MCAS Slides + Notes

Converting Between Celsius
and Fahrenheit
• Temperature reading followed by F = Fahrenheit
(e.g., 98° F)
• Followed by C = Celsius (formerly centigrade) (e.g.,
36° C)
• Freezing point of water is 32° F and 0° C
• Boiling point of water is 212° F and 100° C
Mosby items and derived items © 2014, 2010, 2006, 2002, 1998, 1994 by Mosby, Inc., an
imprint of Elsevier Inc.
Temperature Conversion
Formulas
• To convert from Celsius to Fahrenheit, multiply by 1.8 or 9/5
and add 32 9
5
• Example: Convert 37.5° C to °F
Formula:
°F = 1.8(°C) + 32 or °F = 9/5(°C) + 32
°F = (1.8 × 37.5) + 32
°F = 67.5 + 32
°F = 99.5°
Temperature Conversion
Formulas (Cont.)
• To convert from Fahrenheit to Celsius, subtract 32 and divide by
1.8 or 9/5 9
• Example: Convert 68° F to °C 5
Formula:
°C = (°F - 32) 9/5 or °C = (°F - 32) 1.8
°C = (68 - 32) 9/5
°C = 36 9/5, which inverts to be °C = 36 × 5/9
°C = 180/9
°C = 20°
Case Study 2
• You are taking care of Mr. Hain again today and you
receive report from the night nurse that he had a
temperature of 39° C. Per the physician’s order, you can
administer either:
• 325 mg of Tylenol PO prn fever 99°F - 101 °F
OR
• 650 mg of Tylenol PO prn fever > 101°F
• What is his temperature in Fahrenheit and what will you
administer?
Case Study 2 (Cont.)
Answer:
-102.2° F
-Administer 650 mg of Tylenol PO
Conversions: Metrics and
Length
• Metric measures are used for:
• Pupil size
• Baby’s head circumference
• Wounds and incisions (length
width depth in cm or mm)
• Conversion factor: 1 cm = 10 mm
• If incision is 25 cm, how many mm is it?
25 mm = 25 10 = 2.5 cm or 25 = 2.5 cm
Conversions: Metrics and
Length (Cont.)
• Convert 30 cm to inches (in)
• Conversion factor: 1 in = 2.5 cm
• Think smaller to larger (divide)
30 2.5 = 12 in
10
Conversions Relating to
Weight
• Body weight is important in calculating doses
for certain medications
• Delivered in mg or mcg per kilogram
• Nurse needs to calculate safety of doses
documented as mg/kg
• May need to convert pounds and ounces in
pediatric calculations
11
Weight (Cont.)
Pounds to kilograms
• Conversion factor: 2.2 lb = 1 kg
• Smaller to larger (divide lb value by 2.2)
• Round answers to nearest tenth
Example: Convert 65 lb to kilograms

kg = 65 2.2 = 29.54 rounds to 29.5 kg
12
Weight (Cont.)
Pounds and ounces to kilograms
• Convert oz to nearest tenth of lb and add
to pounds
• Equivalent: 16 oz = 1 lb
• Convert total lb to kg, then round to
nearest tenth
13
Weight (Cont.)
Pounds and ounces to kilograms (cont’d)
• A child weighs 10 lb 2 oz
• Think smaller to larger
2 oz 16 = 0.12 rounds to 0.1 lb
10 lb + 0.1 lb = 10.1 lb
• Think smaller to larger
10.1 2.2 = 4.59 rounds to 4.6 kg
14
Weight (Cont.)
Kilograms to pounds
• Multiply by 2.2 (think larger to smaller)
• Equivalent: 1 kg = 2.2 lb
• A child weighs 24.7 kg; convert to pounds
lb = 24.7 2.2 = 54.34 rounds to 54.3 lb

(weight in kg) (equivalent)
15
Case Study 2
Mr. Hain’s fever has subsided and he tells you that
he feels like he lost weight. He reports that his
usual weight is 200 lb. On admission, he weighed
88 kg. How many pounds and ounces will you tell
him he lost?
16
Answer:
6 lb, 6 oz
17
Military Time
• International time
• Uses a 24-hour clock
• Helps prevent errors by eliminating repetition of
numbers
• NO colon (:) or a.m./p.m. designations
• Midnight = 0000 and 2400
• 1:00 a.m. = 0100
• Now referred to as “Computer Time”
18
19
Figure 9-3 24-Hour clock.
Mosby items and derived items © 2014, 2010,

. 2006, 2002, 1998, 1994 by Mosby, Inc., an
Time: Traditional to Military
• To convert a.m. time, omit the colon and “a.m.,”
then add a zero to the beginning to make a four-
digit number
• Example: 8:45 a.m. = 0845
• To convert p.m. time, omit the colon and “p.m.,”

then add 1200 to the time
• Example: 7:50 pm = 1950
20
Time: Military to Traditional
• To convert times between 0000 and 1200,
delete any zero at the beginning, insert colon,
and add “a.m.”
• Example: 0845 = 8:45 a.m.
• To convert times between 1200 and 2400,

subtract 1200, insert colon, and add “p.m.”
• Example: 1950 = 7:50 p.m.
21
Practice Problems
1) 40 °C = ___ °F
2) 98.6 °F = ___ °C
3) 67 cm = ___ mm
4) 5 in = ___ cm
5) 31 lb, 7 oz = ___ kg
22
Case Study 2
After a 3-day hospital stay, Mr. Hain is now
tolerating a full liquid diet without pain or
discomfort. He is afebrile and his labs are within
normal limits. A 1 L bag of NS with 20 mEq of
potassium was started at 0430 and will take 8
hours to infuse. Mr. Hain is to be discharged at
1000. Will the IV fluid be complete by then?
23
Answer:
The IV fluid will not be finished by 1000. Completion time is

1230.
24
Dosage Calculation Using the
Ratio and Proportion Method
Mosby items and derived items © 2014, 2010, 2006, 2002, 1998, 1994 by Mosby, Inc., an imprint of Elsevier Inc.
After reviewing this chapter, you should be
able to:
1. State a ratio and proportion to solve a
given dosage calculation problem
2. Solve simple calculation problems using
the ratio and proportion method
2
calculations
Example: Available dose is 50 mg in 1 mL,
ordered dose is 25 mg x mL
State known first, then unknown
Sequence must match
Example: mg : mL = mg : mL (left sequence
matches right sequence)
3
4
5
Order: Phenobarbital 0.09 g p.o. at bedtime
WRONG
60 mg : 1 tab = 0.09 g : x tab
RIGHT
Conversion: 1 g = 1,000 mg
0.09 g = 90 mg
60 mg : 1 tab = 90 mg : x tab
x = 1 ½ tab
6
Order: Augmentin 0.25 g p.o. q8hr
WRONG
500 mg : 1 tab = 0.25 g : x tab
RIGHT
Conversion Factor: 1 g = 1,000 mg
0.25 g = 250 mg
500 mg : 1 tab = 250 mg : x tab

X = ½ tab
7
Convert everything into same unit of measure before
starting calculations
Convert to the unit of measure in which the
medication is available
Convert in the direction that eliminates decimals
whenever possible decimals are sources for error
8
Keep left and right sides in matching sequence
mg : mL = mg : mL
Label all terms, including x
9
Label final answer for x in appropriate unit for delivering med (e.g.,
mL, tabs, caps)
Double-check work
Be consistent in setup and performance of calculations
SAFETY ALERT!
If you set up the problem incorrectly, you could
calculate and administer the wrong dose,
potentially harming the client.
10
1) Order: lactulose 30 g p.o. t.i.d.
Available: lactulose 10 g per 15 mL
How many mL will you administer per dose?
2) Order: ibuprofen 600 mg p.o. t.i.d. prn pain
Available: ibuprofen 200 mg tablets
How many tablets will you administer per dose?
3) Order: metformin 500 mg p.o. b.i.d.
Available: metformin 1 g tablets
11
Mr. Ross is 3 days post-op and the plan is to advance the diet to
full liquid and ambulate q2h while awake. The following meds
are scheduled for 0900:
aspirin 162 mg p.o. daily
simvastatin 40 mg p.o. daily
atenolol 50 mg p.o. daily
hold if SBP < 120 or HR < 60
12
How many tablets of each med will you pull from the Pyxis?
Available: aspirin 81 mg tablets
Available: simvastatin 80 mg tablets
Available: atenolol 50 mg tablets
13
Answer:
Aspirin 2 tabs
Simvastatin ½ tab
Atenolol 1 tab
14
Before you administer the 0900 meds to Mr. Ross, you review his
vital signs. They are as follows:
T 98.9 °F P 52 R 18 BP 112/74
What is your next course of action?
15
Answer:
Hold atenolol per MD order and parameters on MAR.
Medication Alert
Beta blockers such as atenolol can cause
bradycardia and hypotension. Giving atenolol to Mr.
Ross at this time could cause him to get dizzy and
fall during his q2h ambulation.
16
CHAPTER 8
CONVERTING WITHIN AND
BETWEEN SYSTEMS
Mosby items and derived items © 2014, 2010, .

2006, 2002, 1998, 1994 by Mosby, Inc., an
CONVERTING WITHIN AND BETWEEN
SYSTEMS: OBJECTIVES
After reviewing this chapter, you should be able to:
1. State the equivalent metric and household
approximate equivalents
2. Convert a unit of measure to its equivalent within
the same system
3. Convert a unit from one system of measurement to
its equivalent in another system of measurement
2
EQUIVALENTS AMONG METRIC AND
HOUSEHOLD SYSTEMS
Equivalents are not exact

Memorization of equivalents is essential for:
Proficiency in medication administration
and
Ensuring that clients can safely self-
administer medications
Learn equivalents before using conversion
3
CONVERTING
Changing from one form to another

Within same system (e.g., mg to mcg)
Between systems (e.g., oz to mL)
Result is approximate, but continuity exists
Converting is a necessary skill used to administer
the ordered amount of medication
4
5

2006, 2002, 1998, 1994 by Mosby, Inc., an
CONVERTING: POINTS
1. Memorization is essential
2. Think of equivalents as ratios
1 g = 1,000 mg is a conversion factor
1 g : 1,000 mg is a ratio
3. Follow basic math rules for all systems
4. Express answers using rules related to the
system to which you are converting (e.g.,
decimals for metric)
5. THINK CRITICALLY use appropriate
equivalents
6
CONVERTING: MOVING DECIMALS
Refer to Chapter 6
Only use with metric conversions
Smaller to larger move decimal to left
350 mg = 0.35 g
Larger to smaller move decimal to right

0.850 L = 850 mL
7
CONVERTING: MOVING DECIMALS
(CONT.)
All measurements must be in the

metric system
0.6 mg = ____ mcg
0.600 mg = 600 mcg
8
CONVERTING: RATIO AND
PROPORTION RULES
Refer to Chapter 4
1. State known equivalent first (memorized)
2. Add incomplete ratio on other side of equals sign
both sides mirrored
Example: mg : g = mg : g
3. Label all terms in the proportion, including x, when
problem is first set up
9
PROPORTION RULES (CONT.)
4. Solve the problem using the principles of ratio and
proportion
Product of the means = product of the extremes
5. Final answer for x should be labeled with correct
unit of measure
Note: Carry division at least two decimal places to ensure

accuracy
10
PROPORTION
11
RATIO AND PROPORTION: FRACTION
EQUATION CONVERSION
You may set up the conversion problem in fraction

format to eliminate errors
First place the conversion factor as the numerator
Next, place problem as the denominator
Then cross multiply to solve for x
12
EQUATION CONVERSION (CONT.)
13
CONVERTING: DIMENSIONAL
ANALYSIS
Steps
1. Identify the unit to which you are converting
2. Write down conversion factor with desired unit in
denominator, and write the next numerator to
match the previous denominator unit of measure
3. Cancel the alternate denominator/numerator
units to leave the desired unit (being calculated)
4. Perform the mathematics
14
ANALYSIS (CONT.)
15
ANALYSIS (CONT.)
8 mg equals how many grams?
g = 1g x 8mg
1000mg 1
g = 8
1000
= 0.008 g
16
CONVERTING BETWEEN SYSTEMS
Can use methods previously discussed

Ratio proportion method
Dimensional analysis method
Or the conversion factor method
Consider the size of the units
Larger to smaller multiply
Smaller to larger divide
17
CONVERTING: CONVERSION FACTOR
Larger to smaller
Multiply by the conversion factor
(household) (metric)
4 oz = ______ mL
(large) (small)
Equivalent: 1 oz = 30 mL
Conversion factor = 30
Multiply 4 by 30
Answer: 120 mL
18
(CONT.)
Smaller to larger
Divide by the conversion factor
(metric) (household)
120 mL = ____ oz
(small) (large)
Divide 120 by 30
Answer: 4 oz
19
(CONT.)
Pounds to kilograms
110 lb = ____ kg
(small) (large)
Equivalent: 1 kg = 2.2 lb
Conversion factor = 2.2
Divide 110 by 2.2
Answer: 50 kg
20
PROPORTION
Pounds to kilograms
1 kg : 2.2 lb = x kg : 110 lb
2.2x = 110
2.2 2.2
x = 50kg
21
ANALYSIS
Pounds to kilograms
110 lb = x kg
2.2 lb 110 lb
x kg = 1 kg x 1
110
x kg = 2.2
x = 50 kg
22
CASE STUDY 2
Mr. Hain is complaining of 7 out of 10 abdominal pain.

There is an order for 1,000 mcg of Dilaudid IV every 3
hours prn for severe pain. It has been 4 hours since he
last received Dilaudid, and you decide to give it.
Dilaudid is only available in 2 mg/mL. How many
milliliters will you give?
23
CASE STUDY 2 (CONT.)
Answer:
0.5 mL
24
CALCULATING INTAKE AND OUTPUT
Abbreviated as I&O
Used to monitor fluids consumed, injected, and
excreted
liquid at body temperature gelatin, popsicles

Includes liquids that exit the body diarrhea, urine,
vomitus, chest tube drainage
25
CALCULATING I&O (CONT.)
Preferred method is milliliters (mL)

May require conversion household to metric
Recorded during the hour within which the
fluid is consumed, injected, or excreted
Totaled every 24 hours
26
I&O record usually has key for conversions (e.g., 6 oz
coffee cup = 180 mL)
After conversions, items are added for totals
1/3 glass apple juice (1 glass = 6 oz) = 60 mL

1/2 cup coffee (1 cup = 8 oz) = 120 mL
1/2 pint milk (1 pint = 500 mL) = 250 mL
430 mL
27
Figure 8-1 Sample I&O flow sheet
28
Record intravenous (IV) fluid intake

Method of recording varies with institutions
Urine is sometimes recorded hourly
Adult hourly output should be 30 mL or more
To find average, add up total urine and divide by number of
hours being recorded
Check institution policies to comply with charting
requirements on I&O record
29
CASE STUDY 2
You have obtained an order for 40 mEq potassium

chloride IV once to be started by the oncoming
well controlled with prn medication, and he is in

stable condition. Before you give a report to the
input and enter the data in milliliters. How many

mL?_________
1.5 L of IV D5 NS
4 oz ice chips
100 mL IV Flagyl
30
Answer:
1,720 mL
31
WHAT IS THE AVERAGE HOURLY
OUTPUT?
1) 740 mL in 8 hours
3) 610 in 24 hours
Which amount is insufficient urine output? Remember

you must have at least 30 mL/hr.___________
32
CONVERT THE FOLLOWING:
1) 6 oz = ? cups
2) 0.125 mcg = ? mg
3) 42 lb = ? kg
4) 3 c = ? mL
33
Critical Care Calculations
Chapter 24
Critical Care Calculations: Objectives
2

1. Calculate dosages in mcg/min, mcg/hr, and mg/min
2. Calculate dosages in mg/kg/hr, and mcg/kg/min
Background: Critical Care
Calculations
3
Critical care medications can be potent and require

close monitoring
May drastically change vital parameters such as BP
and P, so continuous monitoring is necessary
Nurse may need to titrate (adjust) dosages in
response to vital signs
Example: Titrate Dopamine maintain systolic BP > 90
mm Hg, starting at 3 mcg/kg/min
Background: Critical Care Calculations
(Cont.)
4
SAFETY ALERT!
ACCURATE CALCULATION OF DOSAGES AND
TITRATION IS ESSENTIAL!
Infusion pumps are required; if none available, use
microdrip tubing (60 gtt/mL)
Calculating Rate in mL per hr
5
Calculating rate in mL/hr for specific dosage is one of

most common calculations a nurse encounters
Example 1:
A solution of labetelol (Trandate) 100 mg per 100 mL
of D5W is to infuse at a rate of 25 mg per hr.
Calculate the rate to infuse the solution in mL per hr
Ratio and Proportion Method
6
Calculating Rate in mL per hr (Cont.)
7
Example 2:
Isuprel 2 mg per 250 mL D5W. Infuse at 5 mcg per min
Calculating Rate in mL per hr (Cont.)
8
Calculating Critical Care Dosages per
Hour or per Minute 9
Order: Infuse dopamine 400 mg in 500 mL of

D5W at 30 mL per hr.
Calculate dosage in
mcg per min _______
mcg per hr_________
Calculating Critical Care Dosages per Hour
or per Minute (Cont.)
10
1. Use ratio and proportion to determine the dosage per

hour first:
Calculating Critical Care Dosages per Hour
or per Minute (Cont.)
11
2. Convert 24 mg to mcg to find mcg per min and mcg per hr:
24 mg (1,000) = 24,000 mcg
3. Change mcg per hr to mcg per min:
24,000 60 min = 400 mcg/min
Meds Ordered in mg per min
12
Client is receiving Pronestyl at 60 mL/hr. The solution is

available as 2 g in 500 mL D5W. Calculate the mg per hr
and mg per min the client will receive.
1. Convert g to mg (1 g = 1,000 mg)

2 g (1,000) = 2,000 mg in 500 mL
Meds Ordered in mg per min (Cont.)
2. Determine mg/hr via ratio and proportion: 13
3. Convert mg/hr to mg/min (60 min = 1 hr)

240 mg/hr 60 min = 4 mg/min
14
The physician decides that cardioversion should be done
-onset atrial fibrillation. The
consent
Case form 5
Study is signed and Mr. Flint is cardioverted into
sinus rhythm. After cardioversion, Mr. Flint has
decreased cardiac output evidenced by hypotension and
the physician orders:
Levophed 1 mcg/min for 1 hour, monitoring BP every 5
minutes
Available: 2 mg/250 mL D5W
What will be the flow rate?
15
Answer:
1 mcg/min x 60 = 60 mcg/hr
2 mg x 1000 = 2000 mcg
60 mcg/hr x 250 mL/2000 mcg =
7.5 mL/hr
Dosages Based on mcg/kg/min
16
Nipride, dopamine, and dobutamine are ordered in
mcg/kg/min
Round weight to nearest tenth
Example 1:
Order: Dopamine 2 mcg per kg per min. Available
solution is 400 mg in 250 mL D5W. Client weighs 150
lb.
Dosages Based on mcg/kg/min (Cont.)
17
1. Convert 150 lb to kg (2.2 lb = 1 kg )

150
2. Determine dosage per minute

68.2 kg 2 mcg/kg/min = 136.4 mcg/min
18
Convert mcg/min to mL/hr (1,000 mcg = 1 mg)
1. Make conversion:
136.4 mcg per min 60 min = 8,184 mcg/hr
2. Convert to mcg per hr to mg per hr:
8,184 1,000 = 8.18 = 8.2 mg/hr
3. Determine flow rate:
400 mg : 250 mL = 8.2 mg : x mL
x = 5.1 = 5 mL/hr
19
Dimensional Analysis:
IV Flow Rates for Titrated Meds
20
Nurse should know:

Medication information
Proper dosage adjustment
Frequency of adjustments
Double or triple check med dosages
IV Flow Rates for Titrated Meds (Cont.)
21
SAFETY ALERT!
Start at lowest dose first

Increase or decrease as needed
Do not exceed highest dose range without order
22
Example: Nipride has been ordered to

titrate at 3 to 6 mcg per kg per min to
mm Hg.
The solution contains 50 mg Nipride in 250
mL D5W. The client weighs 56 kg. Determine
the flow rate setting for the volumetric
pump.
23
Dimensional Analysis
1. Calculate dosage range first:

(Lower dosage) 3 mcg/kg/min 56 kg = 168 mcg/min
(Higher dosage) 6 mcg/kg/min 56 kg = 336 mcg/min
2. Calculate IV rate in mL/hr for lower dose:
24
3. Calculate IV rate for upper dose:
Developing a Titration Table
25
After infusion is initiated, the client is monitored
If desired response is not achieved, the dosage may
need to be increased and IV rate recalculated
Titration tables provide the IV rate for possible
changes to med dosage
Set up ratio and proportion to develop the titration
table using the minimum rate to find the
incremental flow rate
Developing a Titration Table (Cont.)
26
Recall previous example:
Nipride titrated at 3 to 6 mcg per kg per min to maintain

systolic BP < 140 mm Hg. The solution contains 50 mg Nipride
in 250 mL D5W. The client weighs 56 kg.
3 mcg/min = 1 mcg/min
50 mL/hr x mL/hr
x = 16.7 mL/hr or 17 mL/hr rounded

So for each change of 1 mcg/min, the incremental IV flow rate is
17 mL/hr
Developing a Titration Table (Cont.)
Titration Table: 27
Dosage Rate (mcg/min) Flow Rate (mL/hr)

3 mcg/min (minimum) 50 mL/hr
4 mcg/min 67 mL/hr
5 mcg/min 84 mL/hr
6 mcg/min (maximum) 101 mL/hr
*Notice in this problem mL/hr was rounded to the nearest whole

number. Remember there are pumps capable of accepting the nearest
hundredth.
Case Study 5
28
the Levophed infusion. Although he is alert, he is complaining

of dizziness. The physician changes the dosage:
Levophed titrated at 2 mcg/min to 6 mcg/min, increasing the

rate by 1 mcg/min every 2 hours to maintain SBP > 100 mm Hg
Available: 2 mg/250 mL D5W
Determine the new rate and develop a titration table rounding

to the nearest tenth.
29
Answer:
Dosage Rate (mcg/min) Flow Rate (mL/hr)

2 mcg/min (minimum) 15 mL/hr
3 mcg/min 22.5 mL/hr
4 mcg/min 30 mL/hr
5 mcg/min 37.5 mL/hr
6 mcg/min (maximum) 45 mL/hr
medical surgical unit.
Practice Problem
30
Order Dopamine 5 to 10 mcg/kg/min for a client weighing 184 lb.
Available: 400 mg/250 mL NS
Develop a titration table to determine the flow rates.
Min rate: 15.68 mL/hr

Max rate: 31.36 mL/hr
Chapter 3
Decimals
Copyright © 2018, Elsevier Inc. All rights reserved.

Decimals: Objectives
After reviewing this chapter, you should be able to
1. read decimals 6. add decimals

2. write decimals 7. subtract decimals
3. compare the size of 8. multiply decimals
decimals 9. divide decimals
4. convert fractions to 10. round decimals to
decimals nearest tenth
5. convert decimals to 11. round decimals to
fractions nearest hundredth
Copyright © 2018, Elsevier Inc. All rights reserved. 2

Decimals: Safety Point
Dosages and other measurements in health
care
Understanding is crucial
Misreading decimal points are a major source of
medication errors
Write with great care!
Examples: Digoxin 0.125 mg
Coreg 3.125 mg

Decimals: Definition
A decimal is a fraction with a denominator that is
a multiple of 10. The decimal (.) is used to
indicate place value.
Examples:
Safety Alert: Each decimal expression with a value less than 1 is

preceded by a leading zero to emphasize the presence of a
decimal, according to national patient safety standards (Institute
for Safe Medication Practices (ISMP) and The Joint Commission
(TJC))
Decimals
The whole number is placed to the left of the
decimal point. These numbers have a value of
one or greater.
Decimal fractions are written to the right of the
decimal point and represent a value that is less
than one. The words for all decimal fractions end
-

Decimals: Place Values

Decimals: Reading
To read the decimal numbers, read:
1. the whole number,
3. the decimal fraction by naming the value of

the last decimal place.
Example 1: The decimal number 1.125 is read as
-
Safety Alert: When reading an order back to a health

care provider, read the zero aloud.

Decimals: Writing
To write a decimal number, write the following:
1. The whole number (If there is no whole number,
write zero [0] to the left of the decimal.)
2. The decimal point to indicate the place value of the
right most number
3. The decimal portion of the number to the left of the
decimal
-
NOT be placed
Trailing zeros are only acceptable to demonstrate the precision of
value, such as in lab results or imaging studies or the sizes of
lesions.

Decimals: Comparing Values
Zeros added before or after the decimal point of
a decimal number may change its value.
Examples: .7 equals 0.7
12.6250 equals 12.625
Note: 30.0 can be misinterpreted as 300!
USE leading zeros; AVOID trailing zeros

Decimals: Comparing Values (Cont.)
Zeros added within a decimal number change
the value dramatically
Example: 0.375 mg is NOT equal to 0.0375 mg

2.025 mg is NOT equal to 20.025 mg

If whole numbers are present and different,
whole numbers are compared to determine
which value is greater
Example: 4.8 is greater than 2.9
If the whole numbers being compared are the

same or if there is no whole number, then the
number in the tenths place determines which
decimal is greater.
If the whole numbers are the same or zero and
the numbers in the tenths place are the same,
then the decimal with the higher number in the
hundredths place has the greater value, and so
forth.
Examples: 0.67 is greater than 0.66
0.17 is greater than 0.14

Decimals: Adding and Subtracting
Place the numbers in the columns so that the
decimals are lined up. Add or subtract from
right to left.
Examples:
Safety Alert: Zeros may be added to help line up decimals, but do

NOT include in final answer!

Decimals: Multiplying
Multiply as with whole numbers. In the answer
(product), count off from right to left as many
decimal places as there are in the numbers being
multiplied
Example: (1 decimal place)
(1 decimal place)
Place the decimal

point two places to
the left
Decimals: Multiplying (Cont.)
Add zeros where needed to ensure correct
placement of decimal in answer
Example: (2 decimal places)

(2 decimal places)
Place the decimal

point four places to
the left Add zero to the left
as needed

Multiplying by Decimal Movement
Multiplying by 10, 100, and 1,000 can be done
by moving decimal to the right the same number
of places as there are zeros in the number by
which you are multiplying.
Example: 1.6 x 10 = 1.6 = 16
5.2 x 100 = 5.20 = 520

Decimals: Dividing
Same as for whole numbers
Example:
Read as 27 divided by 9
27 9 Read as 27 divided by 9
27
9
Decimals: Dividing (Cont.)
To divide by a whole number, place decimal in
quotient directly above decimal in dividend

To divide by a decimal, the decimal point in the
divisor is moved to the right until the number is a
whole number. The decimal point in the dividend
is moved the same number of places to the right,
and zeros are added as necessary.
Example:
6.96 0.3 = 0.3 6.96 = 3 69.6

Division by Decimal Movement
To divide by 10, 100, or 1,000, move decimal to
the left the same number of places as there are
zeros in the divisor.
Examples: 00.46 10 = 0.046
000.07 100 = 0.0007

Decimals: Rounding
Based on equipment being used (for example,
syringes)
Most carry to hundredths place and rounds to tenths
To express an answer to the nearest tenth: If
number in hundredths place is 5 or greater, add 1
to tenths place and drop the hundredths
Example: 4.15 rounds to 4.2

Decimals: Rounding (Cont.)
number in hundredths place is less than 5, drop
number to the right of tenths place
Example: and 4.14 rounds to 4.1
To express numbers in hundredths, carry

equations out to thousandths and then round

Changing Fractions to Decimals
Divide the numerator by the denominator and
add zeros as needed
This method can be used to compare fraction

size

Changing Decimals to Fractions
Write decimal as a whole number in
numerator of fraction, express denominator
as powers of 10
Place the number 1 in denominator of fraction
and add as many zeros as there are places to
right of decimal
Example:
reduced
-
65/100 = 13/20 reduced

Complete the Following Problems
Round Answers to the Nearest
Hundredth
a. 1.07 0.342
b. 5.981 1.7
c. 4.8 4.08

Hundredth (Cont.)
1. Change the following decimals to fractions and
reduce to the lowest terms.
a. 1.04 b. 0.16
2. Change the following fractions to decimals and

round to the nearest tenth.
a. 7/8 b. 6/13

Case Study 1
Ms. White tells you that she weighed herself at
home five days ago and she was at 128.7 lb.
Today, she weighed 124.25 lb. How much
weight did she lose?

ANS:
4.45 lb

It has been 5 days since Ms. White weighed
herself at home. On average, how much weight
has she lost each day?

