Dosage Calculations Packet Unit I Basic Mathematics Review

This unit will review Arabic and Roman numerals, fractions, decimals, percentage, and ratio and proportion. ARABIC AND ROMAN NUMERALS Arabic and Roman numerals are used interchangeably to express quantity or degree of measure. Roman numbers are formed by combining the following letters according to the rules stated below: Arabic numbers " $ "$ $$ "$$ $$$ Roman numbers ss ! # % & ' ( )

. To repeat a Roman number doubles its value. ! * + !!*, ,. To place a letter to the right of a Roman number adds its value to that number. #*"+ #!*-. .. To place a letter to the left of a Roman number decreases the value of that number by the amount of the number added. #*"+ !#*/. Practice Problems 0rite the Arabic numbers for the following: . !!!11111 /. #!11111 ,. %#! 11111 ". ')111111 .. %%%!% 11111 -. %%!# 11111

0rite the Roman numbers for the following: 2. , 11111 3. / 11111 4. /$ 11111 111111 . 3$ 11111 ,. "$ 11111 .. 44 11111 /. 4 111111 $. -4

Answers: . . ,. .. .4 2. !! 3. %!# . &%%% ,. '&

/. 4. %& .. !'

". 4$$ -. ,/ $. &%!% /. %!%

FRAC IONS (efinition: A fraction is a part of a whole number. A fraction has , parts, the top number is called the numerator and the bottom number is called the denominator. 5xample: * is the numerator and , is the denominator.

There are / types of fractions: . 6roper fractions 7 the numerator is less than the denominator. 5xample: . ,. !mproper fractions 7 the numerator is greater than the denominator. 5xample: -8". .. 'omplex fractions 7 the numerator or denominator may be either a fraction or a whole number. 5xample: or , 9 /. )ixed number 7 there is a whole number and a fraction
,

combined. 5xample: . . To change a mixed number to an improper fraction, you must multiply the whole number by the denominator and add the numerator. 5xample: . * 28,.

Practice Problems Reduce the following fractions to the lowest terms ,8/*11111 .8-*11111 .84*11111 /8-*11111 $8,$* 11111 "8,$* 11111 ,8 $* 11111 .8 ,* 11111 .. 8/ 4. ,83 * 11111 38 ,*11111 "8 $*11111 .8 "*11111 /. $. ,8. ". 9 . : -. ,8. ,. 8"

Answers: . ,. 2. 8. 3. 8"

'hange the following improper fractions to mixed numbers . -8/*11111 /. .8,*11111 Answers: . ,. ,8" ,. 28"*11111 ". 28.*11111 .. 283 /. .. -. "83* 11111 8 $*11111 ". , 8. -. 8 $

'hange the following mixed numbers to improper fractions . . * 11111 ,. - *11111 /. .. 8.* 11111 ". 3 9*11111
.

.. $ *11111 -. 4 .8"*11111

Answers: . 28, ,. .8, .. , 8, /. $$8. ". ."8/ A!!ing Fractions "it# Like Denominators$

-. /38"

. Add the numerators. ,. 6lace the answer over the denominator. .. Reduce the answer to the lowest term by dividing the numerator and the denominator by the largest number that can divide them both. 5xample: 83 ; 83 *,83 (ivide the numerator and denominator by , and ,83 becomes :.

A!!ing Fractions "it# Unlike Denominators$ . (etermine the smallest number that the denominators of each fraction divide into evenly. This is called the least common denominator<&'(=. ,. (ivide the denominator into the &'( and multiply the results by the numerator. .. Add the new numerators and place over the new denominator. /. Reduce to lowest terms. 5xample: 8, ; 8. < , and . will divide evenly into -= - divided by , * . x * . - divided by . * , x * , .;, * " - This is reduced to the lowest terms.

Subtracting Fractions "it# Like Denominators$ . >ubtract the numerators. ,. 6lace the difference over the denominator. .. Reduce to the lowest terms. 5xample: 2 7 . * / 3 3 3 This reduces to .

Subtracting Fractions "it# Unlike Denominators$ . ,. .. /. ?ind the &'( and convert fractions. >ubtract the numerators. 6lace the difference over the &'(. Reduce to the lowest terms.

