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Conquering Med Math

Calculations
FOR STARTERS:

 Memorize important conversions and formulas

EX: 5 mL = 1 t (teaspoon)

Order: Robitussin 2 t PO now

How many mL will you administer?


Do the math:

 2t x 5mL = 10 mL

Dimensional Analysis (DA):


5mL/1t x 1/2t = 10 mL

Use DA to avoid confusion


 There are several methods to
approach each type of problem.
Determine which method works best
for you

 Practice!

 See Kee & Marshall Clinical


Calculations : With Applications to
General and Specialty Areas
The most common formula used to calculate drug doses:
D/H x V

D= Desired Dose (Dose Ordered)


H =Dose on Hand (Available)

Vehicle: tab, cap, mL

The vehicle is what that drug is being delivered in:


EX: tablet, capsule, milliliter

DA is another way of doing the exact same thing


Pt is being treated for otitis media. The
medication order reads: Ceclor 500 mg PO
BID

Dose on hand is (available): Ceclor 250 mg

D/H x V (capsule)
500 mg/250mg
Administer: 2 Caps

DA: 1 cap/250mg x 500mg/1 = 2 Caps

Calculate Dose
 Order: diphenhydramine 30 mg (Benadryl)
Available: diphenhydramine 12.5 mg/5 mL

 Formula: D/H x V (5 mL is the vehicle)

 Set up the problem and calculate dose

Calculate Dose
D= 30mg
H= 12.5 mg x 5 mL =

2.4 x 5 = 12 mL

12 mL of Benadryl will be administered


SAME Problem using DA

 Set up an equation where you need to


solve for mL.
 REMEMBER: This is a liquid and the
nurse needs to know how many mL to
administer
 5 mL/12.5mg x 30 mg/1 =
150/12.5 = 12 mL

Always keep in mind what you


want to end up with
Before doing any med problem: All units in
the equation must consistent. If not, do
necessary conversion prior to setting up the
problem.

FOR EXAMPLE:
 Order: levothyroxine (Synthroid) 0.1 mg PO
STAT

 Drug available: levothyroxine 50 mcg tabs

What do you need to do first?


CONVERSION: 1 mg = 1,000 mcg

ORDER: levothyroxine (Synthroid) 0.1 mg PO STAT

DRUG AVAILABLE: levothyroxine 50 mcg tabs

1) Convert mcg to mg (or mcg to mg as long as they


are consistent within the problem)

1,000 mcg/1mg x 0.1mg/1= 100 mcg

2) D/H X V → 100 mcg/50 mcg x tab = 2 Tabs

Administer: 2 Tabs
D/H x V
Drug Doses
Grams, mg, mcg

Grams has several acceptable


abbreviations: G, Gm, g, gm
1 G = 1,000 mg
EX: Vancomycin 1 G IV
VOLUME
mL=milliliters

1 Liter = 1,000 mL (cc)

3 mL syringe
Heparin 5,000 U/mL
Order: Levoxyl 0.1mg IV NOW

On Hand: 200mcg/mL

How many mL will your draw up?


All units consistent before calculating
the dose:

Convert mcg to mg
 D/A: 1,000mcg/1mg x 0.1mg/1 =
100 mcg
2) D/H x V
 100 mcg
200 mcg x 1 mL = 0.5 mL

Draw up and administer 0.5 mL


Same problem: D/A and convert to mg to
make all units consistent:

Order: Levoxyl 0.1mg IV NOW

On Hand: 0.2 mg/mL (converted 200mg)

mL/0.2mg x 0.1mg/1=0.1/0.2mL=0.5 mL

Important: Always put a zero in


front of a decimal
 1,000 mL = 1 L
amount of fluid = ml/hr
hours to administer

*Order: 1 Liter 0.9NS to infuse over 8 hrs*

Divide: 1,000 mL/8hr = 125 mL/hr

Simple Division

Flow Rates: mL/hr


Order:
 Heparin 25,000 U in 250 mL in
Normal Saline
 Infuse at 1,000 U/hr

How many mL/hr?

Calculate Rate of Infusion


DA: Always use dimensional analysis
for IV problems:

 250 mL X 1,000 U =
25,000 U X 1 hr

 250,000 = 10 mL/hr
25,000
Heparin 25,000 U in 250 mL NS to
Infuse @ 1,000 U/hr = 10 mL/hr
Calculate the dosage and shade the
dosage on the syringe where provided

 Order: Lovenox 60 mg subcutaneous bid

 Available: Lovenox labeled 40 mg/0.4


mL

a. How many mL will you administer?


