OSAGE 101 Basic formula for Tablets / Cap- sules IV drip rates « When calculating how many hours or how long the infusion will run there is no need for a drop factor. + When calculating gtt/ min you will need the drop factor. mL/hr Total amount to be infused How many hours should the infusion run? Example Infuse 500mL over the next 120 minutes by in- fusion pump. 500mL = 250 mL/ Hr 120min / 60 (2h) lS mL/ min Total to be infused -x gtt factor Hours x 60 Example Calculate the IV flow rate for 1500 mL of NS to be infused in 7 hours. The infusion set is calibrated for a drop factor of 20 gtts/mL. 1500mL 1 gtt/min 7x60 min . (420) Ay i I rate in Hr/ volume amount/Hr ~ --x volume On hand x 20 gtt/MI = 71.4 gtt/ min Rounded to Example Give patient 400 mg of vancomycin in 300 mL of DSW to infuse at 10 mg/hr. Calculate the flow rate in mL/hr. 10 mg/hr -x300mL = 7.5 mL/hr 400mg ©)sinplenursins Example : HCP orders lorazepam 50 mg / day po. The pharmacy has it available in 100 mg tablets. How many tabs would you ad- minister? — X Tablets = 0.5 tablets or ¥2 of a tablet. Pediatric doses + Pediatric doses are based on body weight in kg. + To convert pounds to kg divide by 2.2 Weight per kg x dose per kg = amount to be administered. You use this same formula for safe dose range. Example: The HCP orders 250 mg of meropenem to be taken by a infant weighing 15.7 pounds, every 8 hours. The medication label shows that 75-150 mg/kg per day is the appropriate dosage range. Is this order within the safe dose range for this medication? 15.7/2.2= 7.13 kg. 150mg x 7.13 = 1,069.5 safe perday 75 mg x 7.13 = 534,75 safe per day 24 hrs/8= 3 doses / day ° 250mg x 3 doses = 750 ma/ day This is within safe dose range.Purpose: Decompress the stomach by removing fluids or gas. This promotes abdominal comfort. To allow surgical anastomosis to heal without distention, decrease risk of aspiration, provide nutrition as a feeding tube, to irrigate and remove toxic substances in the stomach . Assessment + Determine indication for NG tube insertion. + Assess for previous insertions. + Assess for latex. + Assess for adhesive allergies. + Assess respiratory status. the airway. technique. Supplies (NG Tube Kit) + Clean gloves «Feeding tube 7 + Sterile water om + Lubricant «Tape or marking pen + Syringe «pH tape / + Feeding solution Procedure 1. Confirm HCP order, obtain consent. 2. Confirm client ID and 3. Provide privacy and introduce yourself. 4, Perform hand hygiene. 5. Explain procedure to family and client. 6. Position the client in Semi Fowler's position with pillows behind the shoulders. 7. Determine the most patent nostril. 8, Measure the length of the tube from the bridge of the nose to the earlobe then the xiphoid process and mark this spot. 9. Don clean gloves. 10. Give the client a drink of water, lubricate the tip of the catheter. 11. When the tube nears the back of the throat, have the client swallow. If resistance is met aim the tip downward. 12. Immediately remove tube if 02 sats drops. 13. Following insertion obtain an X-ray to confirm placement. 14. Connect the tube to suction as ordered. 15. Secure the tube to the client's nose. 16, Aspirate stomach contents and check PH to confirm, placement before feeding. 17, Wash hands. 18, Document. Risks « Risk for placement into + Risk for infection from not using aseptic + Risk for injury from insertion or removal. Documentation - Date and Time of procedure. + Type and size of tube. + Verify method of placement and patency. + Type and amount of contents. + PH of contents. + Type and amount of feeding given. + Client's response and tolerance. + Position of the client post procedure. Tip «Check residual and stomach contents prior to administration of meds or feedings. To avoid electrolyte and fluid imbalances replace aspirated contents. Stomach contents pH should be around four. + Most hospital policies require a KUB before administering meds/ TF. + Check residual every 4 hours if getting TF.Purpose: Performed to prevent infection related to stoma surgery. To monitor output, and assess client's nutritional status, and hydration status. Assessment Risks + Determine indication for + Risk for infections. stoma care. + Risk for impaired + Assess stoma for color, skin integrity. drainage or excoriation. + Risk for injury from + Assess for latex allergies. + Assess for adhesive allergies. + Ensure you have the proper appliance. insertion or removal of appliance. Supplies (Ostomy Supplies) « Bedpan, graduated cylinder, toilet access. ~ «Clean gloves, toilet tissue. + Washcloth, towel, waterproof pad. { + Wash basin with warm water. + Gauze, skin barrier cream. + Stoma measuring guide. + Ostomy tools and bag. + Clamp, trash bag. Procedure Documentation 1. Confirm HCP order, obtain consent. (G *)) + Date and Time of procedure. 