姓名

病歷號碼

床號

出生

　年　　月　　日

年

月

日

時

分

長　　期　　醫　　囑

臨　　時　　醫　　囑

CE :      Carboplatin, and Etopside chemotherapy order

weight: ______Kg.  Height: _______cm. m²:_______. Treatment courses: the ____courses.

1.  Start C/T protocol if data (BUN Cr, GOT, Na, K, Cl, CBC, DC, Platelet, EKG) O.K

2.  On diet as tolerable.

3.  Record vital signs q4h, record I/O q8h, body weight QD.

4.  Set up IV line with D5W 500 c.c keep open

5.  Carboplatin (150,450)mg/ m²  total_____mg in N/S 500c.c run 125 c.c/hr on D1

6.  (a) primperan 2mg/kg,total _____mg in 250c.c D5W drip in 10 min.

   (b) vena 30mg in 100c.c D5W IV drip in 10 min

   (c) Dexan 20 mg in 100c.c D5W IV drip in 10 min

(a)(b)(c) at 30 min before starting carboplatin and the end of carboplatin infusion.

7.  Etoposide (75,100) mg/m², total _____mg in #4 N/S 500 cc. IVF within 2 hrs from D1

to D3.

8.  Akineton 1 Amp IM prn if EPS attack.

9.  Novamin 1 Amp IM q4h prn.

10.  Please notified Dr. if urine < 200cc/8hrs, high fever, conscious change, or dyspnea.