# Medication Math for the Nursing Student A Brief Introduction to Dimensional Analysis: So what's the big idea, anyway

? Take the test: 25 practice problems--have fun with your brain. Review the test with complete answers: Get your intro to dimensional analysis here. Conversion factors for Nursing Students: Copy and make your own cheat-sheet Abbreviations for Nursing Students: Know'm and love'm MedMath Errors and the Nursing Student: Be afraid, be very afraid My Adventures in Med-Math: Or how I came to post so much stuff on this Web site A Guide to Dimensional Analysis: The one-page all-you-really-need-to-know guide How to Minimize Mistakes: You could save a life Dimensional Analysis Summary: A few tips A Critique of Clinical Calculations: A unified approach, 4th ed. Recommended Corrections to Clinical Calculations: A unified approach Dimensional Analysis for everyone else: Some general examples here More examples of Dimensional Analysis: Drug calculations MedMath and your PDA: Files and programs you can use

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Medication Math Errors and the Nursing Student

A shocking number of patients die every year in United States hospitals as the result of medication errors, and many more are harmed. One widely cited estimate (Institute of Medicine, 2000) places the toll at 44,000 to 98,000 deaths, making death by medication "misadventure" greater than all highway accidents, breast cancer, or AIDS. If this estimate is in the ballpark, then nurses (and patients) beware: Medication errors are the forth to sixth leading cause of death in America. How many medication errors are miscalculation errors? No one really knows since by some estimates as little as one in ten errors are reported (Pepper, 2002). Of reported errors one FDA study (Thomas, et. al., 2001) found that 7% were due to "miscalculation of dosage or infusion rate." Combining this estimate with the estimate for total deaths, as many as 3,000 to 6,800 deaths are caused annually by medication math errors. This would mean that in the average hospital one patient dies every year or two because someone makes a miscalculation, and one or two patients are sub-lethally harmed each month. As future nurses, then, there is a distinct possibility that we will harm, or even cause the death of, a patient over the course of our career. If we believe the adage "first do no harm" applies to us, then what can we possibly do to minimize miscalculation errors? If we only aim to pass Medication Math with an 80% or above, are we setting the bar high enough? It might be late some Saturday night, you're the only RN on the floor, the hospital pharmacy is closed, and it's up to you to calculate a needed dosage. Surely getting the right answer only 80% of the time is not acceptable. Perhaps the problem you need to solve is a little different than any you've seen before or recall seeing in the textbook. How confident will you be that your calculation is correct? The time to build confidence is while we are students. I suggest that as conscientious students we should aim for 95% or better. We should, then, carefully study, learn from, and thereby avoid repeating what mistakes we do make, so that by the time we are working in the real world we can be confident that, if we are vigilant enough, we can approach 100% proficiency. Since "to err is human," we will always be at risk of not achieving a goal of 100% proficiency, but we cannot aim for less, and knowing that we are always at risk will make us extremely careful. Neither effort, desire to avoid error, nor carefulness, however, is enough. We need the right tools and techniques that will help us avoid miscalculations. I believe that dimensional analysis is the most appropriate tool available to us. It is, by far, the best method of solving medication math problems with the least chance of making errors. As nurses we're not likely to ever use whatever algebra, trigonometry, calculus, or statistics we may know and (even better?) we need make no effort to learn these subjects, but we should strive for a deep understanding of, and proficiency in, dimensional analysis (DA). The good news is that mastery of DA is not at all an unobtainable goal. While few could master a vast subject such as algebra in a lifetime, most students should be able to master DA in a few weeks of focused effort. Mastery would mean the ability to solve any problem that could crop up, no matter how it is presented, while avoiding pitfalls, and retaining proficiency in the years to come. Needless to say, if I thought that nursing students were mastering DA, I wouldn't be writing this paper. The bad news, then, is that most nursing students seem to have a weak understanding of DA. Most can follow examples given in the textbook; they can then solve all the practice problems

that follow the same general format. If quizzes or tests also follow the textbook examples, most students succeed brilliantly. That all is not well, however, is apparent went problems do not meet expectations. One sophomore class stumbled badly on a test apparently for this reason. They could all follow, if imitatively, the examples in the textbook, and could therefore do all the practice problems, but when the test presented problems in an unexpected format, most failed--only 2 students passed the test. In their final semester before graduating as RNs, a third failed another test. This suggests a weak understanding of DA. Unfortunately most students have almost, but not quite, a complete understanding of DA. I believe this is due to the textbook used (Clinical Calculations: A unified approach, 4th ed.) almost, but not quite, presenting a complete description of DA. It may be that there are too few nurse/mathematicians to write textbooks, and so a weak foundation for DA is laid for students to build on. My aim in writing this paper is to provide nursing students with a more robust foundation to build on, and perhaps reduce future misadventures. I am not a mathematician, but I have been doing DA for 30 years, have made refinements in the technique over that time, and as a substitute teacher I have taught it to middle and high school students. Dimensional analysis is your friend. Embrace it; learn to love it. It is our best defense against doing harm to a patient by miscalculation.

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In med-math a hand written 5. Using a degree symbol for hour instead of "hr" is an invitation to error. With practice all nursing students can acquire a high level of proficiency in doing medication math. Eric Lee. then. then. then do not use "mL" alone without specifying "mL of what?" Your labels. and not 5U insulin. RN busybee@alysion. Conclusions Errors may be unavoidable in absolute terms. Another abbreviation to avoid is using Mu ( µ ) for micro as in microgram (µ g).0 could be mistaken for 50 if the point were over looked.Use abbreviations that are clear and label numbers fully. It may therefore be helpful to label fully rather than minimally. failure to fully label numbers can lead to serious confusion and error. is "mc" for "micro" as in "mcg" for "microgram. The preferred abbreviation." In some problems. would be in the form "23 mL A" or "3 mL C" and you would know to only cancel out "mL B" with "mL B. When writing numbers less than one. A. which could be mistaken for 50." Whenever you label any number with a unit of measure. and C. When doing the math. R. but we can minimize the number of errors we make. "µ " can look like an "m" and so "µ g" looks like "mg" which could lead to a three orders of magnitude error. and so on. If the degree symbol is written a little too big it could be mistaken for a zero resulting in an order of magnitude error.4 and not . A good understanding of dimensional analysis is our best defense against miscalculation errors. the brain is looking for numbers and could see "10" where a "1" is meant: Avoid "cc" and use "mL" instead as cc can look like zeros. so write 0. Likewise don't use U for unit.4 as the point could be overlooked. always start with a zero. always be aware that you are dealing with grams of something or liters of something. Writing "25 mL NS" is much clearer than just "25 mL.org References . Write 5 units insulin. When writing whole numbers omit writing a point zero to indicate that the measurement was made to the nearest tenth (or point zero zero to indicate an accuracy of plus or minus a hundreth) as you would in science lab. B." If you were doing calculations involving milliliter volumes of three solutions. When handwritten.

