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# 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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**My Adventures in Med-Math
**

I did my first med-math problems when my wife was in nursing school. She's pretty sharp and no math weenie, but some problems proved frustrating and she'd say, "Okay Mr. Math Guy, see if you can solve this one." I'd do the old bing-bang-boom, and offer up the (correct) answer. Once I got the old, "Ha! You're wrong, the answer key says it's ..." to which I helpfully replied, "When you go to class tomorrow be sure to let your instructor know her answer key needs correction." Somehow I gave the impression of being some sort of math whiz, which I knew not to be the case, but damned if I was going to admit it to her--I didn't want her thinking she was smarter than me in everything! Unfortunately, at the time, I didn't pay any attention to how nursing students were being taught to do med-math, and she, asking only for the answer, paid no attention to how I so easily and annoyingly came up with the right answer every time. As it happened, during her first year she was taught the traditional (for nurses) approach using ratios, proportions, and formulas. Then during her second year, the school switched over to the new fangled (for nurses) approach based on dimensional analysis. A couple of years later our daughter started nursing school (I started the next year), and I got to hear all the med-math horror stories about how many did or didn't pass the latest med-math quiz (these were given throughout the year after everyone had passed the 8-week med-math class) and

had to attend remedial classes (on the dreaded titration quiz only two students in her class passed the first time!). Unfortunately, once again, I didn't look into how she and other nursing students were being taught to do dimensional analysis. I just thought there was something about medmath problems that made them incredibly difficult to solve. I should have known that there was something horribly wrong. I had learned to do dimensional analysis (DA) some thirty years earlier when I was taking a lot of chemistry classes. I've happily used DA ever since and had never encountered an applied math problem in chemistry, physics, or engineering that DA couldn't readily dispatch, and yet I was willing to assume that med-math problems, with the exception of the ones I had done myself, were somehow different and intrinsically harder. I'm such a bloody moron! It wasn't until I started nursing school and took the obligatory med-math class that I finally realized what was going on. I had an hour or so to kill before the first class, so I opened the textbook to glance through it. Before class began, I had realized, with growing shock and disbelief, that the authors of the textbook didn't understand the technique they were attempting to teach to nursing students. There were serious errors of omission--things you really need to know to do DA right and well. And there were serious errors of commission--using techniques and the language of math so badly as to give the text a distinct air of innumeracy. I was convinced that if I had had to learn DA from this book, I would be at serious risk of not passing the class. My next thought was, "Hmm, wonder where the instructor learned to do DA?" So here I was in an 8-week class with nothing to do apart from memorize a few abbreviations and conversion factors. The instructor made a good show of pretending she knew what the textbook was talking about. Instead of risking doing problems on the board herself, she deftly had students, a half dozen or so at a time, come up to the board to do problems from the text. Then she would point to each problem in turn and ask if everyone got the same answer. If anyone thought the answer wrong, they got to explain how they came up with the right answer. This actually worked out rather well as several students had enough sense to ignore the textbook and figure out how to do the problems in spite of the book. Since I had a lot of spare time, I decide to see if I could do something to improve the situation. Perhaps a critique of the text with suggested corrections would help. Better, I could explain how I was taught to do DA with the gentle hint that maybe the Ph.D. chemist who taught me understood DA better than the nurses who wrote the textbook. I got started, getting my thoughts together in writing, that first week of class. Part of the situation was that here's a freshman nursing student, O ye of zero credibility, seriously thinking about calling into question the mathematical acuity of textbook authors with advanced degrees (in nursing), and implying that those teaching or who have taught the class, having learned DA from the book, didn't quite know what they were doing either. I needed to be careful and make sure I knew what I was doing. My first reality check was to mention my assessment of the textbook to a fellow student known to have a good grounding in science and math. He immediately agreed that the authors were confused, but as he was doing fine, he didn't seem interested in offering any corrections--a wiser man than I. The only students to get in serious trouble were the ones who spent way too much time reading the book. I recall two who had taken the class over the summer and had failed it. They were taking it again and knew they'd be dropped from the program if they failed again. The pressure