ANS:
0.89 lb

CHAPTER 16
Dosage Calculation
Using the Dimensional Analysis
Method
Dosage Calculation Using Dimensional
Analysis Method: Objectives
able to:
1. Define dimensional analysis
2. Implement unit cancellation in dimensional analysis
3. Perform conversions using dimensional analysis
4. Use dimensional analysis to calculate dosages
2
Background: Dimensional
Analysis
Fancy name simple technique
Used to manipulate units in a calculation
Involves cancellation of unwanted units
NO memorization of formulas
Also known as the factor-label method or the unit factor method
Only one equation is used, even if a conversion is required
Memorization of common equivalents is necessary
3
Performing Conversions Using
Conversions can be made within process of calculation rather
than in advance
Equivalents or conversion factors are expressed as fractions
written in one of two ways without changing meaning or value
e.g., CF: 1 kg = 1,000 g is the same as 1 kg/ 1,000 g or 1,000 g/1
kg
How a fraction is written depends on the unit you want to
cancel or eliminate to get the unit desired
4
Making Conversions Using
1. Identify desired unit
2. Identify equivalent needed
3. Write equivalent in fraction format with desired unit in
numerator as first part of equation
4. Label all factors in equation, with x being what you desire to
have in the end
5
Dimensional Analysis (Cont.)
5. Identify unwanted or undesired units and cancel, then
reduce to lowest terms
6. Must be able to eliminate all labels except for answer
label if not, recheck
7. Perform mathematical process
Note: It is key to set up the

equivalent correctly!
6
Example: 1.5 g = _______ mg
1. The desired unit is mg
2. Equivalent: 1,000 mg = 1 g
3. Write equivalent keep mg in numerator (allows cancellation
of unwanted unit, g)
4. Write equivalent as fraction, add multiplication sign
5. Perform calculation
7
8
Dosage Calculation Using
1. Identify unit of measure (caps, mL, tabs) and place x on left
with appropriate unit
2. On right, place available information as a fraction
information matching the x unit will be placed in the
numerator
3. Enter additional factors set up so that unit of numerator
matches preceding denominator
4. Cancel out like units remaining unit MUST match the unit
for x then calculate
9
Example: Order is Lasix 40 mg p.o. daily
Available: 20 mg tablets
1. Place desired unit of measure on left and label as x

x = tab
10
2. Place the information in problem on right in fraction format
matching desired unit in numerator
11
3. Enter additional info (e.g., what is ordered), matching unit in numerator with
preceding denominator
12
Amount to Available Ordered
administer dosage dosage
13
4.
should be what is desired
14
Dimensional Analysis Using
Conversion Factor
When a conversion factor is necessary, the conversion factor is
placed as the second fraction inside the equation
Always match numerator of conversion factor with
denominator of previous fraction
15
16
Practice Problems
Order.
1) Order: Potassium Chloride 40 mEq p.o. b.i.d

Available: KCl 20 mEq tablets
2) Order: Cleocin 300 mg IV q6h
Available: Cleocin 0.6 g per 4 mL
3) Order: Kefzol 0.5 g IV q6h
Available: Kefzol 225 mg per mL
17
Case Study 3
doctor has added Flagyl 500 mg IV q6h and has discontinued the PCA
morphine. She also wrote an order for Percocet 5/325 2 tab p.o. q6h prn
pain. Mr. Ross is now complaining of 7/10 pain. It is also time to hang the
Flagyl.
At the Pyxis, you have available:

Flagyl 0.5 g in 100 mL
Percocet 5/325 tablets
18
Answer:
Pull 2 tabs of Percocet and 100 mL of Flagyl from the Pyxis.
As long as Mr. Ross remains in stable condition throughout the night, he

will be discharged tomorrow.
19
Dosage Calculation
Using the Formula Method
able to:
1. Identify the information from a calculation
problem to place into the formula given
2. Calculate dosages using
3. Calculate the number of tablets or capsules
to administer
4. Calculate the volume to administer for
medications in solution
2
Determine the components of the formula from the problem
Substitute the information from the problem into the formula
SAFETY ALERT!
Do NOT rely solely on formulas. Use critical
thinking skills such as considering what the answer
should be, reasoning, problem solving, and finding
rational justification for your answer. Formulas
should be used as tools for validating the dosages
you THINK should be given.
3
Units of measure must be in same system before solving with
the formula
Memorize the formula:
4
D = Desired dose
Ordered in unit of measure desired mg, units, mEq
H = Strength available
Have on hand in unit of measure available mg, g,
units
Q = Quantity
Unit of measure that carries what is on hand cited in
tabs, mL, caps
x = Unknown
5
1. Memorize or verify formula from resource
2. Place information in formula and label terms
3. Make sure everything is in same system
4. Apply logic test for reasonable answer
5. Calculate
6. Label answer with correct unit of measure
Note: Convert to metric equivalents when possible; metric

is the principal system used for medications
6
7
outcome of the equation; however, it should NEVER
be omitted because it can render an error in dosage
calculations.
x
unit of measure
8
9
WRONG
(D) 0.09 g x (Q) 1 tab = x
(H) 60 mg
RIGHT
(D) 90 mg x (Q) 1 tab = x
(H) 60 mg
10
Conversion Factor: 1 g =
1,000 mg
Therefore, 0.25 g = 250 mg

WRONG!
=x
RIGHT
=x
11
1) Order: dilaudid 1000 mcg IV q4h prn pain
Available: dilaudid 2mg per 1mL
2) Order: lisinopril 5 mg p.o. daily
Available: lisinopril 10 mg tablets
3) Order: synthroid 0.075 mg p.o. daily
Available: synthroid 25 mcg tablets
12
While Mr. Ross is ambulating, you notice that he looks
flushed and feels warm to the touch. You check his
temperature orally and you find that it is 101.2° F. You
check the chart and find an order for:
Tylenol 650 mg p.o. q6h prn fever > 37.8° C
You go to the Pyxis and find that you have
acetaminophen 325 mg tablets. What is your next
course of action?
13
Answer:
administer two tablets.
14
Chapter 2
Fractions

Fractions: Objectives
After reviewing this chapter, you should be able
to
1. compare the size of fractions
2. add fractions
3. subtract fractions
4. divide fractions
5. multiply fractions
6. reduce fractions

Fractions: Why?
Seen in medical orders, client records,

prescriptions, care documentation, and
health care literature
Used in conversion of dosage calculations
Apothecary
Household

Fractions: Safety Alert
Fractions may be used on drug labels in addition
to metric equivalent to help clarify and prevent
errors
2.5 mg (2½ mg) Coumadin on same label
(Cohen, MR (ed.): Medication errors, ed 2, Washington, DC, 2007, American Pharmacists Association)

Fractions: Definition
A fraction is part of a whole number
Fractions have a numerator and a denominator
Figure 2-1 Diagram representing fractions of a whole. Five parts shaded out of the six parts represent:
Numerator 1 part 1
Denominator = 6 parts = 6

Fractions: Types
Proper
Numerator is less than denominator; the fraction
has a value of less than 1
Examples:
Improper
Numerator is larger than, or equal, to
denominator; the fraction has a value of 1 or
greater than 1
Examples:

Fractions: Types (Cont.)
Mixed
A whole number and a fraction; the value is greater
than 1
Example:
Complex
Numerator, denominator, or both, are fractions; the
value may be less than, greater than, or equal to 1
Example:

Whole numbers
Have an expressed denominator of one (1)
Examples:

Converting Fractions
An improper fraction can be changed to a mixed
number or whole number by dividing the
numerator by the denominator

Converting Fractions (Cont.)
A mixed number can be changed to an improper
fraction by multiplying the whole number by the
denominator, adding the numerator, and placing
the sum over the denominator
Example:

Fractions: Comparing Size
If the numerators are the same, the fraction
with the smaller denominator has the larger
value
Example:
If the denominators are the same, the fraction

with the larger numerator has the larger value
Example:

Fractions: Comparing Size (Cont.)
Two or more fractions with different denominators
can be compared by changing both fractions to
fractions with the same lowest common
denominator (LCD).
LCD is the lowest number evenly divisible by the
denominators of the fractions being compared
Example:

Fractions: Fundamental Rules
1. The value of a number is unchanged when the
numerator and denominator are multiplied or divided by
the same number
Example:
2. To change (reduce) a fraction to its lowest terms,

divide its numerator and its denominator by the largest
whole number that will divide both evenly
Example:

Fractions: Reducing
Note: Fractions should always be reduced to
lowest terms
Numerator and denominator are each divided
by the largest number by which they are both
evenly divisible
Example:

Fractions: Adding
With same denominator, add the numerators,
then reduce to lowest terms
Example:
With different denominators, change fraction to

equivalent denominators by using the LCD, then
add numerators as described above
Example:

Fractions: Subtracting
The rules for subtraction are the same as
those for addition
If denominators are the same, perform subtraction
with the numerators, obtain the value, place it over
the denominator, and reduce to lowest terms
If denominators are different, find the lowest
common denominator (LCD), change to equivalent
fractions, subtract the numerators, and place that
value over the common denominator. Reduce if
necessary.

Fractions: Subtracting (Cont.)
To subtract a fraction from a whole number,

follow these steps:
1. Borrow 1 from the whole number, and change it
to a fraction, creating a mixed number.
2. Change the fraction so it has the same
denominator as the fraction to be subtracted.
3. Subtract the fraction from the mixed number.
4. Reduce if necessary.
6 7
6=5+ =5
- Elsevier
Copyright © 2018, = Inc. All rights reserved. 17
Fractions: Multiplying
1. Cancel terms if possible.
2. Multiply numerators, multiply denominators
3. Reduce if necessary
Note: Fractions can be reduced to lowest terms

before multiplication
Express whole numbers as fractions with a
denominator of 1 to visually aid in multiplication

Fractions: Dividing
Invert the second number (turn it upside down)
and then multiply. Reduce if necessary.
Note: Change mixed numbers to improper fractions

before performing division steps

Fractions: Dividing (Cont.)
When dividing mixed fractions, change the
problem visually so that division steps are
easily seen

Convert the following mixed
numbers to improper fractions
9½
4¾

Add the following fractions
5 8
6 9
And reduce if necessary

Subtract the following fractions
8 5
6 9

Multiply the following fractions
5 8
8 9

Divide the following fractions
5 8
6 9

Case Study 1
Further examination of your 25-year-old patient,
Ms. White, reveals signs and symptoms of
dehydration. The doctor instructs her to drink
1½ L of water. An hour later you find ¼ L left.
How many Liters did Ms. White consume?

ANS:
1¼ liters

Chapter 7
Apothecary and Household
Systems
Mosby items and derived items © 2014, 2010, 2006, 2002, 1998, 1994 by Mosby, Inc., an imprint of
Elsevier Inc.
Apothecary & Household: Objectives
1. Differentiate apothecary and household system of
measurement
2. Identify reasons for non-use of apothecary measures
and symbols
3. State common household equivalents
4. State specific household system rules
5. Identify measures in the household system
6. Define other measures used in medication
administration
2
Elsevier Inc.
Apothecary: Background
English origin considered to be oldest
Notations and Roman numerals are potentially confusing
TJC recommends they NOT be used in medication

administration. Discouraged by ISMP.
Found on labels of older medications

Always convert to metric
3
Elsevier Inc.
Safety Alert!
Do NOT use the following abbreviations and symbols:

gr (grains, apothecary unit of weight) confused with
metric gram
m (minim) mistaken for mL
(dram, apothecary drop) mistaken for 3
(ounce, apothecary symbol) obsolete
ss, ss (apothecary symbol for ½ ) mistaken for 55
4
Elsevier Inc.
Apothecary: Units of Measure
Minims and drams ( ) no longer used some
syringes or cups may still have markings
Nurse needs to know
1 pint = 16 fluid ounces
1 quart = 32 fluid ounces = 2 pints
Weight
Grain = gr
Be careful not to confuse gr with g for gram
Metric equivalents: gr 15 = 1 g and gr 1 = 60-65 mg
Most meds are based on the equivalent gr 1 = 60 mg
5
Elsevier Inc.
Apothecary: Units of Measure (Cont.)
Volume
Ounce = oz
Metric equivalent: 1 oz = 30 mL
Medicine cups are 1 oz capacity
Although apothecary measures may still be on

syringes and containers, they should always be
converted to metric
6
Elsevier Inc.
Household: Background
Old system and least accurate
Capacities of glasses and utensils vary by brand unless

CALIBRATED
Advise use of droppers and devices provided with
medications for accurate dosing
Memorize:
1 teaspoon (t, tsp) = 5 mL
1 tablespoon (T, tbs) = 15 mL
1 measuring cup (c) = 8 oz
7
Elsevier Inc.
Households: Particulars
1. Some are same as apothecary measures
Pints and quarts
2. No standard rules for expressing measures

3. Cookbook abbreviations commonly used
4. Arabic numerals and fractions are used
5. Smallest unit of measure is drop (gtt)
Never use as unit of measure unless delivery device is
calibrated (e.g., medicine dropper or IV tubing)
6. The unit ounce used to measure liquid is sometimes

referred to as fluid ounce
8
Elsevier Inc.
Mosby items and derived items © 2014, 2010, 2006, 2002, 1998,
9 1994 by Mosby, Inc., an imprint of Elsevier Inc.
Household/Metric Equivalents
10
Elsevier Inc.
Case Study 2
When obtaining a history on Mr. Hain, he tells you

that he started feeling sick after consuming 2 cups of
fish soup. You know that he is using which system of
measurement?
a) Metric
b) Apothecary
c) Household
11
Elsevier Inc.
Answer:
c) Household
12
Elsevier Inc.
Household: Solutions
Use calibrated spoons and measuring cups!
Normal Saline (0.9%)

2 teaspoons salt in 4 cups of water
Acetic Acid (0.25%)

3 tablespoons of white vinegar in 4 cups of water
Used for some wound/dressing care and for
cleaning equipment
13
Elsevier Inc.
Other Measurements Used in Dosage
Calculation
Units: amount of medication in 1 mL of solution.
Measure specific medications in terms of action
(examples: heparin, penicillin, and insulin).
International Units: unit of potency. Represent the

amount needed to produce a certain effect
(examples: vitamins, chemicals).
Milliequivalents (mEq): used to measure

electrolytes and ionic activity of a medication. One
thousandth of the equivalent weight of an ion
(examples: potassium, calcium).
14
Elsevier Inc.
Determine the Following Equivalents
1. 16 oz = _____ cup
2. 2 pts = ______ mL
3. 60 mL = ______ oz
4. 45 mL = ______ tbs
15
Elsevier Inc.
Which Unit of Measurement Should
Not Be Abbreviated?
1) Drops (gtt)
2) Unit (U)
3) Milliequivalent (mEq)
4) Pound (lb)
5) Kilograms (kg)
16
Elsevier Inc.
Case Study 2
It is common for serum potassium levels or (K+)

to decrease with vomiting and diarrhea. Normal
serum potassium levels are 3.3-5.3 mEq/L. Mr.
will you read this value aloud when notifying the

doctor?
17
Elsevier Inc.
Answer:
18
Elsevier Inc.
CHAPTER 20
Insulin
INSULIN: OBJECTIVES

1. Identify important information on insulin labels
2. Identify various methods for insulin administration
3. Read calibrations on 30-, 50-, and 100-unit syringes
4. Measure insulin in single dosages
2
INSULIN: OBJECTIVES (CONT.)
5. Measure combined insulin dosages

6. Calculate doses for U-500 Insulin using a 1 mL
syringe
7. Calculate doses for U-500 Insulin to measure
using a U-100 insulin syringe
3
BACKGROUND: INSULIN
Natural hormone secreted by the pancreas

Used to control blood sugar levels in people who cannot
produce enough (e.g., in diabetes mellitus)
Doses are measured in units
Typically U-100
U-500 Rare - for clients with marked insulin resistance
who require doses > 200 units per day
SAFETY ALERT!
Accuracy in insulin preparation and administration is crucial.
Inaccurate dosages can lead to serious or life-threatening
effects! 4
COMMON MEDICATION ERRORS WITH
INSULIN
Incorrect rates programmed into infusion pumps

Incorrect concentrations of insulin used to prepare dose
Use of an insulin syringe to prepare a nonstandard concentration
Use of tuberculin syringes to prepare dose (10-fold errors)
Look-alike names and packaging
Miscommunication of orders
Insulin being mistakenly administered to patients who are not

diabetic, leading to profound hypoglycemia
(From Cohen, MR (ed): Medication errors, abridged edition, Washington, DC, 2010, American Pharmacists Association)
5
SAFETY ALERT!
U-100 = 100 units per mL
U-500 = 500 units per mL
U-500 insulin is FIVE TIMES as concentrated as

U-100. It is crucial to USE EXTREME
CAUTION when administering U-500 insulin to
prevent unintentional overdose, which can result
in irreversible insulin shock and death for a client.
6
U-500 INSULIN
Notice the red warning
Figure 20-2 Label for U-500 insulin.
7
TYPES OF INSULIN
Choice of dosage and choice of insulin are client specific

Rapid-acting all are clear solutions
Humalog (lispro) 5 min before meal Subcut
Novolog (aspart) Subcut or IV
Apidra (glulisine) Subcut or IV
Short-acting:
Regular (R) takes 30 min to work Subcut or IV, clear
Intermediate:
NPH (N) cloudy
8
TYPES OF INSULIN (CONT.)
Long-acting
Lantus (insulin glargine)
Clear
Subcut only and cannot be mixed
No peak, 24-hr duration
Give at same time daily
Levimir (detemir)
Not as long-lasting as Lantus
May need two daily doses
Clear
Cannot be mixed
9
Figure 20-3 Labels for insulin grouped by action times. A, Rapid acting (fast acting). B, Short acting. Labels for insulin
grouped by action times. C, Intermediate acting. D, Long acting.
10
APPEARANCE OF INSULIN
Clear insulins
HumulinR (regular) short acting, can mix
Humulog (lispro) short acting, can mix
Novolog (aspart) short acting, can mix
Apidra (glulisine) short acting, can mix
Levemir (detemir) LONG acting, CANNOT mix
Lantus (glargine) LONG acting, CANNOT mix
Cloudy
NPH can mix, combined mixture will be cloudy
Draw up clear mixable insulin first
11
FIXED COMBINATIONS OF INSULIN
Popular admixtures of fast- and intermediate-

acting insulins
Novolin 50/50 = 50% NPH with 50% of
regular
If 25 units Novolin 50/50 is to be given, client
receives 12.5 unit of NPH and 12.5 units of
regular
12
Figure 20-4 Fixed-combination insulins.
13
C ASE STUDY 4
Mrs. Garcia receives two types of insulin daily:
Humulin R U-100 insulin

Lantus U-100 insulin
Are these rapid, short, intermediate, or long-

acting insulins?
14
C ASE STUDY 4 (CONT.)
Answer:
Humulin R is short acting
Lantus is long acting
15
MEASURING INSULIN IN A U-100
SYRINGE
No calculations are required
Various types of syringes are used:
Lo-Dose:
Two types of 1 mL syringe:
-even scale read on appropriate side for the

dose being delivered (e.g., 16 units on even side, 17
units on odd)
16
Figure 20-6 Types of insulin syringes. A, Single-scale (100 units). B, Lo-Dose insulin
syringe (50 units). C, Lo-Dose insulin syringe (30 units). D, Double-scale syringe (100
units). 17
ALTERNATE DELIVERY DEVICES
Insulin Pumps
Deliver rapid or short-acting insulin continuously for 24
hours a day through a catheter placed under the skin
Basal: delivered continuously
Bolus: delivered before meals meal
Insulin Pens
Looks like an ink pen when capped
Disposable or with replaceable insulin cartridges
18
Figure 20-5 A, Humulin N pen with no cap. B, Paradigm® 515 insulin pump
C, Prefilled pens, Humulin 70/30
and Humulin N. (A and C, Copyright © Eli Lilly and Company. All rights
reserved. Used with permission. ® Humalog and Humulin are registered
trademarks of Eli Lilly and Company. B, From Medtronic, Minneapolis, MN.)
19
U-500 INSULIN
500 units per mL

Check insulin label carefully
If you have uncertainty, clarify it, NEVER ASSUME!
Check calculations and preparations with 2 nurses
Administer U-500 insulin with a 1 mL syringe
Educate the client about U-500 Insulin and dosages
20
U-500 INSULIN (CONT.)
21
INSULIN ORDERS: SCHEDULED
Must be written clearly and must include the following:

human origin and rapid
onset)
SAFETY ALERT!
BEEN MISTAKEN FOR A ZERO RESULTING IN A 10-FOLD OVERDOSE!
22
INSULIN ORDERS: COVERAGE
confused with apothecary

Order rule is same as for scheduled insulin, with additional
Times to draw capillary blood glucose (CBG)
Most sliding scales use regular insulin or lispro

Dosage specified on basis of specific blood glucose range
23
SAMPLE SLIDING SCALE
HumulinR U-100 based on result of finger stick q8h:

CBG of
0-
181-
241-
341-
health care provider. Repeat CBG in 2 hr.
24
SLIDING SC ALE INSULIN ORDERS
American Nurse Today

glucose levels in hospital patients: Current
regimen is not ideal:
Largely ineffective because it treats hyperglycemia
after it occurs rather than preventing it
Can be dangerous
Likely to remain unmodified throughout hospital stay
when prescribed on admission
Exacerbation of hyper- and hypoglycemia has
increased the risk of poor clinical outcomes and
even death
25
SLIDING SC ALE INSULIN ORDERS (CONT.)
The American Nurse article recommends:

Scheduled Subcut insulin
Basal insulin uses long-acting insulin
Nutritional intake covered by rapid-acting insulin
Correctional components, determined by patient insulin
sensitivity
Basal prandial insulin therapy has evidence to support it
as being optimal for glycemic control
26
MEASURING TWO TYPES
OF INSULIN IN SAME SYRINGE
ALWAYS draw up regular or other short-acting insulin FIRST
(clear solutions); then draw up cloudy intermediate-acting
(cloudy solutions)
The insulin that acts first is drawn up first
Mix only same types such as HumulinR with HumulinN or
NovolinR with NovolinN
NEVER mix Lantus or Levemir (clear)
SAFETY ALERT!
ALWAYS CHECK EACH STEP TO VERIFY DOSAGES

WITH ANOTHER NURSE!
27
SEQUENCE FOR MIXING INSULINS
1. Gently roll vials in palm to even suspension

2. Cleanse tops of both vials with alcohol
3. Inject air equal to dose of cloudy insulin into that
vial first (do not touch solution with needle)
4. Remove needle from cloudy vial
5. Using same syringe, inject air equal to needed
dose into clear type mixable insulin; invert bottle
and withdraw
28
SEQUENCE FOR MIXING INSULINS (CONT.)
6. Remove needle from clear insulin vial and check

for bubbles (small bubbles can alter dose). Tap, if
necessary, to remove bubbles.
7. Invert cloudy insulin vial, insert needle into
solution, and withdraw to desired total dosage.
Stabilize plunger to avoid contamination with or
loss of clear insulin.
8. The total volume should equal the total number
of units ordered.
29
Figure 20-7 Mixing insulins. Order: Humulin N (NPH) U-100 30 units subcut, Humulin R
(Regular) U-100, 12 units subcut. A, Inject 30 units of air into Humulin N first; do not allow needle
to touch insulin. B, Inject 12 units of air into Humulin R and withdraw 12 units; withdraw needle.
C, Insert needle into vial of Humulin N and withdraw 30 units. Total 30 units Humulin N (NPH) +
12 units Humulin R (Regular) = 42 units. (Modified from Harkreader H, Hogan MA: Fundamentals
of nursing: caring and clinical judgment, ed 3, St. Louis, 2007, Saunders.)
30
INSULIN
Figure 20-7 Mixing insulins. Order:

Humulin N (NPH) U-100 30 units
subcut, Humulin R (Regular) U-100, 12
units subcut.
A, Inject 30 units of air into Humulin
N first; do not allow needle to touch
insulin.
B, Inject 12 units of air into Humulin
R and withdraw 12 units; withdraw
needle.
C, Insert needle into vial of Humulin
N and withdraw 30 units. Total 30
units Humulin N (NPH) + 12 units
Humulin R (Regular) = 42 units.
(Modified from Harkreader H, Hogan MA: Fundamentals
of nursing: caring and clinical judgment, ed 3, St. Louis,
2007, Saunders.)
31
SAFETY ALERT!
Insulin doses are always checked by two (2)

nurses!
Have second nurse tell you what you have do
not tell the nurse what you have drawn
Show second nurse your syringe and the vials
SAFETY ALERT!
NEVER combine long-acting insulin types (Lantus,
Levemir) or dilute them with any other insulin
preparation. 32
PRACTICE PROBLEMS
Indicate the dosages shown by the arrows
A B C D
33
ANSWER
A) 9 units
B) 44 units
C) 60 units
D) 85 units
34
C ASE STUDY 4
Mrs. Garcia has returned from surgery and has exhibited

decreased signs and symptoms of infection. She needs blood
glucose checks with sliding scale insulin ordered every 6
hours.
On the basis of the order, you will administer 4 units of
Humulin R U-100 insulin subcut for a blood glucose level of
196 mg/dL. She also has 30 units of Lantus U-100 insulin
subcut ordered.
What are the steps to draw up the two insulins?
35
C ASE STUDY 4 (CONT.)
Answer:
Use TWO separate syringes to draw up the

insulins. NEVER mix long-acting insulins (Lantus).
Have another nurse verify each dose and
document per facility policy.
36
PRACTICE PROBLEMS
How much insulin would you administer for a CBG level of

331mg/dL on the basis of the following sliding scale order?
HumulinR U-100 based on result of finger stick q8h:

CBG of 0-
CBG of 181-
CBG of 241-
CBG of 341-
provider. Repeat CBG in 2 hr.