ashp. Drug Topics. (Oct. Phillips J.gov/cder/drug/MedErrors/mixed. Available online: http://www.nsf/isbn/0309068371? OpenDocument Pepper.nas. Hoquist C. (2002) Errors in drug administration by nurses from Understanding and Preventing Drug Misadventures Conference. Ginette A. 145(19). review the underlying concept.Institute of Medicine (2000) To Err Is Human: Building a Safer Health System National Academy Press. 23. General Math Which of the following statements are True? 1. 1 7/8 = 15/8 4.html Thomas MR. xiv = 14 See Answers . 1.35 10. If you get them all right. ask if you can take the final. Each problem is a mini-test of some important concept. 16/5 = 3 1/5 3. 2/3 + 3/4 = 19/12 5. 20/48 = 5/12 2. 7 1/8 x 3/4 = 5 11/32 8. 5/9 + 2/3 = 1 2/9 6. Available online: http://www. If you miss any question.6 3/5 = 3 3/5 7. Available online: http://www4. 2001) Med error reports to FDA show a mixed bag.edu/news. 35% = 0.org/public/proad/mederror/pep. 5/8 ÷ 1/16 = 10 9.fda.pdf Go to top MedMath Practice Problems for Nursing Students The following problems will test your math ability without wasting your time with repetitive problems. 10 1/5 .

a 0. Your order is for meperidine (Demerol) 35 mg.) 3. How many milligrams is the order for? (Yes. You give your home health patient an unopened 500-mL bottle of guaifenesin and tell them to take 2 teaspoons 4 times a day as ordered. Just as a warm up. Without writing anything down.4 grams lidocaine. You are to give "gr 5 FeSO4" but the available bottle gives only the milligrams of iron sulfate per tablet (325 mg/tab). On hand are 1 cc and 3 cc syringes. how many seconds are in a day? 2. STAT. You are shadowing a nurse during a clinical who receives an order to adjust the infusion rate of a pump so that 1. Available is a 2-mL vial containing 50 mg/mL meperidine. this and several of the other problems are ones I've actually encountered in my nursing practice. Hanging is a 100 cc piggyback containing 0. You just opened a 500-mL bottle of guaifenesin and will be giving 1 tablespoon per dose. They ask you how long the bottle will last. 5.6 mg of lidocaine are being delivered per minute. How many doses are in the bottle? In other words how many tablespoons are in 500 mL? 4.4% solution. IM.Dimensional Analysis Problems (see Conversion Factors for Nursing Students) 1. How much should you draw up into which syringe? 6. the .

2. 1/2 tsp lite salt. At what rate should you set the pump? 9. As a home health nurse you need to help a client make homemade pediatric electrolyte solution using the following recipe: 1 L boiled water. You would normally use a prefilled syringe containing 1 mg/1 mL MS and give 0. and 1/2 tsp baking soda. He is receiving 60 mL Jevity per hour as ordered when the pump fails and no other pumps are available.2 mg MS in 5 minutes.nurse tries to solve the problem on a calculator. 30 g sugar. After the fifth different and incorrect answer you find a piece of scratch paper and offer to show her how to set up the problem. 2 tbsp sugar.5 g baking soda.2 mg MS STAT. She assures you she can always do problems like this on tests. You decide to adjust the drip rate accurately to give the ordered amount. Since only kitchen measuring cups and spoons are available you need to convert from metric. is 1 qt boiled water. 2. It occurs to you that you could reset the pump to deliver 0. Your hospice patient is on a double pump. but admits that at the moment her brain doesn't seem to be working. She begins to show signs of breakthrough pain and her doctor orders 0.2 mL IV push. On your first day of clinicals at a long-term care facility you are caring for a resident receiving total enteral feeding through a PEG tube. How would you set up and explain the problem to her? 7." and rushes on to her next demand. His over-extended regular nurse hangs drip tubing. and the other has a 100 cc bag containing 2 mg morphine sulfate (MS) running at 5 cc/hr for pain management. A textbook on clinical calculations includes the following conversion for household to metric: 1 teaspoon = 5 mL = 5 g. but on looking in the narcotic cabinet you find none available and the pharmacy is closed. 1. then go back to 5 mL/hr. according to the textbook. What do you need to know to do so? 8. adjusts the drip rate to something that "looks about right. What questionable assumption does the textbook make? . 1/4 tsp salt. The answer. One side is running NS at 30 cc/hr KVO.5 g lite salt (KCl).5 g salt.

13. In another textbook you are given the following example: The order is for Chloromycetin 300 mg IV bolus via saline lock. Label: Chloromycetin 1 g. You have an order to infuse 1000 mL of D5W (5% Dextrose in water) IV over a period of 5 hr. Directions: Reconstitute with 10 mL sterile water for injection to yield 100 mg/mL.9% NaCl) using water and table salt if you have only a measuring cup and a teaspoon? On hand is an unopened 1 lb box of salt. What error did the textbook make? 11. 1000 mg = 1 g 300 mg x 1000 mg 1g 1 g x 10 mL = 3 mL While the answer "3" happens to be right. How would you adjust the drip rate? . No pump is available. the set up is not. how would you prepare 1 L (or so) of normal saline (0. In a home setting. 12. but the tubing set package notes that the drop factor is 10 gtt/mL.10. How would you prepare 2 L of 3% sodium hypochlorite (bleach) and water solution? You have only a measuring cup. How may mL of Chloromycetin should be administered? Equivalents: 1 g = 10 mL.

