Unique Plan Description: ONC 7 + 3 AML Induction
Plan Selection Display: ONC 7 + 3 AML Induction
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2022-08-19 16:21:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-04-18 12:16:07
Available at all facilities: Yes

ONC 7 + 3 AML Induction
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
	Pregnancy Test Urine
		T;N, Routine, Routine, Urine Random, spec type = Urine
Diagnostic Tests
	Echo w Doppler resting
		Stat, Indication: Chemotherapy/follow-up exam
			Comment: Stat if not previously done, prior to administration of daunorubicin/idarubicin
IV Solutions
	Sodium Chloride 0.9% IV Flush
		250 mL, IVPB, DAILY, 25 ml/hr, T;N+30, duration: 7 Day(s)
			Comment: Use as primary/flush with cytarabine and daunorubicin/idarubicin
Premeds
	palonosetron/dexamethasone/NS 50mL
		0.25 mg, IVPB, Once, Routine, infuse over 15 min(s), T;N+90
			Comment: Give 30 minutes prior to chemotherapy
		12 mg, EVERY BAG
		50 mL, EVERY BAG
Chemotherapy Agent
	Cytarabine 100mg/m2 NS 1000mL
		80 mL, EVERY BAG
		1,000 mL, EVERY BAG
		100 mg/m2, IVPB, Q24H, Routine, T;N+135, 7 Dose(s)/Time(s), 42 ml/hr
			Comment: Vesicant. Give daily over 24 hours each day for 7 days
	Cytarabine 200mg/m2 NS 1000mL
		80 mL, EVERY BAG
		1,000 mL, EVERY BAG
		200 mg/m2, IVPB, Q24H, Routine, T;N+135, 7 Dose(s)/Time(s), 42 ml/hr
			Comment: Vesicant. Give daily over 24 hours each day for 7 days
	IDArubicin/NS 50mL
		12 mg/m2, IVPB, Q24H, T;N+120, 3 Dose(s)/Time(s), 200 ml/hr
			Comment: 12 mg/m2 Vesicant. Give daily over 15 minutes each day for 3 days. Drug is red-orange in color.
		5 mL, EVERY BAG
		50 mL, EVERY BAG
	DAUNOrubicin/NS 100mL
		45 mg/m2, IVPB, Q24H, T;N+120, 3 Dose(s)/Time(s), 200 ml/hr
			Comment: 45 mg/m2 Vesicant. Give daily over 15 minutes each day for 3 days. Drug is red in color.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		60 mg/m2, IVPB, Q24H, T;N+120, 3 Dose(s)/Time(s), 200 ml/hr
			Comment: 60 mg/m2 Vesicant. Give daily over 15 minutes each day for 3 days. Drug is red in color.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
		90 mg/m2, IVPB, Q24H, T;N+120, 3 Dose(s)/Time(s), 200 ml/hr
			Comment: 90 mg/m2 Vesicant. Give daily over 15 minutes each day for 3 days. Drug is red in color.
		10 mL, EVERY BAG
		100 mL, EVERY BAG
Medications

	dexAMETHasone
		8 mg, Tab, By Mouth, DAILY, T+1;0900, duration: 2 Dose(s)/Time(s)
			Comment: Give daily on days 2 and 3
	dexamethasone Injectable
		8 mg, Injection, IV Push, DAILY, T+1;0900, duration: 2 Dose(s)/Time(s)
			Comment: Give daily on days 2 and 3
	prochlorperazine
		10 mg, Tab, By Mouth, Q8H, PRN nausea and/or vomiting
		10 mg, Injection, IV Push, Q6H, PRN nausea and/or vomiting
	ondansetron
		8 mg, Tablet-Disintegrating, By Mouth, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting, consider IV if NPO and/or if unrelieved by prochlorperazine
		8 mg, Injection, IV Push, Q8H, PRN nausea and/or vomiting
			Comment: For nausea/vomiting unrelieved by prochlorperazine, (if ordered).
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 means of vascular access
	Oral Care
		BID
			Comment: Strict oral care
	Neurologic Assessment (CP)
		Q4H
			Comment: With start of cytarabine administration
	Notify MD
		T;N, Contact Provider for further orders if allergic reaction protocol initiated.
			Comment: Any abnormal baseline vital signs or Symptoms of moderate to severe reaction or severe hypersensitivity.
	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, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, Solution-Injection, IVPB, DAILY, PRN see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 1st choice steroid
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 2nd choice steroid
	Solu-CORTEF
		100 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: for moderate to severe reaction to chemotherapy, 3rd choice steroid
	EPINEPHrine
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, may repeat every 10 minutes for up to 3 doses
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN see comment
			Comment: for hypersensitivity reaction not resolved by diphenhydramine and/or anaphylactic				reactions to chemotherapy, 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
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