Administer 6 units Humulin R subcut after checking with another nurse.
37
PRACTICE PROBLEMS (CONT.)
There is an order for Humulin R U-100 8 units and

Humulin N U-100 15 units subcut a.c.
What are the steps to draw up the two insulins?
What is the total amount in the syringe?
38
ANSWER
Sequence for Mixing Insulins

1. Gently roll vials in palm to even suspension
2. Cleanse tops of both vials with alcohol.
3. Inject 15 units of air into Humulin N first (do not touch solution with needle).
4. Remove needle from Humulin N vial.
5. Using same syringe, inject 8 units of air into Humulin R; invert bottle and withdraw 8
units.
6. Remove needle and check for bubbles (small bubbles can alter dose). Tap
if necessary to remove bubbles.
7. Invert Humulin N vial, insert needle into solution, and withdraw 15 units for
a total of 23 units. Stabilize plunger to avoid contamination with or loss of
clear insulin.
39
PRACTICE PROBLEMS (CONT.)
Name an insulin in each category

Short acting insulin
Intermediate acting insulin
Long acting insulin
Describe the difference between
U-100 and
U-500
40
ANSWER
Short- Humulin R
Intermediate- Humulin N
Long- Lantus
U-100- 100 units per mL
U-500- 500 units per mL
41
CHAPTER 11
UNDERSTANDING AND
INTERPRETING MEDICATION
ORDERS
UNDERSTANDING MEDICATION
ORDERS: OBJECTIVES
able to:
1. Identify the components of a medication order

2. Identify meanings of standard abbreviations
used in medication administration
3. Interpret a given medication order
2
UNDERSTANDING MEDICATION
ORDERS: OBJECTIVES (CONT.)
4. Identify abbreviation, acronyms, and

symbols recommended by The Joint
-prone
abbreviations, symbols, and dose
designations
5. Read and write correct medical
notations
3
UNDERSTANDING ORDERS
Prior to implementation, a legal written order or prescription is
required
Physicians, dentists, nurse practitioners, nurse midwives,
under state laws
Verbal orders (from prescriber to nurse)
By telephone or in person
Error prone
Emergent situations by qualified staff
WRITE it, READ it back, receive CONFIRMATION
4
(CONT.)
Transcribed to Medication Administration Record (MAR) or

faxed to Pharmacy
Nurse who administers is accountable regardless of who
transcribes to MAR
Some facilities utilize electronically generated MARs
5
(CONT.)
Memorization of acceptable common symbols and abbreviations
is essential
Refer to Tables 11-1 and 11-2
Some symbols have double meaning
ID = intradermal, also means initial dose
Reminder of TJC and ISMP guidelines
The nurse who administers an unsafe or incorrect medication
shares the liability for injury and is responsible for the
medication error
6
CASE STUDY 3
You call the physician to alert her that, despite the correct
use of the PCA morphine, Mr. Ross is having persistent,
uncontrolled pain at a level of 8 out of 10. She gives you new
orders to increase the PCA settings. Before hanging up, you
need to do what three things?
7
Answer:
1) Write the order

2) Read it back to the physician
3) Receive confirmation that the order is correct
8
TRANSCRIPTION OF
ORDERS
Before transcribing, nurse must be familiar with reading and
interpreting an order
Nurse must memorize abbreviations and symbols used in
medication orders
Refer to Tables 11-1, 11-2, and 11-3
Incorrect transcription is one of the main causes of
medication orders
9
WRITING MEDICATION
ORDERS
Seven ESSENTIAL components
1. full name
2. Date and time written If parts are
3. Name of medication missing order is
NOT legal and
4. Dosage should NOT be
5. Route filled!
6. Time and frequency
7. Signature of prescriber or proxy
10
WRITING MEDICATION ORDERS:
SPECIAL CONSIDERATIONS
Medication names
Trade = proprietary
Caution = look-alike or sound-alike names

Dosage
Amount and strength clear
11
WRITING MEDICATION ORDERS:
SPECIAL CONSIDERATIONS (CONT.)
Route Special instructions
Very important, never
assume
Frequency For blood pressure
Standard
abbreviations and
meaning (q.i.d., t.i.d.) NEVER
ASSUME
Signatures CLARIFY IF IN
DOUBT!
Legibility and co-
signing
12
CASE STUDY 3
You review the new order you have just
sending the order to the pharmacy, you

make sure it has what seven essential
components?
13
Answer:
1. full name
2. Date and time written
3. Name of medication
4. Dosage
5. Route
6. Time and frequency
7. Signature of prescriber or proxy
14
INTERPRETING A MEDICATION
ORDER
Written in following order:
1. Name of medication
2. Dosage
3. Route
4. Frequency
Example: Colace 100 mg p.o. t.i.d.
(name) (dose) (route) (freq)
15
ORGANIZE THE FOLLOWING
ANTIEMETIC ORDERS IN THE
CORRECT SEQUENCE
25 mg PR Phenergan b.i.d.
Zofran ODT prn nausea q4hr 8 mg SL
IV Reglan once 10 mg
Daily p.o. Meclazine 25 mg
16
WHAT DO THE FOLLOWING
ABBREVIATIONS STAND FOR?
prn stat
q.i.d. q8h
hs IM
SQ IV
TD NGT
cc EC
gtt NS
NPO ID
17
Figure 11-2 Glucophage label. Notice the two names. The first, Glucophage, is the
trade name, identified by the registration symbol ®. The name in smaller and different
print is metformin hydrochloride, the generic or official name.
18
19
20
Chapter 22
Intravenous Calculations
Elsevier Inc.
IV Calculations: Objectives 2
1. Calculate milliliters per hour (mL/hr)
2. Identify two types of administration tubing
3. Identify drop factor on tubing package
4. Calculate IV flow rate in drops per mL (gtt/mL)
5. Calculate IV flow rate in gtt/min using the shortcut

method
Elsevier Inc.
3
6. Calculate flow rate for medications ordered IV

over a specific time
7. Calculate infusion times and completion times
8. Recalculate IV flow rates and determine the

percentage (%) of increase or decrease
9. Calculate the rate for medication administered

by IV push
Elsevier Inc.
IV Flow Rate Calculation 4
Nurse is responsible for ensuring that the IV fluid

infuses at the correct rate
Rate is usually expressed in mL per hr
If calculation yields a decimal expression, round to

nearest whole number of mL/hr
If the infusion is managed without an electronic pump,

the rate is calculated in drops per min (gtt/min)
Elsevier Inc.
+ 5
Calculating Flow Rates for Infusion

Pumps
Elsevier Inc.
Practice Problem 6
Problem: Infuse 3,000 mL over 24 hr
Elsevier Inc.
+ 7
Calculating Flow Rates for Infusion

Pumps
Elsevier Inc.
+ 8
Practice Problem
Order:
4.5 g Zosyn in 100 mL NS IVPB in 30 min BID
What is the rate in mL/hr?
Elsevier Inc.
+ 9
Calculating Flow Rates
SAFETY ALERT!
The usual rate ranges from 50-200 mL/hr. If the rate

exceeds this amount, double check the order and
your calculations.
Elsevier Inc.
Calculating IV Flow Rates in 10
Drops (gtt) per Minute
If pumps are not available, the rate is

manually regulated with flow regulator in
tubing
Drops per minute is determined by the drip
factor of the drop chamber below IV bag
Calibration is printed on package;
NEVER assume
Elsevier Inc.
IV Tubing 11
Macrodrop
Standard type for general infusions
Delivers 10, 15, or 20 gtt/mL for each mL
Used to deliver large volumes
Microdrop
Delivers tiny drops 60 gtt/mL
Used to deliver small amounts with exactness
Because drop factor is 60 gtt/mL, drops per minute
equals mL per hour (e.g., 25 mL per hr = 25 gtt/min)
Elsevier Inc.
12
Figure 22-2 Observing the drop chamber to count drops per minute. (From Potter
PA, Perry AG, Stockert P, Hall A: Fundamentals of nursing, ed 8, St Louis, 2013,
Mosby.)
Elsevier Inc.
13
Elsevier Inc.
+ 14
Calculating Flow Rates in

Drops per Minute
Can be used for primary solutions
and intermittent solutions of large
and small volumes (e.g., IVPB and
boluses)
Elsevier Inc.
Formula Method 15
Problem: Infuse NS at 100 mL per hr. The drop factor

on tubing is 10 gtt/mL. How many gtt/min?
Elsevier Inc.
Dimensional Analysis 16
Problem: Infuse D5W at 100 mL per hr
What is rate in gtt/min? DF = 10 gtt/mL
Elsevier Inc.
Calculating Drops per Minute 17
with Large Volumes of Fluid

IV fluid can be ordered in large volumes over
several hours (e.g., 1,000 mL over 6 hours)
Preliminary step to determine the volume per hour:
Dimensional analysis incorporates this preliminary

step in one equation
Elsevier Inc.
Dimensional Analysis 18
Problem: IV of 1,000 mL NS to infuse in 8 hr IV tubing has drop

factor of 20 gtt/mL
Elsevier Inc.
Shortcut Method 19
All tubings in facility must have same gtt/mL

throughout to prevent errors in macrodrops.
Can also be used for microdrop (60 gtt/mL)
IV flow rate must be expressed in mL per hr or mL

per 60 min
Must obtain drop factor constant
For 15 gtt/mL:
Elsevier Inc.
Problem: Administer 0.9% NS at 20
100 mL/hr Drop factor = 20 gtt/mL

Constant = 3
Remember: Drop factor constant is obtained by
dividing 60 by drop factor of tubing (20)
Elsevier Inc.
+ 21
Case Study 5
is necessary for another patient and you must

calculate the rate in gtt/min. You check the tubing
package and find a drop factor of 20 gtt/ml. You
recall the order:
1 L NS IV at 100 mL/hr now
What is the rate?
Elsevier Inc.
+ 22
Answer:
Run the NS at 33 gtt/min. Remember to
count the drops for a whole minute in
order to accurately set the rate.
Elsevier Inc.
Calculating IV Flow Rates for 23
Several Solutions
May have different amounts and types
ordered over an extended period
Usually for 24-hr period
Usually divided by 3 shifts
Steps to calculate:
1. Add up the total amount of fluid
2. Proceed as with other IV calculations
Elsevier Inc.
Order: Administer the following IVs for 24 hours: 24
a. 1,000 mL D5W with 10 mEq KCl (potassium

chloride)
b. 500 mL D5NS with 1 amp MVI (multivitamin)
c. 500 mL D5W
Steps:
Calculate mL per
hr of total volume
Calculate gtt per
min
Reduce
Elsevier Inc.
25
Determining Amount of Medication in

Specific Amount of Solution
Elsevier Inc.
Order: Mix solution of 20 mEq KCl in 1,000 mL of NS. 26
Administer at 2 mEq per hour.
Step 1 Calculate number of mL needed to deliver 2

mEq of KCl from this solution
Step 2 Calculate rate of flow to deliver 100 mL per

hour via pump or by drop factor
Elsevier Inc.
+ Case Study 5 27
decreased at 3.1 mEq/L. The physician changes the

IV fluid to 1 L of D5 NS + 20 mEq KCl at a rate of 2.25
mEq/hr. You add the potassium to the D5 NS and
calculate the new rate.
Using the same drop factor of 20 gtt/mL, what is the

rate in gtt/min?
Elsevier Inc.
+ 28
Answer:
38 gtt/min
Elsevier Inc.
29
Calculating a Problem with an

Unknown Using the Formula Method
Elsevier Inc.
Steps 30
1. Take information in problem and place in formula

2. Place an x in position of unknown
place x in position for min.
When answer obtained, divide by 60 to get hours
For volume place x in position for volume
3. Set up algebraic equation to solve for x
4. Solve the equation
5. Label the answer in hours or milliliters
Elsevier Inc.
Problem: An IV is regulated at 20 microgtt/min. 31
How many hours will it take to infuse 100 mL?
Elsevier Inc.
Recalculating IV Flow Rate 32
Change in rate for gravity flow infusions

Rate can change with changes in position of
client in the bed or positional IVs
The recalculated flow rate should not vary from the

original rate by > 25%. If it does, the physician
should be notified
ALWAYS assess status of client before

compensating, and follow facility policy
Elsevier Inc.
+ 33
Recalculating IV Flow Rate
Elsevier Inc.
Checking Amount of 34
Change
Elsevier Inc.
Calculating Adjusted Flow Rate 35
Example 1:
1,000 mL of D5LR was to infuse in 8 hr at 31 gtt/min

(macrogtt/min). The drop factor of the tubing is 15
gtt/mL. After 4 hours, you notice that 700 mL of fluid
are left in the IV. What will be the new rate necessary
to infuse the solution in the time prescribed?
Elsevier Inc.
Shortcut Method 36
Elsevier Inc.
+ 37
Shortcut Method (Cont.)

Calculate the % of variance
44 (new rate) - 31 (old rate)/31 (old rate) =
13/31; 13/31= 0.419 = 42%. Notify
prescriber, 42% is greater than 25%. The
order may need to be revised
Elsevier Inc.
Calculating Total Infusion 38
Times
IV rates often ordered in mL per hr
Need to calculate volume infused over time:
Elsevier Inc.
Calculating Infusion Time When 39
Rate in mL per hr Is Not Indicated

Prescriber orders a specific large volume of fluid and
a rate in gtt/mL, but not mL/hr
Steps:
1. Convert gtt/min to mL/min
2. Convert mL/min to mL/hr
Problem: Client is receiving 1,000 mL of RL. The IV is

infusing at 21 gtt/min. Drop factor is 10 gtt/mL.
Calculate the infusion time.
Elsevier Inc.
40
Elsevier Inc.
Charting IV Therapy and 41
Labeling Bags
IV administration may be charted on special flow
sheets and may include IV site assessment
IV bags must be labeled with contents, rate, and

client identifiers
Rate tapes may be applied to visually cue hour and

volume correlations
Elsevier Inc.
42
Figure 22-3 IV solution with time taping. (From Potter PA, Perry AG, Stockert PA, Hall A:
Basic nursing, ed 7, St Louis, 2011, Mosby.)
Elsevier Inc.
+ 43
Case Study 5
Before you can administer the new IVF, you
must place a label. You just finished adding
20 mEq of potassium chloride to 1,000 mL
dextrose 5% in 0.9 % sodium chloride. What
will your label look like?
Elsevier Inc.
+ 44
Answer:
Elsevier Inc.
Administration of Medications 45
by IV Push
IV push medications are given via injection ports
SAFETY ALERT!
Results are rapid; drugs are potent

Administer or over 1 to 5 minutes, depending on drug
guidelines
Medications are diluted in various volumes
Solution compatibility is verified
Tubing is flushed
Calculate rate of push
Elsevier Inc.
Order: Tagamet 200 mg IV push now 46
Available: Tagamet 300 mg per 2 mL

Note: Literature says dilute Tagamet to 20 mL
Elsevier Inc.
47
Elsevier Inc.
+ 48
Practice Problems
A) Patient: 32 y/o male Dx: +MRSA leg wound
Orders: Vancocin 1 g/250 mL over 2 hrs IVPB q12hrs,
NS 1 L over 8 hrs IV x 3
What is the total volume infused in 4 ½ hrs?
Orders: Cipro 400 mg/100 mL IV BID over 1 hour. DF

15 gtt/mL
What is the rate in mL/hr and gtt/min?
Elsevier Inc.
CHAPTER 6
METRIC SYSTEM
METRIC SYSTEM: OBJECTIVES
able to:
1. Express metric measures correctly using rules

of the metric system
2. State common equivalents in the metric system
3. Convert measures within the metric system
2
METRIC SYSTEM:
BACKGROUND
France late 17th/18th centuries
Also known as International System of Units or SI units
Simple and accurate because it is based on the decimal

system
System of choice for medications and measurements in
health care setting
3
METRIC SYSTEM
4
METRICS: PARTICULARS
1. Decimal system multiples of ten (10)
2. Three basic units of measure
Gram (weight) measure medications as solids
Liter (volume) measure medications as solutions
Meter (length) measure body parts, wounds, etc.
3. Prefixes memorization is necessary
Kilo, centi, milli, micro
4. Name of basic unit is incorporated into measure
Milliliter, kilogram, centimeter
5
(CONT.)
Examples of use of prefixes and suffixes
67 milligrams
milli = thousandths, grams = unit of weight therefore, 67
milligrams = 67 thousandths of a gram
Milliliter = one thousandth portion of a liter
Kilogram = one thousand grams
Deciliter = one tenth of a liter
Cubic millimeter = mm3 (length width height)
Used to count blood cells in fixed volume on slides
6
7
(CONT.)
5. Abbreviations are first letter of the word
Gram = g
Meter = m
Liter = L (capital letter)
6. When prefixes are used with basic units, first letter of
word is written in lower case
Milligram = mg
Microgram = mcg
Exception Liter as in milliliter = mL
8
METRICS: RULES
1. Arabic number express quantity (1, 0.5)

2. Parts or fractions of a whole are expressed as decimals (0.4
g NOT 2/5 g)
3. Quantity precedes unit of measure ( 2 L)
4. A full space is used between number and abbreviation (5
mg)
5. Use leading zero before a decimal, but eliminate trailing
zeros (0.4 mg NOT .4 mg, and 2 mg NOT 2.0 mg)
9
METRICS: RULES (CONT.)
6.
May still be seen on some medication labels

7.
2 mL NOT 2 cc
ISMP and TJC recommendation
May still be seen on some syringes
8. Avoid periods (mg NOT mg.)
10
METRICS: RULES (CONT.)
9. Place commas in values starting at one thousand (ISMP
recommendation)
1,000 NOT 1000
10. could lead to
misinterpretation
mg NOT mgs
Safety Point These rules are designed to prevent

medication errors and ensure accurate interpretation of
metric annotations used in medication administration.
11
12
METRICS: UNITS OF
MEASURE
Gram basic unit of weight

Milligrams and micrograms are multiple times smaller than a gram
1 g = 1,000 mg
and 1 g = 1,000,000 mcg
Kilogram is only unit typically used in medicine that is larger than

the basic gram unit (used to measure client weight)
1,000 g = 1 kg so 1 kg is 1,000 times larger than 1 g
13
METRICS: UNITS OF
MEASURE (CONT.)
Liter basic unit of volume

Milliliter (mL) is much smaller than a liter
1 L = 1,000 mL, and 1 mL is 0.001 of a liter
ISMP and TJC

Pints and quarts (used in home care) are not metric but
have metric equivalents
1 quart 1,000 mL and 1 pint 500 mL
14
Volume Comparison
1000 mL 30 mL
(FROM KEE JL, MARSHALL SM: CLINICAL CALCULATIONS:
WITH APPLICATIONS TO GENERAL AND SPECIALTY AREAS,
ED. 7, ST. LOUIS, 2013, SAUNDERS.)
15
16
METRICS: CONVERSIONS
BETWEEN UNITS
Convert means to change from one unit to another, such as mg

to mcg
Done by moving decimal
Left to divide Right to multiply
Each metric unit in health care differs by
1,000 or 3 decimal places
Conversion factors:
1 kg = 1,000 g 1 g = 1,000 mg 1 mg = 1,000 mcg
1 L = 1,000 mL
17
METRICS: CONVERSIONS
BETWEEN UNITS (CONT.)
Smaller to larger DIVIDE move left

Example: 100 mL = ___ L (CF: 1,000 mL = 1 L)
(smaller) (larger)
Move decimal 3 places to left 100 = 0.1 L
Larger to smaller MULTIPLY move right

Example: 0.75 g = ___ mg (CF: 1 g = 1,000 mg)
(larger) (smaller)
Move decimal 3 places to right 0.750 = 750 mg
18
SAFETY ALERT!
When converting quantities from one unit of measure to
another, remember that moving the decimal point incorrectly
can result in a dangerous med error.
Never guess at the meaning of a metric notation; always ask
for clarification.
19
COMPLETE THE
FOLLOWING PROBLEMS
Convert the following metric measures:
a) 400 mg = ____ mcg
b) 49 mL = ____ L
c) 3.75 L = ____ mL
d) 0.08 kg = ____ g
20
CASE STUDY 2
Mr. Hain will be admitted to the unit from the emergency
department (ED) with nausea, vomiting, and diarrhea. You
receive a report from the ED nurse and prepare to admit the
ED?
250 mL yellow-tinged emesis
0.65 L urine
140 mL loose stool
21
Answer:
1,040 mL
22
Mr. Hain is dehydrated. The doctor orders 2 L of D5 NS to be
given IV at a rate of 250 mL/hr. How many milliliters will the
patient receive?
23
Answer:
2,000 mL
24
MEDICATION ADMINISTRATION
AND CALCULATIONS SAFETY
For Nursing Students
Updated 8/21
WHAT WE WILL ACCOMPLISH
Objectives
Discuss why MCAS is important
Take a look at abbreviations/six rights/Do not
use list
Discuss ways to calculate medication
Dimensional analysis
Ratio and Proportions
Formula Method
Practice using these methods
THE 6 RIGHTS
The right drug

The right dosage
The right patient
The right time
The right route
The right
documentation
MEDIC ATION ERRORS ARE
PREVENTABLE
Medication Errors affect over 250,000 ..
https://www.hopkinsmedicine.org/news/media/releases
study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_
us
ABBREVIATIONS AND CONVERSIONS
Abbreviations Conversions
Gram = g
Milligram = mg 1 kg= 1000 g
Kilogram = kg 1 g=1000 mg
Liter = L 1 mg=1000 mcg
Milliliter = mL
1 L=1000 (960) mL
Microgram= mcg
Centimeter = cm
*1 ml =1 cc not used
Grain = gr 1 oz=30 ml
Pound = lb 1 kg=2.2 lbs
Ounce = oz 1 grain=60 mg
Cup = c. *1 cup = 240 mL
1 pint = 480 mL
1 tsp = 5 mL
1 tbsp = 15 mL
ABBREVIATIONS
Drop = gtt, gtts

Keep vein open = KVO
Teaspoon = t or tsp
Nothing by mouth = NPO
Tablespoon = T or Tbsp
Twice a day = bid., b.i.d. As needed = PRN
Three times a day= tid., t.i.d. As desired = Ad lib
Four times a day = q.i.d.,qid Temperature
Before meals = ac 37 C = 98.6 F
After meals = pc C= F 32
Every 4 hours = q4h 1.8
F = 1.8( C) + 32
CONVERSIONS AND ABBREVIATIONS
Weight
Volume
Drops: 15 drops = 1 mL Pound: 1 lb = 16 oz
Grams: 2.2 lb = 1 kg
Teaspoon: 1 tsp = 5 mL
Metric Volume
Tablespoon: 1 Tbsp = 15
1- T = 3 tsp 1 L = 1000 ml
Cup: 1 C = 8 oz = 240 mL Metric Weight

1 kg = 1000 g
Quart: 1 qt = 1 L
1 g = 1000 mg
2 pint = 4 C
1 mg = 1000 mcg
Metric Measure
1 in = 2.5 cm
DO NOT USE LIST
The Institute for Safe Medication Practices (ISMP) and

the Food and Drug Administration recommend that
-prone abbreviations be considered
whenever medical information is communicated.
Complete list is located at:
www.ismp.org/Tools/errorproneabbreviations.pdf
THE FOLLOWING
NOTATIONS SHOULD
NEVER BE USED
Notation Reason Instead Use
U Mistaken for 0, 4, cc
IU Mistaken for IV or 10
QD Mistaken for QID
QOD Mistaken for QID, QD every other day
accreditation
THE FOLLOWING NOTATIONS SHOULD
NEVER BE USED
AD, AS, AU: Mistaken for OD, OS, OU right ear, or

left ear, or both ear
OD, OS, OU: Mistaken for AD, AS, AU right eye, or

left eye or both eyes
D/C, dc, d/c: Misinterpreted as discharge or

discontinue when discontinued followed by list of of
medications.
THE FOLLOWING NOTATIONS
Notation SHOULD
ReasonNEVER BE Use
Instead USED
Trailing zero:
THREE WAYS TO C ALCULATE
Formula Method
You can use one or two of these
methods.
Find the one or two that is comfortable
for you and use it consistently
UNIT CONVERSION
Start with what you have:

what has been ordered (by the provider)
what is available.
Identify what you need:
how are you giving it (tablet, IM, IV,
sublingual)?
Convert units by:
multiplying or dividing with appropriate
conversion factors so that units cancel out.
#1 FORMULA METHOD
D = dosage desired or what the provider has ordered

H/A = the dosage strength that is available, what is on
hand
Q = quantity, or the unit of measure that contains the
dose that is available
When solving problems for medications, the amount for
Dosage amount = represent the unknown, the dosage

you are looking for, the dosage you are going to
administer. How many ml, tab, etc. You will give.
#1 FORMULA METHOD
Desired Amount
______________ X Quantity = Amount to Give
On Hand/Available
Or
D
____ x Q = Dosage amount
H
EXAMPLE FORMULA METHOD
Order: Zoloft 50 mg p.o. daily

On Hand/Available: Zoloft 25 mg tablets
Dosage: How many tablets will you
give?_____________
Desired: 50 mg
On hand/Available: 25 mg
Quantity: tablets
D = 50 mg
_______ ________ X 1 Tab = 2 Tabs
H 25 mg
#2 RATIO AND PROPORTIONS
Desired Known (mg, g,units)

_________ = _________
Unknown Known (mL, tabs)
The Ratio is known or what you have available.

The desired is what is ordered to be administered
The unknown is the amount that you will give the
client.
FORMULA AND RATIO

Available: Zoloft 25 mg tablets
Dose: How many tablets will you give?_____________
Desired = 50mg
Available known = 25 mg/tablet
50 mg = 25 mg
_______ _______ = 25X = 50 mg = 50/25 = 2 tabs
X 1 tab
RATIO AND PROPORTIONS

How many tablets will you give?_____________
Desired = 50mg
50 mg : X = 25 mg : 1tab = 25 mg X = 50 mg = 50/25 = 2 tabs

DIMENSIONAL ANALYSIS
Identify the desired unit

Identify the equivalent needed
Write the equivalent in a fraction keeping the desired units
in the numerator
Label the all factors in the problem
Identify unwanted units and cancel them out.
Amount to give = Available dose x Ordered dosage

DIMENSIONAL ANALYSIS

Desired = 50mg
X tab = 1 tab x 50 mg 1 x 50
_____ ______ = _________ = 2
25 mg X tab 25 X
TABLET: PO MEDS
Ordered : Kantrex 1 g p.o. q6h for 5 days

Available: Kantrex 500 mg caps
How many capsules will you give for one dose?
How many capsules will you give for 1 day
Use you method

1. Dimensional Analysis Method
2. Ratio and Proportions Method
3. Formula Method
IV C ALCULATIONS: FLOW RATE
Gravity flow IV is an IV bag that hangs higher than the
The plastic tubing determines the drop factor or the

number of drops (gtt) per mL
-Microdrip chamber has a needle in the chamber and
delivers 60 gtt/ml = Drop Factor
-Macrodrip chamber has no needle, check label to see
the drops per ml: Could be 10, 15, or 20 gtt/mL = Drop
Factor
Flow Rate = mL/hr and gtt/min

1. IV pump measures in mL/hr
2. gravity flow answer will be gtt/minute.
CALCULATING FLOW RATE IN ML/HR
Hourly Rate
mL of solution ordered divided by total hours
ordered = mL/hour
Example
Order: administer 1000 mLs over 8 hours
Divide total volume(1L) by total hours

1000 divided by 8 = 125 mL/hr
FLOW RATE IN ML/HR
Give 200 mL of NS over 3 hours.

Calculate the mL/hr_____66.7 = 67mL/hr
Give 3000 mL over 24 hours

Calculate the mL/hr____125 mL/hr
IV FORMULA-GTT/MIN
V X C = R or Flow Rate = Volume X Calibration(DF)

T Time (minutes)
V = Total volume to be infused by mL/hr (volume

to be infused in one hour)
T = Total time in minutes (minutes X 60 min)
C = Drop factor (df) calibration (gtt/mL)
R = Rate of flow (gtt/min)
IV C ALCULATIONS GTT/MIN
Number of mL/hr x drop factor = gtt/min

60 minutes
Ordered 500 ml of D5NS at 50 ml/hr drop factor

is 10 gtt/ml
50 mL/hr x 10 gtt/mL = 500 = 8.33 or 8 gtt/min

60 min 60
FLOW RATE = GTT/MIN
2 L of D5W 0.9NS to infuse over 125 mL/hr.The Drop

Factor (df) is 20 gtt/mL
Calculate the flow rate in gtt/min____41.66 = 42mL/hr
Infuse 500 mL of Intralipids IV at 75 mL/hr.The Drop

factor (df) is 10 gtt/mL
Calculate the flow rate in gtt/min__12.5 = 13 mL/hr
IV C ALCULATIONS GTT/MIN
Order 1500 ml lactated ringers in 12 hrs. Drop factor

20gtt/mL
Calculate the flow rate _____________________gtt/min
1. 1500 X 20gtt/mL = 41.6 or 42gtt/min (whole

number only)
(12 x 60) 720 min
2. 1500/12 = 125mL/hr = 125 mL/hr x 20 gtt/mL = 42

60
**gtt/min and mL/hr record in whole numbers

FLOW RATE: EXAMPLES
The client has an order to receive and antibiotic in 50

mL of 0.9%NS over 30 minutes. Calculate mL/hr
50 mL 60 min 50 x 60 = 3000 = 100 mL/hr

_______ X ________ = ___________ 30
30 min 1 hr 30
The client has an order to receive an antibiotic in 100

mL of 0.9%NS over 45 minutes. Use a microdrip.
Calculate the gtt/min________________
IV PRACTICE QUESTIONS
Ordered: 1000 ml D5W to run 10 hours. The df = 10

gtt/mL. Determine the gtt/min and mL/hr
IV PRACTICE QUESTIONS ANSWER
Ordered: 1000 ml D5W to run 10 hours. The df = 10 gtt/mL. Determine the
gtt/min and mL/hr
Need to first determine hourly rate
1000 ml divided by 10 = 100 ml/hr

______________________________________________
100 ml/hr x 10 gtt/ml = 1000 = 16.66 gtt/min = 17 gtts/min

60 min 60
FLOW RATE: ML/HR
Mr. Sampson has an order to receive Levaquin 500 mg in 150 mL of 0.9%

NaCl over 45 min. Calculate the mL/hr.
150 mL x 60 min
___________________ = 200 mL/hr
45 min
FLUID INTAKE
Calculate the following Coffee:1 1/2 C x 8 oz x 30 ml

intake =360mL
In mL only not ounces: 1 c.
A. 1 ½ c. of coffee (8 oz)
B. 4 oz of juice Juice: 4 oz x 30 ml = 120 mL
C. 1.5 L of IV fluid 1 oz
= How many mL?

Intake is always recorded in mL Fluids: 1.5 L x 1000 ml =1500 mL
Determine each mL amount 1L
separately then add together
Total = 1980 mL
FLUID INTAKE
1 ½ cup coffee (6 oz) =

2 cups of water (8 oz) =
1 container of jello (4 oz) =
4 oz of milk =
1 bowl of soup (12 oz) =
How many mL did the client have for this shift?