You are to dilute a portion of this in 100 mL NS and infuse over 20 minutes using a Buretrol with a drop factor of 60 gtt/mL. IV. tid for a child weighing 13 lb. What is the concentration of heparin solution? When you clear the pump you note that 187 mL have been infused. The meperidine on hand is 100 mg/mL and the atropine is 0. Is the dose safe? 17. Available is Tagamet 300 mg in a 2 mL vial of aqueous solution. The two are compatible so you plan to draw up both in the same syringe. How much of each will you draw up? 15. IM.4 mg/mL. A child with severe poison ivy weighs 25 kg and Benadryl po 5 mg/kg/day is ordered q6h. The pediatric dosage range is 20-40 mg/kg/day in three equal doses. How much Tagamet will you inject into the Buretrol. You are to infuse heparin 5000 U in 250 mL NS at 30 mL/hr. The order is for meperidine 60 mg and atropine gr 1/150. The order is for amoxicillin 60 mg. Benadryl is available as a 12. Tagamet is ordered 200 mg.14. How much heparin has been given? . po. What dose should be given? 18. and what will the drip rate be? 16. q6h.5 mg/5 mL solution.

lower and upper range. Nipride is ordered and you are to titrate to maintain the systolic blood pressure at 150 mm Hg.29 m2. could be administered? • Within what range will the pump rate be set? . A microdrip chamber (60 gtt/mL) is used with a pump. Your patient weighs 143 lb. How much will each dose be? 21. The piggyback contains 120 mg Lidocaine in 100 mL NS. How many milligrams of dobutamine will infuse per hour? 20. Phenobarbital 180 mg/m2/24 hours given every eight hours is ordered for a child whose BSA (body surface area) is 0. Available is Nipride 50 mg/250 mL. • What is the concentration of the solution in mcg/mL? • How many mcg/min.19. and you are ordered to infuse 250 mg dobutamine in 500 mL NS at 10 mcg/kg/min. You are to give Lidocaine 30 mcg/kg/min to a child weighing 55 lb. At hat rate will you set the pump? 22. The range is 3-6 mcg/kg/min. Your patient weighs 155 lb.

4 pennyweights of Morphine dissolved in 1000 drachms of solution. The patient weighs 79 kilograms. If you increase the gtt/min by 5 gtt. just how to get from what you are given to what you want to know.• What is the titration factor in mcg/gtt? • The patient's systolic BP is currently 170 mm Hg while receiving the low range dose.9 milliscruples of Morphine IV for each stone of body weight to be administered over a 300-minute period. so you decrease the gtt/min by 6 gtt. but the point is you don't even have to know what the units are. How would you prepare 500 mL of a 1:35 bleach solution from a 1:10 bleach solution using water? 24. if seldom used. then use the Back button on your browser to return. At what rate should you set the pump? Your drug guide says that 0. the systolic blood pressure is 120 mm Hg. See the long list of Conversion factors for clues. How many mcg/min is the patient now receiving? 23. Kissoff. orders 1. how many mcg/min will the patient be receiving? • After 1 hr. Dr. Is the ordered dose safe? (Yes. Available is 1 gill of Morphine (MS) solution having a concentration of 0.) . all the units of measure are real. wishing to test your perspicacity.8 to 10 mg of morphine can be given per hour.

60 drops=1 tsp. She gives you an eyedropper bottle labeled: Take 1 drop per 15 lb of body weight per dose four times a day until the geebies are gone. Contains gr 8 heebie bark per dr 100 solvent. Do you need to see her before leaving to get a refill? Go to top Abbreviations for Nursing Students Units of Measure c cc cm dr dss fl ft g gal gl gr gt gtt in = = = = = = = = = = = = = = 2 cubic cup centimeters centimeters drams teaspoons fluid foot grams gallon glass grains drop drops inches . You weigh 128 lb. You are going on a three-week trip and are deeply concerned that you might run out of granny's geebie tonic. and the 4-oz bottle is half-full.25. You have come down with a bad case of the geebies. but fortunately your grandmother has a sure cure. You test the eyedropper and find there are actually 64 drops in a teaspoon.

kg L lb m mcg mEq mg mL mm oz pt qt tbsp tsp U = unit Other Abbreviations a ABG ABT ac AD ADH ad ADA am AMA aq AS AU bid BP BUN c cap CAD CAT CBC CF CHF CNS CO COPD CPK CSF CVA CVP EC ECG EEG elix ext GFR GT h hct hgb = = = = = = = = = = = = = = kilograms liters pound meters micrograms milliquivalents milligrams milliliters millimeters ounce pint quart tablespoons teaspoons = = = lib = = = = = = = = = = = = = = (ante) gas = antibiotic therapy before meals (ante cibum) right ear (auricula dexter) = antidiuretic hormone = as desired American Diabetes Ass. before noon (ante meridian) against medical advice = water left ear (auricula sinister) both ears (auriculi utro) twice a day (0900. 1700) = blood pressure blood urine nitrogen = with = capsule coronary artery disease computerized axial tomography complete blod count = cystic fibrosis congestive heart failure central nervous system = cardiac output chronic obstructive pulmonary disease = creatinine phosphokinase = cerebrospinal fluid = cerebrovascular accident central venous pressure = enteric coated = electrocardiogram = electroencephalogram = elixir = extract glomerulofiltration rate = gastrostomy = hour = hematocrit = hemoglobin arterial blood = before .