and to tough it out in the hope that. superficial technique that gives us the right answer every time looks pretty darn good. they would at last master med-math by the book. and even I found it difficult to consider the possibility that I might be right. math. but the aim is to understand deeply and not merely crank out the right answer using some superficial technique. and technology issues. these were the two who were dropped because they couldn't pass med-math. but that I wasn't going to teach them to do DA the book way. but all reported that my clairifications were helpful. Prior to that he was a professor of computer science at UCSD. Jef Raskin may not be a household name. I was prepared to argue my points based on evidence and reason. This approach. Steven Hawking was too busy. but Jef is the creator of the Macintosh computer and was lead designer of the Mac OS. I didn't mention my correspondence with Jef to my project mentor or other faculty. for those of us less gifted folk. I sent Jef copies of the textbook. but decided not to risk being confused any more than they already were. Basically he agreed that the authors' presentation of DA was "illogical and incorrect. At the end there would be an Honor's Colloquium. One student asked me a couple of days before the final how to pick a starting factor (something the text fails to mention). Ideally I wanted someone whose math ability was off the scale. The instructor tried without success then asked me to tutor them. I realized that my presumptuousness was off the scale. I emailed Jef Raskin about my problem who replied that he was a strong supporter of DA and was willing to help. and felt that to play the Authority Card to gain credibility would be in bad form. working on another project--something about a theory of everything. It was a pleasure and a privilege to correspond with Jef. and they just weren't getting it. so he could form his own opinion. the think-it-through technique.was on. I really like this guy. I needed to consult with someone whose mathematical acuity was beyond reasonable doubt. and as a bonus his wife is a nurse with advanced degrees (which is what made me think he'd take an interest). is slow and error is a risk. . and reported the next day that she tried my technique out on various problems the night before and that it worked! She later mentioned getting 100% on the final. so I had to find someone else. Sadly. with enough effort. namely none at all. which would involve some faculty involvement and oversight. There were others more willing to let me confuse them. I thought of spinning my work into an Honor's Project. Problems are approached from first principles and reasoned through to the answer that makes sense. I assured them I could help. he has written over 300 articles and books on science. apart from being known widely as a human interface guru. or so he claimed. As the hours put in to the project began to mount up. and since then. I was given the nod to go ahead." But he went on to explain that gifted scientists and mathematicians use a different technique. They thanked me for the offer. those portions I found questionable. someone whose judgement I could completely trust. Of course. In hindsight I probably should have in order to gain enough credibility to be listened to in the first place. but from there on I pretty much did my own thing. and I'd invite all the faculty listen to my presentation. I felt that my critique and suggestions should stand on their own merit.

due to schedule conflicts. pick a logical factor to start with. felt I was listened to. you have a major clue you're doing something wrong and that your answer is guaranteed to be wrong." attached to them. The technique has been taught to students of applied science for longer than I have been able to determine and for the sole reason that students using it make fewer mistakes. My presentation went well and was well received by the 30 or so academics present. then add others until all the units you don't want cancel out and you're left with only the one or ones you do want (which is why you determine the answer units first). no one from the nursing department was able to attend. I hope someone out there is being helped. This got me a meeting. Go to top A Brief Introduction to Dimensional Analysis When you're doing applied math. Someone noticed that when you plug values into a formula and pay close attention to what happens to the units as the formula is simplified. At the end of my final year of nursing school I felt I had an ethical responsibly to try again. you always get the right answer. You pay attention to the units of measure and if they're not canceling out right. I personally invited the Director of Nursing and any faculty who might be interested to attend. you'll see that most of the units cancel out and you're left with only those units that end up in your answer. and here I must note that I detected or imagined some annoyance on her part that I was bringing up the subject yet again. I was the only nursing student on the list. This process is fairly trivial. On the off chance that someone out there in cyber land would be interested in my work. I told the Director of Nursing I would be willing to meet with her and any interested faculty to explain my concerns about the med-math program at a time of their convenience. This always happens if the formula is correct and you plug in the appropriate factors. numbers have units of measure. but had yet to determine what it was. . I contacted by email the instructor currently teaching med-math (not the one I had had). For every problem you can just take the factors associated with it. and with only slight attention to detail. I posted some stuff on a Web site. At any rate she never called and I never offered again. mentioning straight off that she had already come to the conclusion that there was something not quite right with the textbook. I don't know if med-math students are doing any better as a result. Needless to say I had plenty to say on that point. She was receptive. She said she'd let me know. and shamelessly played the Authority Card. and that all points were taken. Unfortunately.When all the students at the college who had done Honor's Projects were scheduled to present. So then someone figured out that you don't need formulas at all. or "dimensions. I was given time to make my case. As my first year of nursing school came to a close. but one can always hope.

