F L U I D S AND ELECTROLYTES

Water overview
*Water comprises about 60% -70% of the total body weight *Varies with age weight gender

Normal Composition in Average Man

•When a person loses more than 10% of his total body fluids,he can DIE!!!

Functions of Water in the Body •-Transporting nutrients to cells and wastes from cells •-Transporting hormones. blood platelets. enzymes. and red and white blood cells •-Facilitating cellular metabolism and proper cellular chemical functioning •-Facilitating digestion and promoting elimination •-Acting as a solvent for electrolytes and non-electrolytes •-Acting as a tissue lubricant and cushion •-Helping maintain normal body temperature .

PO4--.Two Compartments of Fluid in the Body •Intracellular fluid (ICF) (70%) — fluid within cells . HCO3-. Mg++ •Extracellular fluid (ECF) (30%) — fluid outside cells . Cl-.large amounts of Na+.large amounts of K+.Includes intravascular(15%) and interstitial fluids(5%) . Ca+.

Water Loss ROUTES OF WATER LOSS -SENSIBLE Urine Feces -INSENSIBLE Lungs Sweat .

Causes of Increased Water Loss •Fever •Diarrhea •Diaphoresis •Vomiting •Gastric suctioning •Tachypnea Causes of Increased Water Gain •Increased sodium intake •Increased sodium retention •Excessive intake of water •Excess secretion of ADH .

salts. gives a solution that can conduct electricity (Electrochemistry Dictionary) -Simple inorganic salts -Electrolytes dissociate when dissolved in water to form positively and negatively charged ions (Dissociation and electrolytes) -All inorganic acids. are electrolytes -Also known as Ionic solutes . bases.Ions Electrolytes Cations — positive charge Anions — negative charge -An electrolyte is a substance. that when dissolved in water.

potasium. chlorine. bases or salts (Sodium.Importance of electrolytes -Maintain voltages across cell membranes -Carry electrical impulses to other cells -Found in blood or the human body in the form of acids. calcium. magnesium. bicarbonate) -Conduct an electric current that transports energy thoughout the body .

5 2 3   144 4 2 1   114 30 1 0.5 0.5 1   102 27 1 0.1 6   10 155 1 15   5 10 50 10 8 2 Cations (mmol per litre) Sodium Potassium Calcium Magnesium Anions (mmol per litre) Chloride Bicarbonate Phosphate Sulphate Protein Organic Anions .Normal Composition in Average Man   Plasma/ Interstitial Fluid Intracellular fluid Intravascular   140 4 2.

Effects of Electrolytes •The loss of electrolytes in the body can lead to an unbalance of fluids in the body and the pH. and a damage of the electric potential between the nerve cells that transmit the nerve signals (Encarta) .

Major Electrolytes/Chief Function Sodium — controls and regulates volume of body fluids Potassium — chief regulator of cellular enzyme activity and water content Calcium — nerve impulse. B12 absorption Magnesium — metabolism of carbohydrates and proteins. cell division and hereditary traits . produces hydrochloric acid Bicarbonate — body’s primary buffer system Phosphate — involved in important chemical reactions in body. vital actions involving enzymes Chloride — maintains osmotic pressure in blood. blood clotting. muscle contraction.

Regulation of Body Fluid Compartments •Osmosis •is the movement of water from an area of lower solute concentration to an area of higher solute concentration. •Semi-permeable membrane •membrane must be more permeable to water •a greater concentration of solutes on one side of the membrane .

•Lipid insoluble substances cannot cross the plasma membrane (glucose). •Facilitated Diffusion . •Movement of the particles is from an area of higher concentration to an area of lower concentration.•Requires a carrier molecule. •ATP is not expended.

ATP is expended. The sodium-potassium pump is an example of active transport.•Active Transport    movement of a substance across the cell membrane from an area of lower concentration to an area of higher concentration. .

Regulation of Body Fluid Compartments .