5xample:

7 <?ind the &'(= * . 7 , * , . - - This answer is reduced to the lowest terms.

Multi%l&ing Fractions$ . )ultiply the numerators. ,. )ultiply the denominators. .. Reduce to the lowest terms. 5xample: . x , * - Reduced * / . , ,

"

Di'i!ing Fractions$ . ,. .. /. ". !nvert the divisor <,8. would become .8,=. 'hange the division sign to multiplication. )ultiply the numerators. )ultiply the denominators. Reduce to the lowest terms.

5xample:

divided by * x, * , . , . . This answer is reduced to the lowest terms. Practice Problems (or Fractions$ . 8/ ; : * 111111 ,. 8. ; ,8. * 111111 .. ,8" ; ,8" * 111111 /. .8/ ; : * 111111111 ". 8- ; .8 , *111111 -. : ; * 111111 2. "83 ; 9 * 111111 3. ,8. ; .8" * 11111 4. ,8. 7 8. * 111111 $. "83 7 .83 * 111111 . 9 @ * 11111 ,. 28 $ 7 8,$ *11111 Answers: . ,. .. /8" /. ". "8 , -. 9 2. .83 4. $. . ,. .. /. ". .. 28 , 7 8/. 284 7 8. ". ,8. % 83
-. 8. % 8- * 11111

* 111111 * 111111 * 111111

2. 3. 4. ,$. , . ,,. ,.. ,/. 8. 8/ 8/ .8,$ "8 , /84 8 ,

-

9% * 111111 48," % /8., * 111111 "8- % ,8. * 111111 9 divided by ,8. *111111 84 divided by .84 *111111 83 divided by ,8. *111111 8" divided by *11111 .83 divided by .83 *111111 2. 3. 4. ,$. , . ,,. ,.. .83 48,$$ "84 83 8. .8 ,8"

3. /8 " -. 8 3 ,/. 6lease see Aursing ?aculty if you need further homeworB. DECIMALS$ A!!ing Decimals$ Align the decimals and add. 5xample: ; $., -.$4. ,.4$ ./.$/ "..,/

Subtracting Decimals$ Align the decimals and subtract. 5xamples: ,."@ $.3. .2. -.$$ @ $.4$ ". $

Multi%l&ing Decimals$ . )ultiply as whole numbers. ,. 'ount the number of decimal places in each number. .. 'ount from right to left in the answer and place the decimal point. 5xamples: .../ x $.3 ,.-2, ,.-2 x .," -.." ,"./ .. -2"
2

Di'i!ing Decimals$ . 'hange the dividing number to a whole number by moving the decimal point to the right. ,. 'hange the number being divided by moving its decimal point the same number of places to the right. .. (ivide as usual. /. 6lace the decimal point in the answer directly above the decimal point in the dividend. ". 'arry out the answer to . decimal places before rounding off to , places. 5xample: 2.. $.$.. ,. 4. , $4 4 $

The answer is 2.

5xample:

3 . $.$". /.$"." /$ $" " $" " $

The answer is 3 .

Roun!ing Decimals$ . (etermine at what place you are going to round. ,. !f the number to the right of the place you are going to round is greater than or equal to ", round up to the next number. .. !f that number is less than ", delete the remaining number or numbers. Practice Problems . ,.$. ; .$$4 ; ,.4 *11111 ,. .... ; $.- ; /.$$ * 11111 .. ,.$$4 @ .34 * 111111111 /. ..4$ 7 ,.$, * 111111111 ". /.., % .4 * 11111111111 -. $.43$ % $., * 111111111 2. ,/ divided by ., * 11111 3. $.2" divided by $." * 111 Round the decimal to the tenth place: 4. $.2" *111111 . $.43 * 111111 $. $.,. *1111111 ,. $..- *1111111

Round the decimal to the hundredth place: .. .$3- *11111 ". ,.,./ *111111 /. $./"- * 111111 -. 4.$ / * 11111

Answers: . /.4.4 ". ..333 4. $.3 .. .$4 /. $./-

2.4. $. 4$., $./". ,.,.

4

,. -. $. /.

.. . 4 2. ,$ . .$ ". ,.,.

