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Feb 07, 2009

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drug calculations for nurses

Attribution Non-Commercial (BY-NC)

100%(9)100% found this document useful (9 votes)

14K views78 pagesdrug calculations for nurses

Attribution Non-Commercial (BY-NC)

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Example

Continue

s

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Converting factors

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Common

Abbreviations

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Dosage Forms

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Solution

Measurements

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Miscellaneous Usage

in the

Hospital

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Abbreviations to

Avoid

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Micrograms should be written out, insist on

µg

it!

__

Write out one-half or 1/2 clearly.

ss or ss

OD

should be acceptable.

BT

use the standard hs.

Fishing

for

answers?

Examples

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Example 1 نصف ملغ تعادل حبة

Doctor's order:

0.25 mg of digoxin p.o. 1 X =كم حبة

0.25

0.5

On hand: 0.5 mg tablets

Answer

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Example 1 نصف ملغ تعادل حبة

Doctor's order:

0.25 mg of digoxin p.o. 1 X =كم حبة

0.25

0.5

On hand: 0.5 mg tablets

0.5 tablet

Example

AVAILABLE

المتوفر حاليا

Doctor's order:

Give deltasone 7.5 mg PO now.

Available : deltasone 2.5 mg tablet.

Answer

Example

AVAILABLE

المتوفر حاليا

Doctor's order:

Give deltasone 7.5 mg PO now.

Available : deltasone 2.5 mg tablet.

3 tablet

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Example

Doctor's order:

Give ranitidine 40 mg PO ABT.

Available is ranitidine 20 mg tablet

How many tablet you should give?

Answer

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Solution

ABT عند النوم

40 X 1

20

40

20

2 tablets

Example

Doctor's order:

Give 7500 i.u of heparin injection S/C .

Available:( heparin injection 5000

i.u/ml)

How many ml you should give?

Answer

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Solution

7500 X 1

5000

7500

5000

1.5 ml

Example

Doctor's order:

Give 500 cc D5RL to be infused in 6

hrs.

You should regulate the I.V at:

Answer

المعادلة

Solution (عامل التنقيط xالكمية بالمل (

مقسومة على

(دقيقة X 60عدد الساعات (

15ال اذا ذكر في السؤال

15

6 hrs X غير ذلك

60 m

7500

360

21 drop/m

Example

Doctor's order:

Give 1500 cc normal saline over 4 hrs.

You should regulate the I.V at:

Answer

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المعادلة

Solution (عامل التنقيط xالكمية بالمل (

مقسومة على

(دقيقة X 60عدد الساعات (

15ال اذا ذكر في السؤال

4 hrs

15 X غير ذلك

60 m

22500

240

94 drop/m

Example

Doctor's order:

Give 1000 cc dextrose 5% I.V Q 8 hrs.

You should regulate the I.V at:

Answer

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Solution دائما يعتبر عامل التنقيط

15ال اذا ذكر في

السؤال غير ذلك

1000 cc X

15

8 hrs X

60 m

15000

480

31 drop/m

exit

Example

Doctor's order:

Give 3 L of I.V fluid 5% D/0.45%

normal saline over 24 hrs.(the drop

factor is 60 gtt/ml).

You should regulate the I.V at:

Answer

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Solution دائما يعتبر عامل التنقيط

15ال اذا ذكر في السؤال

غير ذلك

24

60hrs X

60 m

180000

1440

125

drop/m

Example

Doctor's order:

Give 3000 cc dextrose 5% I.V Q 6 hrs,

drop factor is 20 gtt/m)

How many drops should you give per

minute?

Answer

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Solution دائما يعتبر عامل التنقيط

15ال اذا ذكر في السؤال

غير ذلك

3000 cc X

6 hrs

20 X

60 m

60000

360

166.66

)(167

Example

Doctor's order:

Give penicillin 600.000 u I.M stat

Available: (penicillin 800.000 u/2 cc)

How many ml should you give?

Answer

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Example

Doctor's order:

Give penicillin 600.000 u I.M stat

Available: (penicillin 800.000 u/2 cc)

How many ml should you give?

1.5 ml

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Example

Doctor's order:

Give G/S 2000 cc I.V Q 24 hrs,

The rate will be how many drop per

minute?

Answer

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Example

Doctor's order:

Give G/S 2000 cc I.V Q 24 hrs,

The rate will be how many drop per

minute?

21 drop/m

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Example

• The physician orders IV fluids to

hydrate a client. The order is written

as "D5NS 4 Liters over 24 hours."

Looking at the package indicates the

drip factor of the tubing is 15 gtt/ml.

What is the drip rate?

Answer

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Example

• The physician orders IV fluids to

hydrate a client. The order is written

as "D5NS 4 Liters over 24 hours."

Looking at the package indicates the

drip factor of the tubing is 15 gtt/ml.

What is the drip rate?

42 gtt/m

:Shortcut method when you know the ordered ml/hr

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43.75

4 / 175 =

gtt/min

29.16

6 / 175 =

gtt/min

58.33

3 / 175 =

gtt/min

Example

The client's K+ is 2.0 mEq/dl and the •

physician orders a potassium bolus

of 40 mEq of KCl in 200 ml of NS to

be delivered at a rate of 10 mEq/hr.