ANSWER TO INTAKE
1 ½ cup coffee (6 oz) = 270

2 cups of water (8 oz) = 480
1 container of jello (4 oz) = 120
4 oz of milk = 120
1 bowl of soup (12 oz) = 360
total = 1350
How many mL did the client have for this shift?
CALCULATIONS
Check safe 24 dosage range

Calculate the safe dosage range for
individual multiply the recommended
Determine if ordered dose within the safe

range: Too low or too high not safe!!
Calculate the dosage to be given
PEDIATRIC C ALCULATIONS
Order: Benadryl 25 mg po q6hr

Recommended dose: 2-5 mg/kg/day
Available: Benadryl 10 mg/mL
Client weighs: 45 lb. (round weight to the tenths
place)
What is the weight in kg?
What is the safe dose range?
Is the dosage safe? (use the order)
How many mL will you give per dose?
PEDIATRIC CALCULATIONS ANSWER

Ordered: 25 mg/10 mg x 1 mL = 2.5 mL
Client weighs: 45 lb/ 2.2 = 20.45 = 20. 5kg
Range = 41 mg to 102.5 mg
(20.5 x 2 = 41 mg and 20.5 x 5 = 102.5 mg)
Ordered: 25 mg x 4 doses = 100 mg
Is the dosage safe = yes
IV
CALCULATIONS/CONVERSIONS
Start with what you have (what has been
ordered and what is available).
Identify what you need (how are you

giving it?)
Set the problem up so that the

appropriate units cross out.
BODY WEIGHT C ALCULATIONS
Nitroprusside 10 mg in 250 ml of 0.9% NaCl to infuse at

4 mcg/kg/min. The patient weighs 18 lb 3oz. (Round
weight to the nearest tenths place)
How many ml/hour will the patient receive?
1. 3oz/16 oz = 0.2 + 18 = 18.2/2.2 = 8.3 kg
2. 8.3 kg x 4 mcg/kg/min = 33.2 mcg/min
3. 33.2 mcg/min x 60 = 1992 mcg/hr
4. 10 mg x 1000 = 10,000 mcg
1992 mcg/hr x 250 mL

__________________________ = 49.8 = 50 ml/hr
10,000 mcg
CRITIC AL C ARE HEPARIN
Heparin 25,000 units in 500 ml of 0.45%

NaCl to infuse at 1000 units/hour.
How many mL/hour is the patient receiving?
1000 u/hr x 500 mL

______________________
25,000 u
IV HEPARIN
Heparin 25,000 units in 500 mL of 0.45%

NaCl to infuse at 23 mL/hour.
How many units/hour is the patient

receiving?
25,000 units x 23 mL/hr

____________________________
500 mL
IV INSULIN ADMINISTRATION
Insulin 100 units in 100 ml of 0.9% NaCl to

infuse at 5 units/hour.
Calculate the flow rate (mL/hr).
5u/hr x 100 mL
__________________
100 u
IV INSULIN
Insulin 500 units in 250 ml of 0.9 % NaCl to

infuse at 4 mL/hour.
Calculate the units/hour you will administer.
500 u x 4 mL/hr
___________________
250 mL
CRITIC AL C ARE
Nitroglycerine 100 mg in 250 ml of 5 %

dextrose in water infusing at 5.4 ml/hour.
How many mcg/hour is the patient

receiving?
100 mg x 1000 = 100,000 mcg
100,000 mcg x 5.4 mL/hr

____________________________ = mcg/hr
250 mL
RECONSTITUTION
Rocephin is available as 1g powder to be reconstituted with 2.1 mL of

sterile water for a final dilution of 350 mg/mL (Reconstitution amount).
Ordered dosage is 250 mg IM now. How many milliliters of Rocephin will
the client receive?
1g 2.1 mL 350 mg/mL

RECONSTITUTION
Ordered: Amoxicillin sodium 250 mg p.o. q6h. Available: A multidose vial

that reads amoxicillin oral suspension; add 70 mL water. Each 5 mL of
solution contains 250 mg (reconstitution amount)
How many milliliters will you administer?___________
1 gram Diluent? 250/5 mL

RECONSTITUTION
Ordered: Cefadyl 700 mg IM q6h. Available: Cefadyl 1 g. Directions

read: For IM use, add 2 mL sterile or bacteriostatic water for injection
For IV use, add 1.7 mL. USP.
Each IM injection, 1.5 mL contains 500 mg of cefadyl.
How many milliliters will you administer per IM injection?
____________mL
Medication? Diluent? Reconstitution dose

OTHER IV PROBLEMS
A nurse records an infant s weight as 10

pounds 6 ounces. Ranitidine (Zantac) is
prescribed for the infant. The prescription
reads: Ranitidine 2mg/kg twice daily
The medication is supplied as 15 mg/ml. The

nurse should instruct the parent to give ______
ml per dose.
INFUSION TIME
Calculate infusion time:

Mr. Sampson s intravenous solution of 1500 mL, was
ordered to infuse at 110 mL/ hour. The IV was started
at 8:45am.
1. How long will it take for the IV to infuse (Infusion

time) (example: 3 hours and 6
minutes)?________________
2. What time will the IV infusion be completed?

Record in Regular time__________________and Military
time? _______________
INFUSION TIME
Calculate Infusion Time:

The IV of 500 mL NS is to infuse at 60mL/hr
Traditional and Military time.
1) Determine infusion Time (hours and minutes).
2) If the IV was started at 10:00 pm, when would the
IV infusion be completed?
AND CALCULATIONS SAFETY
For Nursing Students
Updated
8/21
What we will Accomplish
Objectives
Discuss why MCAS is important
Take a look at abbreviations/six rights/Do
not use list
Discuss ways to calculate medication
Dimensional analysis
Formula Method
Practice using these methods
The 6 Rights
The right drug
The right dosage
The right patient
The right time
The right route
The right
documentation
Medication Errors are preventable
Medication Errors affect over 250,000

..
https://www.hopkinsmedicine.org/news/medi
a/releases
study_suggests_medical_errors_now_third_l
eading_cause_of_death_in_the_us
Abbreviations and Conversions
Abbreviations Conversions
Gram = g
Milligram = mg 1 kg= 1000 g
Kilogram = kg 1 g=1000 mg
Liter = L 1 mg=1000 mcg
Milliliter = mL 1 L=1000 (960) mL
Microgram= mcg *1 ml =1 cc not used
Centimeter = cm 1 oz=30 ml
Grain = gr 1 kg=2.2 lbs
Pound = lb 1 grain=60 mg
Ounce = oz *1 cup = 240 mL
Cup = c. 1 pint = 480 mL
1 tsp = 5 mL
1 tbsp = 15 mL
Abbreviations
Drop = gtt, gtts
Keep vein open = KVO
Teaspoon = t or tsp
Tablespoon = T or Tbsp Nothing by mouth =
Twice a day = bid., b.i.d. NPO
Three times a day= tid., As needed = PRN
t.i.d. As desired = Ad lib
Four times a day = Temperature
q.i.d.,qid
Before meals = ac 37 C = 98.6 F
After meals = pc C = F 32
Every 4 hours = q4h 1.8
F = 1.8( C) + 32
Conversions and Abbreviations
Volume Weight
Drops: 15 drops = 1 mL Pound: 1 lb = 16 oz
Teaspoon: 1 tsp = 5 mL Grams: 2.2 lb = 1 kg
Tablespoon: 1 Tbsp = 15 Metric Volume
1- T = 3 tsp 1 L = 1000 ml
Cup: 1 C = 8 oz = 240 mL Metric Weight
Quart: 1 qt = 1 L 1 kg = 1000 g
2 pint = 4 C 1 g = 1000 mg
1 oz = 30 mL 1 mg = 1000 mcg
Metric Measure
1 in = 2.5 cm
Do Not Use List
The Institute for Safe Medication Practices (ISMP)
and the Food and Drug Administration
-prone
abbreviations be considered whenever medical
information is communicated.
Complete list is located at:
www.ismp.org/Tools/errorproneabbreviations.pdf
The Following Notations Should
Never Be Used
U Mistaken for 0, 4, cc
IU Mistaken for IV or 10
QD Mistaken for QID
QOD Mistaken for QID, QD every other day
accreditation
The Following Notations Should Never
Be Used
AD, AS, AU: Mistaken for OD, OS, OU right ear, or
left ear, or both ear
OD, OS, OU: Mistaken for AD, AS, AU right eye, or

left eye or both eyes
D/C, dc, d/c: Misinterpreted as discharge or

discontinue when discontinued followed by list of of
medications.
The Following Notations Should Never
Be Used
Trailing zero:
Chapter 2
Fractions

Three Ways to Calculate
Formula Method
You can use one or two of these
methods.
Find the one or two that is comfortable
for you and use it consistently
Unit Conversion
Start with what you have:
what has been ordered (by the provider)
what is available.
Identify what you need:
how are you giving it (tablet, IM, IV,
sublingual)?
Convert units by:
multiplying or dividing with appropriate
conversion factors so that units cancel out.
#1 Formula Method
D = dosage desired or what the provider has ordered
H/A = the dosage strength that is available, what is on
hand
Q = quantity, or the unit of measure that contains the
dose that is available
When solving problems for medications, the amount for
Dosage amount = represent the unknown, the dosage

you are looking for, the dosage you are going to
administer. How many ml, tab, etc. You will give.
#1 Formula Method
Desired Amount
______________ X Quantity = Amount to Give
On Hand/Available
Or
D
____ x Q = Dosage amount
H
Example Formula Method
On Hand/Available: Zoloft 25 mg tablets
Dosage: How many tablets will you
give?_____________
Desired: 50 mg
On hand/Available: 25 mg
Quantity: tablets
D = 50 mg
_______ ________ X 1 Tab = 2 Tabs
H 25 mg
#2 Ratio and Proportions
Desired Known (mg, g,units)
_________ = _________
Unknown Known (mL, tabs)
The Ratio is known or what you have available.

The desired is what is ordered to be
administered
The unknown is the amount that you will give
the client.
Formula and Ratio
Dose: How many tablets will you give?_____________
Desired = 50mg
50 mg = 25 mg
_______ _______ = 25X = 50 mg = 50/25 = 2 tabs
X 1 tab

Desired = 50mg
50 mg : X = 25 mg : 1tab = 25 mg X = 50 mg =
50/25 = 2 tabs
Identify the desired unit
Identify the equivalent needed
Write the equivalent in a fraction keeping the desired units
in the numerator
Label the all factors in the problem
Identify unwanted units and cancel them out.
Amount to give = Available dose x Ordered dosage


Desired = 50mg
X tab = 1 tab x 50 mg 1 x 50
_____ ______ = _________ = 2
25 mg X tab 25 X
Tablet: PO meds
Ordered : Kantrex 1 g p.o. q6h for 5 days
Available: Kantrex 500 mg caps
How many capsules will you give for one dose?
How many capsules will you give for 1 day
Use you method

1. Dimensional Analysis Method
2. Ratio and Proportions Method
3. Formula Method
IV Calculations: Flow Rate
Gravity flow IV is an IV bag that hangs higher than the
The plastic tubing determines the drop factor or the

number of drops (gtt) per mL
-Microdrip chamber has a needle in the chamber and
delivers 60 gtt/ml = Drop Factor
-Macrodrip chamber has no needle, check label to see
the drops per ml: Could be 10, 15, or 20 gtt/mL = Drop
Factor
Flow Rate = mL/hr and gtt/min

1. IV pump measures in mL/hr
2. gravity flow answer will be gtt/minute.
Calculating Flow Rate in mL/hr
Hourly Rate
mL of solution ordered divided by total hours
ordered = mL/hour
Example
Order: administer 1000 mLs over 8 hours
Divide total volume(1L) by total hours

1000 divided by 8 = 125 mL/hr
Flow Rate in mL/hr
Give 200 mL of NS over 3 hours.

Calculate the mL/hr_____66.7 = 67mL/hr
Give 3000 mL over 24 hours

Calculate the mL/hr____125 mL/hr
IV Formula-gtt/min
V X C = R or Flow Rate = Volume X Calibration(DF)
T Time (minutes)
V = Total volume to be infused by mL/hr (volume

to be infused in one hour)
T = Total time in minutes (minutes X 60 min)
C = Drop factor (df) calibration (gtt/mL)
R = Rate of flow (gtt/min)
IV Calculations gtt/min
Number of mL/hr x drop factor = gtt/min
60 minutes
Ordered 500 ml of D5NS at 50 ml/hr drop factor

is 10 gtt/ml
50 mL/hr x 10 gtt/mL = 500 = 8.33 or 8 gtt/min

60 min 60
Flow Rate = gtt/min
2 L of D5W 0.9NS to infuse over 125 mL/hr. The Drop

Factor (df) is 20 gtt/mL
Calculate the flow rate in gtt/min____41.66 = 42mL/hr
Infuse 500 mL of Intralipids IV at 75 mL/hr. The Drop

factor (df) is 10 gtt/mL
Calculate the flow rate in gtt/min__12.5 = 13 mL/hr
IV Calculations gtt/min
Order 1500 ml lactated ringers in 12 hrs. Drop factor
20gtt/mL
Calculate the flow rate _____________________gtt/min
1. 1500 X 20gtt/mL = 41.6 or 42gtt/min (whole

number only)
(12 x 60) 720 min
2. 1500/12 = 125mL/hr = 125 mL/hr x 20 gtt/mL = 42

60
**gtt/min and mL/hr record in whole numbers

Flow Rate: Examples
The client has an order to receive and antibiotic in 50
mL of 0.9%NS over 30 minutes. Calculate mL/hr
50 mL 60 min 50 x 60 = 3000 = 100 mL/hr

_______ X ________ = ___________ 30
30 min 1 hr 30
The client has an order to receive an

antibiotic in 100
mL of 0.9%NS over 45 minutes. Use a
microdrip.
Calculate the gtt/min________________
IV Practice questions
Ordered: 1000 ml D5W to run 10 hours. The
df = 10 gtt/mL. Determine the gtt/min and
mL/hr
IV Practice questions Answer
Ordered: 1000 ml D5W to run 10 hours. The df = 10
gtt/mL. Determine the gtt/min and mL/hr
Need to first determine hourly rate
1000 ml divided by 10 = 100 ml/hr

____________________________________________
__
100 ml/hr x 10 gtt/ml = 1000 = 16.66 gtt/min = 17

gtts/min
60 min 60
Flow Rate: ml/hr
Mr. Sampson has an order to receive Levaquin
500 mg in 150 mL of 0.9% NaCl over 45 min.
Calculate the mL/hr.
150 mL x 60 min
___________________ = 200 mL/hr
45 min
Fluid Intake
Calculate the Coffee:1 1/2 C x 8 oz x 30
following intake ml =360mL
In mL only not ounces: 1 c.
A. 1 ½ c. of coffee (8 oz)
B. 4 oz of juice Juice: 4 oz x 30 ml =
C. 1.5 L of IV fluid
120 mL
1 oz
= How many mL?
Intake is always
recorded in mL Fluids: 1.5 L x 1000 ml
Determine each mL =1500 mL
amount separately then 1L
add together
Total = 1980 mL
Fluid Intake
1 ½ cup coffee (6 oz) =
2 cups of water (8 oz) =
1 container of jello (4 oz) =
4 oz of milk =
1 bowl of soup (12 oz) =
How many mL did the client have for this

shift?
Answer to Intake
1 ½ cup coffee (6 oz) = 270
2 cups of water (8 oz) = 480
1 container of jello (4 oz) = 120
4 oz of milk = 120
1 bowl of soup (12 oz) = 360
total = 1350
How many mL did the client have for this
shift?
Calculations
Check safe 24 dosage range

Calculate the safe dosage range for
individual multiply the recommended
Determine if ordered dose within the safe

range: Too low or too high not safe!!
Calculate the dosage to be given
Pediatric Calculations
Client weighs: 45 lb. (round weight to the tenths
place)
What is the weight in kg?
What is the safe dose range?
Is the dosage safe? (use the order)
How many mL will you give per dose?
Pediatric Calculations Answer

Ordered: 25 mg/10 mg x 1 mL = 2.5 mL
Client weighs: 45 lb/ 2.2 = 20.45 = 20. 5kg
Range = 41 mg to 102.5 mg
(20.5 x 2 = 41 mg and 20.5 x 5 = 102.5 mg)
Ordered: 25 mg x 4 doses = 100 mg
Is the dosage safe = yes
IV Calculations/conversions
Start with what you have (what has been
ordered and what is available).
Identify what you need (how are you

giving it?)
Set the problem up so that the appropriate

units cross out.
Body Weight Calculations
Nitroprusside 10 mg in 250 ml of 0.9% NaCl to infuse at
4 mcg/kg/min. The patient weighs 18 lb 3oz. (Round
weight to the nearest tenths place)
1. 3oz/16 oz = 0.2 + 18 = 18.2/2.2 = 8.3 kg
2. 8.3 kg x 4 mcg/kg/min = 33.2 mcg/min
3. 33.2 mcg/min x 60 = 1992 mcg/hr
4. 10 mg x 1000 = 10,000 mcg
1992 mcg/hr x 250 mL

__________________________ = 49.8 = 50 ml/hr
10,000 mcg
Critical Care Heparin
Heparin 25,000 units in 500 ml of 0.45%
NaCl to infuse at 1000 units/hour.
How many mL/hour is the patient receiving?
1000 u/hr x 500 mL

______________________
25,000 u
IV Heparin
Heparin 25,000 units in 500 mL of 0.45%

NaCl to infuse at 23 mL/hour.
How many units/hour is the patient

receiving?
25,000 units x 23 mL/hr

____________________________
500 mL
IV Insulin Administration
Insulin 100 units in 100 ml of 0.9% NaCl to

infuse at 5 units/hour.
Calculate the flow rate (mL/hr).
5u/hr x 100 mL
__________________
100 u
IV Insulin
Insulin 500 units in 250 ml of 0.9 % NaCl to
infuse at 4 mL/hour.
Calculate the units/hour you will administer.
500 u x 4 mL/hr
___________________
250 mL
Critical Care
Nitroglycerine 100 mg in 250 ml of 5 %
dextrose in water infusing at 5.4 ml/hour.
How many mcg/hour is the patient

receiving?
100 mg x 1000 = 100,000 mcg
100,000 mcg x 5.4 mL/hr

____________________________ = mcg/hr
250 mL
Reconstitution
Rocephin is available as 1g powder to be
reconstituted with 2.1 mL of sterile water for a final
dilution of 350 mg/mL (Reconstitution amount).
Ordered dosage is 250 mg IM now. How many
milliliters of Rocephin will the client receive?
1g 2.1 mL
350 mg/mL
Reconstitution
Ordered: Amoxicillin sodium 250 mg p.o. q6h.
Available: A multidose vial that reads amoxicillin
oral suspension; add 70 mL water. Each 5 mL of
solution contains 250 mg (reconstitution amount)
How many milliliters will you administer?___________
1 gram Diluent?
250/5 mL
Reconstitution
Ordered: Cefadyl 700 mg IM q6h. Available:
Cefadyl 1 g. Directions read: For IM use, add 2
mL sterile or bacteriostatic water for injection
For IV use, add 1.7 mL. USP.
Each IM injection, 1.5 mL contains 500 mg of
cefadyl.
How many milliliters will you administer per IM
injection? ____________mL
Medication? Diluent?
Reconstitution dose
Other IV Problems
A nurse records an infant s weight as 10
pounds 6 ounces. Ranitidine (Zantac) is
prescribed for the infant. The prescription
reads: Ranitidine 2mg/kg twice daily
The medication is supplied as 15 mg/ml. The

nurse should instruct the parent to give ______
ml per dose.
Infusion Time
Calculate infusion time:
Mr. Sampson s intravenous solution of 1500 mL, was
ordered to infuse at 110 mL/ hour. The IV was started
at 8:45am.
1. How long will it take for the IV to infuse (Infusion

time) (example: 3 hours and 6
minutes)?________________
2. What time will the IV infusion be completed?

Record in Regular time__________________and Military
time? _______________
Infusion Time
Calculate Infusion Time:
The IV of 500 mL NS is to infuse at 60mL/hr
Traditional and Military time.
1) Determine infusion Time (hours and minutes).
2) If the IV was started at 10:00 pm, when would
the IV infusion be completed?
Fractions: Objectives
After reviewing this chapter, you should be able
to
1. compare the size of fractions
2. add fractions
3. subtract fractions
4. divide fractions
5. multiply fractions
6. reduce fractions

Fractions: Why?
Seen in medical orders, client records,

prescriptions, care documentation, and
health care literature
Used in conversion of dosage calculations
Apothecary
Household

Fractions: Safety Alert
Fractions may be used on drug labels in addition
to metric equivalent to help clarify and prevent
errors
2.5 mg (2½ mg) Coumadin on same label
(Cohen, MR (ed.): Medication errors, ed 2, Washington, DC, 2007, American Pharmacists Association)

Fractions: Definition
A fraction is part of a whole number
Fractions have a numerator and a denominator
Figure 2-1 Diagram representing fractions of a whole. Five parts shaded out of the six parts represent:
Numerator 1 part 1
Denominator = 6 parts = 6

Fractions: Types
Proper
Numerator is less than denominator; the fraction
has a value of less than 1
Examples:
Improper
Numerator is larger than, or equal, to
denominator; the fraction has a value of 1 or
greater than 1
Examples:

Mixed
A whole number and a fraction; the value is greater
than 1
Example:
Complex
Numerator, denominator, or both, are fractions; the
value may be less than, greater than, or equal to 1
Example:

Whole numbers
Have an expressed denominator of one (1)
Examples:

Converting Fractions
An improper fraction can be changed to a mixed
number or whole number by dividing the
numerator by the denominator

Converting Fractions (Cont.)
A mixed number can be changed to an improper
fraction by multiplying the whole number by the
denominator, adding the numerator, and placing
the sum over the denominator
Example:

Fractions: Comparing Size
If the numerators are the same, the fraction
with the smaller denominator has the larger
value
Example:
If the denominators are the same, the fraction

with the larger numerator has the larger value
Example:

Fractions: Comparing Size (Cont.)
Two or more fractions with different denominators
can be compared by changing both fractions to
fractions with the same lowest common
denominator (LCD).
LCD is the lowest number evenly divisible by the
denominators of the fractions being compared
Example:

Fractions: Fundamental Rules
1. The value of a number is unchanged when the
numerator and denominator are multiplied or divided by
the same number
Example:
2. To change (reduce) a fraction to its lowest terms,

divide its numerator and its denominator by the largest
whole number that will divide both evenly
Example:

Fractions: Reducing
Note: Fractions should always be reduced to
lowest terms
Numerator and denominator are each divided
by the largest number by which they are both
evenly divisible
Example:

Fractions: Adding
With same denominator, add the numerators,
then reduce to lowest terms
Example:
With different denominators, change fraction to

equivalent denominators by using the LCD, then
add numerators as described above
Example:

Fractions: Subtracting
The rules for subtraction are the same as
those for addition
If denominators are the same, perform subtraction
with the numerators, obtain the value, place it over
the denominator, and reduce to lowest terms
If denominators are different, find the lowest
common denominator (LCD), change to equivalent
fractions, subtract the numerators, and place that
value over the common denominator. Reduce if
necessary.

Fractions: Subtracting (Cont.)
To subtract a fraction from a whole number,

follow these steps:
1. Borrow 1 from the whole number, and change it
to a fraction, creating a mixed number.
2. Change the fraction so it has the same
denominator as the fraction to be subtracted.
3. Subtract the fraction from the mixed number.
4. Reduce if necessary.
6 7
6=5+ =5
- Elsevier
Copyright © 2018, = Inc. All rights reserved. 69
Fractions: Multiplying
1. Cancel terms if possible.
2. Multiply numerators, multiply denominators
3. Reduce if necessary
Note: Fractions can be reduced to lowest terms

before multiplication
Express whole numbers as fractions with a
denominator of 1 to visually aid in multiplication

Fractions: Dividing
Invert the second number (turn it upside down)
and then multiply. Reduce if necessary.
Note: Change mixed numbers to improper fractions

before performing division steps

Fractions: Dividing (Cont.)
When dividing mixed fractions, change the
problem visually so that division steps are
easily seen

Convert the following mixed
numbers to improper fractions
9½
4¾

Add the following fractions
5 8
6 9

Subtract the following fractions
8 5
6 9

Multiply the following fractions
5 8
8 9

Divide the following fractions
5 8
6 9

Case Study 1
Further examination of your 25-year-old patient,
Ms. White, reveals signs and symptoms of
dehydration. The doctor instructs her to drink
1½ L of water. An hour later you find ¼ L left.
How many Liters did Ms. White consume?

ANS:
1¼ liters

Chapter 3
Decimals

Decimals: Objectives
1. read decimals 6. add decimals

2. write decimals 7. subtract decimals
3. compare the size of 8. multiply decimals
decimals 9. divide decimals
4. convert fractions to 10. round decimals to
decimals nearest tenth
5. convert decimals to 11. round decimals to
fractions nearest hundredth

Decimals: Safety Point
Dosages and other measurements in health
care
Understanding is crucial
Misreading decimal points are a major source of
medication errors
Write with great care!
Examples: Digoxin 0.125 mg
Coreg 3.125 mg

Decimals: Definition
A decimal is a fraction with a denominator that is
a multiple of 10. The decimal (.) is used to
indicate place value.
Examples:
Safety Alert: Each decimal expression with a value less than 1 is

preceded by a leading zero to emphasize the presence of a
decimal, according to national patient safety standards (Institute
for Safe Medication Practices (ISMP) and The Joint Commission
(TJC))
Decimals
The whole number is placed to the left of the
decimal point. These numbers have a value of
one or greater.
Decimal fractions are written to the right of the
decimal point and represent a value that is less
than one. The words for all decimal fractions end
-

Decimals: Place Values

Decimals: Reading
To read the decimal numbers, read:
1. the whole number,
3. the decimal fraction by naming the value of

the last decimal place.
Example 1: The decimal number 1.125 is read as
-
Safety Alert: When reading an order back to a health

care provider, read the zero aloud.

Decimals: Writing
To write a decimal number, write the following:
1. The whole number (If there is no whole number,
write zero [0] to the left of the decimal.)
2. The decimal point to indicate the place value of the
right most number
3. The decimal portion of the number to the left of the
decimal
-
NOT be placed
Trailing zeros are only acceptable to demonstrate the precision of
value, such as in lab results or imaging studies or the sizes of
lesions.

Decimals: Comparing Values
Zeros added before or after the decimal point of
a decimal number may change its value.
Examples: .7 equals 0.7
12.6250 equals 12.625
Note: 30.0 can be misinterpreted as 300!
USE leading zeros; AVOID trailing zeros

Zeros added within a decimal number change
the value dramatically
Example: 0.375 mg is NOT equal to 0.0375 mg

2.025 mg is NOT equal to 20.025 mg

If whole numbers are present and different,
whole numbers are compared to determine
which value is greater
If the whole numbers being compared are the

same or if there is no whole number, then the
number in the tenths place determines which
decimal is greater.
If the whole numbers are the same or zero and
the numbers in the tenths place are the same,
then the decimal with the higher number in the
hundredths place has the greater value, and so
forth.
Examples: 0.67 is greater than 0.66

Decimals: Adding and Subtracting
Place the numbers in the columns so that the
decimals are lined up. Add or subtract from
right to left.
Examples:
Safety Alert: Zeros may be added to help line up decimals, but do

NOT include in final answer!

Decimals: Multiplying
Multiply as with whole numbers. In the answer
(product), count off from right to left as many
decimal places as there are in the numbers being
multiplied
Example: (1 decimal place)
(1 decimal place)
Place the decimal

point two places to
the left
Decimals: Multiplying (Cont.)
Add zeros where needed to ensure correct
placement of decimal in answer
Example: (2 decimal places)

(2 decimal places)
Place the decimal

point four places to
the left Add zero to the left
as needed

Multiplying by Decimal Movement
Multiplying by 10, 100, and 1,000 can be done
by moving decimal to the right the same number
of places as there are zeros in the number by
which you are multiplying.
Example: 1.6 x 10 = 1.6 = 16
5.2 x 100 = 5.20 = 520

Decimals: Dividing
Same as for whole numbers
Example:
27 9 Read as 27 divided by 9
27
9
To divide by a whole number, place decimal in
quotient directly above decimal in dividend

To divide by a decimal, the decimal point in the
divisor is moved to the right until the number is a
whole number. The decimal point in the dividend
is moved the same number of places to the right,
and zeros are added as necessary.
Example:
6.96 0.3 = 0.3 6.96 = 3

69.6

Division by Decimal Movement
To divide by 10, 100, or 1,000, move decimal to
the left the same number of places as there are
zeros in the divisor.
Examples: 00.46 10 = 0.046
000.07 100 = 0.0007

Decimals: Rounding
Based on equipment being used (for example,
syringes)
Most carry to hundredths place and rounds to tenths
number in hundredths place is 5 or greater, add 1
to tenths place and drop the hundredths
Example: 4.15 rounds to 4.2

Decimals: Rounding (Cont.)
number in hundredths place is less than 5, drop
number to the right of tenths place
Example: and 4.14 rounds to 4.1
To express numbers in hundredths, carry

equations out to thousandths and then round

Changing Fractions to Decimals
Divide the numerator by the denominator and
add zeros as needed
This method can be used to compare fraction

size

Changing Decimals to Fractions
Write decimal as a whole number in
numerator of fraction, express denominator
as powers of 10
Place the number 1 in denominator of fraction
and add as many zeros as there are places to
right of decimal
Example:
reduced
-
65/100 = 13/20 reduced

Hundredth
a. 1.07 0.342
b. 5.981 1.7
c. 4.8 4.08

Hundredth (Cont.)
1. Change the following decimals to fractions and
reduce to the lowest terms.
a. 1.04 b. 0.16
2. Change the following fractions to decimals and

round to the nearest tenth.
a. 7/8 b. 6/13

Case Study 1
Ms. White tells you that she weighed herself at
home five days ago and she was at 128.7 lb.
Today, she weighed 124.25 lb. How much
weight did she lose?

