foundations of professional nursing ii exam prep

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1. Foundations of Professional Nursing IIExam Prep Drug Math Dimensional Analysis

3. Basic Dimensional Analysis Review The doctor ordered Rocephin 750 mg IM x 1 dose. You have available a 5 mL vial labeled “Rocephin 1 gram/2.5 mL” How many mL will you administer? _________

4. Basic Dimensional Analysis Review The doctor ordered Rocephin 750 mg IM x 1 dose. You have available a 5 mL vial labeled “Rocephin 1 gram/2.5 mL” How many mL will you administer? _________ We are looking for (calculating) mL The order is 750 mg Available concentration is 1 gram/2.5 mL (Conversion) 1 gram = 1000 mg (the question doesn’t tell us this; we have to know it) The 5 mL tells us the size of vial (Extra info)

5. Basic Dimensional Analysis Review The doctor ordered Rocephin 750 mg IM x 1 dose. You have available a 5 mL vial labeled “Rocephin 1 gram/2.5 mL” How many mL will you administer? _________ 2.5 mL 1 gram 750 mg mL = ---------- X ------------ X ----------- = 1 gram 1000 mg

6. Basic Dimensional Analysis Review 1st, reduce commons 2.5 mL 1 gram 750 mg mL = ---------- X ------------ X ----------- = 1 gram 1000 mg

7. Basic Dimensional Analysis Review 2nd, do the math (follow UAMS rounding rules) 2.5 mL 1 gram 750 mg 7.5 mL = ---------- X ------------ X ----------- = ------ = 1.875 = 1.9 1 gram 1000 mg 4

8. Basic Dimensional Analysis Review Is your answer “reasonable”? How many mL can safely be giving in a single IM injection (assuming you are caring for an adult)? Rocephin is an irritating antibiotic and will hurt when given IM; use a large muscle and administer it deep IM, so avoid the deltoid muscle (maximum amount there is 1 mL per site). You will use the ventrogluteal, so you may give 2-3 mL per site (depending on your institutional policy). So, 1.9 mL is a “reasonable” answer. If you had 4 mL to give, then you’d have to divide it into two injections given in 2 separate sites

9. Medication Administration Lab In addition to basic calculations, you will have to calculate each of the following for Foundations II Drug Math Exam before the beginning of Fall semester mL/hr gtt/min units to administer (Heparin & Insulin)

10. IV Therapy Review previous IV Calculations

11. mL/hr Calculation Since IV infusion pumps are frequently used in practice today, doctors will usually write out in the order how many mL/hr they want an IV to infuse; So, no calculation is necessary Order IVF: 1000 mL D5 ˝ NS to run at 42 mL/hr 1000 mL D5NS IV at 83 mL/hr Run 1 L NS at 125 mL/hr

12. mL/hr Calculation However, doctors sometimes will write how many hours to run an IV over and the nurse will then need to calculate mL/hr Order IVF: 1000 mL D5 ˝ NS at 24 hour rate IVF: D 5 ˝ NS to run at 42 mL/hr 1000 mL D5NS over 12 hours 1000 mL D5NS IV at 83 mL/hr Run 1 L NS at 8 hour rate Run NS at 125 mL/hr

13. mL/hr Calculation IVF: 1000 mL D5 ˝ NS at 24 hour rate 1st, what are we looking for? We do have an infusion pump, so it is mL/hr. Infusion pumps always run in mL/hr!! mL 1000 mL ------ = ------------ = 41.66666 = 42 mL/hr hr 24 hr

14. mL/hr Calculation Now, what happens if the doctor orders an amount of fluid to run over minutes rather than 1 hour? Remember, the pumps are calibrated for mL/hr so you will need to plug the conversion for hours/minutes into your formula 60 min = 1 hour

15. mL/hr Calculation The doctor orders 100 mL IVPB to infuse over 30 minutes. How many mL/hr do you set the pump? mL 100 mL 60 min ------ = ---------- X --------- = hr 30 min 1 hr

16. mL/hr Calculation The doctor orders 100 mL IVPB to infuse over 30 minutes. How many mL/hr do you set the pump? mL 100 mL 60 min 200 ------ = ---------- X --------- = ----- = 200 mL/hr hr 30 min 1 hr 1

17. gtt/min Calculation You will use this formula when you don’t have a pump to infuse the ordered IV fluids!! You will have to locate the drop factor (found on the IV tubing package) Drop factor = how many drops does it take to equal 1 mL

18. gtt/min Calculation Standard macrodrip calibration 10, 15, or 20 gtt/mL Used for most adult IV sets Microdrip calibration set 60 gtt/mL Used in pediatrics or critical medication drips

19. gtt/min Calculation 1000 mL D5W with 40 mEq KCL is to infuse over 12 hours. The IV drop factor is 10 gtt/mL. How many drops per minute will be given? We calculate drops/minute because we don’t have a pump and it doesn’t make sense for the nurse to stand at the bedside and count drops for one hour; the nurse counts drops for 1 minute and then a second minute to verify that the correct drops are infusing to deliver the ordered amount over 1 hour