1700) = telephone order = tincture = ointment = urinary tract infection hour of = sleep. 0600. 1400. 1800) every 8 hours (0600.. bedtime .0500) every 6 hours (2400. 1700. 1300.. 1200. 2200) = every day (0900) = every hour four times a day (0900. 1300. 2100) = every other day = quantity sufficient = red blood count = range of motion = without = subcutaneous = sublingual = solution = subcutaneous = sustained release = one half = signs and symptoms = immediately = suppository = suspension = syrup = tablet three times a day (0900..hs ID ICP IM IV IVP IVPB KVO MI NG NJ NPO NS OD oint OTC OS OU p pc per pm po pr prn PT PTT q q1h q2h q3h q4h q6h q8h qd qh qid qod qs RBC ROM s sc sl sol sq SR ss S/S stat supp susp syr tab tid TO tr ung UTI = = = = = = (2100) intradermal = intracranial pressure = intramuscular = intravenous = intravenous push/pyelogram = intravenous piggyback = keep vein open = myocardial infarction = nasogastric = nasojejunal = nothing by mouth = normal saline = right eye (oculus dexter) = ointment = over the counter = left eye (oculus sinister) = both eyes (oculo utro) = after (post) = after meals (post cibum) = by = after noon (post meridian) = by mouth (per os) = per rectal = whenever necessary = prothrombin time = partial prothrombin time = every = every 1 hour = every 2 hours = every 3 hours every 4 hours (0900. 1700. 1300.

946 2 3 6 ounces grains 60 quarts ounces milligrams grains centimeters pounds quarts 16.000.000 15.23 drop tablespoons drams milliliters ounces ounces liters pints teaspoons ounces (oz) (gr) minims (qt) (oz) (mg) (gr) (cm) (lb) (qt) minims (gt) (tbsp) (dr) (mL) (oz) (oz) (L) (pt) (tsp) (oz) Long list 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 cental = centimeter (cm) = cubic centimeter (cc) cup (c) = drachm = dram (dr) = dram (fl dr) gallon (gal) = gill = glass = grain (gr) = gram (g) = gram (g) = gram (g) = hand = inch (in) = kilogram (kg) = kilogram (kg) = 45.000 2.57 16 16 0.8 1.VO VS WBC = WNL = within normal limits = = white verbal vital blood order signs count Go to top Conversion Factors for Nursing Students Short list 1 cup (c) = 1 dram (dr) = 1 dram (fl dr) 1 gallon (gal) = 1 glass = 1 grain (gr) = 1 gram (g) = 1 inch (in) = 1 kilogram (kg) = 1 liter (L) = 1 milliliter (mL) 1 minim = 1 ounce (oz) = 1 ounce (oz) = 1 ounce (fl oz) = 1 pint (pt) = 1 pound (lb) = 1 quart (qt) = 1 quart (qt) = 1 tablespoon (tbsp) = 1 teacup = 1 teaspoon (tsp) = 4.54 1.8 15.54 2.93 mL 8 60 = 4 8 64.000 1.43 4 2.057 = 1 2 8 29.43 2.359 10 = 1 8 3.55 60 = 4 4 8 64.2 grams millimeters milliliter ounces milliliter grains 60 quarts ounces ounces milligrams milligrams micrograms grains inches centimeters grams pounds (g) (mm) (mL) (oz) (mL) (gr) minims (qt) (oz) (oz) (mg) (mg) (mcg) (gr) (in) (cm) (g) (lb) .2 1.

This is seriously useful stuff. What this is all about is just conversion-converting one thing to another. We're talking about measurable stuff you can count or measure. not about numbers in the abstract.14 3 teaspoons 6 ounces 60 drops (mL) (qt) (mm) (cm) (mcg) (cc) (gt) minims (gt) (tbsp) (dwt) scruples (g) (gr) (dr) (mL) (in) (gr) (oz) gills (oz) scruples (L) (pt) (gr) centals (tsp) (oz) (gtt) Go to top Appendix A Fun with Dimensional Analysis Dimensional analysis (also known as the factor-label method) is by far the most useful math trick you'll ever learn. This is something you will have occasion to do in real life.946 liters 2 pints 20 grains 0.000 micrograms cubic centimeter 15 drops = 16. Anything you measure will have a number with . This trick is about applied math.57 milliliters 3 inches 24 grains 16 ounces = 4 16 ounces = 350 0. however. Maybe you've learned some algebra.23 1 drop 2 tablespoons 20 pennyweights = 24 31." First off.000 millimeters 100 centimeters 1." For a fraction of the effort needed to learn algebra. but do you ever use it? Ever foresee using it? For most people the answer is "not after the final exam. fluid (fl 1 palm = 1 pennyweight (dwt) 1 pint (pt) 1 pint (pt) 1 pound (lb) 1 pound (lb) 1 quart (qt) 1 quart (qt) 1 scruple = 1 stone 1 tablespoon (tbsp) 1 teacup = 1 teaspoon (tsp) 1 teaspoon (tsp) = 4.1 grams 480 grains 8 drams = 29.93 mL = = = = = 1 = = = = = = oz) = = = = = = = = 1000 milliliters 1.1 liter (L) 1 liter (L) 1 meter (m) 1 meter (m) 1 milligram (mg) 1 milliliter (mL) = 1 milliliter (mL) 1 milliliter (mL) 1 minim = 1 ounce (fl oz) 1 ounce (oz) 1 ounce (oz) 1 ounce (oz) 1 ounce (oz) 1 ounce (oz) 1 ounce. let's get rid of the big words. you too can learn "dimensional analysis.057 quarts 1.

gallons. 16/5 = 3 1/5 3. xiv = 14 All are true except #4. If you missed any. 4. 5. 1 7/8 = 15/8 4. 2. 20/48 = 5/12 2. 35% = 0. which should be 17/12. First a little test of basic math: Which of the following statements are True? 1. miles per second. 7 1/8 x 3/4 = 5 11/32 8. or pizza slices per person. 5/9 + 2/3 = 1 2/9 6. 10 1/5 .35 10.some sort of "unit of measure" attached. Reducing to lowest terms Changing an improper fraction to a mixed number Changing a mixed number to an improper fraction Finding a common denominator Addition of fractions Subtraction of fractions . 6. review: 1. A unit could be miles.6 3/5 = 3 3/5 7. 3. 5/8 ÷ 1/16 = 10 9. peas per pod. 2/3 + 3/4 = 19/12 5.

