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醫囑單
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姓名 |
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病歷號碼 |
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出生 |
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月 |
日 |
時 |
分 |
長 期 醫 囑 |
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臨 時 醫 囑 |
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PC :Carboplatin and
Cyclophosphamide chemotherapy order
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weight: ____Kg. Height: _____cm. Bs:_______. Treatment courses: the
__courses. |
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Start C/T protocol if data (BUN Cr, GOT, Na, K,
Cl, CBC, DC, Platelet, EKG) O.K. |
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On diet as tolerable. |
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Record vital signs q4h, record I/O q8h, body
weight QD. |
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Set up IV line 1 with |
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#4 Carboplatin (200, 300, 400)
mg/m2 total _____mg in 500 cc. N/S IV drip in 1 hr. |
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#5 20% mannitol 300 c.c. IV
drip in 30 min. |
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#6,#7D5W N/S 500 c.c. each
run 500 cc./hr. |
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Antiemetics
with |
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□ #2 100 cc, #3
100 cc. left for antiemetic solvent |
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1.
Tropisetron 1pc in 100 cc D5W (#2) IV drip in 10
min. |
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2. Dexan 10 mg in 100 cc. D5W (#3)
IV drip in 10 min |
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(1),(2). at 30
min. before cisplatin begins, |
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Cyclophosphamide (500, 750, 1000) mg/m2,
total _____ mg IV push during #5~ #7. |
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Akineton 1 Amp IM prn if EPS attack. |
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Novamin 1 Amp IM q4h prn. |
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Please notified Dr. if urine < 200cc/8hrs,
high fever, conscious change, or dyspnea. |
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使用方法：(1)無簽章或簽字之醫囑無效
(2)醫師及護士簽章請緊接於每次醫囑之後簽立。
(3)長期醫囑由粗線邊緣，臨時醫囑由虛線邊緣起寫，務求端正。