What is the drip rate inmicrodrops?

(.(Ideal, deliver on a pump

Answer

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•This is a two-part problem.

•Calculate the concentration of the KCl

in the NS using ratio and proportion

mEq 40 mEq 10

=

ml 200 x ml

40x = 2000

x = 50

• Now you can use the IV formula.

ml 50 gtt 60

60 min x 1 cc

x 60 50 = 3000

60 / 3000 = 50

Answer: 50 (microgtts/min)

Calculating flow rate

• Flow rate refers to number of ml of

fluid to be infused over one hour

(ml/hr).

total # of hours = X ml/hr

Example

Order:

500 ml NS bolus over 3 hours

Answer

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Example

Order:

500 ml NS bolus over 3 hours

167 ml/h

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Example

• The nurse makes rounds and notes

that the current IV bag contains

approximately 450 ml. The IV flow

rate is 150 ml/hr. How long will it be

before the nurse must hang a new

bag?

Answer

exit

Example

• The nurse makes rounds and notes

that the current IV bag contains

approximately 450 ml. The IV flow

rate is 150 ml/hr. How long will it be

before the nurse must hang a new

bag?

3 hrs

exit

Example

• Order:

Administer 1000 cc at 50 gtt/min.

Answer

exit

Example

• Order:

Administer 1000 cc at 50 gtt/min.

5 hrs

exit

Example

• John is to receive Cleocin 150 mg IV

q 8 hours. The nurse dilutes the

medication to a total volume of 30 ml

and plans to deliver it via an infusion

pump over thirty minutes. What

would be the flow rate?

Answer

exit

Example

• John is to receive Cleocin 150 mg IV

q 8 hours. The nurse dilutes the

medication to a total volume of 30 ml

and plans to deliver it via an infusion

pump over thirty minutes. What

would be the flow rate?

60

exit

Example

• For the client whose weight is 130 lbs

and has dopamine ordered at 8

mcg/kg/min, what rate should the

infusion pump be set for a solution of

400 mg dopamine in 250 ml D5W?

Answer

exit

• Client's weight: 130 lbs

• Dosage: 8 mcg/kg/min

• Solution: 400 (mg) in 250 (ml)

Tip

• Convert wt to kg. 130 / 2.2 =

59.09 kg

• Find concentration of dopamine in

mg 400 x mg

1 cc.

250 ml

=

1 ml

250x = 400

x = 1.6

• 3) Concentration is 1.6 mg /cc.

Convert the mg to micrograms.

• 1.6 (mg) x 1000 (mcg per 1 mg) =

1600 mcg/cc.

Now that you have gathered all

the information, plug it into the

formula

28363.32

=

unit"/kg/min) ") 8 X 59.09 )wt in kg)X 60 )min/hr)

)1600 )"unit" / ml

1600

x = 17.727

Example

• A client is receiving dopamine at 12

ml/hr. The solution hanging indicates

"D5W 250 ml/200 mg dopamine".

The client weighs 133 lbs. What is

the dosage (mcg/kg/min) the client is

receiving?

Answer

exit

• Flow rate: 12 ml/hr

• Solution: 200 mg dopa / 250 cc D5W

• Client's weight: 133 lbs

Tip

1) Convert wt to kg. 133 / 2.2 =

60.45 kg

2) Find concentration ofx dopamine

mg 200 mg

in 1 cc.

250 ml = 1 ml

250x = 200

x = 0.8

3) Concentration is 0.8 mg/ml.

Convert mg to mcg.

0.8 (mg) X 1000 (mcg per 1 mg) =

800 mcg /ml.

Now that you have gathered all

the information, plug it into the

formula.

(Time) 60 min/hr X( 60.45 (weight in kgs = 3627

X = 2.65

Example

• A client is receiving a heparin drip at

22 ml/hr via an infusion pump. The

label on the liter bag of D5W

indicates 40,000 U of heparin. How

many units of heparin does the client

receive per hour?

Answer

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U 40,000 xU

1000 ml = 22 ml

1000x

= 880,000

x

= 880

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3) Concentration is 0.8 mg/ml.

Convert mg to mcg.

0.8 (mg) X 1000 (mcg per 1 mg) =

800 mcg /ml.

Now that you have gathered all the information,

plug it into the formula.

(Time) 60 min/hr X( 60.45 (weight in kgs = 3627

X = 2.65

Example

• The physician becomes concerned

about John’s renal function and orders

the Vancomycin dose (60 mg) to be

infused over 90 minutes instead of the

usual 60 minutes. If the Vancomycin

dosage is diluted into 60 ml of IV fluid,

what will be the flow rate? (Given on an

IV pump for control.)

X ml

ml 60 60 min

=

90 min

x 90 = 3600

x = (ml/hr) 40

exit

Example

• John's primary IV is running at 34 ml/hr while

NPO. When the nurse runs the Vancomycin

(250 mg IV q 8 hr) in over 90 minutes [volume

is 100 ml--(2 50 ml syringes)], the primary IV is

stopped. The ampicillin (395 mg IV q 6 hr) is

given concurrently in 10 ml of fluid over 30

minutes. He received 2 boluses of

aminophylline (20 ml each over 20 minutes).