While not all steps listed below will be needed to solve all problems.g.2 lb. such as "60 min/1 hour. The only fault lies in the name." Rephrase if necessary.2 lb" and/or "2. but coming up with the right answer only four out of five times isn't good enough. e. Some familiarity with DA is assumed. Passing med-math may require getting 80% of test problems right." Example: You want to know "milligrams per liter. rewrite as 25/100 with appropriate labels (see example 5) b. Translate into "math terms" using appropriate abbreviations to end up with "mg/L" as your answer unit (AU). e. Rephrase if necessary using "per. "AU= mg/L" 2. Setup the problem using only what you need to know." then write down "2. What are you given by the problem. so write down "1 kg/2. but rather understanding and practicing them. e. Pick a starting factor. Determine what you want to know. e. rewrite as mg/kg x day (see example 4) If a percentage is given. I would not suggest memorizing the sequence of steps." b. Think: "Drip rate is 45 drops per minute.As nurses doing calculations. a. dimensional analysis does the best job of minimizing them. Factors known from memory: You may know that 1 kg = 2. I have found that any problem that can be solved using DA will yield its answer if the following steps are followed.2 lb/1 kg" 3. Read the problem and identify what you're being asked to figure out. Determine conversion factors that may be needed and write them in a form you can use. Go to top A Step by Step Guide to Dimensional Analysis The following summary can be used as a guide for doing DA. Understanding is more durable than memory." a. See example 1. you counted 45 drops. pick from what you know a factor having one of the units that's also in your answer unit and that's in the right place.g. Factors from a conversion table: If the table says "to convert from lb to kg multiply by 2. 25%. While mistakes can still be made using any technique. Determine what you already know. . "45 gtt/min" If a given is in the form mg/kg/day. a.2 lb/1 kg" as conversion factors you may need. if anything? Example: "In one minute. error is not an option. See the answers to the self test for a detailed explaination of DA. 1. Write this down. "how many milligrams are in a liter of solution." Translate into math terms using abbreviations.2." You will need enough to form a "bridge" to your answer unit(s). Perhaps The Math-Weenie NoBrainer Technique would be more appropriate.g.g. See example 1. If possible.

then use the rounded off answer as a new starting factor. See example 6. The steps are best taught. Take a few seconds and ask yourself if the answer you came up with makes sense. Compare units in answer to answer units recorded from first step. Go to top How to Minimize Mistakes Anything we can do to reduce errors by even the smallest degree is worth doing. Solve: Make sure all the units other than the answer units cancel out. then divide into that number all the bottom numbers. If you can't get to what you want. about the answer unit(s) we are . or 74. b. can make a difference. See example 1. alternating until finished.73 + 0.725 and 74. such as what the physician ordered. or actually write it down? At best we will hit what we aim for.7 mL or 75 mL.735. Pick from what you know a conversion factor that cancels out a unit in the starting factor that you don't want. b. Round off the calculated answer. A more realistic answer would probably be 74. How we choose to write down a DA problem. try picking a different starting factor. cancel them out. or checking for a needed conversion factor. See example 9. setup as a separate sub-problem. d.Or pick a factor that is given. start over. If the same number is on the top and bottom. e. so we must be very clear about what we want. If you round off 74. Multiply all the top numbers together. If it doesn't. for example. e.73 mL that implies that all measurements were of an extreme accuracy and that the answer is known to fall between 74. circle it in the problem. c. Be realistic. If you round to a whole number that implies a greater accuracy than is appropriate. and so would serve better as a guide to tutoring students than as a self-teaching guide. then comparing the answer to the first one. so refer to Appendix A for examples. write your answer to indicate a range. This is a fairly bare outline. See example 9. Note that the starting factor will always have at least one unit not in the desired answer unit(s) that will need to be changed by canceling it out. a. 5. such as 75 + 5 mL. 4. Miskeying is a significant source of error. Keep picking from what you know factors that cancel out units you don't want until you end up with only the units (answer units) you do want. Simplify the numbers by cancellation. Double check to make sure you didn't press a wrong calculator key by dividing the first top number by the first bottom number. If an intermediate result must be rounded to a whole number. c. rather than read.733333 to 74. so always double check.005 mL. then do the math. Should we just keep the answer unit in mind. such as drops/dose which can only be administered in whole drops. solve. Add labels (the answer unit) to the appropriately rounded number to get your answer. d.

