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NURS-216 and 317 Med-Math Calculations

2. Table of Contents. Introductory text . . . . . . . . . . . . . . . . . . . . . . . . 1Problems solved in class . . . . . . . . . . . . . . . . . 19Reconstitution problems (juniors) . . . . . . . . . 50Easily solved problems (outside class). . . . . . 66More solved problems (outside class).

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NURS-216 and 317 Med-Math Calculations

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    1. 1 NURS-216 and 317 Med-Math Calculations Variety of calculation types Varying levels of difficulty Must learn before 1st clinical assignment B. Glick: 5/4/2008 @ 21:22

    2. 2 Table of Contents Introductory text . . . . . . . . . . . . . . . . . . . . . . . . 1 Problems solved in class . . . . . . . . . . . . . . . . . 19 Reconstitution problems (juniors) . . . . . . . . . 50 Easily solved problems (outside class). . . . . . 66 More solved problems (outside class). . . . . . 68 Answers to More solved problems . . . . . . . . 92 Version control . . . . . . . . . . . . . . . . . . . . . . . .109

    3. 3 Why are you learning to make these calculations? It is physically impossible to stock every medication in every possible dosage. APRNs & physicians don’t know (or care) what is in your medication inventory. Nurse must ACCURATELY do the arithmetic to use what is in the inventory and convert it to what the physician or APRN ordered.

    4. 4 The nurse’s most important role in medicating a patient The nurse is the patient’s last line of defense against receiving an inappropriate medication. Right patient? Right medication? Right time? Right route? Right dose? Right form? Expiration date?

    5. 5 Arguments for/against using dimensional analysis For: Formulas are derived from dimensional analysis. If you forget the formula, you have no rational backup. Guessing is not rational! For: By canceling the excess labels before doing the arithmetic, the problem setup is very likely to be correct. (Avoids the generation of an inappropriate or nonsense answer such as: mL2) Against: Dimensional analysis is more work than using formulas.

    6. 6 Med-Math question types & sample units of measure Intake/output Counting (tablets, units of medication) Mass (weight) Volume (mL, Liter) Rate (drops/min, mL/hr, mg/min, units/hr) Time-based (what time will the IV bag empty?) Reconstitution – Junior level nursing students IV rate changes - Junior level nursing students

    7. 7 Time Abbreviations – Use of the “q” abbreviation is discouraged, but remains prevalent. q4h – every 4 hours q8h – every 8 hours q12h – every 12 hours qd – every day (1 time/day) bid – every 12 hours (two times a day) tid – every 8 hours (three times a day)

    8. 8 Other Abbreviations Mass (weight): microgam (mcg) milligram (mg) gram (g) kilogram (Kg) English: pounds (lbs, #) Volume: milliliter (mL) = (cc) do not use “cc” liter (L) English: teaspoon (tsp) ounce (oz) tablespoon (tbs) cup (C)

    9. 9 Other Abbreviations -continued Time: hour (h, hr) minute (min) Count: tablet (tab) drop = gtt [Latin: gutta or guttae] (singular plural) Unit [quantity of certain medications] mEq [milliequivalents for electrolytes] tablet

    10. 10 Rate definition Rate = flow (These two words mean the same thing) How much medication AND how quickly? Volume & Time (gtt/min, mL/hr) Mass & Time (mg/min) Counting & Time (tablets/dose, Units/hr) mL/hr is the default flow for IV pumps

    11. 11 Graphic representation of grams, milligrams and micrograms

    12. 12 Introduction to problem solving Answer exactly what you are being asked to find. Not what you think the question means. Not what you think the question should ask. Determine the label for the answer. NOTE: The answer label should be, but may not always be explicitly stated in the problem. Example: IV flow through a pump implies mL/hr.

    13. 13 Problem solving strategy (1) Based upon the question, determine what the answer’s label will be. Then place an equal sign (=) to the right of the label. (2) The numerator of term immediately to the right of the answer’s numerator label must match the answer’s numerator label. You may require a conversion factor such as (1,000 mcg/1 mg) to force the correct label in the 1st numerator.

    14. 14 Problem solving strategy (3) If the question asks you to find (for example) mL/hr, set up the following generic statement. The intention is to cascade as many labels as you need so that the labels that do not appear in the answer are arithmetically canceled. (x to x, y to y and z to z; leaving mL per hr, as required in the answer) mL = mL * x * y * z hr x y z hr

    15. 15 Problem solving strategy Include medication order, medication source and other factors to cancel labels that are not used in the answer. (examples that may be relevant: patient weight, drip set ratio, time factors and conversions) Notice that all parts of the formula contain PAIRS of data. Examples: gtt/mL, mg/hr, mg/mL, g/L, “something”/dose, mg/Kg/day By definition: a microdrip set = 60 ggt/mL By definition: a macrodrip set = 10, 15 or 20 gtt/mL

    16. 16 Rounding Rules. Always follow special directions in the question. BEFORE beginning test, verify the rounding rules with your instructor. Typical rules follow: Infant & Pediatric: calculate final answer to 3 places to right of decimal; then round back to 2 places. Follow the 5/4 rule. Adult: calculate final answer to 2 places to right of decimal; then round back to 1 place. Follow the 5/4 rule. Drops (gtt) and Units [medication] are always rounded to the nearest whole number. Follow the 5/4 rule.