20. gtt/min Calculation 1000 mL D5W with 40 mEq KCL is to infuse over 12 hours. The IV drop factor is 10 gtt/mL. How many drops per minute will be given? gtt 10 gtt 1000 mL 1 hr ----- = -------- X ------------ X ---------- = min 1 mL 12 hr 60 min

21. gtt/min Calculation 1000 mL D5W with 40 mEq KCL is to infuse over 12 hours. The IV drop factor is 10 gtt/mL. How many drops per minute will be given? gtt 10 gtt 1000 mL 1 hr 500 ----- = -------- X ------------ X ---------- = ------- = 13.888 = 14 min 1 mL 12 hr 60 min 36

22. gtt/min Calculation The doctor orders furosemide (Lasix) 20 mg in 50 mL of NS. Infusion time is 30 minutes. Drop factor is 60 gtt/mL. How many gtt/min will you give? gtt 60 gtt 50 mL ----- = -------- X --------- = min 1 mL 30 min

23. gtt/min Calculation The doctor orders furosemide (Lasix) 20 mg in 50 mL of NS. Infusion time is 30 minutes. Drop factor is 60 gtt/mL. How many gtt/min will you give? gtt 60 gtt 50 mL 100 ----- = -------- X --------- = ----- = 100 gtt/min min 1 mL 30 min 1

24. gtt/min Calculation Be careful, Some problems with have “too much” information for your calculations!!! 250 mL D5W is to infuse at 10 mL/hr. The IV drop factor is 60 drops per mL. How many drops per minute will this IV run? Work the question this way!!! We are looking for (calculating) gtt/min 250 mL is extra information The doctors order is 10 mL/hr Drop factor is 60 gtt/mL Note: We don’t have (and we don’t need) a specific time for the infusion to infuse over

25. gtt/min Calculation 250 mL D5W is to infuse at 10 mL/hr. The IV drop factor is 60 drops per mL. How many drops per minute will this IV run? gtt 60 gtt 10 mL 1 hr 10 ----- = -------- X -------- X --------- = ---- = 10 gtt/min min 1 mL 1 hr 60 min 1

26. mL/hr Calculation Beware of the question that gives “too much” information by giving you the drop factor but ask you to calculate mL/hr The doctor ordered 1000 mL D5NS to infuse over 8 hours. The drop factor is 15 drops per mL. How many mL/hr will the IV run?

27. mL/hr Calculation The doctor ordered 1000 mL D5NS to infuse over 8 hours. The drop factor is 15 drops per mL. How many mL/hr will the IV run? mL 1000 mL ---- = ------------ = 125 mL/hr hr 8 hr

28. Remaining Time in IV Bag Now, what if you want to know how many hours/minutes the current IV bag will run before it is empty? You might want to know this during your morning assessment, so that you can plan to bring a new bag before the time expires on the current bag You might want to know this if you need to give blood after the current bag of IV fluids runs dry

29. Remaining Time in IV Bag The information needed is: Total volume (remaining in bag, not bag size) Current mL/hr it is infusing at Infusion Time = Total Volume / mL/hr rate During the morning assessment the RN notes that the IV has 750 mL remaining in the bag. The IV rate is currently 75 mL/hr. How long will the current bag of IV fluids last?

30. Remaining Time in IV Bag During the morning assessment the RN notes that the IV has 750 mL remaining in the bag. The IV rate is currently 75 mL/hr. How long will the current bag of IV fluids last? Infusion Time = 750 mL / 75 mL/hr = 10 hours

31. Remaining Time in IV Bag What happens if your answer comes out with a number right of the decimal point? Example 10.48 Just multiply the .48 X 60 minutes 60 minutes X .48 = 28.8 = 29 minutes So the answer 10.48 = 10 hours 29 minutes

32. Remaining Time in IV Bag The IV is infusing at 30 gtt/min. The remaining volume is 1000 mL. The drop factor is 15 gtt/mL. How long will the IV bag last? 1 hr 1 min 15 gtt 1000 mL hr = --------- X -------- X -------- X ------------ = 60 min 30 gtt 1 mL

33. Remaining Time in IV Bag The IV is infusing at 30 gtt/min. The remaining volume is 1000 mL. The drop factor is 15 gtt/mL. How long will the IV bag last? 1 hr 1 min 15 gtt 1000 mL 100 hr = --------- X -------- X -------- X ------------ = ------ = 8.333 60 min 30 gtt 1 mL 12

34. Remaining Time in IV Bag The IV is infusing at 30 gtt/min. The remaining volume is 1000 mL. The drop factor is 15 gtt/mL. How long will the IV bag last? 8.33 = 8 hours 60 min X .33 = 19.8 = 20 minutes Answer: 8 hours 20 minutes