Perhaps with the exception of conversion factors you have memorized. an error. especially if you're using scratch paper with other problems on it. When written in factor form using bars. DA problems are often written in fraction form. and is more appropriate for working with factors. Reading the problem with the sole. then. Since the first factor is normally multiplied." Occasionally a factor like "50 kg" will need to be divided rather than multiplied which could cause confusion or errors when doing the math if the division sign is not noticed when written in fraction form. An error of omission is less likely using the following non-fraction format: This format is more visually integrated.aiming for. perhaps because it is visually different and not in line with other values. In this format. the first number can be overlooked. it is advisable to actually write down. 2/3 is not equal to 3/2. like me. It is also less confusing when doing amounts-per-body-weight-per-dose or day calculations. When it comes time to do the math. Often the hardest part of a problem is translating fuzzy English phrasing into crisp math terms you can use. then dividing by 50 and 500. more bridge like. even though they are factors and shouldn't be confused with fractions. focused purpose of determining the answer unit. then writing it down (least we forget or get confused later on) is an example of good technique. the horizontal bar means "divide. mistakes and confusion are minimized: This is." and vertical bars mean "multiply. . in "math terms" or factor form anything given to you by the problem as well as any conversion factors you had to look up. You can be sloppy and still get the right answers most of the time. but eventually you'll blunder because of poor technique. Fractions cannot be inverted and remain correct.3 mL/min" as your answer forgetting that you were supposed to calculate "mL/hr" and all because you neglected to write down the answer units and compare them with your answer. You'll triumphantly. instead of multiplying 250x50x1000. write down "4. another reason to avoid the fraction format. students might stumble if division is required and divide everything into 50. while factors can be (3 tsp/1 tbs is equivalent to saying 1 tbs/3 tsp.

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.

sol Checking to make sure all the units of measure. On hand are 1 cc and 3 cc syringes. sol = 0. which has "time" on the bottom so starting with 1. sol = 24. 1 mL mep. Your set up: 35 mg mep. Your order is for meperidine (Demerol) 35 mg.0 mL L.6 mg 1 min L. now is the time for the calculator. x 60 min 1 hr 400 mg L. the nurse tries to solve the problem on a calculator.5 days. but admits that at the moment her brain doesn't seem to be working.6 mg/min should work. 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. Available is a 2 mL vial containing 50 mg/mL meperidine. cancel out. the number of milliliters that will contain 35 mg meperidine. we can now set the pump with confidence. 5. except for mL and hr.7 mL mep. then x x ÷ x ÷ ) and getting 24. She assures you she can always do problems like this on tests. How much should you draw up into which syringe? Your answer will be in mL (cc). since you know that you want "mL on top" in your answer. x 50 mg mep.You could give an answer in hours or weeks. x 100 hr mL L.7 mL If you don't actually write down full labels. you could start with 1 mL/50 mg: 1 50 mg mL x 35 mg = 0. Hanging is a 100 cc piggyback containing 0. and get from mg to mL. at least be thinking "mL of what?" "mg of what?" 6.6 mg of lidocaine are being delivered per minute.0 each time. STAT. You are shadowing a nurse during a clinical who receives an order to adjust the infusion rate of a pump so that 1. How would you set up and explain the problem to her? We want to know mL/hr. 1. Crunching the numbers twice (first x x x ÷ ÷ . You know from the label that there is 50 mg meperidine in 1 mL of meperidine solution. sol or. Your set up: 500 mL x 1 5 mL 2 tsp tsp x 4 doses 1 dose x 1 day = 12. so you tell them the bottle will last 12 days. but you figure "days" is the better choice for an answer unit. We now just have to change minutes to hours.4 grams lidocaine. .4% solution. IM. a 0. Without writing anything down. You realize you will give less than 1 mL.

The reason is drop size varies from 10 to 60 drops per mL.0 mg MS MS sol x 0.2 mg 1 hr MS x hr 60 min = 120 mL MS sol Now that you know the rate. and the other has a 100 cc bag containing 2 mg morphine sulfate (MS) running at 5 cc/hr for pain management. You finally find the tubing used and the package says 12 drops/mL. It occurs to you that you could reset the pump to deliver 0. and it is the drop factor (drops/mL) that you need to know. but on looking in the narcotic cabinet you find none available and the pharmacy is closed. As a home health nurse you need to help a client make homemade pediatric electrolyte solution using the following recipe: 1 L boiled water. adjusts the drip rate to something that "looks about right. 30 g sugar." and rushes on to her next demand. Your answer will be in drops/min. A textbook on clinical calculations includes the following conversion for household to metric: 1 teaspoon = 5 mL = 5 g.2 mg MS in 5 minutes.2 mg MS = 10 mL MS sol Just to double check. You decide to adjust the drip rate accurately to give the ordered amount. . 8.5 g salt. His over-extended regular nurse hangs drip tubing.2 mL IV push. you need the volume to be infused: 100 mL 2. She begins to show signs of breakthrough pain and her doctor orders 0. but don't see it. One side is running NS at 30 cc/hr KVO. 1.0 mg MS 5 min 0. Your hospice patient is on a double pump. so: 60 1 hr mL 1 mL x 12 60 min drops min x 1 hr = 12 drops or 3 drops every 15 seconds which is easier to count. how many minutes will it take for the pump to deliver 10 mL at 120 mL/hr? 60 1 hr min 120 mL x 1 hr x 10 mL = 5 min 9. 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. You would normally use a prefilled syringe containing 1 mg/1 mL MS and give 0. It turns out that "about right" was about twice the ordered rate. You recall seeing tubing in the supply room and go there looking for the same tubing as what was hung.2 mg MS STAT. He is receiving 60 mL Jevity per hour as ordered when the pump fails and no other pumps are available. What do you need to know to do so? You look in the trash for the tubing package. so start with mL on top: 100 mL MS sol x 2. The manufacture would have calibrated their drip chamber and put the number of drops/mL on the package.7. At what rate should you set the pump? Again you want mL/hr. then go back to 5 mL/hr.