    17. 17 Problem with an explicit answer Order: 400 mg of med. Supply: 125 mg per 5 mL. How many mL will you give? 5 mL * 400 mg ? mL = ------ --------- 125 mg 1 ? an number over “1” makes the numerator obvious & does not = 16 mL change the numerator’s value.

    18. 18 Problem with an implied answer Order: 400 mg of med. Supply: 125 mg per 5 mL. 5 mL * 400 mg ? mL = -------- --------- 125 mg 1 = 16 mL All further examples are typed on these slides as follows: mL = (5 mL/125 mg) * (400 mg/1) = 16 mL

    19. 19 Class Problem mg/min Determine the mg/min required to administer when the flow and solution concentration are given. The medication is infusing at 32 mL/hr. The IV volume is 250 mL. The amount of dissolved medication is 700 mg. If necessary, round answer to 1 decimal place. See next slide for important considerations.

    20. 20 Class Problem mg/min Identify the pairs of data: 250 mL & 700 mg 1 hour and 32 mL Orient the pairs as required to satisfy the answer’s label and cancel all other labels. Which conversion “tool” will you use to change the hours to minutes?

    21. 21 Answer - mg/min Determine the mg/min required to administer when the flow and solution concentration are given. The medication is infusing at 32 mL/hr. The IV volume is 250 mL. The amount of dissolved medication is 700 mg. mg/min=(700mg/250mL) * (32mL/hr) * (1 hr/60min) = 1.49 Round up to 1.5 mg/min

    22. 22 Class Problem – mcg/min Determine how many mcg/min are infusing if the IV contains 240 mg of medication per 500 mL and is infusing at 16 mL/hr. If necessary, round answer to 1 decimal place. This problem does not have mcg in any of the data; therefore, put a conversion “tool’ for mcg and mg immediately to the right of the equal sign (=). Then cascade and orient the rest of the data so that labels not appearing in the answer’s label are canceled.

    23. 23 Answer – mcg/min Determine how many mcg/min are infusing if the IV contains 240 mg of medication per 500 mL and is infusing at 16 mL/hr mcg/min = (1000mcg/mg) *(240mg/500mL) * (16mL/hr) * (hr/60min) = 218 mcg/min

    24. 24 Class Problem – mL/hr The provider has ordered 2 mcg/min. The nurse has 5 mg per 250 mL. The flow rate is _________________ mL/hr. If necessary, round answer to 1 decimal place.

    25. 25 Answer – mL/hr The provider has ordered 2 mcg/min. The nurse has 5 mg per 250 mL. The flow rate is _________________ mL/hr mL/hr = (250mL/5mg) * (1 mg/1000mcg) * (2 mcg/min)* (60min/1 hr) = 6 mL/hr

    26. 26 Class Problem – mL/hr The provider ordered a medication at the rate of 46 mcg/Kg/min. The client weighs 72.7 Kg. The medication is supplied as 300 mg in 75 mL of solution. The client should receive ______________mL/hr. If necessary, round answer to 1 decimal place. When using a 3-part component (e.g., mcg/Kg/min), always use the 1st component in the numerator (mg) and everything else in the denominator. For example: mg Kg/min

    27. 27 Answer – mL/hr The provider ordered a medication at the rate of 46 mcg/Kg/min. The client weighs 72.7 Kg. The medication is supplied as 300 mg in 75 mL of solution. The client should receive ______________mL/hr mL/hr = (75mL/300mg) * (1 mg/1000mcg) * (46mcg/1 min) * (72.7 Kg/1) * (60min/1 hr) = 50.163 rounds up to 50.2 mL/hr

    28. 28 Class Problem - tablets A medication comes out of the bottle as 2.5mg/tablet. Give 2.5mg tid. If necessary, round answer to 1 decimal place. (1) How many tablets/dose? (2) How many tablets daily?

    29. 29 Answer - tablets A medication comes out of the bottle as 2.5mg/tablets. Give 2.5mg tid. (1) How many tablets/dose? (Each 1 dose = 2.5 mg.) tabs/dose = (1 tab/2.5mg) * (2.5mg/1 dose) = 1 tablet/dose (2) How many tablets daily? (tid = 3 doses/day) tabs/day = (1 tab/2.5mg) * (2.5mg/dose) * (3doses/day) = 3 tablet/day

    30. 30 Class Problem – mg/day The provider ordered 2 mg/Kg/day IV for a 16 pound infant. The infant should receive _____________mg per day. If necessary, round answer to 2 decimal places.