/. .33 3. ." ,. $./ -. 4.$

6lease see Aursing ?aculty if you need further homeworB. PERCEN A)E$ A percentage is a part of $$. C#anging Percent to Fractions$ . ,. .. /. The numerator will be the number in front of the C sign. The denominator will always be $$. (ivide as usual. Reduce to the lowest terms.

5xample: ,"C * ," * <," divided by $$= * : $$

C#anging Fractions to Percent$ . (ivide the numerator by the denominator. ,. )ultiply the answer by $$. 5xample: : * divided by / * $.," % $$ * ,"C

C#anging Percent to a !ecimal$ . Remove the C sign. ,. (ivide by $$ <or move the decimal , places to the left=. 5xample: ,"C * ," * .," $$

Practice Problems$ 'hange to fraction: . $C * 11111 'hange to C: ,. * 11111 ". 8. * 11111 3. : * 11111 . /8" * 11111 'hange to decimal: .. $C * 11111

/. /"C * 11111 2. 2"C * 11111 $. ,"C * 11111 Answers: . 8 $ ". ..C 4. $.2"

-. /"C * 11111 4. 2"C * 11111 ,. ,"C * 11111

,. "$C -. $./" $. :

.. $. 2. 9 . 3$C

/. 48,$ 3. ,"C ,. $.,"

RA IO an! PROPOR ION$

Ratio$ (efinition: A ratio expresses the relationship of one quantity to another. 0hen solving dosage calculations, a ratio is composed of two numbers that are separated by a colon. 5xamples: ,:/ or /: - or :"$

Pro%ortion$

(efinition: A proportion shows the relationship between two ratios that are equal. 5xamples: : , :: , : / or , : 3 :: " : ,$ The first example is read liBe this: is to , as , is to /. Dou can see that these two ratios are equal. The way to demonstrate this mathematically is to multiply the two outer numbers together and the two inner numbers together. The answers will be equal to one another. 5xample: , : 3 :: " : ,$ , x ,$ * *+ <outer numbers multiplied together= 3 x " * *+ <inner numbers multiplied together= Ratio and proportions are used to solve dosage calculation problems when you do not Bnow one of the four numbers. This is called solving for E%F or solving for the unBnown.

Sol'ing (or ,-.$ . )ultiply the outer numbers. ,. )ultiply the inner numbers. .. 6lace the answer that contains the E%F to the left of the equals sign and solve the equation by diving the entire equation by the number before the E%F. 5xample: . : " :: " : % .% * 2" <divide the equation by .= .% * 2" % *," . . To checB your worB, put the answer into the equation and multiply the outer numbers and the inner numbers and they should be equal. 5xample: . : " :: " : ,"
,

. x ," * /0 <outer numbers multiplied together= " x " * /0 <inner numbers multiplied together= Practice Problems ?ind the value of x: . , : . :: 3 : x ,. x : "$$$ :: $ : "$$ .. ,8. : 9 :: x : , 8,/ /. " : x :: ,$ : .$ ". $. ," : 2. :: $.," : x -. ,., : - :: x : /$ , : - :: ,/ : x : 8 $$ 3. x : 8 "$ :: Answers: . , ,. $$ .. 284 /. 2 8, ". , -. " ... 2. , 3. ,8.

Unit II 1 S&stems o( Measurement an! Con'ersion

Aurses have the legal responsibility for administering the appropriate amount of medications. They must be able to interpret dosage instructions from manufacturers and doctors to administer doses accurately. They must also be able to provide client education regarding home administration. There are three primary systems of measure that are currently used in medication administration: the metric system, the apothecary system, and the household system. 2E ME RIC S3S EM The metric system is widely used in dosage calculations. !t uses powers of $ and the basic units of measure are the gram, liter, and meter. A gram measures weight, a liter measures fluid, and a meter measures length .

Gram: measures weight. Gram may be written G, g, Gm or gm.