2. Confirm client ID and DOB. ~S = Why you performed the 3. Provide privacy and introduce yourself. ) procedure or if the client did 4, Perform hand hygiene. ( OTe Rees 5. Help the client to a sitting position. «Size of the stoma. 6. Place graduated cylinder under bag for measurement. aiemeerenisciccortneteemea 7. Remove the clamp and uncuff the bag and allow . J contents to empty into the measuring device. color, odor, drainage, redness, 8. Wipe the end of the cuff with toilet tissue. excoriation. 9. To remove the appliance start at the top and move + Characteristics of feces, amount, around pushing skin away from the appliance. color, odor. 10. Discard the appliance unless reusable. - How the client tolerated the 11. Gently clean the surrounding skin with a washcloth procedure. and warm water. 12. Pat the skin dry and apply barrier cream no closer than 2 in from the stoma. Let dry completely. 13, Remove gauze and assess and measure stoma. 14, Cua hole in the appliance to % inch larger than Tip the stoma. 15. Carefully peel the backing off the appliance and lay ‘over the stoma. 16. Smooth out air and hold even pressure for 5 minutes. 17. Apply the clamp to the bottom of the new pouch. 18. Wash hands. 19, Document. + Some clients have their own routine when it comes to stoma care and appliance care. Allow them to maintain their own home routine if possible.Trach care and Purpose: Routine trach care is provided to aid in the healing process of the stoma and prevent skin breakdown. Frequent suction aids in clearing the clients secretions and decreases the risk of infection and oxygen deprivation. Assessment Risks Patient Teaching « Assess odor. «Risk for infection. + Explain procedure and + Assess cannula type. + Risk for decreased oxygenation. indications. «# Assess respiratory sounds + Risk for injury from insertion or Patients should verbalize before and after procedure. removal. . understanding of proper «Assess for secretions. + When performing tracheostomy care. + Assess skin integrity and for signs of infection. + Assess type of tracheostomy and dressing. RowNe aw 10. nL. 12. 2B. Procedure Confirm the patient's ID using two identifiers. Explain procedure to patient. Open trach tray and put on one sterile glove in order to set up two basins. With an ungloved (non-sterile) hand, pour saline into each basin. Don the second sterile glove - both hands are now sterile. Remove inner cannula, if applicable: Secure ‘outer cannula neck plate with index finger and thumb. Unlock inner cannula - usually by turning LEFT 90 degrees. Gently pull cannula up and out -it should withdraw easily. Soak and clean the inner cannula in sterile normal saline or discard if disposable. Remove any secretions by cleansing and wiping the lumen with moistened brush. Place cleaned inner cannula on sterile gauze and dry thoroughly. Replace inner cannula with care, stabilizing outer flange with opposite hand. Lock into place (turn RIGHT). Cleanse skin around stoma with gauze or applicator soaked in sterile saline from the clean basin (the basin that was not used to clean inner cannula). Use a separate gauze/applicator to clean the outer cannula. Apply new dressing: Apply presplit non-fraying gauze/split drain sponge around ostomy/trach tube with flaps pointing up. (See picture of how to make folded 4x4 dressing if a presplit is not available) Change trach ties/tube holder if needed. (See: Changing tracheostomy tube ties) Ask the pt if they need anything. Lock bed, put it in lowest position with call bell in reach. care, emergency supplies should be available at all times in case the tube is inadvertently dislodged, and an ambu bag to administer breaths as needed for the client on a vent. + Explain feelings the client will feel (they may gag). Explain you will maintain privacy. + Be supportive. iy Supplies for trach care «Trach cleaning tray (includes sterile gloves, sterile basins, pipe cleaners, brush, cotton-tipped applicators, gauze). + Presplit non-fraying 4x4 or split drain sponge. + Replacement inner cannula, if applicable. * Sterile normal saline. lean cotton trach ties or Velcro tube holder. * Two sterile containers for cleaning solution and extra sterile gloves. Documentation + Date and Time of procedure. + Any drainage, color, odor and amount on dressing, + Client's response and tolerance. + Position of the client post procedure. + If suctioned, color, type and amount of secretions.