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# BERT RODGERS SCHOOLS CONTINUING EDUCATION COURSE Computation of Dosage and Solutions 2 H r s \$12.

95 C O U R S E A B S T R A C T This course teaches one simple method of calculating all dosages without the nee d to memorize cumbersome and easy-to-forget rules. The method presented is calle d dimensional analysis. Dimensional analysis simply, easily, and systematically converts one unit of measurement to another by using a conversion factor. The co urse provides an opportunity to see how dimensional analysis works for a wide va riety of oral, intramuscular, subcutaneous, and intravenous calculations. It pro vides practice calculations and a onestep, no-rules method for calculating the n umber of drops per minute at which an intravenous solution should be run. This c ourse is highly useful to nurses with math phobia, student nurses, those studying for the NCLEX exam, and others who are preparing to take a pre-employment medica tion or pharmacology exam. Alene M. Burke, RN, MSN Bert Rodgers Schools of Continuing Education is accredited as a provider of cont inuing education in nursing by the American Nurses Credentialing Centers (ANCC) C ommission on Accreditation. Bert Rodgers Schools is also approved by the Florida Board of Nursing, Provider FBN # 2783, by the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling, Provider # BAP57 0Exp. 3/2005, and by the California Board of Registered Nursing, Provider # CEP 1 2763. See Provider Approval Summary page for other professions. Learning Objectives 1. Use dimensional analysis to solve a wide variety of dosage and solution probl ems. 2. Calculate oral dosages using dimensional analysis. 3. Compute intramuscu lar and subcutaneous dosages using dimensional analysis. 4. Determine intravenou s (IV) ow rates using dimensional analysis and the onestep, no-rules method of ca lculation. Ms. Burke serves as Nursing Consultant and Instructor for Bert Rodgers Schools o f Continuing Education. Her degrees in nursing were granted by Queensborough Com munity College of New York (ASN), State University of New York, Regents College (BSN), and Adelphi University (MSN). Alene has served as an innovative and creat ive nursing staff development director for more than 15 years for major metropol itan New York medical centers. She has, for the last several years, presented se minars and workshops to large groups of healthcare INTRODUCTION In nursing school, most nurses learned how to calculate, or compute, drug dosage s and IV ow rates. Not too many of us were great mathematicians, and few enjoyed or looked forward to our medication or pharmacology exam every semester. As we p repared for these tests, we spent many hours memorizing rules, such as desired ov er have times quantity, and the correct method of calculating dosage and solution rates using ratio and proportion. The primary reason we studied and restudied a ll of these cumbersome rules is that they are easily forgotten. Now, nally, there is a method to easily and accur ately calculate all dosage and solution problems using one step and no rules for each type of dosage and solution problem that you need to calculate. The method used for this course is called dimensional analysis. Dimensional analysis is a

method that converts one unit of measurement to another unit of measurement usin g a conversion factor or factors. Once you have mastered this method you do not have to remember multiple cumbersome rules and steps. Instead, you will be (800) 432-0320 2004 Bert Rodgers Schools of Continuing Education w w w. b e r t r o d g e r s . c o m