ANS:
4.45 lb

It has been 5 days since Ms. White weighed
herself at home. On average, how much weight
has she lost each day?

ANS:
0.89 lb

Chapter 4
Ratio and Proportion

Ratio and Proportion: Objectives
1. define ratio and proportion

2. define means and extremes
3. calculate problems for a missing term (x) using
ratio and proportion

Ratio and Proportion: Background
A ratio indicates the division of two quantities

Can be used to calculate all types of med
problems or nurse/client ratios
Example: 4 nurses to 28 clients = 1:7 ratio
Some meds use ratio to express strength of
solution
Example: Epinephrine 1:1,000
Ratios should be expressed in lowest terms

Ratios
Used to indicate relationship between two
numbers
Numbers are separated by a colon (:)
Colon indicates division
Numerator on left : Denominator on right
Example: 1:3 is the same as 1/3

Ratios: Measures in Solutions
In medications
Ratio of parts of drug to parts of solution = strength
Safety Alert
The more solution in which a drug is dissolved, the
less potent it becomes
Example: 1 part drug to 1,000 parts solution is more
potent (stronger) than 1 part drug in 10,000 parts
solution

Proportions
An equation of two ratios of equal value
Written in any of following formats
Example: 3:4 = 6:8 (separated with equals)

3:4 :: 6:8 (separated with double
colon)
(written as a fraction)
or

Proportions: Means and Extremes
Relationship between left and right terms is

expressed by means and extremes
Means = Middle Extremes = End
In a true proportion, product of means is equal
to product of extremes
Means
250=250 TRUE
Extremes

Example

Ratio and Proportion: Solving for x
If three numbers in a true proportion are
known, the unknown fourth number called
x can be found
x is usually placed on the left

Example

Proportion: Proof
12:9 = 8:x
Place the value previously obtained in the
spot for x
12:9 = 8:6
Multiply means by extremes should be
equal
9(8) = 12(6)
72 = 72

Ratio: Dosage Calculation
Ratio is used to represent the weight of a
medication that is in tablet or capsule form
or in a certain volume of solution.
Examples:
1 tab : 0.125 mg or
1 mL : 250 mg or
In dosage calculation, include the unit of

measurement in the dosage strength

Proportion: Dosage Calculation
Solve for x in medication dosage
calculations
Example: If there are 500 mg in 1 capsule, how
many milligrams are delivered in 2 capsules?
1 cap : 500 mg = 2 caps : x mg

1(x) = 500(2)
1(x) = 1,000
x = 1,000 mg

Express the following dosages as ratios:
a. Amoxicillin 250 mg in each capsule
b. Diphenhydramine Elixir 12.5 mg in each 5 mL
Determine the value for x:

c. Available: Lisinopril 5 mg tablets, Order: 10 mg
5 mg:1 tab = 10 mg:x tab
d. Available: Zocor 40 mg tablets, Order: 20 mg

Case Study 1
Ms. White has told the provider that she has

difficulty swallowing pills. An order is written for
Ciprofloxacin oral suspension 450 mg PO once.
You have on hand Cipro 250 mg/5 mL. Using
ratio proportion, how many mL will you
administer?

ANS:
9 mL

Chapter 5
Percentages

Percentages: Objectives
1. define percentage 5. convert decimals to

2. convert percents to percents
fractions 6. convert fractions to
decimals 7. convert fractions to
4. convert percents to ratios
ratios 8. determine the percent
of numbers

Percentages: Background
Way to express the relationship of parts to a
whole. Percent (%) means parts per hundred. A
percentage is the same as a fraction in which
the denominator is 100
Health care uses:
Medications: Magnesium sulfate 50%
IV solutions: of D5W (Dextrose 5% in water)
Diet consumed
Level of burns

Percentages: Definition
Percentage refers to how many parts are
related to the whole (100 parts)
5% = 5 parts of 100 parts or or

5 per 100

Percentages: Convert to a Fraction
% symbol may be used with whole numbers
(15%), mixed numbers (3½%), fractions (¾%), or
decimals (0.6%)
To convert to a fraction, drop % sign, write the
number as the numerator, and 100 as the
denominator and reduce
Examples:

Percentage: Convert to a Decimal
To convert to a decimal, drop % sign and divide
the number by 100, this is the same as moving
the decimal two places to the left (add zeros if
needed)
Examples: 25% = 0.25
1.4% = 0.014
Alternative method: write as a fraction with 100
as the denominator and divide numerator by
denominator

Percentage: Convert to a Ratio
To convert to a ratio, drop % sign and convert to
a fraction, reducing to the lowest terms. Then,
place the numerator as the first term of the ratio
and the denominator as the second term.
Separate the two terms with a colon (:)
Example:

Percentage: Fraction to Percent
Multiply the fraction by 100, reduce, add percent
sign
Example:
Alternative method: convert the fraction to a

decimal, multiply by 100, add percent sign
Example:

Percentage: Decimal to Percent
Multiply the decimal by 100 (which is the same
as moving the decimal point two places to the
right). Add zeros if necessary. Add the percent
sign.
Examples:

Percentage: Decimal to Percent (Cont.)
Change the decimal to a fraction, then follow the

steps to convert a fraction to a percent. If the
percent does not end as a whole number,
express the percent with the remainder as a
fraction, to the nearest whole percent, or to the
nearest tenth of a percent.
0.625 = 625 = 5 = 62 ½%, 63%, or 62.5%

1000 8

Percentage: Ratio to Percent
Convert the ratio to a fraction, then change the
fraction to a percent as described previously
Example:

Percentage Measures
Intravenous (IV) solutions are ordered in
percentage strengths
Percentage = number of grams (g) of solute per
100 mL of diluent
1,000 mL of D5W (Dextrose 5% in water)
5 g in 100 mL = (x) g in 1,000 mL

100(x) = 5(1,000)
x = 50 g

Comparing Percents and Ratios
Converting percentages and ratios to equivalent
decimals can clarify values so professionals can
compare concentrations.
The higher the percentage, the stronger the
solution
Examples:
A 10% solution is STRONGER than a 5% solution
A 0.99% solution is WEAKER than a 1% solution
1:1,000 is a STRONGER concentration than 1:10,000

Determining the Percent
of a Quantity
First, convert the given percentage to a decimal
or fraction, then multiply the decimal or fraction
by the number
Example: A client reports he drank 25% of his 8-
ounce cup of tea. Determine how much tea the client
drank.

Determining What Percent One
Number Is of Another
Make a fraction with the numbers the
denominator is the number following the word
Convert to a decimal, then to a percentage

Example: 12 is what percentage of 60?

Calculating the Percent of Change
First make a fraction of change: change
old
Change the fraction to a percent
Example: Before starting his diet, the client

weighed 206 lb. Now he weighs 174 lb. What is
the percent of change?
The decrease = 206 lb 174 lb = 32 lb
Fraction 32 x 100 = 3200 = 15.5 % decrease
206 206

1. Convert the following decimals to percents
a. 0.379 b. 2.94
2. Convert the following percents to decimals

a. 78.3% b. 402%
3. What is 41% of 209?

4. A client was given 1000 mL to drink. You find
50 mL left in his cup. What percent did he
drink?

Case Study 1
Ms. White was started on IV NS at a rate of
100 mL/hr. The prescriber changed the rate to 150
mL/hr. What is the percent of change?
Round final answer to the nearest whole number.

ANS:
33% increase
50/150

Ms. White returns to the clinic for a checkup after
being treated last week for UTI. Today, she weighs
127.6 lb, which is 3.35 lb more than she weighed
last week. What is the percent increase in her
weight? Round final answer to the nearest tenth.

ANS:
2.6%

CHAPTER 17
ORAL MEDICATIONS
CALCULATION OF ORAL MEDICATIONS:
2 OBJECTIVES

1. Identify forms of oral medications
2. Identify terms on labels used in calculation
3. Calculate dosages for oral medications using ratio and
proportion, the formula method, and dimensional analysis
4. Apply principles to obtain rational answers
BACKGROUND: ORAL MEDICATIONS
3
Most economical
Easiest to administer
Most common type of medication given
Available as solids and liquids
Unit dose and bulk packaging
Usually simple calculations
FORMS OF SOLID MEDICATIONS
4
Tablets
Powdered medications molded in shapes
Caplets
Elongated tablets coated to ease swallowing
Scored tablets use pill cutter
Tablets with indented markings designed to cut and deliver ½ or ¼
what is in a whole tablet
SAFETY ALERT!
Breaking an unscored tablet is dangerous
and can result in an unintended dose
FORMS OF SOLID MEDICATIONS (CONT.)
5
Enteric-coated tablets and film tablets

Special coating protects against gastric secretions
NEVER crush EC tablets defeats the purpose
Sublingual tablets
Placed under tongue for direct absorption
Buccal tablets placed between gums and cheek
NEVER swallow SL or Buccal tablets prevents
desired effect
Layered tablets
Two meds with different components
Disintegrating and chewable tablets
6
Time-release and extended-release tablets
Labeled SA, LA, XL, SR, or ER
Released over a period of time
NEVER crush, chew, or break
Capsules
Contains powder, liquid, or oil with hard/soft gelatin
coating
NEVER crush, chew, or break without consulting a
pharmacist
Others: troches, lozenges, pulvules, spansules, sprinkle capsules
7
Figure 17-1 Clonazepam tablet scored. (From Mosby's

drug consult 2007, St. Louis, 2007, Mosby.)
Figure 17-2 Pill/tablet cutter. (From Kee JL,

Marshall SM: Clinical calculations: with
applications to general and specialty areas, ed
7, St Louis, 2013, Saunders.)
8
Figure 17-3 Sublingual (A) and buccal (B) tablets. (From Figure 17-4 Layered tablet. (From Clayton BD,
Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed Willihnganz M: Basic pharmacology for nurses, ed
16, St Louis, 2013, Mosby.) 16, St Louis, 2013, Mosby.)
9
Figure 17-5 Types of oral medications. A, Scored tablet. B, Chewable tablet. C, Sublingual. D, Timed-release
tablet. E, Capsule. F, Timed-release capsule. G, Gelatin capsule.
CASE STUDY 4
10
Mrs. Garcia is a 67-y/o female admitted at 1930 to the unit

with gangrenous toes and heel of the left foot. Report from
the ER nurse reveals a history of DM II, ESRD, HTN, and
depression. She also has dysphagia and L- sided weakness
due to a stroke last year. She receives enteral feedings and
meds through a PEG tube. She has a Foley catheter and a 20-
gauge IV to the R forearm running NS at a rate of 30 mL/hr.
She is to have enteral feeding held after midnight and
prepped for L BKA tomorrow at 0830.
11
The doctor orders to continue home meds and you review the
medication reconciliation form. What problems can you detect given the
Metoprolol ER 50 mg p.o. daily

Lisinopril 5 mg p.o. daily
HCTZ 12.5 mg p.o. daily
Lasix 20 mg p.o. b.i.d.
Glyburide 5 mg p.o. daily
Wellbutrin XL 300 mg p.o. daily
Percocet 5/325 1 tab q3h prn pain
12 CASE STUDY 4 (CONT.)
Answer:
Metoprolol ER and Wellbutrin XL are long-acting
tablets. Long-acting tablets should NEVER be
crushed.
You alert the physician and he changes the order

accordingly.
POINTS TO REMEMBER
13
Converting dosages from one system to another can result
in discrepancies
10% rule no more than 10% variance should exist
between dose ordered and dose administered
Capsules are administered whole only
Tablets are available in different strengths
Choose the least number of tablets or capsules without
dividing a tablet
POINTS TO REMEMBER (CONT.)
14
It is safer to give whole tablets equal to the dose than to

cut tablets
Maximum number of tablets or capsules used to deliver a
dose is usually three (3)
Exceptions exist, such as some HIV meds always
double-check dosage
Some measures and units such as mEq and units do not
convert to metric
EXAMPLES
15
The following three examples are based on
this order:
Give: Digoxin 0.375 mg p.o. daily

Available: Digoxin in scored tablets of 0.25 mg
RATIO AND PROPORTION METHOD
16
FORMULA METHOD
17
DIMENSIONAL ANALYSIS METHOD
18
VARIATIONS OF TABLET/CAPSULE
19 PROBLEMS
To determine the number of tablets needed over a

period of days, multiply doses per day by the number of
days
Example:Valium 10 mg p.o. q.i.d for 7 days. Tablets
available are 5 mg tablets. How many will the client
take in one week?
1. Multiply 5 mg 2 for each dose = 2 tablets per dose
2. Multiply 2 tablets 4 for 4 doses/day = 8 tablets/day
3. Multiply 8 tablets per day 7 to find number needed
for 7 days = 56 tablets
20 VARIATIONS OF TABLET/CAPSULE
PROBLEMS (CONT.)
PROBLEMS (CONT.)
21
Determining dosage to be given each time

Example: A client is to receive 1 g of a drug daily in four divided doses
CASE STUDY 4
22
Lasix 20 mg p.o. q8h at 2100, 0500, 1100

Available: Lasix 20 mg tablets
Wellbutrin 300 mg p.o. daily at 2100
Available: Wellbutrin 150 mg tablets
Percocet 5/325 1 tab q3h prn pain last given at 1700
Available: Percocet 5/325 tablets
Answer:
Lasix 1 tab
Wellbutrin 2 tab
Percocet 1 tab
The physician wants to know how many tablets of

Percocet Mrs. Garcia typically takes in one week.
Mrs. Garcia and her daughter report that she has
been consistently taking 1 tablet of Percocet every
6 hours. What will you tell the physician?
CALCULATING ORAL LIQUIDS
26
For clients with dysphagia (difficulty swallowing) or
nasogastric, jejunostomy, or gastrostomy tube
For infants and young children
Types may contain multiple meds
Elixir: meds dissolved in alcohol and water
Suspension: meds dissolved in liquid such as water
Syrup: meds dissolved in sugar and water
SAFETY ALERT!
NEVER give oral liquids by IV - FATAL!
MEASURING ORAL LIQUIDS
27
1. Standard calibrated measuring cup
Metric, apothecary, or household measure
Place on flat surface and view at eye level
Pour with label facing you so that it can be read
Read at the level of the meniscus (low point)
2. Calibrated droppers
Use only dropper supplied with medication
3. Calibrated oral syringes (tsp/mL marks)
Used for accuracy of liquid doses (e.g., 6.4 mL)
Pour medication in cup and draw up into syringe
NEVER use oral syringes for parenteral meds
28
Figure 17-8 Reading meniscus. The meniscus is

caused by the surface tension of the solution against
the walls of the container. The surface tension Figure 17-9 Medicine dropper. (Modified from
causes the formation of a concave or hollowed Clayton BD, Willihnganz M: Basic pharmacology for
curvature on the surface of the solution. Read the nurses, ed 16, St Louis, 2013, Mosby.)
level at the lowest point of the concave. (From
Clayton BD, Willihnganz M: Basic pharmacology for
nurses, ed 16, St Louis, 2013, Mosby.)
29
Figure 17-10 Oral syringes. (Courtesy Chuck Dresner. From

Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed
16, St Louis, 2013, Mosby.) Figure 17-11 Filling a syringe directly
from medicine cup. (Modified from
Clayton BD, Willihnganz M: Basic
pharmacology for nurses, ed 16, St Louis,
2013, Mosby.)
MEASURING ORAL LIQUIDS (CONT.)
30
Do NOT confuse dosage strength with total volume in container
Example: May contain 100 mL in bottle, but strength will be
something like 125 mg in 5 mL
Calculations are performed in the same manner as for solid forms
of medicines
Med errors occur with oral liquids because they are

least likely to be in unit doses and are prescribed
often for pediatric and geriatric patients.
Use the correct calibrated measuring device!
ORAL LIQUIDS EXAMPLE
31
Order: Dilantin 200 mg p.o. t.i.d.

Available: Dilantin suspension 125 mg in 5 mL
CASE STUDY 4
32
temperature is 101.6° F. You review the chart and find the following order:
Tylenol Elixir 400 mg q4h prn fever > 100° F

(not to exceed 2,500 mg daily)
Available: Tylenol Elixir 160 mg per 5 mL
How many mL will you administer and what device will you use to
measure the dosage?
Answer:
Tylenol Elixir 12.5 mL measured in a plastic medicine cup.
MEDICATION ALERT!
Acetaminophen is a component in the Percocet Mrs. Garcia takes for pain.
Clients with hepatic or renal impairment should not exceed 2.5 g of
acetaminophen daily. Make sure to include the 325 mg of acetaminophen
in each Percocet when calculating totals before administration.
An overdose of acetaminophen is toxic!
34 PRACTICE PROBLEMS
1) Order: KCl 20 mEq p.o. t.i.d.

Available: KCl 40 mEq per 15 mL
How many mL will you give per day?
2) Order: Imodium 2.5 mg p.o. now
Available: Imodium 1 mg per 5 mL
How many mL will you give?
3) Order: Tagamet 250 mg p.o. q6h
How many mg will you give per day?
CHAPTER 9
ADDITIONAL CONVERSIONS USEFUL
IN THE HEALTH CARE SETTING
ADDITIONAL USEFUL CONVERSIONS:
OBJECTIVES
36

able to:
1. Convert between Celsius and Fahrenheit

temperatures
2. Convert between units of length: inches,
centimeter, and millimeters
3. Convert between units of weight: pounds and
kilograms, pounds and ounces to kilograms
CONVERTING BETWEEN CELSIUS
AND
37 FAHRENHEIT
Temperature reading followed by F = Fahrenheit

(e.g., 98° F)
Followed by C = Celsius (formerly centigrade) (e.g.,
36° C)
Freezing point of water is 32° F and 0° C
Boiling point of water is 212° F and 100° C
38
Figure 9-2 Ranges of normal temperature values and physiological consequences

of abnormal body temperature. (From Potter PA, Perry AG, Stockert P, Hall A:
Fundamentals of nursing, ed 9, St Louis, 2013, Mosby.)
Figure 9-1 Celsius and Fahrenheit temperature scales. (From Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed. 16,
St. Louis, 2013, Mosby.) Note: Glass thermometers pictured here are for demonstration purposes only. Electronic digital
temperature devices are more commonly used in health care settings.
TEMPERATURE CONVERSION
FORMULAS
39
To convert from Celsius to Fahrenheit, multiply by 1.8 or 9/5 and add

32 9
5
Example: Convert 37.5° C to °F

Formula:
°F = 1.8(°C) + 32 or °F = 9/5(°C) + 32
°F = (1.8 × 37.5) + 32
°F = 67.5 + 32
°F = 99.5°
TEMPERATURE CONVERSION
40FORMULAS (CONT.)
To convert from Fahrenheit to Celsius, subtract 32 and divide by 1.8 or

9/5
9
5
Example: Convert 68° F to °C
Formula:
°C = (°F - 32) 9/5 or °C = (°F - 32) 1.8
°C = (68 - 32) 9/5
°C = 36 9/5, which inverts to be °C = 36 × 5/9
°C = 180/9
°C = 20°
41 CASE STUDY 2
You are taking care of Mr. Hain again today and you receive
report from the night nurse that he had a temperature of
39°
325 mg of Tylenol PO prn fever 99°F - 101 °F
OR
650 mg of Tylenol PO prn fever > 101°F
What is his temperature in Fahrenheit and what will you
administer?
Answer:
-102.2° F
-Administer 650 mg of Tylenol PO
CONVERSIONS: METRICS AND LENGTH
43
Metric measures are used for:

Pupil size
Wounds and incisions

(length width depth in cm or mm)
Conversion factor: 1 cm = 10 mm
If incision is 25 cm, how many mm is it?
25 mm = 25 10 = 2.5 cm or 25 = 2.5 cm
CONVERSIONS: METRICS AND
LENGTH
44 (CONT.)
Convert 30 cm to inches (in)

Conversion factor: 1 in = 2.5 cm
Think smaller to larger (divide)
30 2.5 = 12 in
CONVERSIONS RELATING TO WEIGHT
45
Body weight is important in calculating doses

for certain medications
Delivered in mg or mcg per kilogram
Nurse needs to calculate safety of doses
documented as mg/kg
May need to convert pounds and ounces in
pediatric calculations
(CONT.)
46
Pounds to kilograms
Conversion factor: 2.2 lb = 1 kg
Smaller to larger (divide lb value by 2.2)
Round answers to nearest tenth
Example: Convert 65 lb to kilograms

kg = 65 2.2 = 29.54 rounds to 29.5 kg
CONVERSIONS RELATING TO
WEIGHT
47 (CONT.)
Pounds and ounces to kilograms
Convert oz to nearest tenth of lb and add

to pounds
Equivalent: 16 oz = 1 lb
Convert total lb to kg, then round to
nearest tenth
(CONT.)
48
A child weighs 10 lb 2 oz
Think smaller to larger
2 oz 16 = 0.12 rounds to 0.1 lb
10 lb + 0.1 lb = 10.1 lb
Think smaller to larger
10.1 2.2 = 4.59 rounds to 4.6 kg
CONVERSIONS RELATING TO
49
WEIGHT (CONT.)
Kilograms to pounds
Multiply by 2.2 (think larger to smaller)
A child weighs 24.7 kg; convert to pounds
lb = 24.7 2.2 = 54.34 rounds to 54.3 lb

(weight in kg) (equivalent)
50 CASE STUDY 2
you that he feels like he lost weight. He

reports that his usual weight is 200 lb. On
admission, he weighed 88 kg. How many
pounds and ounces will you tell him he lost?
Answer:
6 lb, 6 oz
MILITARY TIME
52
International time
Uses a 24-hour clock
Helps prevent errors by eliminating repetition of
numbers
NO colon (:) or a.m./p.m. designations
Midnight = 0000 and 2400
1:00 a.m. = 0100
53
Figure 9-3 24-Hour clock.
. 1998, 1994 by Mosby, Inc., an imprint of Elsevier Inc.

Mosby items and derived items © 2014, 2010, 2006, 2002,
TIME: TRADITIONAL TO MILITARY
54
then add a zero to the beginning to make a four-

digit number
Example: 8:45 a.m. = 0845
then add 1200 to the time

Example: 7:50 pm = 1950
TIME: MILITARY TO TRADITIONAL
55
To convert times between 0000 and 1200,

delete any zero at the beginning, insert colon,
Example: 0845 = 8:45 a.m.
To convert times between 1200 and 2400,
Example: 1950 = 7:50 p.m.
PRACTICE PROBLEMS
56
1) 40 °C = ___ °F
2) 98.6 °F = ___ °C
3) 67 cm = ___ mm
4) 5 in = ___ cm
5) 31 lb, 7 oz = ___ kg
57 CASE STUDY 2
After a 3-day hospital stay, Mr. Hain is now

tolerating a full liquid diet without pain or
discomfort. He is afebrile and his labs are
within normal limits. A 1 L bag of NS with 20
mEq of potassium was started at 0430 and will
take 8 hours to infuse. Mr. Hain is to be
discharged at 1000. Will the IV fluid be
complete by then?
Answer:
The IV fluid will not be finished by 1000. Completion time is

1230.
CHAPTER 14
DOSAGE CALCULATION USING THE
DOSAGE CALCULATION USING
60RATIO AND PROPORTION METHOD:
OBJECTIVES

able to:
1. State a ratio and proportion to solve a given

dosage calculation problem
2. Solve simple calculation problems using the
ratio and proportion method
USE OF RATIO AND PROPORTION
61IN DOSAGE CALCULATION
calculations
Example: Available dose is 50 mg in 1 mL, ordered
dose is 25 mg x mL
State known first, then unknown
Sequence must match
Example: mg : mL = mg : mL (left sequence matches
right sequence)
62
63
CONVERT TO SAME SYSTEM FIRST
64
WRONG
60 mg : 1 tab = 0.09 g : x tab
RIGHT
Conversion: 1 g = 1,000 mg
0.09 g = 90 mg
60 mg : 1 tab = 90 mg : x tab
x = 1 ½ tab
CONVERT TOWARD NO
DECIMALS
65
WRONG
500 mg : 1 tab = 0.25 g : x tab
RIGHT
Conversion Factor: 1 g = 1,000 mg
0.25 g = 250 mg
500 mg : 1 tab = 250 mg : x tab

X = ½ tab
RATIO AND PROPORTION: KEY
66POINTS
Convert everything into same unit of measure before starting

calculations
Convert to the unit of measure in which the medication is
available
Convert in the direction that eliminates decimals whenever
possible decimals are sources for error
RATIO AND PROPORTION: KEY POINTS
67 (CONT.)
Keep left and right sides in matching sequence

mg : mL = mg : mL
Label all terms, including x
RATIO AND PROPORTION: KEY POINTS
(CONT.)
68
Label final answer for x in appropriate unit for delivering med (e.g., mL, tabs,
caps)
Double-check work
Be consistent in setup and performance of calculations
SAFETY ALERT!
If you set up the problem incorrectly, you could calculate
and administer the wrong dose, potentially harming the
client.
1) Order: lactulose 30 g p.o. t.i.d.