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.

3. Does the answer make sense? The flow rate is within usual limits.55 milliliters per drachm.4 pennyweights MS per 1000 drachms and that you have a whole gill of this solution however much a gill is. 24 grains per pennyweight. just how to get from what you are given to what you want to know.) Breaking the problem down stepwise: As always. 3. start by asking what do you want to know? If you've worked with IV pumps you know they are programmed in mL/hr. since you want "mL" on top. (or in math terms you know 60 min/1 hr. and that you are to infuse 0. You are also told that there are 0.4 pennywts 1 drachm hr Does everything cancel out except for "hr" and "mL"? Bingo. See the long list of Conversion factors for clues.14 centals 1 stone x 300 min 1 hr 1 scruple 24 grains 0. you know "hours" has to be on the bottom. there is 1 hr. 20 grains per scruple. and 3. Doing so you find that there are 4 ounces per gill. punch the numbers in (correctly) and you got it: 35 mL/hr. You also know that since you need "hours" in your answer you will need to get from minutes (300 minutes) to hours at some point. but you decide to pick 79 kg as your starting factor. since you know your answer has to be in mL/hr. The rest of what you need to know will have to be looked up. which forces you to lookup "cental" where you find that there are 45. and 1 hr/60 min).0019 scruples x 60 min x 20 grains x 1 pennyweight x 1000 drachms x 3. Since you need "hr" on the bottom.36 kilograms per cental. What do you know? From the problem you know the patient weighs 79 kg. Setup: What factor should you start with? Since you know that the patient's weight is a determining factor. and you'll need a conversion factor to get from grains to milligrams.4 pennyweights x 24 grains 1 hr 3.55 mL 1000 drachms 1 pennyweight 1 grain x 64. start with 35 mL/hr. 79 kg x 1 cental x 1 stone x 0. you realize you get the same answer no matter what order you multiply (or divide) your terms in.55 mL/drachm would also be a logical starting factor.8 mg = 6. so 60 min/1 hr would be a logical starting factor (you would then just have to get from "min" to "mL"). your answer unit. but is the dose safe? Go back to step 1: you'll need to know mg/hr.36 kg 0.14 centals per stone. Or.have to know what the units are. Looking up "stone" you find that there are 0.1 mg hr . Or. then use the Back button on your browser to return. If you recall the Commutative Law of Multiplication. And everyone knows that in 1 hour there are 60 minutes and in 60 min.55 mL = ? mL 45. you could start with it. so your answer will have to be in these units of measure. 35 mL x 1 drachm x 0.0019 scruples per stone per 300 minutes (it helps to rephrase the problem using the word "per").

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.

