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 \nPHYO  \nCMC84733-001NS Rev. 11/2022  \nCHILDREN'S HEALTH  \nPatient Name:  \nDate of Birth:  \nEculizumab (SOLIRIS) Therapy Plan  \nPage 1 of 6  \nBaseline Patient Demographic  \nTo be completed by the ordering provider.  \nDiagnosis:    \n NKDA-No Known Drug Allergies   \nHeight:   cm Weight:   kg Body Surface Area:   (m2 )  \nAllergies:    \nTherapy Plan orders extend over time (several visits) including recurring treatment.  \nPlease specify the following regarding the entire course of therapy:  \nDuration of treatment:   weeks   months   unknown  \nTreatment should begin:  as soon as possible (within a week)  within the month  \n**Plans must be reviewed / re-ordered at least annually. **  \nORDERS TO BE COMPLETED FOR EACH THERAPY  \nADMIT ORDERS  \n~~􀀹~~ Height and weight  \n􀀹 Vital signs  \nHypotension Defined Admit  \n􀀹 Nursing communication  \nPrior to starting infusion, please determine the patient's threshold for hypotension as defined by the following parameters. This information will be needed in the event of an infusion reaction occurring.  \nHypotension is defined as follows:  \n1 month to 1 year-systolic blood pressure (SBP) less than 70  \n1 year to 11 years-systolic blood pressure (SBP) less than 70 + (2 x age in years)  \n11 years to 17 years-systolic blood pressure (SBP) less than 90  \nOR any age-systolic blood pressure (SBP) drop of more than 30% from baseline.  \nBaseline systolic blood pressure (SBP) x 0.7 = value below defined as hypotension.  \nNURSING ORDERS  \nPlease select all appropriate therapy  \nIV START NURSING ORDERS  \n Insert peripheral IV / Access IVAD  \nPlace PIV if needed or access IVAD if available  \n lidocaine 1% BUFFERED (J-TIP LIDOCAINE)  \n0.2 mL, INTRADERMAL, PRN  \n when immediate procedure needed  when procedure will take about 1 minute  patient / family preference for procedure Administration Instructions: NOTE: Do not use this medication in patients with bleeding disorders, platelets \u003C 20,000, or in patients taking anticoagulants, when accessing implanted ports or using a vein that will be utilized for chemotherapy administration, nor for pre-term infants or neonates.  \n lidocaine-prilocaine (EMLA) cream  \nTOPICAL, PRN  \n when more than 60 minutes are available before procedure  when procedure will take more than 1 hour  \n patient / family preference for procedure  \nAdministration Instructions: NOTE: In children \u003C 3 months of age, or \u003C 5 kg in weight, maximum application time is 1 hour.  \nKey: cm = centimeter; gm = gram; IV = intravenous; IVAD = implantable venous access device; kg = kilogram; m² = square meters; mg = milligram; mL = milliliter; mL / hr = milliliters per hour; mOsm / L = milliosmole per liter; NKDA = No Known Drug Allergies; pH = hydrogen ion concentration; PIV = peripheral intravenous; PRN = as needed; PVC = peripheral venous catheter  \n*PHYO*  \nPHYO  \nCMC84733-001NS Rev. 11/2022  \nCHILDREN'S HEALTH  \nPatient Name:  \nDate of Birth:  \nEculizumab (SOLIRIS) Therapy Plan  \nPage 2 of 6  \nORDERS TO BE COMPLETED FOR EACH THERAPY  \nNURSING ORDERS, CONTINUED  \n lidocaine with transparent dressing 4% kit  \nTOPICAL, PRN  \nwhen 20-30 minutes are available before procedure  when procedure will take more than 1 hour patient / family preference for procedure  \n Heparin flush  \nheparin flush  \n10-50 units, INTRAVENOUS, PRN, IV line flush. Per protocol, heparin should not be used to flush peripheral IVs. This heparin flush should be used with all central lines including IVADs, with the exception of de-accessing the IVAD.  \nheparin flush  \n100 - 300 units, INTRAVENOUS, PRN, IV line flush. Per protocol, heparin should not be used to flush peripheral IVs. For use only when de-accessing IVADs.  \nSodium chloride flush  \nSodium chloride flush 0.9% injection  \n1-20 mL, INTRAVENOUS, PRN, IV line flush Sodium chloride-preservative free 0.9% injection  \n1-30 mL, INTRAVENOUS, PRN, IV line flush  \nPRE-PROCEDURE LABS  \n􀀹 Haptoglobin INTERVAL: every visit  \nUnit collect  \n􀀹 Lactate Dehydrogenase INTERVAL: every visit U","cbCaijWpUi7CU8El","https://ap.wps.com/l/cbCaijWpUi7CU8El","pdf",268205,"English","# Baseline Patient Demographic\n## Orders to be completed for each therapy\n## Admit orders\n## Nursing orders\n## Pre-procedure labs\n## Intra-procedure","[{\"question\":\"该治疗计划需要多久复核一次？\",\"answer\":\"计划要求至少每年进行复核并重新开立/重订医嘱。\"},{\"question\":\"如何判定输注前的低血压阈值？\",\"answer\":\"根据年龄段的收缩压（SBP）阈值以及“与基线相比SBP下降超过30%”的标准判定；并可用基线SBP×0.7推算低血压界值。\"},{\"question\":\"输注期间需要监测哪些内容？\",\"answer\":\"输注前开始前需评估血压、脉搏、呼吸、体温及疼痛；启动后每15分钟观察生命体征，并监测与输注反应相关的症状/主诉，同时记录/监测液体摄入与尿量。\"}]","Eculizumab (SOLIRIS) Therapy Plan | PDF",1790438985,15]