Available: lactulose 10 g per 15 mL
2) Order: ibuprofen 600 mg p.o. t.i.d. prn pain
Available: ibuprofen 200 mg tablets
3) Order: metformin 500 mg p.o. b.i.d.
Available: metformin 1 g tablets
70 CASE STUDY 3
Mr. Ross is 3 days post-op and the plan is to advance the diet
to full liquid and ambulate q2h while awake. The following
meds are scheduled for 0900:
hold if SBP < 120 or HR < 60
How many tablets of each med will you pull from the Pyxis?
Available: aspirin 81 mg tablets
Available: simvastatin 80 mg tablets
Available: atenolol 50 mg tablets
Answer:
Aspirin 2 tabs
Simvastatin ½ tab
Atenolol 1 tab
Before you administer the 0900 meds to Mr. Ross, you review
his vital signs. They are as follows:
T 98.9 °F P 52 R 18 BP 112/74
What is your next course of action?
Answer:
Hold atenolol per MD order and parameters on MAR.
Medication Alert
Beta blockers such as atenolol can cause bradycardia and
hypotension. Giving atenolol to Mr. Ross at this time could
cause him to get dizzy and fall during his q2h ambulation.
CHAPTER 8
CONVERTING WITHIN AND
BETWEEN SYSTEMS

76 CONVERTING WITHIN AND
BETWEEN SYSTEMS: OBJECTIVES
1. State the equivalent metric and household
approximate equivalents
2. Convert a unit of measure to its equivalent within
the same system
3. Convert a unit from one system of measurement
to its equivalent in another system of measurement
77 EQUIVALENTS AMONG METRIC
AND HOUSEHOLD SYSTEMS
Equivalents are not exact
Memorization of equivalents is essential for:
Proficiency in medication administration
and
Ensuring that clients can safely self-
administer medications
Learn equivalents before using conversion
78 CONVERTING
Changing from one form to another

Within same system (e.g., mg to mcg)
Between systems (e.g., oz to mL)
Result is approximate, but continuity
exists
Converting is a necessary skill used to administer
the ordered amount of medication
79

80 CONVERTING: POINTS
1. Memorization is essential
2. Think of equivalents as ratios
1 g = 1,000 mg is a conversion factor
1 g : 1,000 mg is a ratio
3. Follow basic math rules for all systems
4. Express answers using rules related to the system to
which you are converting (e.g., decimals for metric)
5. THINK CRITICALLY use appropriate equivalents
81 CONVERTING: MOVING DECIMALS
Refer to Chapter 6
Only use with metric conversions
Smaller to larger move decimal to left
350 mg = 0.35 g
Larger to smaller move decimal to right

0.850 L = 850 mL
82 CONVERTING: MOVING DECIMALS
(CONT.)
All measurements must be in the
metric system
0.6 mg = ____ mcg
0.600 mg = 600 mcg
83 CONVERTING: RATIO AND
PROPORTION RULES
Refer to Chapter 4
1. State known equivalent first (memorized)
2. Add incomplete ratio on other side of equals
sign both sides mirrored
Example: mg : g = mg : g
3. Label all terms in the proportion, including x,
when problem is first set up
CONVERTING: RATIO AND PROPORTION
84 (CONT.)
RULES
4. Solve the problem using the principles of ratio

and proportion
Product of the means = product of the extremes
5. Final answer for x should be labeled with correct

unit of measure
Note: Carry division at least two decimal places to ensure

accuracy
PROPORTION
86 RATIO AND PROPORTION: FRACTION
EQUATION CONVERSION
You may set up the conversion problem in fraction format to

eliminate errors
First place the conversion factor as the numerator
Next, place problem as the denominator
Then cross multiply to solve for x
87
EQUATION CONVERSION (CONT.)
CONVERTING: DIMENSIONAL ANALYSIS
88
Steps
1. Identify the unit to which you are converting
2. Write down conversion factor with desired unit
in denominator, and write the next numerator
to match the previous denominator unit of
measure
3. Cancel the alternate denominator/numerator
units to leave the desired unit (being calculated)
4. Perform the mathematics
89 CONVERTING: DIMENSIONAL
ANALYSIS (CONT.)
ANALYSIS (CONT.)
8 mg equals how many grams?
g = 1g x 8mg
1000mg 1
g = 8
1000
= 0.008 g
91 CONVERTING BETWEEN SYSTEMS
Can use methods previously discussed

Ratio proportion method
Dimensional analysis method
Or the conversion factor method
Consider the size of the units
Larger to smaller multiply
Smaller to larger divide
92 CONVERTING: CONVERSION
FACTOR
Larger to smaller
Multiply by the conversion factor
4 oz = ______ mL
(large) (small)
Multiply 4 by 30
Answer: 120 mL
FACTOR (CONT.)
Smaller to larger
(metric) (household)
120 mL = ____ oz
(small) (large)
Divide 120 by 30
Answer: 4 oz
FACTOR (CONT.)
Pounds to kilograms
110 lb = ____ kg
(small) (large)
Conversion factor = 2.2
Divide 110 by 2.2
Answer: 50 kg
PROPORTION
Pounds to kilograms
1 kg : 2.2 lb = x kg : 110 lb
2.2x = 110
2.2 2.2
x = 50kg
ANALYSIS
Pounds to kilograms
110 lb = x kg
2.2 lb 110 lb
x kg = 1 kg x 1
110
x kg = 2.2
x = 50 kg
97 CASE STUDY 2
Mr. Hain is complaining of 7 out of 10 abdominal pain. There

is an order for 1,000 mcg of Dilaudid IV every 3 hours prn for
severe pain. It has been 4 hours since he last received
Dilaudid, and you decide to give it. Dilaudid is only available in
2 mg/mL. How many milliliters will you give?
Answer:
0.5 mL
99 CALCULATING INTAKE AND
OUTPUT
Abbreviated as I&O
Used to monitor fluids consumed, injected, and excreted
body temperature gelatin, popsicles

Includes liquids that exit the body diarrhea, urine, vomitus,
chest tube drainage
100 CALCULATING I&O (CONT.)
Preferred method is milliliters (mL)

May require conversion household to metric
Recorded during the hour within which the fluid
is consumed, injected, or excreted
Totaled every 24 hours
I&O record usually has key for conversions (e.g., 6 oz coffee cup = 180 mL)
After conversions, items are added for totals
1/3 glass apple juice (1 glass = 6 oz) = 60 mL

1/2 cup coffee (1 cup = 8 oz) = 120 mL
1/2 pint milk (1 pint = 500 mL) = 250 mL
430 mL
102
Figure 8-1 Sample I&O flow sheet
Record intravenous (IV) fluid intake

Method of recording varies with institutions
Urine is sometimes recorded hourly
Adult hourly output should be 30 mL or more
To find average, add up total urine and divide by number of
hours being recorded
Check institution policies to comply with charting

requirements on I&O record
CASE STUDY 2
104
You have obtained an order for 40 mEq potassium

chloride IV once to be started by the oncoming
controlled with prn medication, and he is in stable

condition. Before you give a report to the oncoming
the data in milliliters. How many mL?_________
1.5 L of IV D5 NS
4 oz ice chips
100 mL IV Flagyl
Answer:
1,720 mL
106 WHAT IS THE AVERAGE HOURLY
OUTPUT?
3) 610 in 24 hours
Which amount is insufficient urine output? Remember you must

have at least 30 mL/hr.___________
107 CONVERT THE FOLLOWING:
1) 6 oz = ? cups
2) 0.125 mcg = ? mg
3) 42 lb = ? kg
4) 3 c = ? mL
CHAPTER 16
DOSAGE CALCULATION
USING THE DIMENSIONAL
ANALYSIS METHOD
109
DIMENSIONAL ANALYSIS METHOD:
OBJECTIVES
able to:
1. Define dimensional analysis

2. Implement unit cancellation in dimensional analysis
3. Perform conversions using dimensional analysis
4. Use dimensional analysis to calculate dosages
BACKGROUND: DIMENSIONAL
110 ANALYSIS
Fancy name simple technique

Used to manipulate units in a calculation
Involves cancellation of unwanted units
NO memorization of formulas
Also known as the factor-label method or the unit factor method
Only one equation is used, even if a conversion is required
Memorization of common equivalents is necessary
PERFORMING CONVERSIONS USING
111 DIMENSIONAL ANALYSIS
Conversions can be made within process of calculation

rather than in advance
Equivalents or conversion factors are expressed as fractions
written in one of two ways without changing meaning or
value e.g., CF: 1 kg = 1,000 g is the same as 1 kg/ 1,000 g or
1,000 g/1 kg
How a fraction is written depends on the unit you want to
cancel or eliminate to get the unit desired
MAKING CONVERSIONS USING
112 DIMENSIONAL ANALYSIS
1. Identify desired unit

2. Identify equivalent needed
3. Write equivalent in fraction format with desired unit in
numerator as first part of equation
4. Label all factors in equation, with x being what you desire
to have in the end
113
DIMENSIONAL ANALYSIS (CONT.)
5. Identify unwanted or undesired units and cancel, then

reduce to lowest terms
6. Must be able to eliminate all labels except for answer
label if not, recheck
7. Perform mathematical process
Note: It is key to set up the

equivalent correctly!
114DIMENSIONAL ANALYSIS (CONT.)
Example: 1.5 g = _______ mg

1. The desired unit is mg
2. Equivalent: 1,000 mg = 1 g
3. Write equivalent keep mg in numerator (allows
cancellation of unwanted unit, g)
4. Write equivalent as fraction, add multiplication sign
5. Perform calculation
115
116DIMENSIONAL ANALYSIS
1. Identify unit of measure (caps, mL, tabs) and place x on left

with appropriate unit
2. On right, place available information as a fraction
information matching the x unit will be placed in the
numerator
3. Enter additional factors set up so that unit of numerator
matches preceding denominator
4. Cancel out like units remaining unit MUST match the unit
for x then calculate
1. Place desired unit of measure on left and label as x

x = tab
118 DIMENSIONAL ANALYSIS (CONT.)

2. Place the information in problem on right in fraction format
matching desired unit in numerator
119 DIMENSIONAL ANALYSIS (CONT.)

3. Enter additional info (e.g., what is ordered), matching unit in numerator
with preceding denominator
120
Amount to Available Ordered
administer dosage dosage
4.
should be what is desired
DIMENSIONAL ANALYSIS USING
CONVERSION FACTOR
122
When a conversion factor is necessary, the conversion

factor is placed as the second fraction inside the equation
Always match numerator of conversion factor with
denominator of previous fraction
123
Order.
1) Order: Potassium Chloride 40 mEq p.o. b.i.d

Available: KCl 20 mEq tablets
2) Order: Cleocin 300 mg IV q6h

Available: Cleocin 0.6 g per 4 mL
3) Order: Kefzol 0.5 g IV q6h

Available: Kefzol 225 mg per mL
125 CASE STUDY 3
doctor has added Flagyl 500 mg IV q6h and has discontinued the PCA
morphine. She also wrote an order for Percocet 5/325 2 tab p.o. q6h
prn pain. Mr. Ross is now complaining of 7/10 pain. It is also time to hang
the Flagyl.
At the Pyxis, you have available:

Flagyl 0.5 g in 100 mL
Percocet 5/325 tablets
Answer:
Pull 2 tabs of Percocet and 100 mL of Flagyl from the Pyxis.
As long as Mr. Ross remains in stable condition throughout

the night, he will be discharged tomorrow.
CHAPTER 15
DOSAGE CALCULATION
USING THE FORMULA METHOD
128 THE FORMULA METHOD: OBJECTIVES

able to:
1. Identify the information from a calculation
problem to place into the formula given
2. Calculate dosages using
3. Calculate the number of tablets or capsules to
administer
4. Calculate the volume to administer for
medications in solution
129 INTRODUCTION TO FORMULA
METHOD
Determine the components of the formula from the problem
Substitute the information from the problem into the formula
SAFETY ALERT!
Do NOT rely solely on formulas. Use critical thinking
skills such as considering what the answer should be,
reasoning, problem solving, and finding rational justification
for your answer. Formulas should be used as tools for
validating the dosages you THINK should be given.
FORMULA FOR CALCULATING
DOSAGES
130
Units of measure must be in same system before solving with the
formula
Memorize the formula:
TERMS IN THE FORMULA
131
D = Desired dose
Ordered in unit of measure desired mg, units, mEq
H = Strength available
Have on hand in unit of measure available mg, g, units
Q = Quantity
Unit of measure that carries what is on hand cited in
tabs, mL, caps
x = Unknown
STEPS TO USE FORMULA
132
1. Memorize or verify formula from resource
2. Place information in formula and label terms
3. Make sure everything is in same system
4. Apply logic test for reasonable answer
5. Calculate
6. Label answer with correct unit of measure
Note: Convert to metric equivalents when possible; metric is the

principal system used for medications
133
134
of the equation; however, it should NEVER be omitted

because it can render an error in dosage calculations.
x
measure
135
CONVERT TO SAME SYSTEM FIRST
136
WRONG
(D) 0.09 g x (Q) 1 tab = x
(H) 60 mg
RIGHT
(D) 90 mg x (Q) 1 tab = x
(H) 60 mg
CONVERT TOWARD Conversion Factor: 1 g =
NO
137DECIMALS 1,000 mg
Therefore, 0.25 g = 250 mg

WRONG!
=x
RIGHT
=x
PRACTICE PROBLEMS
138
1) Order: dilaudid 1000 mcg IV q4h prn pain

Available: dilaudid 2mg per 1mL
2) Order: lisinopril 5 mg p.o. daily
Available: lisinopril 10 mg tablets
3) Order: synthroid 0.075 mg p.o. daily
Available: synthroid 25 mcg tablets
CASE STUDY 3
139
While Mr. Ross is ambulating, you notice that he looks

flushed and feels warm to the touch. You check his
temperature orally and you find that it is 101.2° F. You check
the chart and find an order for:
Tylenol 650 mg p.o. q6h prn fever > 37.8° C
You go to the Pyxis and find that you have acetaminophen
325 mg tablets. What is your next course of action?
Answer:
administer two tablets.
CHAPTER 7
APOTHECARY AND
HOUSEHOLD SYSTEMS
APOTHECARY & HOUSEHOLD:
142 OBJECTIVES
1. Differentiate apothecary and household system of

measurement
2. Identify reasons for non-use of apothecary measures and
symbols
3. State common household equivalents
4. State specific household system rules
5. Identify measures in the household system
6. Define other measures used in medication administration
APOTHECARY: BACKGROUND
143
English origin considered to be oldest
Notations and Roman numerals are potentially confusing
TJC recommends they NOT be used in medication administration. Discouraged by ISMP.
Found on labels of older medications

Always convert to metric
144 SAFETY ALERT!
Do NOT use the following abbreviations and symbols:

gr (grains, apothecary unit of weight) confused with
metric gram
m (minim) mistaken for mL
(dram, apothecary drop) mistaken for 3
(ounce, apothecary symbol) obsolete

ss, ss (apothecary symbol for ½ ) mistaken for 55
APOTHECARY: UNITS OF MEASURE
145
Minims and drams ( ) no longer used some syringes or cups may still have
markings
Nurse needs to know

1 pint = 16 fluid ounces
1 quart = 32 fluid ounces = 2 pints
Weight
Grain = gr
Be careful not to confuse gr with g for gram
Metric equivalents: gr 15 = 1 g and gr 1 = 60-65 mg
Most meds are based on the equivalent gr 1 = 60 mg
APOTHECARY: UNITS OF MEASURE
(CONT.)
146
Volume
Ounce = oz
Metric equivalent: 1 oz = 30 mL
Medicine cups are 1 oz capacity
Although apothecary measures may still be on syringes and containers,

they should always be converted to metric
HOUSEHOLD: BACKGROUND
147
Old system and least accurate

Capacities of glasses and utensils vary by brand unless CALIBRATED
Advise use of droppers and devices provided with medications for
accurate dosing
Memorize:
1 teaspoon (t, tsp) = 5 mL
1 tablespoon (T, tbs) = 15 mL
1 measuring cup (c) = 8 oz
HOUSEHOLDS: PARTICULARS
148
1. Some are same as apothecary measures
Pints and quarts
2. No standard rules for expressing measures

3. Cookbook abbreviations commonly used
4. Arabic numerals and fractions are used
5. Smallest unit of measure is drop (gtt)
Never use as unit of measure unless delivery device is calibrated (e.g., medicine
dropper or IV tubing)
6. The unit ounce used to measure liquid is sometimes referred to as fluid

ounce
149
HOUSEHOLD/METRIC EQUIVALENTS
150
151 CASE STUDY 2
When obtaining a history on Mr. Hain, he tells you that he

started feeling sick after consuming 2 cups of fish soup.You
know that he is using which system of measurement?
a) Metric
b) Apothecary
c) Household
Answer:
c) Household
HOUSEHOLD: SOLUTIONS
153
Use calibrated spoons and measuring cups!
Normal Saline (0.9%)

2 teaspoons salt in 4 cups of water
Acetic Acid (0.25%)

3 tablespoons of white vinegar in 4 cups of water
Used for some wound/dressing care and for cleaning equipment
154 OTHER MEASUREMENTS USED IN
DOSAGE CALCULATION
Units: amount of medication in 1 mL of solution. Measure
specific medications in terms of action (examples: heparin,
penicillin, and insulin).
International Units: unit of potency. Represent the
amount needed to produce a certain effect (examples:
vitamins, chemicals).
Milliequivalents (mEq): used to measure electrolytes
and ionic activity of a medication. One thousandth of the
equivalent weight of an ion (examples: potassium, calcium).
155 DETERMINE THE FOLLOWING
EQUIVALENTS
1. 16 oz = _____ cup
2. 2 pts = ______ mL
3. 60 mL = ______ oz
4. 45 mL = ______ tbs
156 WHICH UNIT OF MEASUREMENT
SHOULD NOT BE ABBREVIATED?
1) Drops (gtt)
2) Unit (U)
3) Milliequivalent (mEq)
4) Pound (lb)
5) Kilograms (kg)
157 CASE STUDY 2
It is common for serum potassium levels or (K+) to decrease

with vomiting and diarrhea. Normal serum potassium levels
are 3.3-
mEq/L. How will you read this value aloud when notifying the
doctor?
Answer:
CHAPTER 10
MEDICATION ADMINISTRATION:
OBJECTIVES
160
1. State the consequences of medication errors
2. Identify the causes of medication errors
3. Identify the role of the nurse in preventing
medication errors
4. Identify the role of the Institute for Safe
Medication Practices (ISMP) and The Joint
Commission (TJC) in preventing medication
errors
MEDICATION
161
ADMINISTRATION:
OBJECTIVES (CONT.)
5.
6. Identify factors that influence medication dosages
7. Identify the common routes for medication administration
8. Define critical thinking
9. Explain the importance of critical thinking in medication
administration
MEDICATION ADMINISTRATION:
162
OBJECTIVES (CONT.)
10. Identify important critical thinking skills necessary in medication

administration
11. Discuss the importance of client teaching
12. Identify special considerations relating to the elderly and
medication administration
13. Identify home care considerations in relation to medication
administration
MEDICATION ERRORS
163
Potential consequences:
Acute or chronic disability
Death
Increased hospital stay
Increased health care cost
Legal consequences
Loss of nursing license
Loss of position
Most common cause of client injury despite advances in technology
MEDICATION ERRORS (CONT.)
164
Causes for errors
Lack of information about patient allergies, meds
Lack of information about the drug
Communication and teamwork failures
Unclear, absent, or look-alike and sound-alike meds
Unsafe standardization, storage, distribution, and devices
Errors in computer entry
(Cohen, MR (ed): Medication errors, abridged edition, Washington, DC, 2010, American Pharmacists Association)
165 MEDICATION ERRORS (CONT.)
Organizations involved in advancement of client safety:

Institute for Safe Medication Practices (ISMP)
United States Pharmacopeia (USP)
The Joint Commission (TJC)
Institute of Medicine (IOM)
U.S. Food and Drug Administration (FDA)
Quality and Safety Education for Nurses (QSEN)
National Quality Forum (NQF)
CRITICAL THINKING AND
MEDICATION
166 ADMINISTRATION
Definition: a process of thinking that includes being reasonable and rational

Organizational skills
Autonomy: willingness to challenge wrong orders and get clarification
Reasoning: selection of right tools and client assessment
The nurse administering medication is legally liable regardless of MOST

causes of error
You are responsible for your own actions
FACTORS INFLUENCING
MEDICATION
167 DOSE AND ACTION
All must be considered

1. Route of administration
2. Time of administration
3. Age of client
4. Nutritional status of client
5. Absorption and excretion of the drug
6. Health status of the client
7. Sex of the client
8. Ethnicity and culture of the client
9. Genetics
SPECIAL CONSIDERATIONS FOR ELDERLY
168
Two thirds use Rx and OTC meds

By 2030, people 65+ are expected to make up 19% of the
population
Physiologic changes slow function
Changes in circulation, absorption, metabolism, excretion, and stress
response
Lowered body mass, change in mental status
SPECIAL CONSIDERATIONS FOR ELDERLY
(CONT.)
169
Require lower doses as a rule

May need
Special delivery devices
Visual aid to read labels
Easy-open lids
Allow extra time for teaching

Clients of every age should demonstrate back what you taught them
170
Figure 10-1 A, B, Container that

C, The Pill Timer beeps, flashes, and automatically resets every time it is closed. (A, From Ogden
SG, Floharty LK: Calculation of drug dosages, ed 9, St Louis, 2012, Mosby. B, From Perry AG, Potter PA, Elkin MK: Nursing
interventions and clinical skills, ed 5, St Louis, 2012, Mosby.)
ADMINISTRATION
171
Right medication
Compare medication administration record (MAR) with order
Right dose
Check calculations and labels
Right client
Two unique identifiers (e.g., name and DOB)
NOT room number
ADMINISTRATION
172 (CONT.)
Right route
How medication is administered (by mouth, injection, etc.)
Check orders and drug guides
Special considerations with feeding tubes
Right time
Time of day and frequency
-
Right documentation
No documentation leads to double-dosing
Outcomes of medications
173
Right to refuse
Document and notify caregiver
Potentially dangerous mentally ill

Court-ordered assisted outpatient treatment (AOT)
Emergency court orders

May give forcibly
174
Right to education about SAFETY ALERT!

medication being given When a client questions a
Right to understand med, STOP and LISTEN.
interactions This may be an
opportunity to identify an
Right to medication
error before a client is
reconciliation across
harmed
continuum of care
175 CASE STUDY 3
Mr. Ross is a 62-year-old male who is s/p palliative colostomy

with mucous fistula. He has a history of advanced metastatic
rectal cancer. Before he is transferred to the unit from the
post-anesthesia care unit (PACU), you must confirm PCA
morphine settings with the PACU nurse. What are the six
rights you will verbalize to reduce medication errors?
Answer:
1) Right Medication
2) Right Dosage
3) Right Client
4) Right Route
5) Right Time
6) Right Documentation
177 MEDICATION RECONCILIATION
Process of comparing medications the client has been

taking before admission with the medications the
organization will provide
On admission, nurses need to get a thorough history of
medications being taken by a client to prevent medication
interactions that may cause harm or death
Avoids errors of
Transcription, omission, duplication of therapy, and medication
interaction
TEACHING
178
CLIENTS ABOUT MEDS
Imperative for preventing errors

Helps prevent adverse reactions
Improves adherence
Include the following:
Brand and generic names, explanation of amount, explanation of timing for dose,
measuring devices, and route
Follow up on teaching
179 CASE STUDY 3
Mr. Ross is transferred to the unit in stable condition. He has

an NGT to low intermittent suction draining brownish red
fluid. Surgical dressing is clean, dry, and intact, with minimal
bloody drainage to colostomy and mucous fistula bags. Mrs.
confirm the medication reconciliation form. How do you
Answer:
Medication reconciliation compares medications Mr. Ross

takes at home with the medications that we will administer
during his stay. This helps to prevent medication interactions.
HOME
181
CARE CONSIDERATIONS
Home health care is increasing with increased population and

early discharges
Practice requires more autonomy

Use the six rights as guidelines
Teaching focuses on devices from local pharmacies and calibrated
home devices
Communication is critical!
182
PREVENTION
Open communication between nurses and clients may
prevent med errors
This involves teaching AND listening
When med errors occur, report them per your
Always adhere to safety standards and use technology to

help you prevent med errors and identify safety risks
183 ROUTES OF ADMINISTRATION
Oral (p.o.) Parenteral

Swallowed tablets, capsules, IV, IM, Subcut, or ID
or liquid solutions
Insertion
Sublingual (SL) Placed into body cavity
Placed under tongue such as rectal or vaginal
suppositories
Buccal
Placed in mouth against Instillation
cheek Placed in the eye, nose, or
ear
ROUTES OF ADMINISTRATION (CONT.)
184
Inhalation (INH) Topical

Administered into respiratory track Applied to skin (lotions, ointments,
such as metered-dose inhalers, pastes)
nebulizers, spacers
Percutaneous
Intranasal Applied to skin or mucous
Solution instilled into the nostrils membranes
Transdermal
Topically applied medicated patches
or discs
185 CASE STUDY 3
Mr. Ross is to receive 2 L of Dextrose 5% in ½ normal saline

through a 20-gauge peripheral IV located on the right
forearm. The IV fluid will run at a rate of 125 mL/ hr. Which
route of administration will be used?
a) Instillation
b) Percutaneous
c) Transdermal
d) Parenteral
Answer:
d) Parenteral
EQUIPMENT FOR MED ADMINISTRATION
187
Medicine cup (30 mL/1 oz/2 Tbs)

Used for liquid medication 5-30 mL
Soufflé cup
Used for solids such as tablets or capsules
Calibrated dropper
Used to administer small amounts of liquid medication
EQUIPMENT FOR MED ADMINISTRATION
188
(CONT.)
Nipple
Adapted for some infant meds
Oral syringe
To administer liquid medications orally
Parenteral syringe
Used for IM, Subcut, ID, IV meds
Barrel marked in mL or units
Needle attached to tip
Plunger pushes medication through needle
1) Which device can you use to administer 1.5 mL of an

oral medication?
2) How many tablespoons can one medicine cup hold?
3) Differentiate between the sublingual and buccal routes of
administration.
4) What should you do if you make a med error?
5) Discuss some special considerations for the elderly.
190
Figure 10-5 A, Plastic medicine cup. B, Soufflé cup.

(Courtesy of Chuck Dresner. From Clayton BD, Willihnganz M:
Basic pharmacology for nurses, ed 16, St Louis, 2013, Mosby.)
Figure 10-6 Medicine dropper. (Modified

from Clayton BD, Willihnganz M: Basic
2013, Mosby.)
191
Figure 10-8 Nipple. (Modified from Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed 16, St Louis, 2013,
Mosby.)
Figure 10-10 Parts of a syringe. (From Potter PA, Perry AG, Stockert P, Hall
A: Fundamentals of nursing, ed 9, St Louis, 2013, Mosby.)
Figure 10-9 Oral syringes. (Courtesy of Chuck
Dresner. From Clayton BD, Willihnganz M: Basic
pharmacology for nurses, ed 16, St Louis, 2013,
Mosby.)
192
Figure 10-11 Types of syringes. A, Luer-Lok syringe marked in 0.1 (tenths). B, Tuberculin syringe marked
in 0.01 (hundredths) for dosages of less than 1 mL. C, Insulin syringe marked in units (100). D, Insulin
syringe marked in units (50). (From Potter PA, Perry AG, Stockert P, Hall A: Fundamentals of nursing, ed 9, St
Louis, 2013, Mosby.)
193
Figure 10-12 A, Acceptable devices for measuring and administering oral medication to children
(clockwise): measuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibrated dropper,
hollow-handled medicine spoon. B, Medibottle used to deliver oral medication via a syringe. (A, From
Hockenberry MJ, Wilson D: ed 9, St Louis, 2011, Mosby. B,
CHAPTER 13
READING MEDICATION LABELS
READING MED LABELS: OBJECTIVES
1. Identify trade and generic names of medications

2. Identify dosage strength of medications
3. Identify forms in which medications are supplied
Mosby items and derived items © 2014, 2010, 2006, 2002, 1998, 1994 by Mosby, Inc., an imprint of Elsevier Inc. 195
READING MED LABELS: OBJECTIVES
(CONT.)
4. Identify the total volume of a medication

container where indicated
5. Identify directions for mixing or preparing a
medication where necessary
6. Identify information on combined medication
labels
READING LABELS: GENERIC NAMES
Given by manufacturer who develops the med

One generic name, not capitalized
Legally required on all labels
Nurses need to know generic AND trade name
Dispensed less expensively than brand
Common generics: morphine, atropine, phenobarbital, meperidine
Look-alike, sound-alike -
busPIRone vs buPROPion
198
FIGURE 13-1 MORPHINE LABEL: 10 MG PER ML. Figure 13-2 A, Furosemide label: 20 mg per 2 mL (10
mg per mL). B, Meperidine label: 50 mg per mL

READING LABELS: TRADE NAMES
May be many for one generic
Prominently displayed, always capitalized

® or to indicate registration of name
Figure 13-3 shows label for
TriCor (trade name) or fenofibrate (generic name)

Isentress (trade name) or raltegravir (generic name)
200
Figure 13-3 TriCor label. Figure 13-4 Isentress label.