Go to top Summary • Don't panic. The story continues: You leave on your trip and on the 19th day you run out of geebie juice. you find you had enough tonic to last somewhere between 16 and 26 days. You wish you had measured the amount and found that the bottle contained 2. You note a small difference.5 oz of tonic. So. or put it in the middle somewhere. we have a problem. .533 drops per dose. What? Can you do that? Sure you can. There could be anything from 1. you have to round off. You sit in a stunned stupor trying to figure out where you went wrong in your calculations.5 days/bottle.Houston. you can't take 8. but conclude that you have just enough geebie tonic. you would have realized you had only slightly less than a 50/50 chance of running out. You didn't spill any. and having enough may not be the same thing. you were not figuring on 9 drops/dose. You could even put 128 lb on the end and on the bottom.0 oz of tonic in the bottle to begin with. but what you were given. What to do? You could hit the 1/x button on your calculator if it had one. was that you had 2 + 0. You figured out how much of the bottle you would use in one day. more or less. Recalculating using the low and high values. or invert the answer by dividing 1 by 0.5 oz in the bottle.044. You ended up with units reversed from what you wanted. A measurement like "half a bottle" should not inspire great certainty. so you figure it out: As a practical matter. You decide to start over.05 oz of tonic. it looks like you'll have enough. You decide to recalculate to see if rounding up to 9 makes a significant difference. At some point you need to know how many drops per dose you will need to take. You finally realize there might not have been 2. If you had figured out the correct answer of 21 + 5 days the first time. and would have gone to see Granny for a refill. and no one took any. however. or start over with 128 lb on the bottom. Concluding that you have enough.0 + 0. Break THE PROBLEM down into small ones you CAN solve. At this point you realize that when you calculated 22. this time picking a starting factor that already has "day" or "bottle" in the right place.5 to 2.

Ask yourself if the answer seems right or reasonable. which of the factors you know would make an appropriate starting factor. or several possible starting factors are given with no way to decide. recheck everything. . which to use. in math terms. Go to top Appendix B Go to top A Critique of Clinical Calculations: A unified approach. after the answer unit is determined. properly labeled factors they can later use to solve the problem. Determine the starting factor and answer unit. then decide. Plug in conversion factors that allow you to cancel out any units you don't want until you are left with only the units you do want (your answer units). This is usually easy. to determine everything you know that might be relevant to solving the problem. Write down. You now need to pick a starting factor. Determining the answer unit or units is crucial. You may need to read the problem several times. If possible pick one that already has one of the units you want in the right place. It is preferable. For some problems. This skill is not emphasized in the textbook.• • • • • • • Figure out what answer unit(s) you want to end up with. everything you know that relates to the problem. If the answer unit is always given in the examples used. Do the math and solve it. Students need to be able to translate sometimes convoluted English descriptions of a problem into clear. in such cases. In some real-world problems no starting factor is given. Now double-check your calculations. then this is because the examples have been contrived to be more simple and consistent than actual problems tend to be. The steps for doing dimensional analysis are given in the textbook as: 1. If you can't solve the problem. pick a different starting factor and start over. but that's inconvenient. not difficult. You may need to look up a few conversion factors. Otherwise start with something you are given that is not a conversion factor. 3. 2. If not. initially. rephrasing parts of it. so you can translate everything into math terms. 4th ed. they are not always obvious and can be challenging to determine. Solve the conversion equation. Formulate a conversion equation. reading the problem correctly is the only challenge.

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.

So. which they simply declare to be 33 gtt/min. that the flow rate is 33 gtt/min. The final statement. but it means nothing to say that I know "1 min" in the context of this problem. 60 min = 1 hr Conversion Equation: 1 min x 60 min 1 hr x 1000 5 hr 1 mL mL x 10 gtt = 33. what do I want to know? The flow rate in gtt/min. Factors are expressed as equalities. they finally come up with the correct answer. Just "gtt" doesn't cut it. let's see. By introducing a spurious starting factor the setup is in error. which is my answer unit. 2.3 = 33 gtt Flow Rate: 33 gtt/min For review. The other is that "1 min" is a meaningless factor. I want to know a rate of flow in drops per some unit of time. It should read "something per something" and not "something equals something" which leads to absurd statements like "25 mg = 1 kg" 4. then introduces a spurious starting factor. What do I know? I'm given that there are . 1. 3. let's go over this problem. One is procedural--there is no logical way to pick a starting factor as the first step. The answer unit is wrong. 5. which makes the setup wrong. I can meaningfully say that I know there are 10 drops per mL. is the only part of the example that is correct. But through some sort of mental slight-of-mind. which is also wrong. 10 gtt = 1 mL. but the answer unit is not. but it is logically disconnected from everything that precedes it. the text manages to state an incorrect answer unit. The number is correct. as is the resultant answer. not just gtt (drops).Here's an actual example from chapter 10: Calculation of IV Flow Rate When Total Infusion Time is Specified Order: 1000 mL of D5W (5% Dextrose in water) IV to infuse over a period of 5 hr Drop Factor: 10 gtt/mL Starting Factor Answer Unit 1 min gtt (drops) Equivalents: 1000 mL = 5 hr. There are two errors relating to the starting factor. Is there a better way to do this problem? First ask. which yields 33 gtt for an answer.

