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201711317

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CSC HEAD/NECK Sorafenib(28D:1-28) VER 11-10-17 (HL 4743)

CSC HEAD/NECK Sorafenib(28D:1-28) VER 11-10-17 (HL 4743) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Head and Neck


CSC HEAD/NECK SORAFENIB (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: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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
URINALYSIS, NO MICROSCOPY
Expected: S Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Treatment Condition A
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

Verify ECG obtained.
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN
starting S, Local Printer
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)
THYROID CANCER: Brose MS, et al. 2013 ASCO Proceedings; abstract 4.
Treatment Plan Summary
DISEASE: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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, Albumin, AST, ALT, Alkaline Phosphatase, Total Bilirubin,
Urine Protein and Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for ANC less than 1000/uL, Platelets less than 75K/uL, Creatinine
Clearance less than 40 mL/min, Urine Protein greater than 100 mg/dL, Albumin less than 2.5 g/dL, Total Bilirubin greater
then 1.5 mg/dL, AST greater than ULN, ALT greater than ULN, Alkaline Phosphatase greater than ULN, Blood Pressure
greater than 140/90 mmHg or QTC greater than 500 msec or QTC increase of greater than or equal to 60 msec from
baseline.
Treatment Condition A
Verify ECG obtained.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Sorafenib: Educate patient about hand-foot syndrome and hypertension.
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
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

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
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): sorafenib (dispensed on Day 1 of
Cycle 1 only - subsequent refills will be ordered through the medication activity).
Take Home Medications
sorafenib (NEXAVAR) 200 MG tab
Take 2 tabs by mouth 2 times daily. Take on empty stomach., 400 mg, Disp-120 tab, R-0, 2 X DAILY starting S
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 and 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: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

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
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Albumin, AST, ALT, Alkaline Phosphatase, Total Bilirubin,
Urine Protein and Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for ANC less than 1000/uL, Platelets less than 75K/uL, Creatinine
Clearance less than 40 mL/min, Urine Protein greater than 100 mg/dL, Albumin less than 2.5 g/dL, Total Bilirubin greater
then 1.5 mg/dL, AST greater than ULN, ALT greater than ULN, Alkaline Phosphatase greater than ULN, Blood Pressure
greater than 140/90 mmHg or QTC greater than 500 msec or QTC increase of greater than or equal to 60 msec from
baseline.
Treatment Condition A
Verify ECG obtained.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Sorafenib: Educate patient about hand-foot syndrome and hypertension.
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.
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sorafenib 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 and 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: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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
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
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Albumin, AST, ALT, Alkaline Phosphatase, Total Bilirubin,
Urine Protein and Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for ANC less than 1000/uL, Platelets less than 75K/uL, Creatinine
Clearance less than 40 mL/min, Urine Protein greater than 100 mg/dL, Albumin less than 2.5 g/dL, Total Bilirubin greater
then 1.5 mg/dL, AST greater than ULN, ALT greater than ULN, Alkaline Phosphatase greater than ULN, Blood Pressure
greater than 140/90 mmHg or QTC greater than 500 msec or QTC increase of greater than or equal to 60 msec from
baseline.
Treatment Condition A
Verify ECG obtained.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Sorafenib: Educate patient about hand-foot syndrome and hypertension.
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, sorafenib 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 and Urinalysis without
Microscopy.
Cycle 4 –  2/5/2018 through 3/4/2018 (28 days), Planned
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

Day 1, Cycle 4 –  Planned for 2/5/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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: CBC with DIFF, Albumin, AST, ALT, Alkaline Phosphatase,
Total Bilirubin, Urine Protein and Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for ANC less than 1000/uL, Platelets less than 75K/uL, Creatinine
Clearance less than 40 mL/min, Urine Protein greater than 100 mg/dL, Albumin less than 2.5 g/dL, Total Bilirubin greater
then 1.5 mg/dL, AST greater than ULN, ALT greater than ULN, Alkaline Phosphatase greater than ULN or Blood Pressure
greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Sorafenib: Educate patient about hand-foot syndrome and hypertension.
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, sorafenib 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 and 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: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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.
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

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
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Albumin, AST, ALT, Alkaline Phosphatase, Total Bilirubin,
Urine Protein and Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for ANC less than 1000/uL, Platelets less than 75K/uL, Creatinine
Clearance less than 40 mL/min, Urine Protein greater than 100 mg/dL, Albumin less than 2.5 g/dL, Total Bilirubin greater
then 1.5 mg/dL, AST greater than ULN, ALT greater than ULN, Alkaline Phosphatase greater than ULN or Blood Pressure
greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Sorafenib: Educate patient about hand-foot syndrome and hypertension.
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 10:47:14 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, sorafenib 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 and 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: Thyroid Cancer (Advanced, Recurrent or Metastatic Progressive); THERAPY: sorafenib 400 mg by mouth twice
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 10:47:14 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
URINALYSIS, NO MICROSCOPY
Expected: S+28 Approximate, Expires: S+365, Normal, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Albumin, AST, ALT, Alkaline Phosphatase, Total Bilirubin,
Urine Protein and Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for ANC less than 1000/uL, Platelets less than 75K/uL, Creatinine
Clearance less than 40 mL/min, Urine Protein greater than 100 mg/dL, Albumin less than 2.5 g/dL, Total Bilirubin greater
then 1.5 mg/dL, AST greater than ULN, ALT greater than ULN, Alkaline Phosphatase greater than ULN or Blood Pressure
greater than 140/90 mmHg.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Sorafenib: Educate patient about hand-foot syndrome and hypertension.
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, sorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
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Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 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

(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 and Urinalysis without
Microscopy.
Zztestonc,PedsBeiber [2668824]
11/13/2017 10:47:14 AM Page 12 of 12
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org