201 CASE STUDY 3
Mr. Ross is 2 days post-op and currently tolerating a clear

liquid diet with no nausea. His pain is adequately controlled
with PCA morphine. The physician orders to continue Mr.
As you look at the label you distinguish which names as trade
and generic?
Answer:
Zocor is the trade name

Simvastatin is the generic name
READING LABELS: DOSAGE STRENGTH
Weight or amount of medication in a specific unit of measure

Solid meds = amount of med per tab, cap, etc.
e.g., amoxicillin 250 mg per capsule
Liquid meds = amount of med per mL, L, etc.
e.g., lactulose 10 g per 15 mL
May be stated in two different but equivalent dosage strengths

e.g., Forteo 0.25 mg per mL = 250 mcg per mL
Sometimes expressed as a ratio or percent

e.g., epinephrine 1 g per 1,000 mL (1:1000)
205
Figure 13-8 Lidocaine label. Lidocaine 1% contains 1 g

of medication per 100 mL solution and 10 mg per mL.
FIGURE 13-7 EPINEPHRINE LABEL. EPINEPHRINE

CONTAINS 1 G OF MEDICATION PER 1,000 ML
SOLUTION (1:1,000) AND 1 MG PER ML.
READING LABELS: FORM
Type of med in package

Tablets, capsules, liquids, suppositories, ointments, etc.
Abbreviations or words that describe form

CR (controlled release), DS (double-strength)
Barcode symbols
Aid in inventory control and distribution
Meds that allow extended action or slow release should

NEVER be crushed or chewed. They may be labeled with:
CR (controlled release), LA (long acting), EC (enteric
coated), SR (sustained release)
READING LABELS: ROUTE
The route should be clearly indicated on the label

Oral, IM, IV, topical, optic, otic
Unless stated otherwise, capsules, pills, and tablets are
understood to be oral meds
Liquid meds may be administered orally or by injection.
Labels will indicate the correct route
READING LABELS:VOLUME
Liquids
Total volume in container is stated
Strength is expressed as medication per volume of solution (e.g., mg in mL 5 mg
per 10 mL)
Figure 13-14 Clindamycin Injectable label.
209 READING LABELS: AMOUNT
Solids
The total number of capsules or tabs is listed
Strength of each tablet or capsule is provided (e.g., mg in each tablet 50 mg
per tablet)
Powders for reconstitution precise instructions
Figure 13-9 A, Metformin Hydrochloride Extended Release Tablets. B, Depakote Sprinkle Capsules. C, Inderal
LA Long Acting Capsules. D, Ery Tab Delayed Release Tab and Enteric Coated.
READING LABELS:
PRECAUTIONS EXPIRATION
Precautions
Safety
Storage
Examples: Protect from light, Keep tightly closed, Refrigerate after opening
Usual dosage
SAFETY ALERT!
ALWAYS CHECK EXPIRATION DATES
READING LABELS: CONTROLLED
LABELING
Narcotic FDA control number

Based on abuse potential
Schedule I to Schedule V
Written as CI, CII, CIII, CIV, CV
Highest abuse potential is CI
Lowest abuse potential is CV
Figure 13-2 A, Furosemide label: 20 mg per 2 mL (10 mg

per mL). B, Meperidine label: 50 mg per mL
READING LABELS: COMBINATIONS
The capsule, tablet, or liquid contains two medicines within one vehicle
Orders must include dosages not just number of tabs or mL
Exceptions: If strength is NOT indicated on label, only one strength
exists, and it can be ordered by number of tabs, caps, mL
Examples: multivitamins, Bactrim DS, Percocet
COMBINATION MEDICATION LABEL
214 COMBINATION MEDICATION
SAFETY ALERT!
Numbers following a medication name may be used to
identify the dosage strengths of more than one
medication in a preparation, and initials may be used
to identify a special medication action. Real labels
carefully to validate that you have the correct
medication and dosage for combined medications.
READING LABELS: UNIT DOSE
Unit dose
Labeled individually
Packaged individually
In computerized dispensing system
In client-specified drawers
Multidose bottles or vials are used if large quantities are
necessary for unit
Examples: Tylenol, insulin
READING LABELS: OTHER INFORMATION
Lot/Control Numbers
Required by law
National Drug Code (NDC) number
Other abbreviations
USP (United States Pharmacopoeia)
NF (National Formulary)
NAME THE PARTS OF THE LABEL
217
A
B
C
Chapter 10
Medication Administration
Medication Administration:
Objectives
1. State the consequences of medication
errors
2. Identify the causes of medication errors
3. Identify the role of the nurse in preventing
medication errors
4. Identify the role of the Institute for Safe
Medication Practices (ISMP) and The Joint
Commission (TJC) in preventing medication
errors
imprint of Elsevier Inc. 2
Objectives (Cont.)
5.
administration
6. Identify factors that influence medication dosages
7. Identify the common routes for medication

administration
8. Define critical thinking
9. Explain the importance of critical thinking in

Objectives (Cont.)
10. Identify important critical thinking skills necessary
in medication administration
11. Discuss the importance of client teaching
12. Identify special considerations relating to the

elderly and medication administration
13. Identify home care considerations in relation to

Medication Errors
Potential consequences:
Acute or chronic disability
Death
Increased hospital stay
Increased health care cost
Legal consequences
Loss of nursing license
Loss of position
Most common cause of client injury despite

advances in technology
Medication Errors (Cont.)
Causes for errors
Lack of information about patient allergies, meds
Lack of information about the drug
Communication and teamwork failures
Unclear, absent, or look-alike and sound-alike meds
Unsafe standardization, storage, distribution, and devices
Errors in computer entry
(Cohen, MR (ed): Medication errors, abridged edition, Washington, DC, 2010, American Pharmacists Association)
Medication Errors (Cont.)
Organizations involved in advancement of client safety:
Institute for Safe Medication Practices (ISMP)
United States Pharmacopeia (USP)
The Joint Commission (TJC)
Institute of Medicine (IOM)
U.S. Food and Drug Administration (FDA)
Quality and Safety Education for Nurses (QSEN)
National Quality Forum (NQF)
Critical Thinking and
Medication Administration
Definition: a process of thinking that includes being
reasonable and rational
Organizational skills
Autonomy: willingness to challenge wrong orders and get
clarification
Reasoning: selection of right tools and client assessment
The nurse administering medication is legally liable regardless

of MOST causes of error
You are responsible for your own actions
Factors Influencing
Medication Dose and Action
All must be considered
1. Route of administration
2. Time of administration
3. Age of client
4. Nutritional status of client
5. Absorption and excretion of the drug
6. Health status of the client
7. Sex of the client
8. Ethnicity and culture of the client
9. Genetics
Special Considerations for
Elderly
Two thirds use Rx and OTC meds
By 2030, people 65+ are expected to make up

19% of the population
Physiologic changes slow function

Changes in circulation, absorption, metabolism,
excretion, and stress response
Lowered body mass, change in mental status
Special Considerations for
Elderly (Cont.)
Require lower doses as a rule
May need
Special delivery devices
Visual aid to read labels
Easy-open lids
Allow extra time for teaching
Clients of every age should demonstrate back what

you taught them
Figure 10-1 A, B,
C, The Pill Timer beeps, flashes, and automatically resets every time it is
closed. (A, From Ogden SG, Floharty LK: Calculation of drug dosages, ed 9, St Louis, 2012, Mosby. B, From Perry
AG, Potter PA, Elkin MK: Nursing interventions and clinical skills, ed 5, St Louis, 2012, Mosby.)
Administration
Right medication
Compare medication administration record
(MAR) with order
Right dose
Check calculations and labels
Right client
Two unique identifiers (e.g., name and DOB)
NOT room number
Administration (Cont.)
Right route
How medication is administered (by mouth, injection, etc.)
Check orders and drug guides
Special considerations with feeding tubes
Right time
Time of day and frequency
-
Right documentation
No documentation leads to double-dosing
Outcomes of medications
Right to refuse
Document and notify caregiver
Potentially dangerous mentally ill

Court-ordered assisted outpatient treatment (AOT)
Emergency court orders

May give forcibly
Right to education about SAFETY ALERT!
medication being given
When a client questions a
Right to understand med, STOP and LISTEN.
interactions This may be an opportunity
to identify an error before a
Right to medication client is harmed
reconciliation across
continuum of care
Case Study 3
Mr. Ross is a 62-year-old male who is s/p palliative
colostomy with mucous fistula. He has a history of
advanced metastatic rectal cancer. Before he is
transferred to the unit from the post-anesthesia care unit
(PACU), you must confirm PCA morphine settings with the
PACU nurse. What are the six rights you will verbalize to
reduce medication errors?
Answer:
1) Right Medication
2) Right Dosage
3) Right Client
4) Right Route
5) Right Time
6) Right Documentation
Medication Reconciliation
Process of comparing medications the client has been
taking before admission with the medications the
organization will provide
On admission, nurses need to get a thorough history of

medications being taken by a client to prevent
medication interactions that may cause harm or death
Avoids errors of
Transcription, omission, duplication of therapy, and
medication interaction
Teaching Clients about Meds
Imperative for preventing errors
Helps prevent adverse reactions
Improves adherence
Include the following:
Brand and generic names, explanation of amount,
explanation of timing for dose, measuring devices,
and route
Follow up on teaching
Case Study 3
Mr. Ross is transferred to the unit in stable condition. He
has an NGT to low intermittent suction draining brownish
red fluid. Surgical dressing is clean, dry, and intact, with
minimal bloody drainage to colostomy and mucous fistula
and you ask her to confirm the medication reconciliation
Answer:
Medication reconciliation compares medications Mr. Ross

takes at home with the medications that we will administer
during his stay. This helps to prevent medication
interactions.
Home Care
Considerations
Home health care is increasing with increased
population and early discharges
Practice requires more autonomy

Use the six rights as guidelines
Teaching focuses on devices from local
pharmacies and calibrated home devices
Communication is critical!
Prevention
Open communication between nurses and clients may
prevent med errors
This involves teaching AND listening
When med errors occur, report them per your
Always adhere to safety standards and use technology

to help you prevent med errors and identify safety risks
Routes of Administration
Oral (p.o.) Parenteral
Swallowed tablets, capsules, IV, IM, Subcut, or ID
or liquid solutions
Insertion
Sublingual (SL) Placed into body cavity such
Placed under tongue as rectal or vaginal
suppositories
Buccal
Placed in mouth against Instillation
cheek Placed in the eye, nose, or
ear
Routes of Administration
(Cont.)
Inhalation (INH) Topical
Administered into respiratory Applied to skin (lotions,
track such as metered-dose ointments, pastes)
inhalers, nebulizers, spacers
Percutaneous
Intranasal Applied to skin or mucous
Solution instilled into the membranes
nostrils
Transdermal
Topically applied medicated
patches or discs
Case Study 3
Mr. Ross is to receive 2 L of Dextrose 5% in ½ normal
saline through a 20-gauge peripheral IV located on the
right forearm. The IV fluid will run at a rate of 125 mL/ hr.
Which route of administration will be used?
a) Instillation
b) Percutaneous
c) Transdermal
d) Parenteral
Answer:
d) Parenteral
Equipment for Med
Administration
Medicine cup (30 mL/1 oz/2 Tbs)
Used for liquid medication 5-30 mL
Soufflé cup
Used for solids such as tablets or capsules
Calibrated dropper
Used to administer small amounts of liquid
medication
Equipment for Med
Administration (Cont.)
Nipple
Adapted for some infant meds
Oral syringe
To administer liquid medications orally
Parenteral syringe
Used for IM, Subcut, ID, IV meds
Barrel marked in mL or units
Needle attached to tip
Plunger pushes medication through needle
Practice Problems
1) Which device can you use to administer 1.5 mL of an
oral medication?
2) How many tablespoons can one medicine cup hold?
3) Differentiate between the sublingual and buccal routes
of administration.
4) What should you do if you make a med error?
5) Discuss some special considerations for the elderly.
Figure 10-5 A, Plastic medicine cup. B, Soufflé cup.
(Courtesy of Chuck Dresner. From Clayton BD,
Willihnganz M: Basic pharmacology for nurses, ed 16, St
Figure 10-6 Medicine dropper.
(Modified from Clayton BD, Willihnganz
M: Basic pharmacology for nurses, ed
16, St Louis, 2013, Mosby.)
Figure 10-8 Nipple. (Modified from Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed 16, St
Figure 10-10 Parts of a syringe. (From Potter PA, Perry AG, Stockert
P, Hall A: Fundamentals of nursing, ed 9, St Louis, 2013, Mosby.)
Figure 10-9 Oral syringes. (Courtesy of Chuck
Dresner. From Clayton BD, Willihnganz M:
Basic pharmacology for nurses, ed 16, St
Figure 10-11 Types of syringes. A, Luer-Lok syringe marked in 0.1 (tenths). B, Tuberculin syringe
marked in 0.01 (hundredths) for dosages of less than 1 mL. C, Insulin syringe marked in units
(100). D, Insulin syringe marked in units (50). (From Potter PA, Perry AG, Stockert P, Hall A:
Fundamentals of nursing, ed 9, St Louis, 2013, Mosby.)
Figure 10-12 A, Acceptable devices for measuring and administering oral medication to children
(clockwise): measuring spoon, plastic syringes, calibrated nipple, plastic medicine cup, calibrated
dropper, hollow-handled medicine spoon. B, Medibottle used to deliver oral medication via a
syringe. (A, From Hockenberry MJ, Wilson D: ed 9, St
Louis, 2011, Mosby. B,
Medications
Calculations
LaDonna Christian, RN, MSN, PhD
Formula Method
D
--- xV=A
H
D desired or ordered dose
H dosage on hands
V volume that the medication is provided in, such
as one tablet or milliliters
A administered medication dose
Example:
50 mg = 25 mL
______ ______ = 2 X 25 = 50 X : 50 = 50 X : X
=1
2 mL X mL
50 mg : 2 mL = 25mg : x mL
50 X = 2 X 25
50 X = 50
X = 1
Example
ordered available
X tab = 1 tab x 40 mg
_______ _______
20 mg 1 tab
available conversion ordered

X mL = 1 mL x 1000 mg x 0.5 g
_____ _______ ______
250 mg 1g 1
Use your Method
1.Your patient complains of nausea and requires
Torecan 50 mg as ordered. You have Torecan 20
mg/2 mL available per vial. Give _______ mL
50 mg/ 20 mg x 2 mL = 5 mL
Use your Method
2. Your patient requires theophylline 16 mg po q6
h. You have theophylline elixir 11.25 mg/mL
available. Give _______ mL.
16 mg/ 11.25 mg x 1 mL = 1.4 mL

Use your method
3.Your patient requires 400 mg allopurinol dose
now. You have allopurinol elixir 100 mg/mL
available. Give _______ mL.
400 mg/ 100 mg x 1mL = 4 mL

Use Your Method
4.Your patient complains of nausea. You have
Compazine 1 mg/mL available.Ordered: Compazine
4 mg. How many milliliters will you administer?
4 mg/ 1mg x 1 mL = 4 mL
Reconstitution Problems
5. Ampicillin is available as 500-mg powder to be
reconstituted with 4.8 mL of sterile water for a final
dilution of 250 mg/mL. Recommended dosage is
200 mg q8 h.. How many milliliters of ampicillin is
the patient receiving?
Ampicillin Powder 4.8 mL dilute 250mg/mL

500 mg
200 mg/ 250 mg x 1 mL = 0.8 mL

6.Ordered: Oxacillin sodium 500 mg IV q6h.
Available: A multidose vial that reads Oxacillin
sodium; add 5.7 mL sterile water for injection. Each
1.5 mL of solution contains 0.25 g. How many
milliliters will you administer?
Oxacillin Powder 5.7 mL dilute 250mg/1.5mL Reconstitution

500 mg
500 mg/ 250 mg x 1.5 mL = 3 mL

7.Ordered: Cefadyl 700 mg IV q6h. Available:
Cefadyl 1 g. Directions read: For IM use, add 2 mL
sterile or bacteriostatic water for injection For IV
use, add 1.7 mL. USP. Each 1.5 mL contains 500 mg
of cefadyl. How many milliliters will you administer
per injection?
Medication 1.7 mL dilute 500 mg /1.5 mL
700 mg/ 500 mg x 1.5 mL = 2.1 mL

8.Ordered: Cefobid 1 g IM q12 h.Available: Cefobid
2 g vial.Directions for IM use read: Add 3.4 mL of
sterile water for injection. For IV use add 3.7 mL
Each 4 mL yields 2 g. How many milliliters will you
administer?
Cefobid Powder 3.4 mL dilute 2g/4mL Reconstitution

1g
1g/ 2g x 4 mL = 2 mL
Calculation of IV Flow Rate
The prescriber orders intravenous fluid and flow
rates for IV infusion pump in milliliters per hour
(ml/Hour).
The formula for calculating ml/hour for intravenous
infusion is:
ml of solution ordered
------------------- = mL/hour
Total hours ordered
*Remember to always round mL/hr to a whole

number
Calculate the mL/hr
The client has an order for 3000 mL of D5W 24 hours. Calculate
the mL/hr
3000 mL
___________ = 125 mL/hr
24 hr
The client has an order to receive and antibiotic in 50 mL of 0.9%NS

over 30 minutes
50 mL 60 min
_______ X ________ = 100 mL/hr
30 min 1 hr
Administering IV Medications by IV
Infusion Pump
9. Insulin 100 units in 100 ml of 0.9% NaCl to
infuse at 5units/hour. Calculate the flow rate.
5u/hr x 100 mL
__________________ = 5 mL/hr
100 u
Infusion Pump
10. Mr. Sampson has an order to receive Levaquin
500 mg in 150 ml of 0.9% NaCl over 45 min.
Calculate the mL/hr.
150 mL x 60 min
___________________ = 200 mL/hr
45 min
Infusion Pump
11. Mr. Williams has an order to receive Flagyl
500 mg in 100 ml of 5% dextrose over 30 min.
Calculate the flow rate.
100 mL / 30 min x 60 = 200 mL/hr

Infusion Pump
12. Nitroglycerine 100 mg in 250 ml of 5 %
dextrose in water infusing at 5.4 ml/hour. How
many mcg/hour is the patient receiving?
100 mg x 1000 = 100,000 mcg
100,000 mcg x 5.4 mL/hr

____________________________ = 2160 mcg/hr
250 mL
Infusion Pump
13. Insulin 500 units in 250 ml of 0.9 % NaCl to
infuse at 4 mL/hour. Calculate the units/hour you
will administer.
500 u x 4 mL/hr
___________________ = 8 u/hr
250 mL
Heparin Drip Formula
Method for calculating IV heparin
flow:
Total Units of Heparin Units/hour

--------------------------- = --------------
Total amount of infusion (mls) mls/hour
Heparin Drip
14. Heparin 25,000 units in 500 ml of 0.45% NaCl
to infuse at 1000 units/hour. How many ml/hour is
the patient receiving?
1000 u/hr x 500 mL

______________________ = 20 mL/hr
25,000 u
Heparin Drip
15. Heparin 25,000 units in 500mlof 0.45% NaCl to
infuse at 23ml/hour. How many units/hour is the
patient receiving?
23 mL/hr x 25,000 u
______________________ = 1150 u/hr
500 mL
Drop Factor
The number of drops delivered per milliliter of
solution varies with different brands and types
of infusion sets.
This rate, called the drip factor (sometimes
called the drop factor), generally is printed on
the package of the infusion set.
A commonly used drip chamber is the 10, 15
and 20 drops which delivers macrodrip, per
milliliter of solution.
There are also 60 drop sets, which deliver
microdrip per milliliter of solution.
Drop Factor Formula
Drops per minute are calculating by the
following formula:
Total infusion volume x drop factor

Drops per minute = --------------------------------
Total time of infusion in minutes
Drop Factor = gtt/min
16. The doctor ordered 1 liter of D5W to be infused
over 12 hours. The drop factor is 15gtt/ml. How
many gtt/min will the patient receive?
1000 mL/12 hours = 83.3 = 83 mL/hr

83 mL/ hr x 15 gtt/mL
________________________ = 20.8 = 21 gtt/min
60 min
1000 mL x 15 gtt/mL
_______________________ = 20.8 = 21 gtt/min
12 x 60
Drop Factor
17. The doctor orders TPN 1800 ml to infuse over
21 hour. The drop factor is 20gtt/ml. How many
gtt/min the will patient receive?
1800/21 =85.7 or 86 mL/hr
86 mL/hr x 20 gtt/mL
_______________________ = 29 gtt/min
60 min
Drop Factor
18. The doctor orders 20 mEq of KCl dissolved in
500ml of 0.9% of NaCl to infuse at 100 mL/hr.
Using microdrip tubing calculate how many gtt/min
will the patient will receive.
100 mL x 60 gtt/mL
_______________________ = 100 gtt/min
60 min
Drop Factor
19. The doctor ordered 1g of Vancomycin in 250 ml
of D5W at 125 mL/hr. Using tubing with drop factor
20 gtt/ml calculate how many gtt/min the patient
will receive.
125 mL/hr x 20 gtt/mL

________________________ = 42 gtt/min
60
Body Weight Method
20. Nitroprusside 100 mg in 250 ml of 0.9% NaCl to
infuse at 4mcg/kg/min. The patient weighs 145 lb
3oz. How many ml/hour will the patient receive?
145.2/2.2 = 66 kg
66 kg x 4 mcg/kg/min = 264 mcg/min
264 mcg/min x 60 = 15,840 mcg/hr
100 mg x 1000 = 100,000 mcg
15840 mcg/hr x 250 mL

__________________________ = 39.6 = 40 ml/hr
100,000 mcg
Body Weight Method
21. Dobutamine 250 mg in 250 ml of D5W to infuse
at 10mcg/kg/min. The patient weighs 136 lb 6oz.
6 oz/16 oz = 0.375
136 + 0.375 = 136.375/2.2 = 61.91kg
61.91 x 10 = 619.1mcg/min
250 mg x 1000 = 250,000 mcg
619.1 mcg/min x 250 mL
__________________________ x 60 min/hr = 37 mL/hr
250,000 mcg
Body Weight Method
22. The client weighs 116 lbs. The order is for
Daptomycin IVPB 200 mg in 100 mL NS to infuse at
4 mg/kg/hr How many mL/hour will the patient
receive?
116/2.2 = 52.73
52.73 x 4 mg = 210.9 mg/hr
100 mL x 210.9 mg/hr
____________________________ = 105 mL/hr
200 mg
Body Weight Method
23. A nurse records an infant s weight as 16
pounds 8 ounces. Ranitidine (Zantac) is prescribed
for the infant. The prescription reads: Give
ranitidine 2mg/kg twice daily The medication is
supplied as 15 mg/mL. The nurse should instruct
the parent to give ______ mL per dose.
8 oz/16 oz = 0.5
16 + 0.5 = 16.5/2.2 = 7.5 kg
7.5 kg x 2mg/kg = 15mg
15mg/15mg x 1 = 1mL
Other IV Problems
24. Mr. Sampson s intravenous solution was
ordered to infuse over 12 hours. When you admit
Mr. Sampson to the unit at 2pm, he has 750 ml of
IV solution left in the bag. At what time IV infusion
will be completed? Regular time and Military time
1000 mL/12 hr = 83
83 mL/hr x 3 hr = 249 mL 1000 = 751 mL
12 3 = 9 hrs
2pm + 9 = 11pm or 2300
IV Infusion Time
The IV of 500 mL NS is to infuse at 60 mL/hr
using a drop factor of 15 gtt/mL. Traditional and
Military time.
1) Determine infusion Time? = 8 hrs 18 min
2) If the IV was started at 10:00 pm, when would

the IV infusion be completed? = 6:18 am: 0618
3) How many gtts/min? = 15 gtt/min

Other IV Problems
25. Infuse dopamine 800 mg in 500 mL D5W at 30
mL/hr. Calculate the dosage in mcg/hr and
mcg/min.
800 mg x 1000 = 800,000 mcg

800,000: 500 = x mg: 30 mL
800,000 x 30 = 500x = 48,000 mcg/hr
48,000/60 min = 800 mcg/min
Measurements
1 oz = ___30_____ mL
1 cup = __8_____oz = ____240_______mL
1 Tbsp = _15_____ mL
1 Tsp = __5_____ mL
1 kg = ___2.2_____ lb
1 inch = ___2.5_____ cm
98.6 °F = ___37____ °C
1 lb = ___16_______oz
Abbreviations
immediately________stat_______
Twice a day _____b.i.d__________
Three times per day___t.i.d.___________
By mouth _____p.o.____________
p.r.n. _____as needed____________
Tablet ______tab_____________
NGT ______Nasogastric tube____________
IV_____Intravenous_______________
IM______intramuscular_____________
Ad lib ____as desired_____________
IVPB_____intravenous piggyback_____________
I&O
The patient drank the following for breakfast and lunch:
2 cups of milk (8 oz)
3 ½ cups of water (8 oz)
1 small ice cream (4 oz)
1 ¼ cup of jello (6 oz)
1/2 large bowl of soup (12 oz)
1 can of ginger ale (12 oz) Intake = 2205 mL
Urine output: 210, 425, 300, 225, 180. Output = 1340 mL
Calculate the intake and output for this client.

Intake = 2205 mL
CHAPTER 17
ORAL MEDICATIONS
CALCULATION OF ORAL MEDICATIONS:
2 OBJECTIVES

1. Identify forms of oral medications
2. Identify terms on labels used in calculation
3. Calculate dosages for oral medications using ratio and
proportion, the formula method, and dimensional analysis
4. Apply principles to obtain rational answers
BACKGROUND: ORAL MEDICATIONS
3
Most economical
Easiest to administer
Most common type of medication given
Available as solids and liquids
Unit dose and bulk packaging
Usually simple calculations
FORMS OF SOLID MEDICATIONS
4
Tablets
Powdered medications molded in shapes
Caplets
Elongated tablets coated to ease swallowing
Scored tablets use pill cutter
Tablets with indented markings designed to cut and deliver ½ or ¼
what is in a whole tablet
SAFETY ALERT!
Breaking an unscored tablet is dangerous
and can result in an unintended dose
5
Enteric-coated tablets and film tablets

Special coating protects against gastric secretions
NEVER crush EC tablets defeats the purpose
Sublingual tablets
Placed under tongue for direct absorption
Buccal tablets placed between gums and cheek
NEVER swallow SL or Buccal tablets prevents
desired effect
Layered tablets
Two meds with different components
Disintegrating and chewable tablets
6
Time-release and extended-release tablets
Labeled SA, LA, XL, SR, or ER
Released over a period of time
NEVER crush, chew, or break
Capsules
Contains powder, liquid, or oil with hard/soft gelatin
coating
NEVER crush, chew, or break without consulting a
pharmacist
Others: troches, lozenges, pulvules, spansules, sprinkle capsules
7
Figure 17-1 Clonazepam tablet scored. (From Mosby's

drug consult 2007, St. Louis, 2007, Mosby.)
Figure 17-2 Pill/tablet cutter. (From Kee JL,

Marshall SM: Clinical calculations: with
applications to general and specialty areas, ed
7, St Louis, 2013, Saunders.)
8
Figure 17-3 Sublingual (A) and buccal (B) tablets. (From Figure 17-4 Layered tablet. (From Clayton BD,
Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed Willihnganz M: Basic pharmacology for nurses, ed
16, St Louis, 2013, Mosby.) 16, St Louis, 2013, Mosby.)
9
Figure 17-5 Types of oral medications. A, Scored tablet. B, Chewable tablet. C, Sublingual. D, Timed-release
tablet. E, Capsule. F, Timed-release capsule. G, Gelatin capsule.
CASE STUDY 4
10
Mrs. Garcia is a 67-y/o female admitted at 1930 to the unit

with gangrenous toes and heel of the left foot. Report from
the ER nurse reveals a history of DM II, ESRD, HTN, and
depression. She also has dysphagia and L- sided weakness
due to a stroke last year. She receives enteral feedings and
meds through a PEG tube. She has a Foley catheter and a 20-
gauge IV to the R forearm running NS at a rate of 30 mL/hr.
She is to have enteral feeding held after midnight and
prepped for L BKA tomorrow at 0830.
11
The doctor orders to continue home meds and you review the
medication reconciliation form. What problems can you detect given the
Metoprolol ER 50 mg p.o. daily

Lisinopril 5 mg p.o. daily
HCTZ 12.5 mg p.o. daily
Lasix 20 mg p.o. b.i.d.
Glyburide 5 mg p.o. daily
Wellbutrin XL 300 mg p.o. daily
Percocet 5/325 1 tab q3h prn pain
Answer:
Metoprolol ER and Wellbutrin XL are long-acting
tablets. Long-acting tablets should NEVER be
crushed.
You alert the physician and he changes the order

accordingly.
POINTS TO REMEMBER
13
Converting dosages from one system to another can result
in discrepancies
10% rule no more than 10% variance should exist
between dose ordered and dose administered
Capsules are administered whole only
Tablets are available in different strengths
Choose the least number of tablets or capsules without
dividing a tablet
POINTS TO REMEMBER (CONT.)
14
It is safer to give whole tablets equal to the dose than to

cut tablets
Maximum number of tablets or capsules used to deliver a
dose is usually three (3)
Exceptions exist, such as some HIV meds always
double-check dosage
Some measures and units such as mEq and units do not
convert to metric
EXAMPLES
15
The following three examples are based on
this order:
Give: Digoxin 0.375 mg p.o. daily

Available: Digoxin in scored tablets of 0.25 mg
16
FORMULA METHOD
17
DIMENSIONAL ANALYSIS METHOD
18
19 PROBLEMS
To determine the number of tablets needed over a

period of days, multiply doses per day by the number of
days
Example:Valium 10 mg p.o. q.i.d for 7 days. Tablets
available are 5 mg tablets. How many will the client
take in one week?
1. Multiply 5 mg 2 for each dose = 2 tablets per dose
2. Multiply 2 tablets 4 for 4 doses/day = 8 tablets/day
3. Multiply 8 tablets per day 7 to find number needed
for 7 days = 56 tablets
20 VARIATIONS OF TABLET/CAPSULE
PROBLEMS (CONT.)
PROBLEMS (CONT.)
21
Determining dosage to be given each time

Example: A client is to receive 1 g of a drug daily in four divided doses
CASE STUDY 4
22
Lasix 20 mg p.o. q8h at 2100, 0500, 1100

Available: Lasix 20 mg tablets
Wellbutrin 300 mg p.o. daily at 2100
Available: Wellbutrin 150 mg tablets
Percocet 5/325 1 tab q3h prn pain last given at 1700
Available: Percocet 5/325 tablets
Answer:
Lasix 1 tab
Wellbutrin 2 tab
Percocet 1 tab
The physician wants to know how many tablets of

Percocet Mrs. Garcia typically takes in one week.
Mrs. Garcia and her daughter report that she has
been consistently taking 1 tablet of Percocet every
6 hours. What will you tell the physician?
CALCULATING ORAL LIQUIDS
26
For clients with dysphagia (difficulty swallowing) or
nasogastric, jejunostomy, or gastrostomy tube
For infants and young children
Types may contain multiple meds
Elixir: meds dissolved in alcohol and water
Suspension: meds dissolved in liquid such as water
Syrup: meds dissolved in sugar and water
SAFETY ALERT!
NEVER give oral liquids by IV - FATAL!
MEASURING ORAL LIQUIDS
27
1. Standard calibrated measuring cup
Metric, apothecary, or household measure
Place on flat surface and view at eye level
Pour with label facing you so that it can be read
Read at the level of the meniscus (low point)
2. Calibrated droppers
Use only dropper supplied with medication
3. Calibrated oral syringes (tsp/mL marks)
Used for accuracy of liquid doses (e.g., 6.4 mL)
Pour medication in cup and draw up into syringe
NEVER use oral syringes for parenteral meds
28
Figure 17-8 Reading meniscus. The meniscus is

caused by the surface tension of the solution against
the walls of the container. The surface tension Figure 17-9 Medicine dropper. (Modified from
causes the formation of a concave or hollowed Clayton BD, Willihnganz M: Basic pharmacology for
curvature on the surface of the solution. Read the nurses, ed 16, St Louis, 2013, Mosby.)
level at the lowest point of the concave. (From
Clayton BD, Willihnganz M: Basic pharmacology for
nurses, ed 16, St Louis, 2013, Mosby.)
29
Figure 17-10 Oral syringes. (Courtesy Chuck Dresner. From

Clayton BD, Willihnganz M: Basic pharmacology for nurses, ed
16, St Louis, 2013, Mosby.) Figure 17-11 Filling a syringe directly
from medicine cup. (Modified from
Clayton BD, Willihnganz M: Basic
2013, Mosby.)
MEASURING ORAL LIQUIDS (CONT.)
30
Do NOT confuse dosage strength with total volume in container
Example: May contain 100 mL in bottle, but strength will be
something like 125 mg in 5 mL
Calculations are performed in the same manner as for solid forms
of medicines
Med errors occur with oral liquids because they are

least likely to be in unit doses and are prescribed
often for pediatric and geriatric patients.
Use the correct calibrated measuring device!
ORAL LIQUIDS EXAMPLE
31
Order: Dilantin 200 mg p.o. t.i.d.