&iter: measures liquid. &iter may be written & or l

/

)eter: measures length. )eter may be written m. . The metric system also uses prefixes to describe how much of the basic unit: 4ilo * $$$ times the basic unit. Centi 5 8 $$ of the basic unit or $.$ . Milli * 8 $$$ of the basic unit or $.$$ . Micro 5 8 ,$$$,$$$ of the basic unit or $.$$$$$ . 'ommonly seen units are the Hg <Bilogram=, ml <milliliter=, and mcg <microgram=. The metric system contains the following rules: . Arabic numbers are used <i.e. "$= ,. The symbol of measure is placed after the number <i.e. "$ ml= .. ?ractions are written as decimals <$.,"=
)5TR!' JA>!' 5KL!#A&5AT> Hg. * $$$ Gm. Gm. * $$$ mg. mg. * $$$ mcg. ml. * c.c. &. * $$$ c.c. or $$$ ml.

Practice Problems Abbreviate the following metric notations: . ?ive grams 1111111111111111 ,. >even hundred fifty milliliters 1111111111111111 .. Ine and one@half Bilograms 1111111111111111 /. Two hundred micrograms 1111111111111111 ". Ine@ half milligram 1111111111111111 -. ?ive@hundredths of a gram 1111111111111111 2. >ix hundred milligrams 1111111111111111 3. Three@tenths of a gram 1111111111111111
"

Answers: . " gm ,. 2"$ ml .. Bg /. ,$$ mcg ". $." mg -. $.$" gm 2. -$$ mg 3. $.. gm Using Ratio an! Pro%ortion "it#in t#e Metric S&stem As stated earlier, nurses use ratios < :,= to maBe comparisons, and proportions to show that two ratios are equal < : , :: , : /=. This principle is used to exchange weights within the metric system.
RL&5> I? 6RI6IRT!IA . ,. .. Lnits of ratios must correspond within the same proportion. 'orrect * Gm. : Hg. :: Gm. : Hg. Ao more than , different units of measure can be used within the proportion. &abel all numbers with the appropriate unit of measure.

5xample:

$." Hg. * 11M111gm.

?irst, find the basic equivalent in the previous chart. This would be, Hg. * $$$ Gm. Aow you Bnow . of the / numbers in the equation. >olve for E%F as you were taught in Lnit ! and utiliNe the above rules of proportion. >et the problem up: Hg. : $$$ gm. :: $." Hg. : % gm % * "$$

Remember, you multiply the outside numbers and then the inside numbers and then divide. !n this example, it was not necessary to divide. 0hat label comes after "$$M &ooB up at your problem, it would be "$$ gm. The label will always be what follows the unBnown E%F.
-

Practice Problems >olve for E%F: . ,"$ Gm. .. " mg. * % Hg. * % mcg. * % c.c. * % Gm. -. .." &. 2. "/ c.c. 3. $.," &. 4. ,$$$ mg. $. ,"$ mg. * % ml. * % &. * % ml. * % gm. * % Gm. ,. ,"$$ mcg. * % mg. /. / ml. ". . Hg.

Answers: . $.," Bg ,. ,." mg .. "$$$ mcg /. /cc ". .$$$gm -. ."$$ ml 2. $. "/ & 3. ,"$ ml 4. , gm $. $.," gm 6lease see Aursing ?aculty if you need further homeworB. 2E APO 2ECAR3 S3S EM The Apothecary >ystem is another method of expressing units of measure. !t is an old system and is not used exclusively because it is not standariNed. That means that each measure is an approximate amount, not an exact amount. Jut, some doctors still order medicines using this system, and some labels contain this system as well. !t is different from the metric system in the following ways: . !t uses Roman numerals <ss * 8,, i * , iv * /, v * ", ix *4, x * $= ,. The unit is written before the amount <gr i, gr ss, gr iv= .. ?ractions are written as common fractions <gr. 8 "$=. The only exception is , which is written as is. The basic units of measure that are commonly used are the grain, ounce, dram, and minim.
2

Grain: written gr.

measures weight and is

Iunce: a cursive

z but with an extra hump on top *

measures liquid amounts and is written liBe

(ram:

Lsed to measure smaller amounts of

liquid medicine. !t is written Oust liBe a cursive

z.

)inim:

Tiny amount of liquid medicine. A minim

equals a drop. !t is written liBe a cursive sometimes it has a long tail.

3

m and

Apothecary measures for dry weight are infrequently used. Therefore, the word EfluidF is generally dropped when referring to the dram or ounce. The table below reflects apothecary measures for volume.