"What units of measure do I want to know or have in the answer?" In this problem you want to know "seconds in a day. If you could now connect "hours" and "minutes" together you would have a sort of bridge that would connect "seconds" to "days" (seconds to minutes to hours to days). click Med-math Practice problems) 1. When you have this kind of connection between units. so this is not a med-math problem. it works fine. Multiplication of fractions 8. The connection you need. is that there are 60 minutes in an hour (and in one hour there are 60 minutes). what you want to know is: b. If you can rephrase what you want to know using the word "per. that's fine because you're not going to solve THE problem. what do you do? First. so rephrase "seconds in a day" to "seconds per day. then you know enough to solve the problem--but first translate what you know into math terms that you can use when solving the problem. write it out: . Ask. If you're up to speed in DA. skip this answer. These are two ways of saying the same thing. Percent 10. How many seconds are in a day? Okay. Ask yourself. "What do I know?" What do you know about how "seconds" or "days" relate to other units of time measure? You know that there are 60 seconds in a minute. If in doubt." After you figure out what units you want to know. as with all DA problems. Division of fractions 9. Roman numerals (Click back button to go back to test if you are taking it) Go to top 25 Examples (To take as a test first. If you have no idea what the answer is or how to come up with an answer. Otherwise. What you are going to do is break the problem down into several small problems that you can solve. translate the English into Math. don't panic.7. of course." In math terms. but as an introduction to dimensional analysis (DA). and here's how. a. You know that there are 24 hours in a day (and in one day there are 24 hours). Math is a sort of shorthand language for writing about numbers of things." then that's a step in the right direction. You also know that in 1 minute there are 60 seconds.

the minutes will cancel out.. You could pick either of the following two factors as your "starting factor:" Write down your starting factor (say you pick 60 seconds per 1 minute): Now the trick is to pick from the other things you know another factor that will cancel out the unit you don't want. c. The problem is you have "minutes" on the bottom but you want "days. . then you know it's time to multiply all the top numbers together. With minutes on top and bottom. You want "seconds" on top in your answer.400 seconds in a day.. so you need to pick a factor that cancels out hours: d." You need to get rid of the minutes. All you need to do now is pick from these statements the ones that you actually need for this problem. what do I need to know?" Remember that you want to know: So pick from the things you know a factor that has seconds on top or day(s) on the bottom. So you need to pick 60 minutes per 1 hour as the next factor because it has minutes on top: You now have seconds per hour. but you want seconds per day. are true or equivalent (60 seconds = 1 minute). Ask. You cancel minutes out by picking a factor that has minutes on top. and divide by all the bottom numbers. since the minutes have cancelled out. or conversion factors. so forget about the seconds--they're okay. "From all the factors I know. When you have cancelled out the units you don't want and are left only with the units you do want. You start with "seconds" on top. In this case you just need to multiple 60x60x24 to get the answer: There are 86. so.All of these statements.. Solve it.

Here's how this problem might look if it were written on a chalkboard: Remember that you don't need to worry about the actual numbers until the very end. as is often done. 2. How many milligrams is the order for? To get from grains to milligrams you'll need a conversion factor like 1 gr = 64. . so rounding to 5 mL is reasonable. Plug in conversion factors that cancel out the units you don't want until you end up with the units you do want. you WILL get the right answer every time. They ask you how long the bottle will last.8 mg = 324 mg. 4. You just opened a 500 mL bottle of guaifenesin and will be giving 1 tablespoon per dose.8 mg. so you decide that's close enough and give 1 tab. 5 gr x 64. Just focus on the units. You give your home health patient an unopened 500 mL bottle of guaifenesin and tell them to take 2 teaspoons 4 times a day as ordered. unless you push the wrong button on your calculator. 1 gr Rounding to 60 mg/1 gr.93 mL 3 tsp 1 tsp x 1 tbs = 33 tbs Rounding to 5 mL gives you the same answer. gives 300 mg as your answer. Only then do you need to worry about doing the arithmetic. You are to give "gr 5 FeSO4" but the available bottle gives only the milligrams of iron sulfate per tablet (325 mg/tab). then. How many doses are in the bottle? In other words how many tablespoons are in 500 mL? 500 mL x 4. which might cause you to doubt if you will be giving the ordered dose. If you set up the bridge so the units work out. 3.

You are given "100 mg/mL" which should be more completely written as "100 mg Chlor.3 g x 1 5 mL mL x 1 tsp = 0.5 grams. Since water has a density of 1 (1 g/1 cc).5 g/cc. factor in the density: Sugar: 30 g x 1 cc x 1 mL x 1 tsp x 1 tbsp = 2. A teaspoon of salt (density 1.0 g/cc. 1 tsp of water would weigh 5 grams. and until you look up the densities and factor them in you wouldn't know if it matters or not.2. In another textbook you are given the following example: Order: Chloromycetin 300 mg 1V bolus via saline lock. The answer. Assuming 5 g/tsp for each seems a bit rough.25 g 1. 2. sol. is 1 qt boiled water. is 2. sol" in your answer. To do the conversions right.2 g/cc (sugar 1.7 g 1 cc 5 mL 3 tsp Salt: 1. pick a factor that has "mL Chlor. In powdered form they would weigh less. these densities are for the solid substances. right? But wait. however. How may mL of Chloromycetin should be administered? Equivalents: 1 g = 10 mL. The density of granulated sugar is 0.0. according to the textbook. Directions: Reconstitute with 10 mL sterile water for injection to yield 100 mg/mL.8 g/cc." When you add 10 mL water to reconstitute you will end up with somewhat more than 10 mL Chlor. NaHCO3 2./mL Chlor." You have to ask. though the text incorrectly uses it.63 tsp (closer to 2/3 than 1/2) 0.8 g 5 mL KCl. 10. sol" in it and in the right place.3 g/cc) would weigh 6." You can't use "mL water" and end up with "mL Chlor. KCl is 1. so a teaspoon would weight over twice as much. the set up is not.2). with density 1. Since only kitchen measuring cups and spoons are available you need to convert from metric. "10 mL of what?" Your answer unit.7 g/cc. is "mL Chloromycetin sol" and not just "mL. and 1/2 tsp baking soda. The density of salt. Since you want "mL Chlor. so a teaspoon of each would actually weigh between 3. 1000 mg = 1 g 300 mg x 1000 mg 1 g 1 g x 10 mL = 3 mL While the answer "3" happens to be right.9 tbsp (not 2. and baking soda is 0. 2 tbsp sugar. 1/4 tsp salt. KCl 2. The 10 mL is "10 mL sterile water.5 g x 1 mL x 1 tsp = 0. Label: Chloromycetin 1 g.5 g/cc and 6.5 g lite salt (KCl). 1/2 tsp lite salt. 1 tsp = 5 g is valid only when measuring water. Does taking the density into account really matter? Realizing that density is something to take into account matters. solution. what you want to know.2 tsp (close to 1/4 tsp) Baking soda: 2. .5 g baking soda. sol" and "10 mL/g" should be "10 mL water/1 g Chlor. What error did the textbook make? The set up is in error due to a failure to fully label units. remains at 1/2 tsp. What questionable assumption does the textbook make? While 1 tsp = 5 mL is a valid conversion factor.6." which is quite an unnecessary bit of information for solving this problem.0 tbsp) 0. "Teaspoon" is a measure of fluid volume and not weight.