the denominator is the number on the bottom of a fraction. When you have feet a s a numerator and feet in one of the denominators of the equation, the word feet can be crossed off, or canceled out in both the numerator and the denominator b ecause they are identical. In the example above, the only remaining unit of meas urement is inches because the feet labels were cancelled out. In this example, I nches should match the unit of measurement used in the answer. As shown below, t he unit of feet in the starting factor cancels out the foot unit in the conversi on factor. The nal answer is computed by simply multiplying 12 by 9. In more complex calculations, once all the units of measurement that can be canc eled have been struck out, the remaining numerators are multiplied and this prod uct, or answer, is then divided by the product of all the remaining denominators . If the numerators and denominators can be divided by a common number, or reduc ed, the multiplication of the numerators and denominators as well as the nal divi sion will be somewhat simpler and less mathematically challenging. You will be t aught how to reduce in this course. The conversion factors that are used to calc ulate dosages and IV ow rates can consist of either established mathematical conv ersion equivalents, such as 20 nickels in a dollar, or manufacturers equivalents. Some examples of manufacturers equivalents are 1 tablet = 250 mg, 5 gr per kg, a nd 20 gtt = 1 mL. Many dosage calculations require knowledge of mathematical con version equivalents to move from one measurement system to another. We use metri c, apothecary, and household measurement systems in pharmacology. It is suggeste d that you refer to a table of equivalents for the less frequently used mathemat ical conversion equivalents (see Table 1) and memorize the ones that you use mos t often. Some of the commonly used conversion equivalents are as follows: 1 gr 1 g 1 kg 1 oz = = = = 60 mg 15 gr 2.2 lb 30 mL

Computation of Dosage and Solutions 3 TABLE 1: CALCULATION EQUIVALENTS: AN EASY REFERENCE 1 gr 15 gr 1000 mcg 1 kg 1 mL or 1 cc 4 mL or 4 cc 5 mL or 5 cc 30 mL or 30 cc 6 0 milligrams (mg) 1 g or 1000 mg 1 mg 2.2 pounds (lbs) 15 minims (m) 1 dram (dr) 1 teaspoon (tsp or t) 1 ounce (oz), 2 tablespoons (T), 6 t or 8 dr teaspoons, o r 8 dr 1 pint (pt) or 16 ounces (oz) 1 liter (L), 1 quart (qt), or 32 ounces (oz ) 10 500 mg 1 mL 50 mg 1 = _____ mL Multiply the numerators (10 1) and the denominators (1), and nally divide the pro duct of the numerators by the denominator to get the nal answer: 10 1 1 = 10 mL = 10 mL 1 Example 2 Doctors order: Lanoxin 0.5 mg po Medication label: Lanoxin 0.25 mg per tablet How many tablets should you give? The starting factor is 0.5 mg, the conv ersion factor is 0.25 mg/1 tablet, and the answer unit is the number of tablets you would give. Starting factor 0.5 mg conversion factor 1 tablet 0.25 mg = answ er unit 500 mL or 500 cc 1000 mL or 1000 cc Source: Joanne M. Daniels and Loretta M. Smith. Clinical Calculations: A Uni ed Ap proach. 4th Edition. Delmar Publishers: Albany et al. 1994 CALCULATING ORAL DOSAGES USING DIMENSIONAL ANALYSIS The following examples show how to compute oral dosage calculations using dimens ional analysis. Example 1 Doctors order: tetracycline syrup 500 mg po Medication label: tetracycline syrup 50 mg/mL How many mL should you administer? In this ex ample, the starting factor is the dosage in the doctors order, that is, 500 mg. T he conversion factor is 50 mg/1 mL, the number of mg that are contained in each mL of the syrup. The answer unit is the number of mL that you would administer t o the patient. Starting factor 500 mg conversion factor 1 mL 50 mg = = answer un it _____ mL = _____ tablets Cancel out and reduce the numerators and denominators: 0.5 mg 2 0.5 1 tablet 0.2 5 mg 1 tablet 0.25 1 = _____ tablets = _____ tablets Multiply the numerators and the denominators and divide their products to get th e nal answer: 2 Example 3 Doctors order: ucytosine 50 mg/kg/day in four divided dos es. The patient weighs 80 kg. Medication label: ucytosine 250 mg/cap How many cap sules should you give for each of the four doses? The starting factor is 80 kg. In this example, the starting factor is 80 kg because the ordered dosage is base d on the patients weight and there are two 1 1 = 2 = 2 tablets 1 All dimensional analysis problems are set up in the same way and performed in th e same manner. Cancel out and reduce the numerators and denominators, multiply a

ll the remaining numerators and denominators, and then divide to get the nal answ er. Cancel out and reduce these numerators and denominators by dividing each by 50:

