 5 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline
Phosphatase greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate,
Magnesium, Urinalysis without Microscopy
Cycle 4 –  2/5/2018 through 3/4/2018 (28 days), Planned
Day 1, Cycle 4 –  Planned for 2/5/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 6 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 7 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline
Phosphatase greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate,
Magnesium, Urinalysis without Microscopy
Cycle 5 –  3/5/2018 through 4/1/2018 (28 days), Planned
Day 1, Cycle 5 –  Planned for 3/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 8 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline
Phosphatase greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 9 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate,
Magnesium, Urinalysis without Microscopy
Cycle 6 –  4/2/2018 through 4/29/2018 (28 days), Planned
Day 1, Cycle 6 –  Planned for 4/2/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Medullary Thyroid Cancer (Advanced); THERAPY: cabozantinib 140 mg by mouth once daily continuously;
CYCLE LENGTH: 28 days; COURSE: until disease progression
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+397, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+397, Routine
BUN
Expected: S+28 Approximate, Expires: S+397, Routine
CREATININE
Expected: S+28 Approximate, Expires: S+397, Routine
CALCIUM
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 10 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Expected: S+28 Approximate, Expires: S+397, Routine
ALBUMIN
Expected: S+28 Approximate, Expires: S+397, Routine
PROTEIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+397, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+397, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+397, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+397, Routine
PHOSPHATE
Expected: S+28 Approximate, Expires: S+365, Routine
MAGNESIUM
Expected: S+28 Approximate, Expires: S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT, Alkaline Phosphatase, Total Bilirubin
Treatment Parameters
Hold treatment and notify authorizing prescriber for: AST greater than 3 x ULN or ALT greater than 3 x ULN or Alkaline
Phosphatase greater than 2.5 x ULN or Total Bilirubin greater than 1.5 x ULN
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome and to call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, cabozantinib will be ordered through the medication activity after the initial order.
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:44:31 AM Page 11 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Phosphate,
Magnesium, Urinalysis without Microscopy
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org