Regulation of Body Fluid Compartments Tonicity is the ability of solutes to cause osmotic driving forces Filtration is the movement of water and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure Osmolality reflects the concentration of fluid that affects the movement of water between fluid compartments by osmosis Osmotic pressure is the amount of hydrostatic pressure needed to stop the flow of water by osmosis .

Fluid Volume Deficit •Involves either volume or distribution of water or electrolytes •Hypovolemia — deficiency in amount of water and electrolytes in ECF with near normal water/electrolyte proportions •Dehydration — decreased volume of water and electrolyte change •Third-space fluid shift — distributional shift of body fluids into potential body spaces .

Fluid Volume Excess Hypervolemia — excessive retention of water and sodium in ECF Overhydration — above normal amounts of water in extracellular spaces Edema — excessive ECF accumulates in tissue spaces Interstitial-to-plasma shift — movement of fluid from space surrounding cells to blood .

Types of IV Solutions ISOTONIC -solution has the same osmolality as the extracellular fluid. 1/3 Normal Saline .Net movement extracellular to intracellular Examples : 1/2 Normal Saline. Examples: D5W . Net movement intracellular to extracellular Examples : 3% saline. Normal Saline Hypertonic solutions have a higher concentration of solute and are more concentrated than extracellular fluids. 5% saline Hypotonic solutions have a lower concentration of solutes and is more dilute than extracellular fluid .

Electrolyte Imbalances SODIUM (Na+)  135-145 mEq/L Functions •Maintains osmolality •Participates in active transport •Helps regulate body fluids •Participates in the action potential Hyponatremia:serum sodium level falls below 130 mEq/L.Cells become swollen.depression.cellular dehydration.shock Hypernatremia: Serum sodium is more than 150 mEq/L. lethargy.convulsions. Neurological Disturbances :cerebral edema. Complications:Osmotic Diuresis.headache.coma Cardiovascular Disturbances: postural hypotension.Cells shrink. confusion. circulation decreases .

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and smooth muscle contractility Hypokalemia: <3 mEq/L Cardiovascular: dysrhythmias.Electrolyte Imbalances POTASSIUM (K+): 3. flaccid paralysis. depression Gastrointestinal : paralytic ileus Skeletal Muscle: weakness. water loss.5-5.0 mEq/L Functions •Transmission of nerve impulses •Resting membrane potential •Acid-base balance •Promotes myocardial. skeletal. digitalis toxicity. respiratory arrest Renal System: decreased ability to concentrate urine. weakness of respiratory muscles. cardiac arrest Neurological: lethargy. confusion. kidney damage Acid-Base Balance: metabolic alkalosis . myocardial damage. hypotension.

muscle weakness. Cardiac arrest .Hyperkalemia: serum value of >6 mEq/L Nervous System : Paraesthesia Neuromuscular: Muscle twitching. paralysis Cardiovascular : Bradycardia.

5 mg/dl or 4.Electrolyte Imbalances CALCIUM :8.5-5.5-10.8 mEq/L Functions •Formation of bone and teeth •Contraction of muscle •Blood coagulation •Blocks sodium transport into the cell •Transmission of nervous impulses .

fractures •-Renal Manifestations:stones •-Gastrointestinal Manifestations • Constipation.•Hypocalcemia •<0. confusion.9 mmo/L ionized Calcium •Hypercalcemia >12 mg/dL total Calcium or >1.anorexia • Nausea and Vomiting •-Cardiovascular Manifestations • Shortened QT interval. Laryngeal • spasms •-Cardiovascular System • congestive heart failure • decreased cardiac • output • cardiac dysrhythmias •-Neurological Manifestation • lethargy. coma •-Skeletal Manifestations • deep bone pain. •Bradycardia • Cardiac arrest end .5 mmol/L ionized Calcium •-Nervous System • Paraesthesia •-Muscular System • Tetany.

• defined as "the excessive loss of water and electrolytes from the body“ • Dehydration can be caused by losing too much fluid. . or both. not drinking enough water or fluids.