    31. 31 Answer – mg/day The provider ordered 2 mg/Kg/day IV for a 16 pound infant. The infant should receive _____________mg per day. mg/day = (2mg/Kg/day) * (1 Kg/2.2 lbs) * (16 lbs/1) =14.545 round up to 14.55 mg/day

    32. 32 Class Problem – determine the label and solve the problem A medication is ordered for your patient at 80 mg/Kg/24 hours every 8 hours. The child weighs 18 lbs. How many mg of medication will you administer at each dose? If necessary, round answer to 1 decimal place.

    33. 33 Answer – determine the label and solve the problem A medication is ordered for your patient at 80 mg/Kg/24 hours every 8 hours. The child weighs 18 lbs. How many mg of medication will you administer at each dose? mg/dose= (80mg/Kg/24hrs) * (8hrs/dose) * (1 Kg/2.2 lbs) * (18 lbs/1) = 218.182 rounds down to 218.2 mg/dose

    34. 34 Class Problem – gtt/min Calculate the drip rate of 1,000 mL of medication to infuse over 10 hours using an infusion set that delivers 15gtt/mL. How many drops/min? If necessary, round answer to 1 decimal place.

    35. 35 Answer – gtt/min Calculate the drip rate of 1,000 mL of medication to infuse over 10 hours using an infusion set that delivers 15gtt/mL. gtt/min= (15gtt/mL) * (1,000 mL/10 hrs) * (1 hr/60 min) = 25gtt/min

    36. 36 4 AM 5 AM 6 AM 7 AM 8 AM 9 AM 10 AM

    37. 37 Class Problem – Is the IV setup working as expected? The IV above was started at 4 AM. At 10 AM 600 mL remain in the bottle. Is the IV running on time? (Refer to previous slide for mL/hr)

    38. 38 Answer – Is the IV setup working as expected? The IV above was started at 4 AM. At 10 AM 600 mL remain in the bottle. Is the IV running on time? (4 AM to 10 AM) = 6 hrs running time. (1,000 mL/10 hrs) = 100 mL/hr. (100 mL/hr * 6 hrs/1) = 600 mL should be used in 6 hours. (1,000 mL – 600 mL) = 400 mL should still be in the bottle. Therefore: bottle is emptying too slowly – NO: not on time. Patient may have laid on the tubing and caused it to crimp. There are other possible reasons for the delayed emptying.

    39. 39 Conversion factors to memorize 1 oz = 30 mL 8 oz = 1 cup = 240 mL ====================== 16 oz = 1 pint = 500 mL 32 oz = 1 quart = 1,000 mL = 1 liter 128 oz = 1 gallon = 4,000 mL

    40. 40 Class Problem – Intake & Output 12 hour I/O for patient Smith on 4/7/2008: 4 oz cranberry juice 175 mL urine 1/2 cup oatmeal 2 slices of toast 120 mL yellow vomit 8 oz black coffee a tuna fish sandwich 1/2 cup flavored gelatin 100 mL diarrhea 3 oz cream of mushroom soup 6 oz 1% milk 230 mL urine 16 oz water 1 pint ice cream 2 tsp liquid medication 1 tbs liquid medication IV @ 150mL for 3 hrs 1 cup applesauce What is the intake? ______________ What is the output? ______________ Net gain or net loss of fluid? _______

    41. 41 Answer - Intake 4 oz cranberry juice 4 oz * 30 mL/oz = 120 mL 8 oz black coffee 8 oz * 30 mL/oz = 240 mL 1/2 cup flavored gelatin 4 oz * 30 mL/oz = 120 mL 3 oz cream of mushroom soup 3 oz * 30 mL/oz = 90 mL 6 oz 1% milk 6 oz * 30 mL/oz = 180 mL 16 oz water 1 pint = 500 mL 1 pint ice cream 1 pint = 500 mL 2 tsp liquid medication 2 tsp * 5 mL/tsp = 10 mL 1 tbs liquid medication 1 tbs * 15 mL/tbs = 15 mL IV @ 150 mL for 3 hrs 150 mL/hr * 3 hr = 450 mL 1 cup applesauce 1 cup * 16 oz/cup = 240 mL Answer: - ----------------------------------------? 2,465 mL

    42. 42 Answer - Output & Net gain or loss 175 mL urine 120 mL yellow vomit 230 mL urine 100 mL diarrhea Input = 2,465 mL 625 mL Output Output = 625 mL Net gain = 1,840 mL More fluid was retained than was excreted; therefore, patient has a net gain.