A6ITP5'ARD JA>!' 5KL!#A&5A'5> -$ minims * fluid dram 3 fluid drams * ! fluid ounce - fluid ounces * pint , pints * quart / quarts * gallon

Practice Problems >olve for E%F using ratio and proportion: . m. .$ ,. dram iv /. qt. , -. dram iv 2. m. xxx 3. $ ss 4. " pt. * dram % * ounce % * pt. % * m. % * dram % * ounce % * qt. %

.. ounce ., * qt. % ". ounce xvi * qt. %

$. ounce ss * m. % Answers: . dram ,. oN .. qt

4

/. / pts

". qt

-. ,/$ m 2. dram 3. 8 - oN 4. 2."qt 2OUSE2OLD MEASURE

$. ,/$ m

The Pousehold Lnit of )easure is the most commonly recogniNed by laypeople in America. !t includes drops, teaspoons, tablespoons, and cups. Dro% is written gtt, teas%oon is written tsp or t., tables%oon is written Tbsp, tbsp or T and cu% is written '. This system is not standardiNed either, it utiliNes approximate measures.

PIL>5PI&( 5KL!#A&5AT> -$ drops <gtts.= . teaspoons , Tablespoons 3 ounces * teaspoon <t.= * Tablespoon <T.= * ounce * cup <'.=

Practice Problems >olve for E%F using ratio and proportion: . " T. ,. . c. .. * % t. * % ounce ". , ounce 2. 4T. 3. " t. ,. ,/ oN 2. / oN .. ,." t 3. .$$ gtts * % t. * % ounce * % gtts. /. 3 T -. ,/ ounce * % c.

"$ gtts. * % t.

/. / ounce * % T. Answers: . " t ". , t -. . c

Aurses must learn all three units of measure <metric, apothecary and household= because medicines are ordered or labeled using the metric system or apothecary system,
,$

and we tell patients how much medicine to taBe using the household system. LEARNIN) t#e BASIC E6UI7ALENCES !n order to calculate dosage amounts you must first memori8e these basic equivalences:
BASIC E6UI7ALENCES COMMONL3 USED g <gram= * $$$ mg <milligrams= Bg <Bilogram= * $$$ g Bg * ,., lb <pounds= &. <liter= * $$$ ml <milliters= ml * cc <cubic centimeter= mg * $$$ mcg. <micrograms= , T <tablespoon= * oN " 7 - gtt <drop= * ml -$ mg * gr <grain= dram * / ml .$ ml * oN <ounce= T * . tsp <teaspoon= ' <cup= * 3 oN T * " ml tsp * " ml

Con'ersion Bet9een S&stems Aow that you Bnow the equivalences, it is time to learn how to convert values between systems. Heep your charts of equivalences handy and refer bacB to them often. )any times the physician will order a medication in one strength but the pharmacy stocBs the medication in a different strength. Jy using ratio and proportion that you were taught in Lnit !, you can determine how much of the medication that the pharmacy stocBs will be needed to equal the amount ordered by the physician. Always set up your problem in the following manner:
HAI0A LA!T : HAI0A :: (5>!R5( LA!T : LAHAI0A I? )5A>LR5 5KL!#A&5AT I? )5A>LR5 5KL!#A&5AT LA!T I? <%= )5A>LR5 ,

E:am%le$ Pow many grams are there in "$$mgM < The Bnown ratio is $$$ mg * gm=
HAI0A LA!T : HAI0A :: I? )5A>LR5 5KL!#A&5AT LA!T I? )5A>LR5 (5>!R5( : % LA!T I? )5A>LR5

$$$ mg

gm

::

"$$ mg : % gm

$$$ % * "$$ % * "$$ $$$ % * $." gm <Remember to checB your answer= E:am%le$ ,$ mg is equal to how many grainsM < The Bnown ratio is -$ mg * gr= Lse the above formula: -$ mg : gr :: ,$ mg : % gr -$ % * ,$ % * ,$ -$ % * 8. grain <Remember to checB your answer=