1 cups water x 1 cup = 1/4 cup bleach 12. You could look up the density. x 1 g Chlor. No pump is available. which are the answer units.9 oz salt 16 oz salt 100 oz salt sol 1 qt x 32 oz x 2 tbsp x 3 tsp = 1 1/3 tsp salt 1 fl oz 1 tbsp qt salt sol To make one quart you would first put the salt into a measuring cup then fill to the 1 quart mark. What you want to know is the number of teaspoons per quart. Recalling that density is weight/volume.3 oz/fl oz. 10 mL water = 3 mL water (not!) The correct set up should be: 300 mg Chlor. The set up follows: 12.9 parts salt by weight to 100 parts salt solution (not water) by weight. you figure the density of salt at 16 oz/12. 1 g Chlor.3 fl oz or 1. How would you adjust the drip rate? First.9% NaCl) using water and table salt if you have only a measuring cup and a teaspoon? On hand is an unopened 1 lb box of salt. x 1000 mg Chlor. In a home setting. Salt is measured by weight. If you knew the density of granulated salt you could convert from a desired weight of salt to a volume of salt.300 mg Chlor. or what if you poured the box of salt (16 oz) into your measuring cup? Doing so you find that you have a bit over 12 fluid ounces of salt. 13. mL Chlor. x 1 100 mg Chlor. How would you prepare 2 L of 3% sodium hypochlorite (bleach) and water solution? You have only a measuring cup. You have an order to infuse 1000 mL of D5W (5% Dextrose in water) IV over a period of 5 hr. What do you know? You're given that there are 10 gtt/mL and that the infusion rate is 1000 mL/5 hr. so 0.3 fl oz salt x 0. how would you prepare 1 L (or so) of normal saline (0. sol 11.9% means. 2 L sol x 1000 mL x 3 mL bleach x 1 oz 1L 100 mL sol 30 mL 8 oz But how much water? The solution is 97% water. The key is to clearly understand what 0. but the tubing set package notes that the drop factor is 10 gtt/mL. sol = 3 mL Chlor. Since you can only measure volume (using cup and tsp).9% means 0. what do you want to know? The flow rate in gtt/min. right? 2 L sol x 1000 mL x 97 mL water x 1 oz 1L 100 mL sol 30 mL 8 oz x 1 cup = 8. . you will somehow have to determine the density of salt.

200 mg T. which true but is unusable in this form. sol 16. You are to dilute a portion of this in 100 mL NS and infuse over 20 minutes using a Buretrol with a drop factor of 60 gtt/mL.3 min mL T. Tagamet is ordered 200 mg. 10 gtt/mL makes a perfectly good starting factor--from there you just need to get from mL to min. The meperidine on hand is 100 mg/mL and the atropine is 0. tid for a child weighing 13 lb. sol = 304 gtt T. so what do you do? What if you added a secondary set with a drop factor of 12 gtt/mL? 12 1 mL gtt x 20 min 101. and what will the drip rate be? You want to know mg of Tagamet. so you rewrite . sol = 1. Can you count 5 gtt/sec? Not likely. your answer unit. sol = 60 gtt T.1 mL meperidine atropine gr x 64.Since you want gtt on top and 10 gtt/mL has gtt in the right place. The pediatric dosage range is 20-40 mg/kg/day in three equal doses. sol x 2 100 mL NS mL T. 100 mL NS 300 mg T. The order is for meperidine 60 mg and atropine gr 1/150. Is the dose safe? You want to know mg/kg/day for this child. po.8 1 gr 0. What you know is that you will give 60 mg per 13 lb body weight per dose or 60 mg/13 lb/dose. How much Tagamet will you inject into the Buretrol.3 mL T.3 mL min T. The two are compatible so you plan to draw up both in the same syringe. 60 1 150 mg 100 mg x 1 mg mL x 1 = mL 0. and gtt/min. How much of each will you draw up? For both you want to know mL.6 = mL 1.4 mg/mL.4 mg 15. IM. IV. The drip rate would be: 60 1 mL gtt x 20 min 101. q6h. 14. so divide by 3 and count for 20 seconds. The order is for amoxicillin 60 mg. The set up then: 10 1 mL gtt 5 hr x 1000 60 min min mL x 1 hr = 33 gtt You wouldn't want to count a full minute. Available is Tagamet 300 mg in a 2 mL vial of aqueous solution.