_________ mL

b. Shade in the dosage on the syringe


D/A
 0.4mL/40mg x 60mg/1 = 0.6mL

 D/H x V can also be used

Either way, Always make sure:


Does the answer make sense to you?

If 60mg = 0.6 mL → 40 mg = 0.4 mL


Yes, it makes sense!

Lovenox (enoxaparin)
 How many mg/mL?

In other words: what is the


concentration?

40 mg/0.4mL = 100 mg/mL


Calculate the infusion rate:

 Order: Regular insulin 10 units/hr IV


 Available: 40 units of insulin in 100
mL 0.9% NS.
 What is the infusion rate? (mL/hr)
______________

Solve for mL/hr


Set Up a problem that will cancel
out units
 DA

 The problem is asking you to solve for


mL/hr

 Need to set up a problem that will cancel


out units

100 mL x 10 U = 25 mL/hr
40 U hr

Order: 40 units of insulin in 100


mL 0.9% NS @ 10 U/hr
Drop Factor Formula:

mL/hr X gtt/mL
60 min

MEMORIZE FORMULA!

 gtt/mL depends on what type of IV set


you have: It will be given in the
problem
 Round final answers to whole numbers!
Remember: we can’t split drops in half

Drop Factors
MACRO MICRO
10 gtt/mL 60 gtt/mL

Drop Factors:
Will be stated on the package
Drop Factor = gtt/mL
Calculate the IV flow rate in gtt/min
(drops/min) using the drop factor
provided

1000 mL 0.9% Saline to infuse at 125


mL/hr
a. 10 gtt/mL _________
b. 15 gtt/mL _________
c. 20 gtt/mL _________
d. 60 gtt/mL _________

On the Med Math Test


FORMULA
mL/hr X gtt/mL
60 min
Calculate gtt/min:
1000 mL 0.9% Normal Saline to infuse
over at 125/hr
a. 10 gtt/mL

125 mL/hr X 10 gtt/mL = 1,250 =


60 min 60

20.833 = 21 gtt/min

Just plug the #s into the formula


Check your answers

b. 31 gtt/min
c. 42 gtt/min
d. 125 gtt/min

 Keep practicing gtt/min problems!

Practice problems in the Book:


Kee & Marshall
Determine the drop factor for the
following using a drop factor of 20
gtt/mL:
300 mL of 0.9 Normal Saline in 2 hours

Take Note:
 mL/hr many not always be given in the
problem
 May need to calculate mL/hr 1st

Drop Factors
 Step 1: To get mL/hr: divide

300mL/2hr = 150mL/hr

 Step 2: Use drop factor formula

150 mL/hr x 20 gtt/mL


60 min

How Many gtt/min?


Ounces (oz) and mL
 1 oz = 30 mL Memorize!

 To convert oz to mL, multiply oz by


30

 To convert mL to oz, divide ounces by


30

 Example:
Change 5 oz to mL: 5 x 30 = 150 ml

Intake and Output (I and O)


A patient's intake was the following:

3/4 cup of coffee (cup = 8 oz)


1 can of ginger ale (1 can = 12 oz)
1/2 glass of cranberry juice (glass = 6 oz)

 How many mL will you record on the


intake and output (I&O) sheet for
intake?

_________mL

Simple Multiplication and Addition


Double Check Your Answers!
 3/4 cup of coffee (cup = 8 oz)
8 oz x 0.75 = 6oz 6oz x 30 = 180 mL

 1 can of ginger ale (1 can = 12 oz)


12 oz x 30 = 360 mL

 1/2 glass of cranberry juice (glass = 6 oz)


3 oz x 30 = 90 mL

 ADD: 180 + 360 + 90 = 630 mL

Intake = 630 mL
Breakfast: 4 oz Apple juice
1/2 cup of tea
1/2 bagel with cream cheese
4 oz of milk for cereal
1 mini box of Special K

Lunch: 6 oz Chicken Broth


1/2 ham sandwich
4 oz cup of cherry Jell-O
8 oz can of diet Ginger Ale

IV: 5% Dextrose 0.45% NaCl @ 65 ml/hr


Voided twice 200 ml and 400 ml
JP wound drain 50 ml

a. What is the patient’s intake for the last 8 hrs? _____________________

b. What is the patient’s output for the last 8 hrs? _____________________

Be Careful: Always Follow


Directions Exactly