35. Units—Heparin Tuberculin syringes 1 mL in size Used to administer small doses Calibrated in hundredths Each mark represents 0.01 We will use it to administer Heparin Heparin is ordered in units, not mL or mg There are no conversions for unit (you can’t convert to mg or grain or gram, etc.) Do not use the tuberculin syringe to administer insulin

36. Unit Calculation The doctor ordered Heparin 4000 units SQ. Available is Heparin 5000 units per mL. How many mL will the nurse administer? Use basic calculations to do this problem; Heparin is ordered in units but is available in mL, so we will calculate mL 1 mL 4000 units mL = -------------- X ------------- = 5000 units

37. Unit Calculation The doctor ordered Heparin 4000 units SQ. Available is Heparin 5000 units per mL. How many mL will the nurse administer? 1 mL 4000 units 4 mL = -------------- X ------------- = ----- = 0.8 mL 5000 units 5 What type of syringe will you use to administer the Heparin?

38. Units—Heparin The doctor ordered Heparin 2000 units SC NOW. Pharmacy sends a vial labeled, Heparin 5000 units per mL. How many mL do you administer? 1 mL 2000 units 2 mL = -------------- X --------------- = ---- = 0.4 mL 5000 units 5

39. Units—Insulin Use Insulin syringes to administer insulin Do not use tuberculin syringes Insulin syringes 1 mL in size Some are ˝ mL in size (if the dose of insulin is less than 50 units) This makes it easier to see the small lines Calibrated in units (1 unit) = hundredths (0.01 mL) Marked U-100 This means there are 100 units of insulin in each mL of the medicine Make sure that the bottle of insulin is also marked U-100 Insulin is available in a 10 mL vial That means there are 1000 units of insulin in the entire bottle

40. Units—Insulin

41. Insulin Information Insulin is a hormone; it’s direct affect on the person is to lower blood glucose (sugar) levels Generally, the normal blood glucose level is 70-110 Insulin is available in several different forms, so make sure you know what is expected from the drug you administer Rapid- and Short-Acting Insulin Intermediate-Acting Insulin Long-Acting Insulin (includes basal insulin) Combination Insulin

42. Insulin Information Refer to your Fundamentals book for specific actions of each insulin Table 35-10, p 743 Potter, P.A. & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis: Mosby Elsevier.

43. Unit Calculation You have Humulin -R insulin available in a bottle labeled U-100. The doctor orders Humulin-R insulin 16 units. How many units will you administer? 16 units, (that’s what the doctor ordered) Now, what if the question asked, how many mL will you administer?

44. Unit Calculation You have Humulin -R insulin available in a bottle labeled U-100. The doctor orders Humulin-R insulin 16 units. How many mL will you administer? 1 mL 16 units 16 mL = ------------ X ----------- = ----- = 0.16 mL 100 units 100

45. Insulin Doctors will sometimes order a longer or intermediate acting insulin along with a short acting insulin These may usually be combined into one syringe and given as a single injection (if they are compatible) Refer to your Fundamentals of Nursing book on the exact procedure for combining insulin

46. Combining Insulin The doctor ordered NPH insulin 25 units and Regular insulin 12 units SC BID AC. How many TOTAL units will you administer? 25 units + 12 units = 37 units

47. Sliding Scale Insulin Potter, P.A. & Perry, A.G. (2009). Fundamentals of nursing (7th ed.). St. Louis: Mosby Elsevier. Sliding Scale insulin is discussed on p. 743 Basically, doctors will order a sliding scale insulin to cover the patients blood glucose level; the orders include checking the patients blood glucose level at specific time frames and giving a specific amount and type of insulin to bring the glucose level down when needed Sliding Scale insulin is usually ordered with a rapid- or short-acting insulin (Humalog, Novolog, or regular insulin). These insulin’s will begin to work (onset) within 15-30 minutes from time of administration!!!! Example sliding scale Box 35-24, p 743

48. Sliding Scale Insulin The doctor ordered regular insulin to follow the sliding scale ac & hs. The clients blood sugar is 393 at 1700. How many units of insulin will the nurse administer? 0-180 0 insulin 181-250 3 units 251-350 5 units 350-400 7 units >400 Call MD

49. Sliding Scale Insulin The doctor ordered regular insulin to follow the sliding scale ac & hs. The clients blood sugar is 393 at 1700. How many units of insulin will the nurse administer? 0-180 0 insulin 181-250 3 units 251-350 5 units 350-400 7 units >400 Call MD

50. Sliding Scale Insulin The doctor ordered regular insulin to follow the sliding scale Q 6 hr. The clients blood sugar is 93 at 1200. How many units of insulin will the nurse administer? 0-150 0 insulin 250-299 5 units 151-199 1 unit 300-349 7 units 200-249 3 units 350-399 8 units

51. Sliding Scale Insulin The doctor ordered regular insulin to follow the sliding scale Q 6 hr. The clients blood sugar is 93 at 1200. How many units of insulin will the nurse administer? 0-150 0 insulin 250-299 5 units 151-199 1 unit 300-349 7 units 200-249 3 units 350-399 8 units

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