    43. 43 Class Problem mL/hr with distracters This problem contains distracters. Determine what the answer label is. Then look to see which components of the question will satisfy the requirements for the answer’s label. Ignore everything else. If necessary, round answer to 1 decimal place. An IV of 1,000 mL medication contains 60 mEq of an electrolyte and is set to infuse at 27 drops per minute. The tubing delivers 10gtts/cc. How many mL/hr are you administering?

    44. 44 Answer - mL/hr with distracters An IV of 1,000mL medication contains 60 mEq of an electrolyte and is set to infuse at 27 drops per minute. The tubing delivers 10gtts/cc. How many mL/hr are you administering? Be in the habit of rewriting drops to gtt and cc to mL. Remember to find pairs of data that may work for you. 27 gtt/min 10 gtt/mL mL/hr 1,000 mL/mEq Correct answer: mL/hr = (1 ml/10 gtt) * (27 gtt/1 min) * (60 min/1 hr) = 162mL/hr Why is this wrong? mL/hr = (1,000 ml/60 mEq) * (27 gtt/1 min) * (60 min/1 hr)

    45. 45 Class Problem – Time-based Unless otherwise specified, and if necessary, round answer to 1 decimal place. 900 mL of medication is ordered to infuse at 80 mL per hour. (1) Assuming that there are no interruptions, how long will it take to empty the bag? (2) If the IV line is started at 2:47 PM, what time will the bag run dry?

    46. 46 Answer - Calculate the hours 1) Assuming that there are no interruptions, how long will it take to empty the bag? Hours = (1 hr/80 mL) * ( 900 mL/1) = 11.25 hours This answer is expressed in hours and it means 11 and Ľ hours. It is NOT 11 hours and 25 minutes!

    47. 47 Answer - Calculate the minutes minutes = (60 min/1 hr) * (0.25 hr/1) = 15 minutes

    48. 48 Answer – total run time expressed in hours & minutes (1) Assuming that there are no interruptions, how long will it take to empty the bag? The bag will empty in 11 hours and 15 min.

    49. 49 Answer - Time bag will theoretically empty (2) If the IV line is started at 2:47 PM, what time will the bag run dry? (from previous page) 2 PM + 11 hours -------> 1 AM 47 minutes + 15 minutes = 62 minutes 1 AM + 62 minutes ------> 2:02 AM 

    50. 50 Class Problem – Reconstitution Reconstitution problems ask the nurse to dissolve a drug (typically a powder) whose quantity is usually expressed in grams or milligrams in: a specific quantity of a liquid (usually measured in milliliters). Frequently, the liquid is normal saline (0.9% NS) or D5W. Conceptually, this is identical to dissolving 1 teaspoon of table salt in 1 cup of hot water.

    51. 51 Class Problem – Reconstitution Order: 350 mg of the drug to be given q8h IV. How many mL will you give per dose? Supply: The drug is available in 500 mg containers. The label tells the nurse to dissolve the powder in 25 mL of normal saline (NS).

    52. 52 Class Problem – Reconstitution Which pairs of data do you find in the problem? 350 mg every 8 hours. (every 8 hours means: 1 dose.) 500 mg of the powder is dissolved in 25 mL of NS. What is the answer’s label for your calculation? How many mL/dose? Can you isolate all of the components that are required to solve this problem? (YES, of course you can do this!)

    53. 53 Answer – Reconstitution mL/dose = (25 mL/500 mg) * (350 mg/dose) = 17.5 mL/dose

    54. 54 Class Problem – Reconstitution Order: 250 mg of the drug to be given q8h IV. How many mL will you give per dose? Supply: The drug is available in 1g containers. The label tells the nurse to dissolve the powder in 50 mL of normal saline (NS). The disconnect is between the grams and the milligrams, so use the appropriate conversion “tool.”

    55. 55 Answer – Reconstitution mL/dose = (50 mL/1 g) * (1 g/1000 mg) * (250 mg/dose) = 12.5 mL/dose

    56. 56 Class Problem – Reconstitution Order: 20 mg/Kg of the drug to be given q8h IV. Patient weighs 50 pounds. How many mL will you give per dose? Supply: The drug is available in 500 mg containers. The label tells the nurse to dissolve the powder in 5 mL of normal saline (NS). With which data pair is the “dose” a factor? Why?

    57. 57 Answer – Reconstitution mL/dose = (5 mL/500 mg) * (20 mg/1 Kg/1 dose) * (1 Kg/2.2 lbs) * (50 lbs/1) = 4.545 rounds up to 4.55 mL/dose Dose is only related mg/Kg. Any other pair does not make any sense.

    58. 58 Class Problem – Reconstitution Order: 700,000 Units given IM. How many mL will you give? Supply: The drug is available in 5,000,000 Unit containers. The label tells the nurse to reconstitute (dissolve) the powder in 3.2 mL of normal saline (NS) to yield 1,000,000 Units/mL. This problem contains a distracting pair. To determine what the distracting pair is, you must understand the sequence of the problem’s operation. See picture on next slide.