## 3. 70 kg 1 5 mg 1 kg 1 tab = 70 = 2.18 tabs, 160 mg 32 32 which rounds off to 2 tabs.

Computation of Dosage and Solutions 5 4. 115 lb 1 kg 2.2 lb 0.1 2.5 mg 1 kg 1 tab = 11.5 = 1.3 tabs, 100 mg 8.8 4 Following are some sample problems involving intramuscular and subcutaneous dosa ges. These calculations are set up and performed using dimensional analysis proc edures in the same manner as that used above for the oral dosage calculations. E xample 1 Doctors order: meperidine 20 mg IM q4h prn for pain which rounds off to 1 tab. 5. 2 1,000,000 U 1 tab = 2 500,000 U 1 1 = 2 tabs Medication label: 50 mg/mL How many mL or cc would you give? The starting factor is 20 mg, and the conversion factor is 1 mL/50 mg. The answer unit is the numbe r of mL or cc. Starting factor 20 mg conversion factor 1 mL 50 mg 1 mL 50 mg = a nswer unit CALCULATING INTRAMUSCULAR AND SUBCUTANEOUS DOSAGES USING DIMENSIONAL ANALYSIS It is often necessary to round off when calculating intramuscular and subcutaneo us dosages. The dosage is rounded off to the nearest hundredth (0.01) of a mL or cc when you are using a tuberculin syringe. When you calculate such a dosage, i t is necessary to perform the mathematical calculation to the thousandths place, or the third decimal place, and round off the second decimal place according to the number that holds the thousandths place. If the number in the third decimal place, or thousandths place, is 5 or higher, you round up one number in the hun dredths place to determine the dosage. For example, if you are calculating a dos age for a tuberculin syringe and your mathematical calculation gives you 0.147 m L, you would round it off to 0.15 mL because the 7 is greater than 5. Heparin is usually given in a tuberculin syringe employing the subcutaneous route. Insulin is given in an insulin syringe and in a speci ed number of units. With rare excep tion, Units 100 insulin is given in a Units 100 syringe that holds either 0.5 cc , equivalent to 50 units, or a 1 cc insulin syringe that holds a maximum of 100 units of insulin. On some rare occasions Units 80 or 60 insulin may be used. In these cases a Units 80 or Units 60 syringe must be used, respectively. Units 80 syringes hold 80 units of Units 80 insulin in one cc. Units 60 syringes hold 60 units of Units 60 insulin in one cc. Most intramuscular injections are given in a 3 cc syringe. Computations are carried out to the hundredths and rounded off t o the nearest tenth (0.1) of a cc or mL. For example, if the calculation is perf ormed and the answer is 1.33 mL, it is rounded off to 1.3 mL. An additional cons ideration for intramuscular injections is that many calculations, particularly t hose necessary to determine an antibiotic dosage, require a conversion factor th at re ects the amount of the drug per mL after a powder is reconstituted with ster ile water or normal saline solution for injection. = ______ mL 20 mg = 2 5 = 0.4 mL Example 2 Doctors order: amikacin 5 mg/kg IM tid. The patient weighs 155 lb. Medi cation label: amikacin 500 mg/2 mL How many mL would you administer? The startin g factor is 155 lb. The conversion factors are 1 kg = 2.2 lb, 5 mg/1 kg, and 2 m L/500 mg. The answer unit is the number of mL. Starting factor 155 lb 1 kg 2.2 l b 1 kg 2.2 lb 1.1 conversion factors 5 mg 1 kg 1 5 mg 1 kg = answer unit

2 mL = _____ mL 500 mg 1 2 mL = 155 = 1.40, 500 mg 110 or 100 1.4 mL 155 lb Example 3 Doctors order: heparin 3,500 U subcutaneously Medication label: 5,000 U /mL How many mL would you administer? The starting factor is 3,500 U. The conver sion factor is 5,000 U/mL. The answer unit is the number of mL.