The IV fluids were stopped while the

aminophylline infused. Since microtubing was

used for the medications, total flush is

negligible (approximately 3 ml). What is John’s

total intake for 24 hours?

exit

Answer

Vancomycin runs for 1.5 hrs x 3 doses .hrs IV is stopped 4.5 =

Primary or maintenance IV

hr) minus 4.5) 24 .hrs 19.5 =

:fluids

min x 2 20 minutes 40 =

:aminophylline is infusing

ml 640.5 =

40 minutes x 34 ml

:Ampicillin cc x 4 10 .ml 40 =

:Aminophylline cc x 2 20 .ml 40 =

Normal saline

)approximate) 3ml =

:flush

Example

• Crystal has an IV infusing at KVO (10

ml/hr). She receives an antibiotic in

22.5 ml q 8° concurrently. One ml flush

is given after each antibiotic. She is

given 30 ml of formula q 3°.

• She had diaper weights of 17 ml, 33 ml,

55 ml, 45 ml, 52 ml, 50 ml, 15 ml, and

36 ml.

• Calculate her I & O for the past 24

hours.

Answer

Intake:

IV @ 10 ml/hr x 24 hr = 240 ml

Med of 22.5 ml x 3 )q8°) = 67.5 ml

Flush of 1 ml x3 = 3 ml

Formula of 30 ml x 8 )q 3°) = 240 ml

Output:

36 + 15 + 50 + 52 + 45 + 55 + 33 + 17 ml 303 =

Example

• John also has an order for ampicillin

sodium 395 mg IV q 6 hr. The safe

range for his type of infection in the

literature is 100-200 mg /kg /day. Is

this a safe dose?

Answer

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Calculate the recommended range:

•Minimal: 100 mg x 20 kg = 2000 mg

•Maximal: 200 mg x 20 kg = 4000 mg

Actual dose is: 395 x 4 )q 6 hr) = 1580 mg

/ day

Compare the two values. The actual dose is

less than the recommended dose. Dose is

“safe”, but not necessarily therapeutic.

Example

• The physician stopped John’s

gentamicin and cleocin when the

culture report came back. His new

orders include Vancomycin 250 mg IV q

8°. The literature indicates that the

minimal dilution concentration for

infusion should be 2.5 mg / ml if given

through a peripheral intravenous line

(PIV). How many ml of diluent will the

nurse need to mix the Vancomycin to

meet this safety requirement?

Answer

Example

• The physician stopped John’s

gentamicin and cleocin when the

culture report came back. His new

orders include Vancomycin 250 mg IV q

8°. The literature indicates that the

minimal dilution concentration for

infusion should be 2.5 mg / ml if given

through a peripheral intravenous line

(PIV). How many ml of diluent will the

nurse need to mix the Vancomycin to

meet this safety requirement?

100 ml

Example

• A newborn has an order for 0.15

micrograms of Prostin VR

(alprostadil) per hour to maintain

patency of the ductus arteriosus.

The pharmacy prepared a Prostin

drip with 25 mcg alprostadil in 50 ml

of D5W. What hourly rate is needed

to deliver the dosage of medication

as ordered?

Answer

Example

• A newborn has an order for 0.15

micrograms of Prostin VR

(alprostadil) per hour to maintain

patency of the ductus arteriosus.

The pharmacy prepared a Prostin

drip with 25 mcg alprostadil in 50 ml

of D5W. What hourly rate is needed

to deliver the dosage of medication

as ordered?

0.3exit

ml/h

Example

• John is to be given an Aminophylline

bolus of 30 mg in 20 ml of fluid over

20 minutes. The primary IV is

running at 40 ml/hr. The drip factor

of the tubing (buretrol) is 60 gtts/cc

or minidrip. What is the flow rate

needed to deliver the Aminophylline

bolus as ordered?

Answer

exit

Example

• John is to be given an Aminophylline

bolus of 30 mg in 20 ml of fluid over

20 minutes. The primary IV is

running at 40 ml/hr. The drip factor

of the tubing (buretrol) is 60 gtts/cc

or minidrip. What is the flow rate

needed to deliver the Aminophylline

bolus as ordered?

60 exit

ml/h

Example

• John is a pediatric client in a hospital in

which the policy is to place all children

on IV therapy on a buretrol and to only

fill the buretrol no more than two-three

hours worth of fluid. The nurse fills the

buretrol to 90 ml at 10 a.m. If John’s IV

is running at 34 ml per hour, how long

will it be before the nurse will need to

fill it again?

exit

Answer

90 ml ÷ 34 (ml/hr) = 2.65 hrs

However, 0.65 hrs = ? minutes

hr 1 hr 0.65

=

60 min X min

1x = 39.00

X = 39

hours. 10 a.m. + 2 hr 39 minutes = 12:39

p.m.

more fluid added so that air does not get

into the tubing.

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