• So are the elderly and those with illnesses .• Infants and children are more susceptible to dehydration than adults because of their smaller body weights and higher turnover of water and electrolytes.

•dehydration occurs when losses are not replaced adequately and a deficit of water and electrolytes develop. •These may occur in Vomiting or diarrhea •Presence of an acute illness where there is loss of appetite and vomiting:  Pneumonia  DHF  Other Acute Ilnesses •Excessive urine output. such as with uncontrolled diabetes or diuretic use •Excessive sweating (sports) •Burns .

the volume of fluid loss may vary from 5 ml/kg (normal) to 200 ml/kg • Concentration of electrolytes lost also varies • NaCl and K are the most common electrolytes lost through stools .• Since diarrhea and vomiting are the most common causes of dehydration in children.

• In order to diagnose the type of dehydration. you need to know the History and you must do a thorough physical examination • We classify type of dehydration depending on the amount of water and electrolytes lost • These are reflected by the signs and symptoms the child will present .

• When severe. dehydration is a life-threatening emergency . or severe dehydration based on how much of the body's fluid is lost or not replenished. some dehydration.• Dehydration is classified as no dehydration.

irritability. restlessness. decreased skin turgor. • As more losses occur. • There are usually no signs or symptoms in the early stages • As dehydration increases. Initially. sunken eyes and sunken fontanelles.Assesment of Dehydration • Graded according to the signs and symptoms that reflect the amount of fluid lost. thirst. these • effects become more pronounced. signs and symptoms develop. .

7. 3. 6. 5. diminished sensorium (lethargy) Lack of urine output Cool moist extremities A rapid and feeble pulse Decreased BP Peripheral cyanosis DEATH. 4.Signs of hypovolemic shock (SEQUELAE) 1. . 2.

alert Normal Present Moist Drinks normally.not Thirsty *restless.drinks eagerly *Lethargic or unconscious. more signs.Look at :condition* Eyes Tears Mouth and tongue Thirst Well . there is *signs*.floppy very sunken & dry absent very dry *drinks poorly or not able to drink * Feel skin pinch Decide Goes back quickly *goes back slowly* *Goes back very slowly The patient has no If the patient has 2 If the patient has 2 or sign of dehydration or more signs. there is Severe Dehydration Some Dehydration . including at including at least 1 least 1 *sign* .irritable sunken absent dry *thirsty.

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diarrheic stool: 50-100 ml (1/4. 1/2 cup) if < 2yrs. vegetable or 100-200 ml (1/2 chicken soup -1 cup) if 2-10 yrs. continue highly breastfeeding after each sweetened). rice water.Degree of Dehydration None Amount of Fluid Type of Fluid Feeding Vol per vol Suitable home Usual diet or replacement or fluids (not salty or formula. ad libitum for older children .ORS.

dry mucus memb. mucus memb. milk or lactoseslightly reduced contg. urine flow undil. 60-90 ml/kg Same as above sunken in 4-6 hrs fontanelle. Moderate . in 4-6 hrs full-strength cow increased thirst. 30-50 ml/kg Breastfeeding. ORS. lactose-free formula Sunken eyes.Degree of Dehydration Mild Signs Fluids Feeding Slightly dry ORS.. loss of skin turgor. formula.

coma Fluids IV or intraosseus fluids (Ringer’s lactate or NSS). delayed capillary refill time. rapid breathing.30/ml/kg in 1/2 hr (1 hr for infants) then 70 ml/kg in 21/2 hrs (5 hrs for infants) Feeding Begin after clinically improved and ORS has begun .cyanosis.Degree of Dehydration Severe Signs Signs of mod. lethargy. thready pulse. dehydration plus one or more of ff: rapid.