so this should work as a starting factor: 10 mcg x 60 min x 1 mg kg x min 1 hr 1000 mcg 2. Your patient weighs 143 lb. What is the concentration of heparin solution? When you clear the pump you note that 187 mL have been infused. 17. which has time on the bottom. so nothing tricky here: 5000 250 mL 187 mL mL sol U sol x = 20 U 20 = 74. Benadryl is available as a 12. What dose should be given? You want to know mL/dose.5 mg/kg/day--a safe dose. rearrange in the form x/y*z and everything will stay straight. How many milligrams of dobutamine will infuse per hour? You want to know mg/hr. Half of one quarter is one eighth. After converting to 10 mcg/kg x min you note that time is also on the bottom.800 U/mL U 19.5 mg 13 lb x 1 dose 1 kg 1 day kg x day = 30.it as 60 mg/13 lb x 1 dose.5 mL 18. Whenever you have x per y per z. to give another example.5 mg/5 mL solution. and you are ordered to infuse 250 mg dobutamine in 500 mL NS at 10 mcg/kg/min. You are to infuse heparin 5000 U in 250 mL NS at 30 mL/hr. which is equal to ft/(sec x sec) or ft/sec2. but how to figure that: 1 4 2 = 4 1 2 x 1 4 = x 1 2 = 1 8 Dividing by 2 is the same as inverting 2 to get 1/2 and multiplying. is measured in feet per second per second or ft/sec/sec. How much heparin has been given? You want to know Units/mL.2 lb x 3 dose = 30. Since you want mL on top. start with: 5 mL x 5 mg 12. How can you do that? Consider dividing 1/4 by 2.2 lb x 1 kg hr x 143 lb = 39 mg . Acceleration. 60 mg x 2. A child with severe poison ivy weighs 25 kg and Benadryl po 5 mg/kg/day is ordered q6h.5 mg kg x day 4 doses x 1 day dose x 25 kg = 12.

Titration problems are just longer. You are to give Lidocaine 30 mcg/kg/min to a child weighing 55 lb.20.29 m2 = 17.4 mg 21. not more difficult. lower and upper range.2 lb kg x min 1000 mcg 120 mg 1 hr hr 22. Nipride is ordered and you are to titrate to maintain the systolic blood pressure at 150 mm Hg. so you could start with 1 day/3 doses or 180 mg/m2/day: 1 day x 3 doses m2 x day 180 mg dose x 0. • Within what range will the pump rate be set? What's the low and high rate the pump could be set at in mL/hr? 184 mcg x 60 min x 1 min 1 hr 200 mcg hr 1 mL = 55 mL low range. so: 50 250 mL • mg 1 mg x 1000 mcg = 200 mcg/mL How many mcg/min. so relax and focus on what you want to know.2 lb Since the high range is twice the low. The piggyback contains 120 mg Lidocaine in 100 mL NS. The range is 3-6 mcg/kg/min. Phenobarbital 180 mg/m2/24 hours given every eight hours is ordered for a child whose BSA (body surface area) is 0. . At what rate will you set the pump? You want to know mL/hr. Available is Nipride 50 mg/250 mL.29 m2. just multiple by 2 to get 368 mcg/min. A microdrip chamber (60 gtt/mL) is used with a pump. could be administered? 1 kg x min 135 lb = 184 mcg low range 3 mcg x kg x min 2. • What is the concentration of the solution in mcg/mL? Here you want mcg/mL. Your patient weighs 135 lb. How much will each dose be? You want to know mg/dose. Starting with the patient's weight usually works out: 55 lb x 1 kg x 30 mcg x 1 mg x 100 mL x 60 min = 37.5 mL 2.

how many mcg/min will the patient be receiving? You want mcg/min and from the above. if seldom used.b. Is the ordered dose safe? (Yes.8 to 10 mg of morphine can be given per hour.3 1 gtt • mcg 1 min x min 60 gtt = 198 mcg After 1 hr. x 1 35 mL w. going from 55 to 60 gtt/min: 3. The patient weighs 79 kilograms. If you increase the gtt/min by 5 gtt. How would you prepare 500 mL of a 1:35 bleach solution from a 1:10 bleach solution using water? You want to know how much concentrated bleach solution (mL c.) you need to make the weaker solution (mL w. mL b. 10 mL 1 mL b.9 milliscruples of Morphine IV for each stone of body weight to be administered over a 300-minute period.b. If you fully label all amounts. the systolic blood pressure is 120 mm Hg. b.b.). Kissoff. = 143 mL c. At what rate should you set the pump? Your drug guide says that 0. 24. all the units of measure are real. c. but the point is you don't even .which is also 55 gtt/min: 55 mL x 1 hr 60 min 1 mL 1 hr min x 60 gtt = 55 gtt You could plug in 368 for 184 and recalculate. so you decrease the gtt/min by 6 gtt. • What is the titration factor in mcg/gtt for the low range? Don't know what a titration factor is? It don't matter 'cause you know you want mcg/gtt: 184 1 min • mcg 55 gtt x gtt 1 min = 3.3 1 gtt mcg 1 min x min 54 gtt = 178 mcg 23. Dr.b. How many mcg/min is the patient now receiving? You again want mcg/min and are going from 60 to 54 gtt/min: 3.3 mcg The patient's systolic BP is currently 170 mm Hg while receiving the low range dose. orders 1. or again just double 55 to get 110 mL/hr for the upper range.4 pennyweights of Morphine dissolved in 1000 drachms of solution. wishing to test your perspicacity. x 500 mL w.b. you should avoid confusion. To the 143 mL of concentrated bleach solution you would add enough water to make 500 mL 1:35 solution. Available is 1 gill of Morphine (MS) solution having a concentration of 0.

but it's easier to just go with 2 oz/bottle. You are going on a three-week trip and are deeply concerned that you might run out of granny's geebie tonic. what do you want to know? You want to know how long the bottle will last. So you write down "Answer units = days/bottle" What do you know to start off with that you might need to know? You write down the following: You realize that if a 4-oz bottle is half-full. You could figure out days/bottle or weeks/bottle and see if the bottle will last longer than 3 weeks or 21 days. You set the problem up: . then there is 2 oz of tonic in it. Contains gr 8 heebie bark per dr 100 solvent. What should you use as a starting factor? You pick 128 lb because it's something you're given and starting with weight usually works.The dose is safe. 25. but you could figure it out dimensionally if you wanted to: You would then end up with "days/half-bottle" in your answer. You test the eyedropper and find there are actually 64 drops in a teaspoon. 60 drops=1 tsp. but on the high side. so you'll be monitoring your patient closely. Do you need to see her before leaving to get a refill? Now this one is a bit hard if you haven't been paying close attention. and the 4-oz bottle is half-full. Oh. You weigh 128 lb. are you going to have enough? Go figure. but fortunately your grandmother has a sure cure. You have come down with a bad case of the geebies. First. She gives you an eyedropper bottle labeled: Take 1 drop per 15 lb of body weight per dose four times a day until the geebies are gone. and since you have 1 gill (4 ounces) or about 120 mL of morphine solution.