    59. 59 Reconstitution Graphic

    60. 60 Answer – Reconstitution The distracters are the 5 million Units and 3.2 mL. Your reconstituted supply is now 1 million Units/mL. The 5 million units dissolved in the 3.2mL is how you arrived at the 1 million Units/mL. Now they are irrelevant = distractors. mL = (1 mL/1,00,000 Units) * (7.000,000 Units/1) = 0.7 mL

    61. 61 Class Problem – Reconstitution Order: 500 mg IV every 4 hours. Supply: The drug is available in 1 gram containers. The label tells the nurse to reconstitute (dissolve) the powder in 10 mL of 0.9% NS. THEN further dilute this mixture in 50 mL of NS. Infuse it over 30 minutes. The drip set is 10gtt/mL.

    62. 62 Class Problem – Reconstitution Refer to the previous graphic and make a similar picture for this problem. Step-A: How many mL will you use of the 10 mL in which you dissolve the 500 mg of powder? Step-B: How many mL/hr will you give the patient? Step-C: How many drops/min?

    63. 63 Answer – Reconstitution This is a multi-step (3) problem. (A) Determine how many mL after mixing the powder (Step-1). mL = (10 mL/1 gram) * (1 gram/1,000 mg) * 500 mg/1) = 5 mL

    64. 64 Answer – Reconstitution (B) Determine how many mL/hr after diluting the mixture (Step-2). mL/hr = (55 mL/30 min) * (60 min/1 hr) = 110 mL/hr Your picture should tell you why we use 55 mL, not 50 mL.

    65. 65 Answer – Reconstitution (C) Determine how many gtt/min: gtt/min = (10 gtt/1 mL) * (110 mL/1 hr) * (1 hr/60 min) = 18.3 rounds down to 18 gtt/min

    66. 66 Easily solved problems with answers – [in brackets] Supply: 5 mg/mL. Order: 50 mg. Tsp____? [2 tsp] Supply: 10 mg tablets. Order: 30 mg. Tablets__? [3 tablets] Supply: 250 mg/5 mL. Order: 1.5 g. mL____? [30 mL] Supply: 50 mg tablets. Order: 0.2 g. Tablets__? [4 tablets] Supply: 100 mg/5mL. Order: 0.25 g. mL____? [12.5 mL] Supply: 5 mL/tsp, tsp contains 250 mg. Order: 0.5 g . mL____? [10 mL]

    67. 67 Easily solved problems with answers Supply: 10 mL/1 million Units. Order: 200,000 Units. mL____? [2 mL] Supply: each tablet contains 0.25 g. Order: 500 mg. Tabs___? [2 tablets] Supply: 2 mL per 600,000 Units. Order: 300,000 Units. mL____? [1 mL] Supply: 0.1 g per tablet. Order: 200 mg. Tabs____? [2 tablets] Supply: 500 mcg in 1.5 mL. Order: 0.8 mg. mL____? [2.4 mL]

    68. 68 More Solved Problems – Unless otherwise instructed, as necessary, round all final answers to 1 decimal place. How many milliliters you will give for each medication? Answers begin on slide 92. 1. Give your patient 0.1 mcg. Your stock has 1.5 mL vials with 0.3 mcg. 2. Order is for 3,500 Units. Supply is 8,500 Units per 1.5 mL.

    69. 69 More Solved Problems 3. Prepare a 25 mEq dose. You have 20 mEq dissolved in 10 mL. 4. Supply is 1 mg/mL. You are ordered to give 750 mcg. 5. Your inventory contains a bottle with 0.4 g in 2 mL. Order is for 300 mg.

    70. 70 More Solved Problems 6. Supply is an elixor labeled 3 mg/mL. Order is for 3 teaspoons. How many milliliters will you give? This dose is equal to how many milligrams? 7. The order is for an oral suspension of 50 mg. your inventory contains 25 mg/5 mL. How many teaspoons will you give?

    71. 71 More Solved Problems 8. Drug comes in 10 mg tablets. APRN orders 30 mg daily. How many tablets will you give over the course of the whole day? How many tabs per dose if the drug is to be given every 8 hours (tid)? 9. Prescribed are 1.5 mg. Liquid is labeled 250 mg per 5 mL. How many mL will you give?

    72. 72 More Solved Problems 10. Give your patient 200,000 Units. Available is a multiple dose vial labeled 1,000,000 Units in 10 mL (cc). How many mL will you give? 11. You have scored (can be split) tablets labeled 0.1 g. Your order is for 200 mg every morning. How many tablets, or part of a tablet, will you give?