Look at :condition* Eyes Tears Mouth and tongue Thirst Well . there is *signs*. including at including at least 1 least 1 *sign* .not Thirsty *restless. alert Normal Present Moist Drinks normally.floppy very sunken & dry absent very dry *drinks poorly or not able to drink * *Goes back very slowly Feel skin pinch Decide Goes back quickly *goes back slowly* The patient has no If the patient has 2 If the patient has 2 or sign of dehydration or more signs. Weigh the patient and use if possible and use treatment Plan C treatment Plan B URGENTLY Treat . there is Severe Dehydration Some Dehydration Use treatment Plan A Weigh the patient .irritable sunken absent dry *thirsty.drinks eagerly *Lethargic or unconscious. more signs.

advise when to return to the doctor (if the child develops blood in the stool. give extra fluids 2. .Three rules of home treatment: 1. drinks poorly. becomes sicker. or is not better in three days). continue feeding 3.

g. These are often hyperosmolar (high sugar content). Also to be avoided are fluids with purgative action and stimulants (e. worsening dehydration and hyponatremia. Can cause osmotic diarrhea. and sweetened fruit drinks.Do not give: Very sweet tea. soft drinks. . coffee.. some medicinal teas or infusions).

including at least 1 *sign* .drinks eagerly *Lethargic or unconscious. there is Severe Dehydration Feel skin pinch Decide Goes back quickly *goes back slowly* The patient has no If the patient has 2 sign of dehydration or more signs.irritable sunken absent dry *thirsty.not Thirsty *restless. there is Some Dehydration Treat Use treatment Plan A Weigh the patient . alert Normal Present Moist Drinks normally. Weigh the patient and use if possible and use treatment Plan C treatment Plan B URGENTLY .Look at :condition* Eyes Tears Mouth and tongue Thirst Well .floppy very sunken & dry absent very dry *drinks poorly or not able to drink * *Goes back very slowly If the patient has 2 or more signs. including at least 1 *signs*.

reassess and reclassify dehydration.• ORS(ml) the mother slowly gives the recommended amount of ORS by spoonfuls or sips • Note: If the child is breast-fed. . and begin feeding to provide required amounts of potassium and glucose. breast-feeding should continue. • After 4 hours.

.If there are no more signs of dehydration. If there is still some dehydration. do Plan A. repeat Plan B. do Plan C. If the child now has severe dehydration.

Weigh the patient and use if possible and use treatment Plan C treatment Plan B URGENTLY . including at including at least 1 least 1 *sign* .floppy very sunken & dry absent very dry *drinks poorly or not able to drink * Feel skin pinch Decide Goes back quickly *goes back slowly* *Goes back very slowly The patient has no If the patient has 2 If the patient has 2 or sign of dehydration or more signs. more signs. there is *signs*.drinks eagerly *Lethargic or unconscious.irritable sunken absent dry *thirsty. alert Normal Present Moist Drinks normally.Look at :condition* Eyes Tears Mouth and tongue Thirst Well . there is Severe Dehydration Some Dehydration Treat Use treatment Plan A Weigh the patient .not Thirsty *restless.

Normal saline does not correct acidosis or replace potassium losses, but can be used. Plain glucose or dextrose solutions are not acceptable for the treatment of severe dehydration.

If IV infusion is not possible, fluids should be given by nasogastric tube. If none of these are possible and the child can drink, ORS must be given by mouth.

Note: In areas where cholera cannot be excluded for patients less than 2 years old with severe dehydration, antibiotics are recommended. Start Cotrimoxazole.

MAINTENANCE REQUIREMENTS
• HOLIDAY-SEGAR METHOD • BODY SURFACE AREA METHOD

HOLIDAY-SEGAR METHOD • Estimates caloric expenditure in fixed weight categories • Assumption – 100 cal metabolized : 100 mL water • Not suitable for neonates < 14 days – Overestimates fluid needs .

2 K+ 2 .HOLIDAY-SEGAR METHOD BODY WEIGHT ml/kg/day ml/kg/hr Electrolytes (mEq/100ml fluid) First 10 kg Second 10 kg Each additional kg 100 50 20 4 2 1 Na+ 3 Cl.

EXAMPLE • What is the maintenance fluid rate for a an 8 year old child weighing 25 kg using the Holiday-Segar Method? .