Available: Dilantin suspension 125 mg in 5 mL
CASE STUDY 4
32
temperature is 101.6° F. You review the chart and find the following order:
Tylenol Elixir 400 mg q4h prn fever > 100° F

(not to exceed 2,500 mg daily)
Available: Tylenol Elixir 160 mg per 5 mL
How many mL will you administer and what device will you use to
measure the dosage?
Answer:
Tylenol Elixir 12.5 mL measured in a plastic medicine cup.
MEDICATION ALERT!
Acetaminophen is a component in the Percocet Mrs. Garcia takes for pain.
Clients with hepatic or renal impairment should not exceed 2.5 g of
acetaminophen daily. Make sure to include the 325 mg of acetaminophen
in each Percocet when calculating totals before administration.
An overdose of acetaminophen is toxic!
1) Order: KCl 20 mEq p.o. t.i.d.

Available: KCl 40 mEq per 15 mL
How many mL will you give per day?
2) Order: Imodium 2.5 mg p.o. now
Available: Imodium 1 mg per 5 mL
How many mL will you give?
3) Order: Tagamet 250 mg p.o. q6h
How many mg will you give per day?
Parenteral Medications
Mosby items and derived items © 2014, 2010, 2006, 2002, 1998, 1994 by Mosby, Inc., an imprint
of Elsevier Inc.
able to:
1. Identify various types of syringes used for parenteral
administration
2. Read parenteral solution labels and identify dosage
strengths
3. Read and measure dosages on a syringe
4. Calculate dosages of parenteral medications already in
solution
5. Identify the appropriate syringe to administer the
dosage on the basis of the dosage calculation
of Elsevier Inc. 2
Technically refers to any route other than via
gastrointestinal system
Commonly refers to meds given by injection with
needle and syringe (IM, Subcut, ID, IV)
Generally act quickly because more rapidly absorbed
than oral meds
Sterile solutions, generally nonirritating
Preferred route if client is vomiting or unconscious
and no gastric route is available
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Ampules
Sealed glass container designed to hold single dose
Designed to snap open
Use protective sleeve, alcohol wipe, or gauze to
hold while snapping open
Insert filter needle into open ampule and withdraw
medication by pulling back on syringe plunger
Withdraw meds with filter needle to prevent
aspiration of tiny glass shards
Remove and discard filter needle and attach
appropriate needle for med administration
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Vial
Plastic or glass with rubber stopper or diaphragm
Sterility of rubber stopper not guaranteed wipe
first with alcohol
Single dose or multi-dose
Always measure regardless
May require reconstitution
Injection of air equal to amount to be withdrawn
facilitates removal of solution DO NOT OVERFILL
Draw up only amount of solution needed for dose
of Elsevier Inc. 5
Figure 18-1 Medication in ampules. (From Perry Figure 18-2 Medication in vials. (From Perry AG,
AG, Potter PA, Elkin MK: Nursing interventions Potter PA, Elkin MK: Nursing interventions and
and clinical skills, ed 5, St Louis, 2012, Mosby.) clinical skills, ed 5, St Louis, 2012, Mosby.)
of Elsevier Inc. 6
Mix-o-vial
Has two compartments powder separated by
stopper from solution; mix before administration
Cartridge
Prefilled glass or plastic, fits into an applicator
White tip can be removed to reveal rubber stopper
Prefilled syringe
Premeasured dosage in a syringe with or without
needle attached
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Figure 18-5 Mix-o-vial directions. A, Remove Figure 18-6 A, Carpuject syringe holder and
plastic lid protector. B, Powdered drug is in lower needleless, prefilled sterile cartridge. B, EpiPen
half; diluent is in upper half. C, Push firmly on the 2-Pak. (A, From Hospira, Inc., Lake Forest, IL. B,
diaphragm-plunger. Downward pressure From Mylan Specialty L.P., Basking Ridge, NJ.)
dislodges the divider between the two
chambers. (Modified from Clayton BD,
Willihnganz M: Basic pharmacology for nurses, ed
16, St Louis, 2013, Mosby.)
of Elsevier Inc. 8
SAFETY ALERT!
Always discard excess medication from a
cartridge or prefilled syringe PRIOR to
administration
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Various sizes
Components
Barrel outer calibrated portion to hold medicine
Plunger fits into the barrel to withdraw and inject
medicine
Tip end of syringe upon which needle or blunt tip
device is placed or into which it is prebuilt; may be
slip tip or Luer-Lok
Disposable one use only
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Figure 18-7 Parts of a syringe. (From Perry AG, Figure 18-8 3-mL Luer-Lok syringe. (From Potter PA,
Potter PA, Elkin MK: Nursing interventions and Perry AG, Stockert P, Hall A: Fundamentals of nursing,
clinical skills, ed 5 St Louis, 2012, Mosby.) ed 9, St Louis, 2013, Mosby.)
of Elsevier Inc. 11
SAFETY ALERT!
Needle-stick prevention is critical
NEVER recap used needles

Specialized needles with safety guards
Needleless systems
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Figure 18-9 Needle with plastic guard to prevent needle sticks. A, Position of guard before
injection. B, After injection the guard locks in place, covering the needle. (From Perry AG,
Potter PA, Elkin MK: Nursing interventions and clinical skills, ed 5, St Louis, 2012, Mosby.)
of Elsevier Inc. 13
Figure 18-10 Figure 18-11 Needless syringe system. (From
Becton, Dickinson, and Company, Franklin Becton, Dickinson, and Company, Franklin
Lakes, NJ.) Lakes, NJ.)
of Elsevier Inc. 14
Sizes 0.5 mL to 60 mL
Calibrated in hundredths, tenths, and whole mL
incorrect
Minims RARE, and use is discouraged
Express dose in metrics use decimals for partial
dose
Do NOT read dose at pointed tip of rubber on
plunger; read where rubber touching solution
also touches inside barrel
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Figure 18-13 Reading measured amount of
medication in a syringe. (From Potter PA, Perry
Figure 18-12 3-mL and 1-mL syringes. AG, Stockert P, Hall A: Fundamentals of nursing,
ed 9, St Louis, 2013, Mosby.)
of Elsevier Inc. 16
3-mL syringe is used for small doses greater
than 1 mL
5-, 6-, 10-, and 12-mL syringes are used to
give WHOLE mL increments
Larger syringes have larger calibrations
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Narrow capacity of 1 mL
Calibrated 0.1 to 0.01 (tenths to hundredths)
Provide accurate measurement
Heparin, PPD, skin testing, and pediatric dosing
SAFETY ALERT!
Understanding the calibration marks on a syringe is critical to
accurately measuring a medication dosage. If not measured
accurately, an incorrect dosage can be administered,
resulting in client harm.
of Elsevier Inc. 18
Use for INSULIN ONLY do not give insulin
with any other syringe
Measured in units
Syringe calibrated to match insulin doses
U-100 syringes for U-100 insulin
NEVER think in terms of mL when giving
insulin; think in units
Two types
Lo-dose
1-mL sizes
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Lo-dose insulin syringes
Have 30- or 50-unit capacities
Have enlarged scales for easy reading
Standard insulin syringe
Capacity of 100 units of insulin
2-unit increments
SAFETY ALERT!
Insulin is a high-alert medication. Always
check insulin dosages with another nurse
before administration.
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Figure 18-17 1-mL capacity insulin syringe (100 units) with dual
scale odd and even calibrations. (From Becton, Dickinson, and
Company, Franklin Lakes, NJ.)
Figure 18-16 Insulin syringes. A, 1-mL size (100 units).

B, Lo-Dose (50 units). C, Lo-Dose (30 units). (From
Macklin D, Chernecky L, Infortuna H: Math for clinical
practice, ed. 2, St. Louis, 20011, Mosby.)
of Elsevier Inc. 21
states she is feeling better. She has blood
glucose checks with sliding scale insulin
ordered every 6 hours. On the basis of the
order, you will administer 2 units of Humulin
Regular U-100 insulin subcut for a blood
glucose level of 164 mg/dL.
Which syringe will you use to draw up the
insulin, and what will you do before
administering it?
of Elsevier Inc. 22
Answer:
Choose the Lo-dose 30-unit insulin syringe for
the best accuracy. Check the dose with another
nurse using the 6 rights of medication
administration. Also be sure to check the
expiration date on the vial.
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Depicts total volume in container
Gives dosage strength expressed in mL
READ LABELS CAREFULLY
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Label gives med in percent and in mg/mL
Express the number of grams of
medication per 100 mL of solution
Typically prescribed in number of mL to
give, rather than dosage
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Most commonly epinephrine
Usually ordered by number of mL
CAUTION with these easy to confuse
1:1,000 with 1:10,000
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Heparin, Pitocin, insulin, and penicillin
Units measure drug in terms of action
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Potassium and sodium bicarbonate
Specific to medication being used
Measure electrolytes and express ionic
activity
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Use same rules and methods as for oral
calculations
Convert if necessary
3-mL syringe: calculate to hundredths,
round to nearest tenth
1-mL syringe: calculate to thousandths,
round to nearest hundredth
NEVER round to the whole number
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Large syringes are calibrated in 0.2-mL
increments
Measure and label doses in mL and
strength (e.g., 2 mg in 4 mL)
Insulin is measured and given in UNITS
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For injectable meds, consider:
Condition of the client
Site selected
Absorption and consistency of med
When the amount exceeds the amount that
can be administered in a single site, divide
into two injections.
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Intramuscular:
Average adult = 3 mL (deltoid muscle = 1 mL)
Children ages 6-12 years = 2 mL
Subcutaneous:
Adults = 1 mL
Intravenous:
Injectable medications should be added to IV
solutions to produce a volume > 5 mL
of Elsevier Inc. 32
Two meds may be mixed
IF they are compatible with each other
AND the total amount does not exceed the
amount that can be safely administered in a site
Calculate the dosage to be administered to
the nearest tenth for each med
Add the results to find the total volume
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Order: Gentamicin 75 mg IM q8h
Available: Gentamicin labeled as 40 mg per
mL
How many mL will you administer?
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Read med labels and syringe calibrations
carefully
The is no conversion of units and mEq
Do not exceed the dosage administration
guidelines
1 mL syringe calibrated in 0.01 mL. Round to
the nearest hundredth
3 mL syringe calibrated in 0.1 mL. Round to
the nearest tenth
5 -, 6 -, and 12 mL syringes calibrated in 0.2
mL. Round to nearest tenth
of Elsevier Inc. 38
What is the total volume in the ampule?
What is the dosage strength?
The order reads:
250 mg Aminophylline IV over 30 minutes now
How many mL are needed and what syringe would
you use to measure the dosage?
of Elsevier Inc. 39
Later in your shift, you notice increasing edema
that she feels slightly short of breath. Her

oxygen saturation is 90% on room air and you
place 2 L of O2 via nasal cannula. You auscultate
coarse crackles to bilateral lung bases and
immediately call the respiratory therapist and
the physician, who tells you to discontinue IV
fluid and administer Lasix 20 mg IM stat.
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How many mL will you administer?
What syringe will you use?
Where will you inject the medication?
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Answer:
Use a 3 mL syringe to administer 2 mL Lasix into

a large muscle (3 mL exceeds injectable
guidelines for the deltoid muscle).
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Chapter 5
Percentages

Percentages: Objectives
1. define percentage 5. convert decimals to

fractions 6. convert fractions to
decimals 7. convert fractions to
4. convert percents to ratios
ratios 8. determine the percent
of numbers

Percentages: Background
Way to express the relationship of parts to a
whole. Percent (%) means parts per hundred. A
percentage is the same as a fraction in which
the denominator is 100
Health care uses:
Medications: Magnesium sulfate 50%
IV solutions: of D5W (Dextrose 5% in water)
Diet consumed
Level of burns

Percentages: Definition
Percentage refers to how many parts are
related to the whole (100 parts)
5% = 5 parts of 100 parts or or

5 per 100

Percentages: Convert to a Fraction
% symbol may be used with whole numbers
(15%), mixed numbers (3½%), fractions (¾%), or
decimals (0.6%)
To convert to a fraction, drop % sign, write the
number as the numerator, and 100 as the
denominator and reduce
Examples:

Percentage: Convert to a Decimal
To convert to a decimal, drop % sign and divide
the number by 100, this is the same as moving
the decimal two places to the left (add zeros if
needed)
Examples: 25% = 0.25
1.4% = 0.014
Alternative method: write as a fraction with 100
as the denominator and divide numerator by
denominator

Percentage: Convert to a Ratio
To convert to a ratio, drop % sign and convert to
a fraction, reducing to the lowest terms. Then,
place the numerator as the first term of the ratio
and the denominator as the second term.
Separate the two terms with a colon (:)
Example:

Percentage: Fraction to Percent
Multiply the fraction by 100, reduce, add percent
sign
Example:
Alternative method: convert the fraction to a

decimal, multiply by 100, add percent sign
Example:

Percentage: Decimal to Percent
Multiply the decimal by 100 (which is the same
as moving the decimal point two places to the
right). Add zeros if necessary. Add the percent
sign.
Examples:

Percentage: Decimal to Percent (Cont.)
Change the decimal to a fraction, then follow the

steps to convert a fraction to a percent. If the
percent does not end as a whole number,
express the percent with the remainder as a
fraction, to the nearest whole percent, or to the
nearest tenth of a percent.
0.625 = 625 = 5 = 62 ½%, 63%, or 62.5%

1000 8

Percentage: Ratio to Percent
Convert the ratio to a fraction, then change the
fraction to a percent as described previously
Example:

Percentage Measures
Intravenous (IV) solutions are ordered in
percentage strengths
Percentage = number of grams (g) of solute per
100 mL of diluent
1,000 mL of D5W (Dextrose 5% in water)
5 g in 100 mL = (x) g in 1,000 mL

100(x) = 5(1,000)
x = 50 g

Comparing Percents and Ratios
Converting percentages and ratios to equivalent
decimals can clarify values so professionals can
compare concentrations.
The higher the percentage, the stronger the
solution
Examples:
A 10% solution is STRONGER than a 5% solution
A 0.99% solution is WEAKER than a 1% solution
1:1,000 is a STRONGER concentration than 1:10,000

Determining the Percent
of a Quantity
First, convert the given percentage to a decimal
or fraction, then multiply the decimal or fraction
by the number
Example: A client reports he drank 25% of his 8-
ounce cup of tea. Determine how much tea the client
drank.

Determining What Percent One
Number Is of Another
Make a fraction with the numbers the
denominator is the number following the word
Convert to a decimal, then to a percentage

Example: 12 is what percentage of 60?

Calculating the Percent of Change
First make a fraction of change: change
old
Change the fraction to a percent
Example: Before starting his diet, the client

weighed 206 lb. Now he weighs 174 lb. What is
the percent of change?
The decrease = 206 lb 174 lb = 32 lb
Fraction 32 x 100 = 3200 = 15.5 % decrease
206 206

1. Convert the following decimals to percents
a. 0.379 b. 2.94
2. Convert the following percents to decimals

a. 78.3% b. 402%
3. What is 41% of 209?

4. A client was given 1000 mL to drink. You find
50 mL left in his cup. What percent did he
drink?

Case Study 1
Ms. White was started on IV NS at a rate of
100 mL/hr. The prescriber changed the rate to 150
mL/hr. What is the percent of change?
Round final answer to the nearest whole number.

ANS:
33% increase

Ms. White returns to the clinic for a checkup after
being treated last week for UTI. Today, she weighs
127.6 lb, which is 3.35 lb more than she weighed
last week. What is the percent increase in her
weight? Round final answer to the nearest tenth.

ANS:
2.6%

Chapter 4
Ratio and Proportion

Ratio and Proportion: Objectives
1. define ratio and proportion

2. define means and extremes
3. calculate problems for a missing term (x) using
ratio and proportion

Ratio and Proportion: Background
A ratio indicates the division of two quantities

Can be used to calculate all types of med
problems or nurse/client ratios
Example: 4 nurses to 28 clients = 1:7 ratio
Some meds use ratio to express strength of
solution
Example: Epinephrine 1:1,000
Ratios should be expressed in lowest terms

Ratios
Used to indicate relationship between two
numbers
Numbers are separated by a colon (:)
Colon indicates division
Numerator on left : Denominator on right
Example: 1:3 is the same as 1/3

Ratios: Measures in Solutions
In medications
Ratio of parts of drug to parts of solution = strength
Safety Alert
The more solution in which a drug is dissolved, the
less potent it becomes
Example: 1 part drug to 1,000 parts solution is more
potent (stronger) than 1 part drug in 10,000 parts
solution

Proportions
An equation of two ratios of equal value
Written in any of following formats
Example: 3:4 = 6:8 (separated with equals)

3:4 :: 6:8 (separated with double
colon)
(written as a fraction)
or

Proportions: Means and Extremes
Relationship between left and right terms is

expressed by means and extremes
Means = Middle Extremes = End
In a true proportion, product of means is equal
to product of extremes
Means
250=250 TRUE
Extremes

Example

Ratio and Proportion: Solving for x
If three numbers in a true proportion are
known, the unknown fourth number called
x can be found
x is usually placed on the left

Example

Proportion: Proof
12:9 = 8:x
Place the value previously obtained in the
spot for x
12:9 = 8:6
Multiply means by extremes should be
equal
9(8) = 12(6)
72 = 72

Ratio: Dosage Calculation
Ratio is used to represent the weight of a
medication that is in tablet or capsule form
or in a certain volume of solution.
Examples:
1 tab : 0.125 mg or
1 mL : 250 mg or
In dosage calculation, include the unit of

measurement in the dosage strength

Proportion: Dosage Calculation
Solve for x in medication dosage
calculations
Example: If there are 500 mg in 1 capsule, how
many milligrams are delivered in 2 capsules?
1 cap : 500 mg = 2 caps : x mg

1(x) = 500(2)
1(x) = 1,000
x = 1,000 mg

Express the following dosages as ratios:
a. Amoxicillin 250 mg in each capsule
b. Diphenhydramine Elixir 12.5 mg in each 5 mL
Determine the value for x:

c. Available: Lisinopril 5 mg tablets, Order: 10 mg
d. Available: Zocor 40 mg tablets, Order: 20 mg

Case Study 1
Ms. White has told the provider that she has

difficulty swallowing pills. An order is written for
Ciprofloxacin oral suspension 450 mg PO once.
You have on hand Cipro 250 mg/5 mL. Using
ratio proportion, how many mL will you
administer?

ANS:
9 mL

CHAPTER 13
Reading Medication Labels
Reading Med Labels: Objectives
1. Identify trade and generic names of
medications
2. Identify dosage strength of medications
3. Identify forms in which medications are
supplied
Reading Med Labels: Objectives
(Cont.)
4. Identify the total volume of a medication
container where indicated
5. Identify directions for mixing or preparing a
medication where necessary
6. Identify information on combined medication
labels
Reading Labels: Generic Names
Given by manufacturer who develops the med

One generic name, not capitalized
Legally required on all labels
Nurses need to know generic AND trade name
Dispensed less expensively than brand
Common generics: morphine, atropine, phenobarbital,
meperidine
Look-alike, sound-alike -
letter
busPIRone vs buPROPion
5
Figure 13-1 Morphine label: 10 mg per mL. Figure 13-2 A, Furosemide label: 20 mg per 2 mL
(10 mg per mL). B, Meperidine label: 50 mg per mL

2006, 2002, 1998, 1994 by Mosby, Inc., an
Reading Labels: Trade Names
May be many for one generic

Prominently displayed, always capitalized
® or to indicate registration of name
TriCor (trade name) or fenofibrate (generic name)
Isentress (trade name) or raltegravir (generic name)
7
Figure 13-3 TriCor label. Figure 13-4 Isentress label.

2006, 2002, 1998, 1994 by Mosby, Inc., an
8
Case Study 3
Mr. Ross is 2 days post-op and currently tolerating a clear
liquid diet with no nausea. His pain is adequately
controlled with PCA morphine. The physician orders to

As you look at the label you distinguish which names as
trade and generic?
9
10

Answer:
Zocor is the trade name

Simvastatin is the generic name
Reading Labels: Dosage Strength
Weight or amount of medication in a specific unit of
measure
Solid meds = amount of med per tab, cap, etc.
e.g., amoxicillin 250 mg per capsule
Liquid meds = amount of med per mL, L, etc.
e.g., lactulose 10 g per 15 mL
May be stated in two different but equivalent dosage
strengths
e.g., Forteo 0.25 mg per mL = 250 mcg per mL
Sometimes expressed as a ratio or percent
e.g., epinephrine 1 g per 1,000 mL (1:1000)
12
Figure 13-8 Lidocaine label. Lidocaine 1% contains

1 g of medication per 100 mL solution and 10 mg
per mL.
Figure 13-7 Epinephrine label. Epinephrine

contains 1 g of medication per 1,000 mL solution
(1:1,000) and 1 mg per mL.
Reading Labels: Form
Type of med in package
Tablets, capsules, liquids, suppositories, ointments, etc.
Abbreviations or words that describe form
CR (controlled release), DS (double-strength)
Barcode symbols
Aid in inventory control and distribution
Meds that allow extended action or slow release

should NEVER be crushed or chewed. They may be
labeled with: CR (controlled release), LA (long
acting), EC (enteric coated), SR (sustained release)
Reading Labels: Route
The route should be clearly indicated on the label
Oral, IM, IV, topical, optic, otic
Unless stated otherwise, capsules, pills, and tablets
are understood to be oral meds
Liquid meds may be administered orally or by
injection. Labels will indicate the correct route
Reading Labels: Volume
Liquids
Total volume in container is stated
Strength is expressed as medication per volume of solution
(e.g., mg in mL 5 mg per 10 mL)
Figure 13-14 Clindamycin Injectable label.
16
Reading Labels: Amount

Solids
The total number of capsules or tabs is listed
Strength of each tablet or capsule is provided (e.g., mg in
each tablet 50 mg per tablet)
Powders for reconstitution precise instructions
Figure 13-9 A, Metformin Hydrochloride Extended Release Tablets. B, Depakote Sprinkle Capsules. C,
Inderal LA Long Acting Capsules. D, Ery Tab Delayed Release Tab and Enteric Coated.
Reading Labels:
Precautions Expiration
Precautions
Safety
Storage
Examples: Protect from light, Keep tightly closed, Refrigerate
after opening
Usual dosage
SAFETY ALERT!
ALWAYS CHECK EXPIRATION
DATES
Reading Labels: Controlled
Labeling
Narcotic FDA control number
Based on abuse potential
Schedule I to Schedule V
Written as CI, CII, CIII, CIV, CV
Highest abuse potential is CI
Lowest abuse potential is CV
Figure 13-2 A, Furosemide label: 20 mg per 2 mL (10

mg per mL). B, Meperidine label: 50 mg per mL
Reading Labels: Combinations
The capsule, tablet, or liquid contains two medicines
within one vehicle
Orders must include dosages not just number of tabs
or mL
Exceptions: If strength is NOT indicated on label, only
one strength exists, and it can be ordered by number
of tabs, caps, mL
Examples: multivitamins, Bactrim DS, Percocet
Combination Medication Label
21
Combination Medication
SAFETY ALERT!
Numbers following a medication name may be
used to identify the dosage strengths of more
than one medication in a preparation, and initials
may be used to identify a special medication
action. Real labels carefully to validate that you
have the correct medication and dosage for
combined medications.
Reading Labels: Unit Dose
Unit dose
Labeled individually
Packaged individually
In computerized dispensing system
In client-specified drawers
Multidose bottles or vials are used if large quantities
are necessary for unit
Examples: Tylenol, insulin
Reading Labels: Other Information
Lot/Control Numbers
Required by law
National Drug Code (NDC) number
Other abbreviations
USP (United States Pharmacopoeia)
NF (National Formulary)
24
Name the Parts of the Label

A
B
C

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Converting Between Celsius

Example: Convert 65 lb to kilograms

lb = 24.7 2.2 = 54.34 rounds to 54.3 lb

Mosby items and derived items © 2014, 2010,

• To convert p.m. time, omit the colon and “p.m.,”

• To convert times between 1200 and 2400,

The IV fluid will not be finished by 1000. Completion time is

500 mg : 1 tab = 250 mg : x tab

What is your next course of action?

Mosby items and derived items © 2014, 2010, .

Equivalents are not exact

Changing from one form to another

Mosby items and derived items © 2014, 2010, .

Larger to smaller move decimal to right

All measurements must be in the

0.6 mg = ____ mcg

0.600 mg = 600 mcg

Note: Carry division at least two decimal places to ensure

You may set up the conversion problem in fraction

Can use methods previously discussed

Mr. Hain is complaining of 7 out of 10 abdominal pain.

liquid at body temperature gelatin, popsicles

Preferred method is milliliters (mL)

1/3 glass apple juice (1 glass = 6 oz) = 60 mL

Record intravenous (IV) fluid intake

You have obtained an order for 40 mEq potassium

well controlled with prn medication, and he is in

input and enter the data in milliliters. How many

Which amount is insufficient urine output? Remember

After reviewing this chapter, you should be able to:

Critical care medications can be potent and require

Calculating rate in mL/hr for specific dosage is one of

Isuprel 2 mg per 250 mL D5W. Infuse at 5 mcg per min

Order: Infuse dopamine 400 mg in 500 mL of

1. Use ratio and proportion to determine the dosage per

24 mg (1,000) = 24,000 mcg

3. Change mcg per hr to mcg per min:

24,000 60 min = 400 mcg/min

Client is receiving Pronestyl at 60 mL/hr. The solution is

1. Convert g to mg (1 g = 1,000 mg)

3. Convert mg/hr to mg/min (60 min = 1 hr)

1. Convert 150 lb to kg (2.2 lb = 1 kg )

2. Determine dosage per minute

136.4 mcg per min 60 min = 8,184 mcg/hr

2. Convert to mcg per hr to mg per hr:

8,184 1,000 = 8.18 = 8.2 mg/hr

3. Determine flow rate:

400 mg : 250 mL = 8.2 mg : x mL

Nurse should know:

Double or triple check med dosages

Start at lowest dose first

Example: Nipride has been ordered to

1. Calculate dosage range first:

2. Calculate IV rate in mL/hr for lower dose:

Nipride titrated at 3 to 6 mcg per kg per min to maintain

x = 16.7 mL/hr or 17 mL/hr rounded

Dosage Rate (mcg/min) Flow Rate (mL/hr)

*Notice in this problem mL/hr was rounded to the nearest whole

the Levophed infusion. Although he is alert, he is complaining

Levophed titrated at 2 mcg/min to 6 mcg/min, increasing the

Available: 2 mg/250 mL D5W

Determine the new rate and develop a titration table rounding

Dosage Rate (mcg/min) Flow Rate (mL/hr)

medical surgical unit.