= _____ mL 1g 2.6 mL = 18.2 = 1.82, or 1.8 mL 1,000 mg 1 g 10 10 Example 5 Doctors order: neomycin 30 mg/kg/day IM in three divided doses. The pat ient weighs 120 lb. Medication label: neomycin 250 mg/mL How many mL would you a dminister for each of the three doses? The starting factor is 120 lb. The conver sion factors are 30 mg/1 kg, 1 kg = 2.2 lb, and 250 mg/1 mL. The answer unit is the number of mL. Starting factor 120 lb 60 120 lb 1 kg 2.2 lb 1 kg 2.2 lb 1.1 c onversion factors 30 mg 1 kg 6 30 mg 1 kg = answer unit 1 mL = _____ mL 250 mg 1 mL = _____ mL 250 mg 50

Computation of Dosage and Solutions 7 Answers 1. 0.55 mL 2. 2.4 mL 3. 2.2 mL 4. 2.2 mL 5. 1.6 mL Here is how each of t he problems was set up and solved: 1. 5 2,500 U 1 mL = 0.555 mL, which rounds of f to 4500 U 0.55 mL 9 CALCULATING IV FLOW RATES USING DIMENSIONAL ANALYSIS AND THE ONESTEP, NO-RULES M ETHOD The nal portion of this course will teach you how to calculate, or compute, IV ow rates and other IV dosage calculations using dimensional analysis. It will also present a one-step, no-rules IV ow rate method to determine the number of drops p er minute when you know the ordered number of cc per hour. Calculating IV Flow Rates Using Dimensional Analysis IV tubing is manufactured by a number of companies. Each tubing set has a drop f actor that indicates whether it delivers 10, 15, 20, or 60 drops (gtt) per mL of solution. The 60 gtt per mL tubing, which is often referred to as microdrop tub ing or pediatric tubing, delivers the smallest drops of all the sets. The 10 gtt /mL tubing delivers the largest drops of solution. Drops are rounded off to the nearest whole drop when calculations are performed. The IV ow rate calculations i mmediately below are set up and performed using dimensional analysis. Example 1 Doctors order: 0.9% NaCl solution at 90 mL per hour How many gtt per minute would you give if the tubing delivered 20 gtt/mL? The starting factor is 1 min; the c onversion factors are 1 hour [h] = 60 min, 90 mL/1 h, and 20 gtt/1 mL; and the a nswer unit is the number of gtt per min, or gtt. Starting factor conversion fact ors 1h 60 min 90 mL 1h 3 90 mL 1h = answer unit 2. 2 500 mg 3.6 mL = 7.2 = 2.4 mL 750 mg 3 3 1.2 3.6 mL = 2.4 = 2.4 mL 750 mg 1 3 1 or 2 500 mg 3. 1 500 mg 1g 1,000 mg 2 1 1.1 2.2 mL = 2.2 mL 0.5 g 4. 60 120 lb 1 kg 2.2 lb 1.1 6 30 mg 1 kg 1 mL = 36 = 6.54 mL 250 mg 5.5 50 1 min 20 gtt = ___ gtt 1 mL 10 20 gtt = 30 gtt 1 mL Because the doctor ecessary to divide e given in each of e 3 5. 8 400,000 U 1 min 1h 60 min 2 1 Example 2 Doctors order: 1,000 mL of 5% D 0.45 normal saline solution to infuse o ver 5 hours How many gtt per minute would you give if the tubing delivered 10 gt t/mL? ordered 30 mg/kg over one day in three divided doses, it is n the 6.54 mL for the day by 3 to determine how many mL would b the doses: 6.54 mL = 2.18, which rounds off to 2.2 mL per dos 1 mL = 8 = 1.6 mL 250,000 Units 5 5