in chapter 6.8 mg. Ignoring a given unit. 10 percent errors are a bit worrisome. 49) gives 25 mg/kg/24 hr. When. all undesired units cancel." Omitting the "per day" part doesn't alter the fact that that is what you want to know--not per hour. As the text acknowledges. The solution is given as: The problem is that the correct answer units should be how many mL should be administered per day. There is actually a simple rule that applies here. it is not written as ft/sec/sec. yet this is what the textbook does. then pulling it out of thin air at the end is poor technique. when acceleration is measured in feet per second per second." Indeed. and fraction of a percent errors are unimportant in medication math. If + 5% errors are acceptable. as an aside. is questionable. When doing dimensional analysis it is essential that all the units given should be used and accounted for. The problem (p. So if you're given mg/kg/day. any answer to a test question that is within 5% of the correct answer should be counted as correct. Equating 1 grain with 60 milligrams when the actual equivalency is closer to 64. then. The textbook method is to calculate "mL. In this form it can be used. this problem would become more difficult to solve. but "250 mL/hour" is not. the solution is presented in an unorthodox way.All examples used throughout the text use only numbers having a single unit attached for starting factors. thus greatly increasing the risk of administering an overdosage (sic). While many conversion factors are approximations. as is equating liters and quarts. but per day. This is not correct as starting factors are often in the form of "something per something.23 minims). but as ft/sec2 because ft/sec/sec is equal to ft/sec x sec." . the preferred way to deal with such a "triple decker" is to rewrite it as mg/kg x day. For example. rounding to the nearest tenth. when far greater errors can be introduced by using loose approximations. then the solution is straightforward: If "day" were omitted." then divide by 4 to get "mL/dose. Apparently "1 hour" is an acceptable starting unit." Students must remember to perform this final "critically important" step which would not exist if better technique were used. and you end up with the desired answer with the right units attached: If the problem called for "mL/dose" given 4 doses per day. or 1 mL to 15 minims (actually 1 mL = 16. however. It is possible to solve a problem and come up with answers that differ by as much as 10% depending on which approximate conversion factors you decide to use. It is oddly inconsistent to insist on carrying out calculations to two decimals. a problem involving amount/body weigh/day comes up. not per dose. "it is easy to forget to divide the total daily dose into the prescribed number of doses. or "mL/day. some problems cannot be solved if they have a single unit starting factor (see example 3 in Appendix A).

the problems are perfectly setup to yield the correct answers with the correct answer units. at least. you would be committing mathematical suicide as the problem would be rendered unsolvable once "hour" is cancelled out. Would they realize that when "mcg" was cancelled that "3 1/min" was left requiring the use of 60 min/1 hr instead of 1 hr/60 min? Trying to explain how to work around the poor technique employed by this example only digs a deeper hole. an example is shown. and are shown conversion equations like the following: The problem. Students should be told to just ignore the nonsensical "1 min" and "1 hour" starting factors. minutes are not omitted then added at the end. In Chapter 10. If you were to introduce "1 hour" as a starting factor in example 3 in Appendix A. The correct answer is just pulled out of nowhere and declared to be "33 gtt/min. Students are given problems that require converting from mL/hr to gtt/min. there is no such requirement when doing dimension analysis. It is not a given. is that the correct answer unit is "gtt/min" and not "gtt" as it appears. as a model for students to follow. and it means absolutely nothing to say that you know "1 min" or "1 hour" or "1 cabbage. The risk of confusing some students by introducing a new rule can hardly be worth the risk of error introduced by teaching a flawed technique. page 184. A student might try to logically extend this technique to determine mL/hr: The student who notices that the answer doesn't make sense might wonder what went wrong. The better response to student confusion would be to have them put a big X mark over this section of the textbook and show them a sensible way to set it up: Another case of flawed technique arises in Chapter 10. again. and it is unfortunate that the authors neglect to show students how to logically deal with them. In the above example "90 mL/1 hr" would make a logical and perfectly good starting factor. but merely confusing to many students and visually awkward. . to determine how many mcg/min must be administered to a 215 lb patient at 3 mcg/kg/min: In this example." If such meaningless starting factors are simply omitted from such examples. and the technique is not even erroneous.Problems of this sort are common. however. As mentioned." The initial starting factor of "1 min" is spurious. It seems that the pseudo-starting factor is used to avoid having a starting factor with more than one unit attached.

must also have only a single unit associated with it. The only equivalent relationship is between what is on the left side of the equal sign and what is on the right side. as in all dimensional analysis conversions. the only clue to their reasoning was given in the following paragraph that preceded this example: "In calculating the flow rate for drops per minute. All of these assumptions are incorrect as generalizations about dimensional analysis. In between are conversion factors that are fundamentally different from the starting factor. is the starting factor and drops is the answer unit and these. 10 gtt/mL makes a perfectly good starting factor--I just need to get from mL to min. the simple conversion problem. one minute becomes the labeled value that must be converted to an equivalent value: number of drops. As to what the authors might be thinking. There is a particular type of DA problem. Since I want gtt on top and 10 gtt/mL has gtt in the right place. One could speak of an equivalent relationship between the "numerator" and "denominator" of a conversion factor (2. which. They see the starting factor as something given.2 lb = 1 kg). that does involve going from one unit of measure to another equivalent measure (such as converting from feet to .2 lb/1 kg means 2. it has only one unit associated with it. but otherwise there is no necessary "equivalent relationship" implied. One minute." On page 9 is the following table: Table 1-2 Conversion Equation This table reveals how the authors think about dimensional analysis. form an equivalent relationship.10 gtt/mL and that the infusion rate is 1000 mL/5 hr. and it forms a special "equivalent relationship" with the answer unit. My set up then: 10 gtt 1 mL 5 hr x 1000 60 min mL min x 1 hr = 33 gtt Just omitting the "1 min" from the textbook's setup would also work. there can be only one starting factor. therefore. being equivalent.