+ + 100 x 10 = 1000 ml 50 x 10 = 500 ml 20 x 5 = 100 ml 1600 ml/day .

+ + 4 x 10 = 40 ml 2 x 10 = 20 ml 1x 5 = 5 ml 65 ml/hr .

EXERCISE Using the Holiday-Segar Method. what is the full maintenance requirement and rate for a 10 year old patient who weighs 37 kg? .

BODY SURFACE AREA METHOD • Assumption: caloric expenditure is related to BSA • Not used in children < 10 kg .

BSA METHOD STANDARD VALUES FOR USE IN BODY SURFACE AREA METHOD Componen Values t Water 1500 ml/m2/24 hrs Na+ K+ 30-50 mEq/m2/24 hrs 20-40 mEq/m2/24 hrs .

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BSA Formula Surface area (m2) = wt (kg) ht (cm) x 3600 .

what is the maintenance requirement of an 8 year old who weighs 25 kg and is 132 cm tall? .EXAMPLE Using the BSA method.

BSA Formula 0.92 m2 = 132 cm x 25 kg 3600 .

92/day= 32.92/day= 1630 ml Na+ = 40 mEq/0.Water = 1500ml/0.6 mEq .92/day= 43.5 mEq K+ = 30 mEq/0.

EXERCISE Using the BSA Method. what is the maintenance requirement of a 12 year old boy who weighs 37 kg and is 142 cm tall? .

DEFICIT THERAPY • Calculated Assessment • Clinical Assessment .

CALCULATED ASSESSMENT Fluid deficit (L) = preillness weight (kg) – illness weight (kg) % Dehydration = (preillness weight – illness weight)/preillness weight x 100% .

CLINICAL ASSESSMENT DEHYDRATION Skin turgor Skin touch Buccal mucosa Eyes Tears Fontanelles CNS Pulse rate Pulse quality Capillary refill Urine output MILD Normal Normal Moist Normal Present Flat Consolable Normal Normal Normal Normal MODERATE Tenting Dry Dry Deep set Reduced Soft Irritable Sl increased Weak ~ 2 secs Decreased SEVERE None Clammy Parched/cracked Sunken None Sunken Lethargic/obtund ed Increased Peeble >3 secs anuric .

FLUID REPLACEMENT Mild (in 8 hours) Moderate (1/4 in 2 hrs then ¾ in the next 6 hours) Severe (1/3 in 2 hrs then 2/3 in the next 6 hours) Infant/< 15 50ml/kg kg Older child/ 30 ml/kg > 15 kg 100 ml/kg 150 ml/kg 60 ml/kg 90 ml/kg .

ICF & ECF COMPARTMENTS Composition Intracellular (mEq/L) Na K Cl HCO3 PO4 CHON 20 150 10 110-115 75 Extracellular (mEq/L) 133-145 3-5 98-110 20-25 5 10 .

there are variable losses from the extracellular and intracellular compartments • Percentage of deficit is based on total duration of illness .ICF & ECF COMPARTMENTS • In dehydration.

BASIC MATH CONCEPTS .

38 = 38 100 .385 = 385 1000 .DECIMALS All figures to the left of the decimal point are whole numbers All figures to the right of the decimal point are decimal fractions tenths hundredth s thousandth s .3 8 5 .3 = 3 10 . 385 = .

CHANGING FRACTIONS TO DECIMALS: • Fractions can be changed to decimals by dividing the numerator and the denominator » ¾ = 3÷4 = 0.75 .

PERCENTAGE • • Percentage ( % ) means hundredths Percent ( % ) is the same as a fraction with denomination as 100. 3% = 3 100 45% = 45 100 .

04 To change a decimal to a percent.CHANGING PERCENT TO A DECIMAL & CHANGING DECIMAL TO PERCENT • To change percent to a decimal. 0.04 = 4% . 4% = 4/100 • = . multiply by 100 or move the decimal point two places to the right and place % sign.04 or 0.04 X 100 = 4% or 0. remove the percent sign and divide the number by 100 or move the decimal point two places to the left.