    73. 73 More Solved Problems 12. Prescribed is a 0.75 mg dose for an infant weighing 8.7 pounds. The drug is available as 500 mcg dissolved in 1.5 mL. How many mL will you give? 13. 360 mg to be given orally every 4 to 6 hours. Available drug is 180 mg/5 mL. How many mL should be given at each dose?

    74. 74 More Solved Problems 14. Your patient weighs 60 Kg. Order is for 500 mg of medication daily. Drug package instructions say there are 125 mg/tsp. How many milliliters will you give? 15. Patient weighs 41 pounds. APRN orders 75 mg/Kg/day in 4 divided doses. Drug is available in 175 mg/3 mL. How many mL should be give for each dose?

    75. 75 More Solved Problems 16. Give 15 mg/Kg/day. Drug is prescribed in 3 evenly spaced doses over 24 hours. Patient weighs 231 pounds. (A) How many hours apart will you give each dose? (B) If the drug is available in units of 75mg/mL, how many milliliters will you give per dose?

    76. 76 More Solved Problems 17. How many micrograms are in 1 gram? 18. How many mL in 4 tablespoons? 19. Give 500 mL of an IV liquid over 8 hours. The drip set is 10 drops/mL. How many gtt/min will you adjust the manual control on the drip set?

    77. 77 More Solved Problems 20. A piggyback IV liquid contains 50 mL of medication. It is attached to a microdrip set. Deliver the medication over 2 hours. How many drops per minute is this? 21. Referring to the previous problem, what happens to the flow of medication from the main medication bag when the piggyback is running thru the IV line?

    78. 78 More Solved Problems 22. An IV drug is administered via a pump. The medication is packaged as 50 mg per 100 mL of liquid to be given over 2 hours. The drip set package is marked 15 gtt. How many mL/hour will you set the pump? 23. Using a pump, an IV medication is to be given over 90 minutes. The medication is dispensed from a 250 milliliter bag. How many mL/hour will you set the pump?

    79. 79 More Solved Problems 24. Order is for 16 mcg/Kg. Infuse in 90 minutes. Drug volume is 75 mL. The patient is a child who weighs 46 pounds. The child should receive 223.03 mcg at a rate of ____ mL/hour?

    80. 80 More Solved Problems 25. 150 mL of liquid contains 8 mEq of a continuous infusion at 25 ml/hour. The patient will receive how many mEq/day? 26. How many mcg/min are being infused if an IV contains 150 mg of medication per 250 mL and is infusing at 10 mL/hr?

    81. 81 More Solved Problems 27. Calculate the intake expressed in mL and in liters. Ignore the output. 6 oz orange juice 150 mL urine 2/3 cup cereal with an additional 4 oz whole milk 3 pancakes covered with 1 oz maple syrup 120 mL of brownish-yellow vomit 6 oz black coffee with an additional 2 oz 2% milk 1/4 cup orange gelatin 100 mL diarrhea 3 tbs apple sauce An IV infusing at 150 mL/hr for 8 hours 2 tsp liquid medicine 2 pills taken with a total of 4 oz water 1 pint sherbet

    82. 82 More Solved Problems 28. 450 mL of medication is ordered to infuse at 52 mL per hour. (A) Assuming that there are no interruptions, how long will it take to empty the bag? (B) If the IV line is started at 7:47 PM, what time will the bag run dry?

    83. 83 More Solved Problems 29. A dehydrated patient is placed on a continuous drip at 15mL/hr. The drip set is 15 gtt/mL. The nurse enters the patient’s bathroom where she observes a toilet mounted hat containing 200 ml of urine. An unlicensed assistant tells the nurse that within the past few minutes he cleaned up 2 times after the patient soiled himself and the bed. Each time about 75 mL of diarrhea came out. Then the patient vomited about 250 mL.

    84. 84 More Solved Problems (A) How much fluid was lost? (B) The physician orders the existing drip to continue as ordered PLUS an order to replace the lost fluid over the next hour. How much fluid will the nurse infuse over the next hour? (C) How many drops/minute?

    85. 85 More Solved Problems (D) In a separate IV, the patient is receiving 1350 Units/hr of a medication that is dispensed from a 500 mL bag containing 25,000 Units of the drug through a micro drip set. How many mL/hr are being infused? (E) How many drops/minute are being infused?

    86. 86 More Solved Problems The physician decides to increase the dosage by 3 Units/Kg/hr. The patient weighs 185 pounds. (F) How many Units/hr will the nurse administer? (G) How many mL/hour will the pump be set?

    87. 87 More Solved Problems (H) How many gtt/min will be infused? (I) How many hours will this IV run? Express as a decimal quantity – 3 decimal places?

    88. 88 More Solved Problems (J) How many whole hours will the IV run? (K) How many remaining minutes will there be? (L) This IV started at 8:57 PM. What time will the bag empty?