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.

to be consistent. Likewise "unit conversion" is not a synonym for DA." While this point is nit-picky. those who do must do so in spite of the textbook and not because of it. any test answer that is within +5% of the correct value . Give the actual equivalents--some students will want to know. but a more complete presentation of dimensional analysis should be given without closely following the material in this chapter." Determining the starting factor should come after Step II.54 cm/1 inch = 25. for example. without any equivalence between starting factor and answer unit. If true. The only synonym commonly used is "factor-label method. "Step I: Determining the Starting Factor and Answer Unit. I would expect the authors to use the same terminology as everyone else by the 4th edition. Indeed. which appears to be what has happened. although usually only one or two factors qualify to be thought of as logical starting factors. Both starting factors and answer units are often in the form of something per something. but such problems should not be taken as a model for all DA problems. the collorilary would be that if the starting factor has one unit of measure associated with it. and the best starting factor to use may be one of the factors determined in Step II. I don't think it is going too far to suggest that the poor technique exhibited by the textbook makes it difficult for students to master med-math. then the answer unit can have only one unit of measure associated with it and vice versa. there can be more than one possible starting factor. By the Commutative Law of Multiplication. Therefore any factor could be first.4 cm). Picking a starting factor from what you are given or know is the first step of Step III--setting up/solving the conversion equation. Page 1: A Google search shows that only this textbook and a few nursing sites associate "label factor" with dimensional analysis (DA). since the starting factor is not always given. Go to top Recommended Corrections to Clinical Calculations: A unified approach (4th ed. Problems that do not conform to their notions are tortured into compliance by introducing spurious starting factors and using obviously incorrect answer units. which can be said to be equivalent to your answer (10 inches x 2. Page 2: At the bottom. It appears that such fundamental misunderstandings underlie the errors in the textbook." The belief that this is true leads to serious error and confusion in Chapter 10. You could start with miles/hour and end up with seconds in your answer. it doesn't matter what order the factors on the left side are multiplied in." should read. Page 7: Emphasize that several of the equivalents in the table are fairly rough approximations. and thus be the starting factor.meters).) Chapter 1 can be a useful supplement for students to read. In this subtype of problem you have only one logical starting factor. Page 4: In the box is the statement: "When the conversion equation is solved. "Step I: Determining the Answer Unit. Also. then. it will be seen that the starting factor and the labeled answer have formed an equivalent relationship. if the value of an equivalent can be 5% off.

In some (unlikely) cases answers could be as much as 10% off when several approximate equivalents are used to compound the error." "easy to forget") that do not apply when the problems are done in a single step. The technique used above has the virtue of working with all problems involving triple unit factors. it is still the technique of choice and will save a lot of grief later on. you are given 50 mg/kg/day and 4 doses/day. thus paving the way for confusion and error. All the various ad hoc attempts to get around these problems result in endless trouble in the long run. Page 105: Avoid the two-step technique. Page 159: Cross out the second paragraph: "In calculating the flow rate for drops per minute.should be counted correct. and ignore the two examples at the bottom of the page. Page 50: In the two examples on this page the Answer Unit is incorrectly given as "cap" whereas "cap/dose" is what is really desired. There is a way to deal with problems of this type (25 mg/kg/day = 25 mg/kg-day) that can be consistently applied to all problems of this type." The problem should be setup as: Whatever initial difficulty this technique may present for students not already familiar with it. but not knowing what to do with "mg/kg/day" the problem is broken into two problems. Page 49: In the example at the bottom of the page you are given 25 mg/kg/24-hr (or day). In this example the answer unit is given as "mL. Triple unit factors are common and the difficulty they pose should be dealt with head on. In the first example. Some of the techniques contrived to deal with these problems work on some problems. The third unit given should not be dropped. The "day" is initially ignored. then brought back in the second part of the problem. one minute becomes the labeled value that must be converted to an equivalent value: number of . The logically consistent one-step setup would be: For the second example the setup should be: In the box at the bottom on the page are several warnings ("critically important. Work out as above." whereas the correct answer unit is "mL/day. but not others.