A ratio is an indicated fraction.g.g. 1:4 A ratio indicates that there is a relationship between the two numbers.RATIO A Ratio consists of two numbers as separated by a colon ( : ) e. e.g. e. ¼ = 1:4 The numbers in ratio must be expressed in the same terms. 3 inches : 2 feet = 3 : 24 (feet changes to inches) .

it can be solved by using the s term X. 1 : X = 2 : 100 or 1 X 2 100 extreme ~ .PROPORTION It is a statement showing that the two ratios have equivalent values 1 : 50 = 2 : 100 means If one value is not known.

the fraction ½ is written as 0. fractions are expressed as decimals ¤ In the decimal system.THE METRIC SYSTEM It is the international decimal system of weights and measures ¤ In the metric system. of fluids Gram = weights of solids hundredths Meter = measure of length milli = one thousandths centi = one deci = one tenth mcg = one thousandths .5 METRIC SYSTEM Liter = vol.

2.g. . 100.RULE OF CONVERSION When converting from a larger unit of measure to a smaller unit.5 grams = ___________ mg. e. multiply the larger unit by (1000. 10) or move the decimal to the left. When converting a smaller unit of measure to a larger unit. divide the smaller unit by (1000. 100. 10) or move the decimal to the right.

60 gr = 4 oz = _________ mg.APOTHECARIES SYSTEM Grain (gr) Dram Ounce Minims Pounds Approximate Equivalent Value: 1 gr = 60 mg 1 ml = 15 minims (16 minims) 1 ounce = 30 ml 1 ounce = 30 Gm 1 kg = 2.g. _________ ml. .2 pounds e.

5 ml = ______ .g.HOUSEHOLD MEASURES 1 1 1 1 teaspoon (tsp) Tablespoon (Tbsp) Tablespoon milliliter = = = = 4 – 5 ml 3 teaspoons (tsp) 15 ml 15 drops (gtts) e.

CONVERSION OF TEMPERATURE Normal Temperature = 37°C = 98°F Conversion of Centigrade (Celsius) to Fahrenheit: °C = 5 ( °F ) – 32 Conversion of Fahrenheit to Centigrade (Celsius): 9 °F = 9 5 ( °C ) + 32 .

.Interpretation of Doctor’s Order for Drugs • The nurse must understand the order perfectly before acting on it – – – – > > > > The The The The Drug Dose Route Frequency • If any of the above are unclear or open for interpretations. it is the Responsibility of the nurse to clarify the order with the physician.

a. What is the Dose? c. What is the Route? d. What is the Frequency? e.Example: The order reads : Inderal 2 x4 a. What is the Drug? b. Do es this order need clarification? The order reads : Lasix 10 mg IV 1 ml O. What is the Dose? c. What is the Frequency? e. Does this order need clarification? .D. What is the Drug? b. What is the Route? d.

BASIC MATH CONCEPTS .

385 = 385 1000 hundredth s thousandth s tenths .38 = 38 100 .3 = 3 10 . 385 = .3 8 5 .DECIMALS All figures to the left of the decimal point are whole numbers All figures to the right of the decimal point are decimal fractions .

75 .CHANGING FRACTIONS TO DECIMALS: • Fractions can be changed to decimals by dividing the numerator and the denominator » ¾ = 3÷4 = 0.

3% = 3 100 45% = 45 100 .PERCENTAGE • • Percentage ( % ) means hundredths Percent ( % ) is the same as a fraction with denomination as 100.

04 = 4% . 0. multiply by 100 or move the decimal point two places to the right and place % sign. remove the percent sign and divide the number by 100 or move the decimal point two places to the left.CHANGING PERCENT TO A DECIMAL & CHANGING DECIMAL TO PERCENT To change percent to a decimal. 4% = 4/100 = .04 X 100 = 4% or 0.04 or 0.04 To change a decimal to a percent.

