Physician Orders
Patient Label
Hypersensitivity Reaction
(Chemotherapy / Infed Infusion)
Drug Allergies:
Patient Weight:
Another brand of drug identical in form and content may be dispensed unless checked 
Symptoms of an infusion reaction can include any or a combination of the following:
Bronchospasm
Chest tightness
Dyspnea
Dysrhythmia
Fever and/or Chills
Flushing
Date & Time
Ordered
Hypotension
Rash / Itching
Tachycardia
Throat Tightness
Wheezing
ORDERS AND SIGNATURE - Please check () off orders you want for patient care.
 If a Chemotherapy or Infed (Iron Dextran) Infusion Reaction is suspected:
1. Put a STAT call out to MD
2. Stop infusion immediately & clamp tubing, flush tubing with Normal Saline at
nearest port to patient
3. Run Normal Saline IV wide open through nearest port to patient
4. Methylprednisolone (Solumedrol) 125mg IVP
5. Diphenhydramine (Benadryl) 25mg slow IVP
6. If SOB, wheezing or having respiratory distress:
a. Oxygen at 2 liters via N/C
b. Unit dose Albuterol Nebulizer (or 2.5mg Albuterol in 3cc Normal Saline)
c. May repeat Albuterol Nebulizer in 5 minutes if no improvement
7. Epinephrine concentration 1:1000 0.3 ml SC : for allergic reaction with severe
respiratory component
8. Check with MD for further Orders
Physician’s Signature/Date:
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Nurse’s Signature/Date:
Attention
The following is a list of abbreviations that are commonly confused and result in
medication errors.
Please do not use any of these abbreviations.
(This list has been approved by the Pharmacy and Therapeutics Committee)
qd, q.d., qod, q.o.d.
Q.D., QD, QOD or
Q.O.D
Often mistaken for one
another or Q.I.D.
Write daily , every
other day or q day
.1
Always include a zero
before a decimal
Write “0.1”
1.0
Never include a trailing
zero
Write “1”
I.U.
Often mistaken for IV
Write “international
units”
U
Often mistaken for zero,
four or cc
Write “unit”
Often confused for one
another, could be
Write “Morphine or
Magnesium”
MS
Morphine Sulfate or
Magnesium Sulfate
MSO4
As above
As above
MgSO4
As above
As above
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