Oregon Health & Science University
Hospital and Clinics Provider’s Orders
ACCOUNT NO.
ADULT AMBULATORY INFUSION ORDER
MED. REC. NO.
CHO:INTRAVENOUS IMMUNE
NAME
GLOBULIN (IVIG)
BIRTHDATE
Page 3 of 4
Patient Identification
ALL ORDERS MUST BE MARKED IN INK WITH A CHECKMARK ( ) TO BE ACTIVE.
HYPERSENSITIVITY MEDICATIONS:
1. DiphenhydrAMINE 25 mg IV, AS NEEDED x2 doses (Max dose : 50 mg) for hypersensitivity
reaction
2. EPINEPHrine 0.3 mg IM, AS NEEDED x1 dose for hypersensitivity reaction
3. Hydrocortisone 100 mg IV, AS NEEDED x 1 dose for hypersensitivity reaction
4. Nursing communication order, every visit: Please follow treatment algorithm for acute infusion
reaction. Algorithm is located in the OHSU Policy Management System.
AS NEEDED MEDICATIONS:
1. Acetaminophen 650 mg oral, EVERY 4 HOURS AS NEEDED for fever
2. Meperidine 25 -50 mg IV, EVERY 2 HOURS AS NEEDED (NTE 50 mg/hr) for rigors in the absence
of hypotension
PO
-8064
ONLINE 06/2015 [supersedes 07/2014]