1:4 A ratio indicates that there is a relationship between the two numbers. A ratio is an indicated fraction. e. ¼ = 1:4 The numbers in ratio must be expressed in the same terms.RATIO A Ratio consists of two numbers as separated by a colon ( : ) e. e.g. 3 inches : 2 feet = 3 : 24 (feet changes to inches) .g.g.

1 : X = 2 : 100 or 1 X 2 100 extreme ~ . it can be solved by using the s term X.PROPORTION It is a statement showing that the two ratios have equivalent values 1 : 50 = 2 : 100 means If one value is not known.

5 METRIC SYSTEM Liter = vol. fractions are expressed as decimals ¤ In the decimal system.THE METRIC SYSTEM It is the international decimal system of weights and measures ¤ In the metric system. the fraction ½ is written as 0. of fluids milli = one thousandths Gram = weights of solids centi = one hundredths Meter = measure of length deci = one tenth mcg = one thousandths .

RULE OF CONVERSION • When converting from a larger unit of measure to a smaller unit. 10) or move the decimal to the right. mg. multiply the larger unit by (1000. e.5 grams = ___________ . 2. 100. 10) or move the decimal to the left. divide the smaller unit by (1000. • When converting a smaller unit of measure to a larger unit. 100.g.

APOTHECARIES SYSTEM Grain (gr) Dram Ounce Minims Pounds Approximate Equivalent Value: 1 gr = 60 mg 1 ml = 15 minims (16 minims) 1 ounce = 30 ml 1 ounce = 30 Gm 1 kg = 2. 60 gr = 4 oz = _________ mg.g. .2 pounds e. _________ ml.

HOUSEHOLD MEASURES 1 1 1 1 teaspoon (tsp) Tablespoon (Tbsp) Tablespoon milliliter = = = = 4 – 5 ml 3 teaspoons (tsp) 15 ml 15 drops (gtts) e. 5 ml = ______ .g.

CONVERSION OF TEMPERATURE Normal Temperature = 37°C = 98°F Conversion of Centigrade (Celsius) to Fahrenheit: °C = 5 ( °F ) – 32 Conversion of Fahrenheit to Centigrade (Celsius): 9 °F = 9 5 ( °C ) + 32 .

it is the Responsibility of the nurse to clarify the order with the physician.Interpretation of Doctor’s Order for Drugs • The nurse must understand the order perfectly before acting on it – – – – > > > > The The The The Drug Dose Route Frequency • If any of the above are unclear or open for interpretations. .

What is the Dose? c. What is the Frequency? e. What is the Route? d. What is the Route? d.Example: The order reads : Inderal 2 x4 a. What is the Frequency? e. What is the Drug? b. Does this order need clarification? . a. What is the Dose? c. What is the Drug? b. Does this order need clarification? The order reads : Lasix 10 mg IV 1 ml O.D.

2. Rule : 1.GENERAL FORMULA FOR DRUG CALCULATION 1. Calculation by Ratio : Proportion 8 mg : x = 16 mg : 1 tab (works for any computation of Dosage if you have a given and a need to determine the unknown). D xQ S 2. Units for each ratio must be placed in the same order. . Units for each ratio must be the same.

008 Gm . Setting up the proportion: a.8 mg 10 mg/ml 2. 1.008 Gm dose 3. the units for each ratio must be the same ( mg to mg ) 8mg : X = 10 mg : ml E. What do you need to know? Known amount in cc for 0. What do you know? 0.When the dose prescribed is in milligram (mg) and the dose available is in Gram (Gm) or vice versa. the units for each ratio must be placed in the same order b. Ampule available is labeled 10 mg/ml. Computation of Dosages: . The order reads : 0.g.008 Gm of Morphine Sulfate IV q4 hours prn for pain.

8 ml . solve for the correct dosage 8 mg : X = 10 mg : ml 10 mg X = 8 mg/ml X = 8 mg/ml 10 mg X = .4.