    89. 89 More Solved Problems (M) An additional IV is ordered to run at 60 mL/hr. The bag contains 2 grams of medication dissolved in 500 mL of D5W. The label specifies that the normal dosage is from 1 to 4 mg/min. What does the manufacturer consider the safe dosage range? (N) At 60 mL/hr, what will be the ordered dosage range in mg/hr?

    90. 90 More Solved Problems (O) Is the order in part (N) a safe dose? (P) If the physician were to order 1800 mg of the same medication at 70 mL/hr, will the nurse accept or reject the order? Why?

    91. 91 More Solved Problems 30. Determine how many of combined drug you will give the patient per minute. Order: 22 mL/hr. If required, round to 3 decimal places. Formulation: Drug A – dissolve 70 mg/10 mL of D5W Drug B – dissolve 30 mg/15 mL of D5W

    92. 92 Answers to Solved Problems 1. mL = (1.5 mL/0.3 mcg) * (0.1 mcg/1) = 0.5 mL 2. mL = (1.5 mL/8500 Units) * (3500 Units/1) = 0.63 rounds down to: 0.6 mL 3. mL = (10 mL/20 mEq) * (25 mEq/1) = 12.5 mL 4. mL = (1 mL/1 mg) * (1 mg/1,000 mcg) * (750 mcg/1) = 0.75 rounds up to: 0.8 mL 5. mL = (2 mL/0.4 g) * (1 g/1,000 mg) * (300 mg/1) = 1.5 mL

    93. 93 Answers to Solved Problems 6. mL = (5 mL/1 tsp) * (3 tsp/1) = 15 mL mg = (3 mg/1 mL) * (15 mL/1) = 45 mg 7. tsp = (1 tsp/5 mL) * (5 mL/25 mg) * (50 mg/1) = 2 tsp 8. mL = (5 mL/250 mg) * (1,000 mg/1 g) * (1.5 g/1) = 30 mL

    94. 94 Answers to Solved Problems 9. tablets = (1 tablet/50 mg) * (1,000 mg/1 g) * (0.2 g/1) = 4 tablets 10. mL = (10 mL/1,000,000 Units) * (200,000 Units/1) = 2 mL 11. tablets = (1 tablet/0.1 g) * (1 g/1,000 mg)*(200 mg/1) = 2 tablets 12. mL = (1.5 mL/500 mcg) * (1,000 mcg/1 mg) * (0.75 mg/1) = 2.250 rounds down to: 2.25 mL

    95. 95 Answers to Solved Problems 13. mL = (5 mL/180 mg) * (360 mg/1) = 10 mL 14. mL = (5 mL/1 tsp) * (1 tsp/125 mg) * (500 mg/1) = 20 mL 15. mL/dose = (3 mL/175 mg) * (75 mg/Kg/day) * (day/4 doses) * (1 Kg/2.2 lbs) * (41 lbs/1) = 5.993 rounds down to 5.99 mL/dose

    96. 96 Answers to Solved Problems 16A. hr = (24 hr/3) = 8 hours 16B. mL/dose = (1 mL/75 mg) * (15 mg/Kg/day) * (1 Kg/2.2 lbs) * (231 lbs/1) * (1 day/3 doses) = 7 mL/dose 17. mcg/g = (1,000 mcg/1 mg) * (1,000 mg/1 g) = 1,000,000 mcg/g 18. mL = (15 mL/tbs) * (4 tbs/1) = 60 mL

    97. 97 Answers to Solved Problems 19. gtt/min = (10 gtt/1 mL) * (500 mL/8 hr) * (1 hr/60 min) = 10.4 rounds down to 10 gtt/min 20. gtt/min = (60 gtt/1 mL) * (50 mL/2 hr) * (1 hr/60 min) = 25 gtt/min 21. Main bag stops flowing into the IV line until piggyback bag is empty. 22. mL/hr = (100 mL/2 hr) = 50 mL/hr

    98. 98 Answers to Solved Problems 23. mL/hr = (250 mL/90 min) * (60 min/1 hr) = 166.66 rounds up to 166.7 mL/hr 24. mL/hr = (75 mL/90 min) * (60 min/1 hr) = 50 mL/hr 25. mEq/day = (8 mEq/150 mL) * (25 mL/1 hr) * (24 hr/ day) = 32 mEq/day 26. mcg/min = (1,000 mcg/1mg) * (150 mg/250 mL) * (10 mL/1 hr) * (1 hr/60 min) = 100 mcg/min