8 Bert Rodgers Schools Continuing Education Course The starting factor is 1 min; the conversion factors are 1 h = 60 min, 1,000 mL/ 5 h, and 10 gtt/1 mL; and the answer unit is the number of gtt. Starting factor 1 min 1h 60 min conversion factors 1,000 mL 5h 200 1,000 mL 5h 1 = answer unit 1 min 1h 60 min 1 45 mL 1h 1 60 gtt = 45 gtt 1 mL 10 gtt = ___ gtt 1 mL 1 10 gtt = 200 = 1 mL 6 1 min 1h 60 min 6 = 33.3, or 33 gtt Example 3 Doctors order: 25 mL/h of 5% D 0.45 normal saline sol ution How many gtt per minute would you give if the tubing delivers 60 gtt/mL? T he starting factor is 1 min; the conversion factors are 1 h = 60 min, 25 mL/1 h, and 60 gtt/1 mL; and the answer unit is the number of gtt. Starting factor 1 mi n 1h 60 min conversion factors 25 mL 1h = answer unit Did you notice that the last two calculations, which use the microdrop, or 60 gt t/mL, IV tubing, yield the same number of gtt per minute as the number of mL per hour that was ordered? Speci cally, the rst doctors order was for 25 mL per hour. Y ou would have to run the IV solution at 25 gtt per minute to deliver 25 mL per h our. The second doctors order called for 45 mL per hour. You would have to run th e IV solution at 45 gtt per minute in order to deliver 45 mL an hour. If you loo k closely at these two calculations, you will see that the conversion factor of 60 min = 1 h cancels out the conversion factor of 60 gtt per mL. We will now mov e one step further with this observation. Calculating IV Flow Rates Using the OneStep, No-Rules Method In order to calculate using the one-step, no-rules method, you need to know the number of mL per hour ordered. Occasionally, the doctors order clearly states the number of mL per hour, which is the easiest scenario. If the doctors order speci e s the number of mL per 8, 12, or any other number of hours rather than each hour , it is necessary to rst determine the number of mL to be administered per hour. For example, if the doctor orders 1,000 mL in 8 hours, you must divide 1,000 mL by 8 to determine the number of mL per hour. The answer is 125 mL/h. Likewise, i f the doctor orders 2 liters of IV uid over 12 hours, the calculation to determin e the number of mL per hour is as follows: 2,000 mL/12 = 166.6 mL, which rounds off to 167 mL/h. Once you have observed that the number of mL/h is identical to the number of gtt/min, something that never changes when you are using a 60 gtt/ mL tubing, it soon becomes apparent that for tubing with other drop factors (10 gtt/mL, 15 gtt/mL, and 20 gtt/mL), you must simply look at the relationship of t he drop factor to the ever-present 60, the never-changing number of minutes in a n hour. For example, if you are using IV tubing with a 20 gtt/mL drop factor, yo u have to look at the relationship between the 20 in the tubing drop factor and the ever-present 60, the number of minutes in an hour. The relationship between 60 and 20 is 3; in other words, 60/20 = 3. Similarly, if you are using IV tubing with a 10 gtt/mL drop factor, you have to look at the relationship between the 10 in the tubing drop factor and the

60 gtt = ___ gtt 1 mL 1 60 gtt = 25 gtt 1 mL 1 min 1h 60 min 1 25 mL 1h Example 4 Doctors order: 45 mL/h of 5% D 0.45 normal saline solution How many gtt per minute would you give if the tubing delivers 60 gtt/mL? The starting factor is 1 min; the conversion factors are 1 h = 60 min, 45 mL/1 h, and 60 gtt/1 mL; and the answer unit is the number of gtt. Starting factor 1 min 1h 60 min conver sion factors 45 mL 1h = answer unit 60 gtt = ___ gtt 1 mL