What do you need to know? # of tablets for ¼ gr dose .015 Gm / tab1 Gm = 1000 mg ¼ = .O. E. 1. q 8 hrs PRN for pain.015 Gm tablets.g.• When the dose is ordered in one system and the dose on hand is in another system. Tablets on hand are labeled 0. What do you know? Known ¼ gr 1 gr = 60 mg 0.25 2. The order reads : codeine sulfate ¼ gr P.

Solve for the correct dosage: 15 mg : x = 15 mg : 1 tab 15 mg x = 15 mg / tab x = 15 mg / tab 15 mg x = 1 tab . the units for each ratio must be the same b. . Setting up the proportion a. the units for each ratio must be placed in the same order.015 gm : 1 tab 15 mg : 1 tab 4.25 gm : X 15 mg : x = = 0.3.

Computation of Correct Insulin Dosage • U .40 means • U . • U 40 insulin needs a U 40 syringe • U 80 insulin needs a U 80 syringe .80 means • U .100 means • Insulin syringes are calibrated according to the strength of insulin with which it is to be used.

If this can not be done, the dose can be converted to milliliters Dose Required Dose on Hand X 1 ml = ml needed

• Serious error can occur if incorrect syringe or incorrect b calculations are used • It is essential that all insulin be checked by a second RN to confirm that errors in dosage are not made and error in the type of insulin were not made.

Fractional Dosages in Infants and Children

Children’s Doses
• Clarks’ Rule: weight of child in pounds 150 X A.D. = child’s dose

Body Surface Area e.g. Wt = 10 kg BSA X A.D. = child’s dose 1.7 BSA = 4(wt in kg) + 7 = BSA in m² wt in kg + 90 = 4(10 kg) + 7 10+ 90 = .47 m² Child’s dose = .47 m² 1.7 X 500 = 47

D. = Child’s dose Age of child + 12 .• Youngs’ Formula: Age of child in Years X A.

Eg.500 + 20 1. 1. WEIGHT --. 27 -20 X 7 7 140 20 > 20 kg. ml/excess b.000+50ml/excess b.wt.11 – 20 kg. --. Wt = 15 kg. WEIGHT --. 1640 ml.100ml/kg.--1. Wt = 27 kg.500 + 140 ml = . Eg. WEIGHT Eg.800cc 2.CALCULATION OF FLUID VOLUME (BASED ON BODY WEIGHT) 1.wt. --.1 – 10 kg. Wt = 8 kg.000=250ml = 1. 1.250ml 15 50 -10 X 5 5 250 3.

Calculation of IV Flow Rates • Calculation of cc/hr is essential in most IV therapy. Volume # of hrs = cc/hr E. 1 L over 8 hrs = 125 cc/hr 50 cc over 20 minutes = 150 cc/hr .g.

20 gtts/ml microdrip 60 gtt/ml EXAMPLE : LONG METHOD Doctors Order : Run 1L D5W over 8 hours Microdrip 1000 ml ÷ 8 hours = 125 cc/hr 125 cc x 60 min 10 gtt/ml set 60 15 gtt/ml set 60 20 gtt/ml set 60 60 gtt/ml 1 = 125 gtt/ml = = = 20 – 21 gtt/min 31 gtt/min 41 – 42 gtt/min 125cc x 10 gtt/ml min 1 125cc x 15 gtt/ml min 1 125 cc x 20 gtt/ml min 1 .Calculation of gtt/min (Long Method) STEPS : 1. Gtt factor = gtt / ml gtt factors : macrodrip 10. 15. Need to know cc/hr to calculate 2.

SHORT METHOD cc / hr ÷ 6 cc / hr ÷ 4 cc / hr ÷ 3 for for for 10 gtt / min 15 gtt / min 20 gtt / min for microdrip set cc / hr = gtt / min .

htm .gov/MEDLINEPLUS/en cy/article/000982. Lippincott Williams & Wilkins • Fluids & Electrolytes.nih. Walters Kluwer • Nelson’s Texbook of Pediatrics • WHO department of child and adolescent development • (Medline Plus) http://www.nlm.Sources • Fluids & Electrolytes.

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