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CSC HEM Prednisone(7D:1-7) Vincristine(7D:1) VER 10-3-16 (HL 4361)

CSC HEM Prednisone(7D:1-7) Vincristine(7D:1) VER 10-3-16 (HL 4361) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Lymphoma


CSC HEM PREDNISONE(7D:1-7)/VINCRISTINE(7D:1) VER: 10-3-16 – Properties
Pre-Cycle – 11/15/2016 through 11/21/2016 (7 days), Planned
Day 1, Pre-Cycle – Planned for 11/15/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma; THERAPY: vinCRIStine 1 mg IV Day 1, prednisone 100 mg by mouth once daily Day 1
through 7; CYCLE LENGTH: 7 days; COURSE: 1 cycle
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
Take Home Medications
ranitidine (ZANTAC) 150 MG tab
Take 1 tab by mouth 2 times daily for 7 days., 150 mg, Disp-14 tab, R-0, 2 X DAILY starting S until S+7 or ending after 14 doses
Cycle 1 – 11/22/2016 through 11/28/2016 (7 days), Planned
Day 1, Cycle 1 – Planned for 11/22/2016
Treatment Plan Information
Reference Information (1)
NON-HODGKIN LYMPHOMA: Pfreundschuh M, et al. Lancet Oncol 2008;9:105-16
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma; THERAPY: vinCRIStine 1 mg IV Day 1, prednisone 100 mg by mouth once daily Day 1
through 7; CYCLE LENGTH: 7 days; COURSE: 1 cycle
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 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: WBC, ANC, Platelets, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 500/µL or Platelets less than 50K/µL or Total Bilirubin greater than ULN
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ZZtestonc,Andrew [2428787]
11/22/2016 12:32:57 PM Page 1 of 2
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Nursing Procedure, Assessment and Monitoring
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.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Treatment Medications
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, ONCE, 1 dose Starting when released
vinCRIStine (ONCOVIN) 1 mg in sodium chloride 0.9 % 25 mL bag
1 mg, Intravenous, ONCE, 1 dose Starting when released
MUST be administered via gravity through a peripheral IV (not on an infusion pump).
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): prednisone
Take Home Medications
prednisone (DELTASONE) 50 MG tab
Take 2 tabs by mouth one time daily. Take on Day 2 through 7., 100 mg, Disp-12 tab, R-0, 1 X DAILY starting S
Follow-Up
FOLLOW-UP
Follow up appointment per MD
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ZZtestonc,Andrew [2428787]
11/22/2016 12:32:57 PM Page 2 of 2
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org