Computation of Dosage and Solutions 9 number 60. The relationship between 60 and 10 is 6: 60/10 = 6. Finally, if you a re using IV tubing that delivers 15 gtt/min, the relationship of 60 to 15, or 4, requires you to divide the number of mL an hour by 4. Now that you know all the possible relationships, it is only necessary to divide the number of mL an hour by 3 for a 20 gtt/mL drop factor tubing, by 6 for a 10 gtt/mL drop factor tubin g, and by 4 for a 15 gtt/mL drop factor tubing. All you have to do is one step. There are no rules to forget, no complicated formulas, and no unnecessary steps! Here are some examples: If you are using a 10 gtt/mL set, the number of drops p er minute will always be the number of mL an hour divided by 6. 100 mL/h: 100/6 = 16.6 = 17 gtt/min rounded off 125 mL/h: 125/6 = 20.8 = 21 gtt/min rounded off 150 mL/h: 150/6 = 25 gtt/min If you are using 20 gtt/mL IV tubing, the number of drops per minute will always be the number of mL an hour divided by 3. 100 mL/h : 100/3 = 33.3 = 33 gtt/min rounded off 125 mL/h: 125/3 = 41.6 = 42 gtt/min roun ded off 150 mL/h: 150/3 = 50 gtt/min And, nally, if you are using 15 gtt/mL tubin g, the number of drops per minute will be the number of mL an hour divided by 4. 100 mL/h: 100/4 = 25 gtt/min 125 mL/h: 125/4 = 31.2 = 31 gtt/min rounded off 15 0 mL/h: 150/4 = 37.5 = 38 gtt/min This one-step, -no-rules- method of calculatin g the number of IV drops per minute works all the time because there are always 60 minutes in an hour. The one step involved in calculating the number of drops per minute consists of dividing the relationship number for the speci c IV tubing set into the number of mL per hour ordered by the doctor. Pediatric (60 gtt/mL) tubing has an identity relationship; therefore, the number of drops per minute w ill always exactly match the number of mL per hour. This one-step method is part icularly useful because nurses caring for patients with IV infusions should coun t and verify the number of drops per minute at the bedside with each patient con tact. Volumetric controllers and pumps are not always accurate and do not always function properly. tions that you will also have to know. These include calculating the following: total infusion time; the concentration of a medication in an IV solution that sh ould be given; and IV ow rates based on body weight. Calculating Total Infusion Time When you have adjusted an IV solution to run at a certain number of drops per mi nute, you will want to know when the solution is due to nish infusing so that you can anticipate the need to hang another bag of solution, if so ordered. You mus t, therefore, be able to calculate the total infusion time for the presently inf using bag. Following is an example of how this type of calculation is accomplish ed using dimensional analysis. Total volume of IV uid: 1,000 mL Infusion rate: 23 gtt/min Drop factor: 10 gtt/mL When will the liter of uid run out? The starting factor is 1,000 mL; the conversion factors are 10 gtt/1 mL and 23 gtt/1 min; and the answer unit is time, that is, the number of hours and/or minutes. Starting factor 1,000 mL 10 gtt 1 mL 1 10 gtt 1 mL conversion factors 1 min 23 gtt = answ er unit 1 h = ___ h 60 min 1,000 mL 1 min 23 gtt 1 h = 1,000 = 60 min 138 6 = 7.24 h (7 h 14 min) Calculating the Concentration of a Medication in an IV Solution On some occasions, a physician may order an hourly dosage of a medication that h as been diluted in an IV uid. For example, the doctor may order an hourly dosage

of 1,200 units of heparin that has 20,000 units of heparin diluted in 1,000 mL o f normal saline solution. The nurse must then be able to calculate the ow rate of the uid based not on the volume of the uid ordered but on the dosage of the medic ation. The starting factor is 1 h; the conversion factors are 1,200 U/1 h and 20 ,000 U/1,000 mL; and the answer unit is the number of mL. OTHER IV CALCULATIONS Calculating the number of drops per minute, or the ow rate, is perhaps the most f requently encountered IV calculation; however, there are other IV computa-