as in all dimensional analysis conversions. "10 mL of what?" Your answer unit is "mL Chloromycetin sol" and not just "mL. Also. 190: Cross out the meaningless Starting Factors in examples 1. sol" in your answer." You have to ask. 5. A better setup for step 1 would be: For step 2: For steps 3 and 4. ." You can't use "mL water" and end up with "mL Chlor. The 10 mL is "10 mL water. the setup is in error due to a failure to fully label units." Page 160: Ignore examples. just omit the "1 min. All that needs to be done is to cross out the "1 min" at the beginning of each example and add "/min" to "gtt" (to get the correct answer unit). and examples 2 and 3 on page 178. The correct setup should be: Page 205: Omit spurious Starting Factors from example. Pages 164. change "mcg/min" over "kg" to "mcg" over "kg x min." Page 196: In Example a. 178: Again. Students will get into trouble if they try to extend this example to other problems. sol" in it and in the right place. pick a factor that has "mL Chlor. 4. 185: Ignore examples. though the text incorrectly uses it (and by luck gets away with it). Omit the spurious "1 min" Starting Factors. therefore. what if the desired answer units were "mcg/hr?" Would students have trouble canceling out "min" with "min" apparently on top? Putting "mcg/min" on top invites confusion. is the starting factor and drops is the answer unit and these. Note that Answer Units are also wrong (should be "gtt/min." which is quite an unnecessary bit of information for solving this problem." and "1 gtt" Page 189. One minute. ignore the spurious Starting Factors and use the correct Answer Units for the last two examples on page 177. You are given "100 mg/mL" which should be more completely written as "100 mg Chlor. In example 2. Pages 184. solution." When you add 10 mL water to reconstitute you will end up with somewhat more than 10 mL Chlor. form an equivalent relationship. 3. sol" and "10 mL/g" should be "10 mL water/1 g Chlor. and 166: Ignore these examples as above. Pages 177./mL Chlor. and 6." not just "gtt"). 165. sol. Another ad hoc variation in technique is introduced without comment in step 1 of the first example.drops.. Since you want "mL Chlor.

You will need enough to form a "bridge" to your answer unit(s). therefore. ignore the third unit. Page 225: Again.g. When the conversion equation is solved. it will be seen that the starting factor and the labeled answer have formed an equivalent relationship. example gives 50." You are given 15 mcg/kg/dose. 221: The first example asks. and the desired unit to which the starting factor will be converted. should be "mL/dose" and not "mL. is the starting factor and drops is the answer unit and these. 25%. in which successive units can be cancelled until the desired answer unit is reached. form an equivalent relationship. do the conversion. rewrite as 25/100 with appropriate labels. the answer unit. If a given is in the form mg/kg/day. Use only conversion factors that have a 1:1 relationship . change to mcg/min over kg if mcg/min is the answer unit. so solve as shown above for examples on pages 49 and 50--likewise with the second example on page 221. "How many mL should the child receive per dose?" The answer unit.Page 220. therefore. as in all dimensional analysis conversions. Determine conversion factors that may be needed. Initially. One minute. it is essential to determine exactly what information is sought: the known quantity called the starting factor.000 U/kg/day and 4 doses/day. so a one-step setup would be: That's about it. If in the form mcg/kg/min. Formulate a conversion equation consisting of a sequence of labeled factors. Go to top Textbook Guide to Dimensional Analysis (as compiled from various pages throughout the textbook) Determine the starting factor* and answer unit. e. then remember to factor the omitted unit back in. If a percentage is given. The other 96% of the text is okay. In calculating the flow rate for drops per minute (or mL per hour) one minute (or one hour) becomes the labeled value that must be converted to an equivalent value: number of drops (or mL).

Cancel units first Reduce numbers to lowest terms. Several medication math textbook titles are currently available. I've heard that it is much better than its predecessor. A better rounded. Reduce answer to lowest terms. but come away feeling confident in their ability to handle any problems that may come their way in the future. and may have been omitted for that reason. more robust presentation of dimensional analysis is definitely needed. Students should not only do well solving test problems. There are errors of omission where students are not given a complete enough understanding of dimensional analysis to do all problems that could crop up. start over. but I think other titles should be looked into. Errors of omission are not indicated. * The text in red represents weak or erroneous technique. . and/or round off. overly simplified examples are used that fail to show the range of problems that students may encounter. Multiply/divide to solve the equation. I would say that this book is quite useable provided its shortcomings and flaws are amended. Overall. A wider range of problems. In setting up the conversion factors. would have illustrated the shortcomings of the techniques as taught. however. Solve the conversion equation by use of cancellation and simple arithmetic. Conclusions This may be a case of a book being the worst textbook on dimensional analysis available--with the exception of all the others. Take a few seconds and ask yourself if the answer you came up with makes sense. however. convert to decimal. I can't assume any do a better job. There are errors of commission where students are taught flawed or even erroneous technique.It is desirable that conversion factors be arranged in a sequence so that identical units are placed diagonally. Throughout the textbook. as this contains the unit of the preceding numerator and facilitates cancellation of successive units. but not having reviewed them. it is helpful to write the denominator first. If it doesn't.