    99. 99 Answers to Solved Problems 27. orange juice (6 oz * 30 mL/oz) = 180 mL milk (4 oz * 30 mL/oz) = 120 mL syrup (1 oz * 30 mL/oz) = 30 mL coffee + milk (8 oz * 30 mL/oz) = 240 mL gelatin (1/4 cup * 240 mL/cup) = 60 mL apple sauce (3 tbs * 15 mL/tbs) = 45 mL infusion (150 mL/hr * 8 hr) =1,200 mL medication (2 tsp * 5 mL/tsp) = 10 mL water (4 oz * 30 mL/oz) = 120 mL sherbet (1 pt * 500 mL/pint) = 500 mL --------------- 2,505 mL (2,505 mL * 1,000 mL/liter) = 2.5 liters

    100. 100 Answers to Solved Problems 28. (A) hours = (1 hr/52 mL) * (450 mL/1) = 8.65 hours Not 8 hours and 65 minutes! minutes = (60 min/hr) * (0.65 hr/1) = 39 minutes The bag will empty in 8 hours and 39 minutes (B) 7 PM + 8 hours = 3 AM 47 minutes + 39 minutes = 86 minutes 3 AM + 86 minutes = 4:26 AM The clock will show 4:26 AM.

    101. 101 Answers to Solved Problems 29. (A) How much fluid was lost? 200 urine + 2 * 75 diarrhea + 250 vomit = 600 mL (B) The physician orders the existing drip to continue as ordered PLUS an order to replace the lost fluid over the next hour. How much fluid will the nurse infuse over the next hour? 600 replacement + 15 existing order = 615 mL (C) How many drops/minute? gtt/min = (15 gtt/mL) * (615 mL/60 min) = 154 mL

    102. 102 Answers to Solved Problems (D) In a separate IV, the patient is receiving 1350 Units/hr of a medication that is dispensed from a 500 mL bag containing 25,000 Units of the drug through a micro drip set. How many mL/hr are being infused? mL/hr = (500 mL/25,000 Units) * (1350 Units/hr) = 27 mL/hr (E) How many drops/minute are being infused? gtt/min = (60 gtt/mL) * (27 mL/hr) * (hr/60 min) = 27 gtt/min

    103. 103 Answers to Solved Problems The physician decides to increase the dosage by 3 Units/Kg/hr. The patient weighs 185 pounds. (F) How many Units/hr will the nurse administer? Units/hr = (3 Units/Kg/hr) * (Kg/2.2 pounds) * (185 pounds/1) = 252 Units/hr + 1,350 Units/hr 1,602 Units/hr (G) How many mL/hour will the pump be set? mL/hr = (500 ml/25,000 Units) * (1,602 Units/hr) = 32 mL/hr

    104. 104 Answers to Solved Problems (H) How many gtt/min will be infused? gtt/min = (60 gtt/mL) * (32 mL/hr) * (hr/60 min) = 32 gtt/mmin (I) How many hours will this IV run? Express as a decimal quantity – 3 decimal places. hr = (hr/32 mL) * (500 mL/1) = 15.625 gtt/min

    105. 105 Answers to Solved Problems (J) How many whole hours will the IV run? 15 hours (K) How many remaining minutes will there be? min = (60 min/hr) * (0.625 hr/1) = 38 min (L) This IV started at 8:57 PM. What time will the bag empty? 8:57 PM + 15 hrs = 11:57 AM 11:57 AM + 38 minutes = 11:95 AM = 12:35 PM

    106. 106 Answers to Solved Problems (M) An additional IV is ordered to run at 60 mL/hr. The bag contains 2 grams of medication dissolved in 500 mL of D5W. The label specifies that the normal dosage is from 1 to 4 mg/min. What does the manufacturer consider the safe dosage range? 1 to 4 milligrams per minute (N) At 60 mL/hr, what will be the ordered dosage range in mg/hr? (1 mg/min) (60 min/hr) = 60 mg/hr (4 mg/min) (60 min/hr) = 240 mg/hr

    107. 107 Answers to Solved Problems (O) Referring back to slide #104, is the order in part N a safe dose? mg/hr = (1,000 mg/g) * (2 g/500 mL) * (60 mL/hr) = 240 mg/hr Yes it is a safe dose (P) If the physician were to order 1800 mg of the same medication at 70 mL/hr, will the nurse accept or reject the order? Why? mg/hr = (1,800 mg/500 mL) * (70 mL/hr) = 252 mg/hr Reject & question the order. It is (252 mg – 240 mg) =12 mg/hr too large.

    108. 108 Answers to Solved Problems 30. Determine how much of the combined drug you will give the patient per minute. Order: 22 mL/hr. If required, round to 3 decimal places. Formulation: Drug A – dissolve 70 mg/10 mL of D5W Drug B – dissolve 30 mg/15 mL of D5W You will dissolve and mix the 2 drugs as above. This will yield 25 mL of combined drugs. Of the 25 mL, you will give the patient 22 mL spread over 60 minutes. The 70 & 30 mg are distracters. mL/hr = (22 mL/hr) * (hr/60 min) = 0.367 mL/hr THE END 5/4/2008 @ 21:22

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