,,

Practice Problems . : gr * 111111 mg ,. ,$ mg * 111111 gm .. $.$" gm * 111111 gr /. "" lbs * 111111 Bg ". ,"$ mcg *111111 mg -. $.. ml * 111111 m 2. / drams *111111 ml 3. /" ml *111111 oN 4. .," & *1111111 ml $. ,$ ml * 111111 tsp . gr *1111111 gm ,. $., mg *1111111 gr Answers: . " mg ,. $. ,$ gm .. $.2" gr /. ," Bg ". $.," mg -. " m 2. - ml 3. oN 4. ,"$ ml $. / tsp . $. gm ,. 8.$$ gr .. /. ". -. 2. 3. 4. ,$. , . ,,. ,.. ,/. ,." gm -- lbs .-$ cc . mcg , pts 2" Bg 2." cc 3$ mg 3 tsp - mg , tsp ,/$ c .. ,"$$ mg * 11111gm /. .$ Bgs * 11111lbs ". , oN * 11111cc -. $.$$. * 11111mcg 2. $$$ ml * 11111pts 3. -" lbs * 11111Bg 4. ." tsp * 11111cc ,$. . gr * 11111mg , . 8. oN * 11111tsp ,,. $.$$- gm * 11111mg ,.. $ ml * 11111tsp ,/. . ' *11111cc

6lease see Aursing ?aculty for further homeworB.

,.

UNI III 1 Sim%le Dosage Calculations

The focus of this unit is learning to interpret physician orders and read medication labels correctly. !n addition, the administration of safe dosages of oral and parenteral medication will be discussed. IN ERPRE IN) P23SICIAN ORDERS !n order to administer medications safely and correctly the nurse must first be able to interpret the physicians order. 5xample: Ambien $ mg p.o. q h.s. p.r.n. sleep. 0hat is the name of the medicationM Ambien 0hat is the prescribed dosageM $ mg 0hat is the route of administrationM p.o. <by mouth= 0hen is the drug to be administeredM h.s. <hr of sleep= 0hy is the drug to be administeredM to help pt sleep Practice Problems ?or each of the )( orders interpret the following: a. b. c. d. e. . ,. .. /. )edication nameM 6rescribed dosageM Route of administrationM Time of administrationM 0hat other directions, if any, are givenM H@&or ,$ m5q p.o. in ,$ cc orange Ouice b.i.d. #alium " mg p.o. q / hr p.r.n. anxiety. Tylenol gr % p.o. q / hr p.r.n. temp Q $ . (emerol 2" mg !.). q / hr p.r.n. pain.
,/

Answers: . a. H@&or b. ,$ m5q c. po <by mouth= d. , times a day e. mix in ,$ cc orange Ouice ,. a. b. c. d. e. .. a. b. c. d. e. /. a. b. c. d. e. #alium " mg po every / hours as needed give as needed for anxiety Tylenol grain $ po every / hours as needed give if temp Q $ (emerol 2" mg !) <intramuscular= every / hours as needed give as needed for pain

IN ERPRE IN) MEDICA ION LABELS )edication label information varies from one medication to another. Powever, most all labels contain the following information+ brand name, generic name, dosage, route of administration and manufacturer. !f a medication has to be reconstituted, the label will contain information regarding suitable diluents, amount of diluents to be added, concentration of medication after it is reconstituted and its stability. The label of a medication to be administered !# should tell what !# fluids are compatible with the
,"

medication. !f the medication is in a multi@dose pacBage it will give the total amount of the medication contained. Practice Problems !dentify the following for each of the medication labels: a. Generic name c. Route of administration or form b. Trade name d. (osage .

,.

..

/.

Answers: . a. ramipril ,. a. cefotaxime

b. Altace c. capsules b. 'laforan c. !)8!#

,-

d. ,." mg8cap d. gm

.. a. phenobarbital b. none c. tablets d. " mg8tab /. a. epoetin alfa b. 5pogen c. ml vial d. .,$$$ u8ml CALCULA ION OF ORAL DOSA)ES Iral dosage forms of medications include tablets, capsules, suspensions, loNenges, powders, emulsions, solutions, tinctures, syrups and elixirs. The liquid forms of oral medications are generally calculated to be administered in millimeters, cubic centimeters teaspoons, tablespoons and sometimes minims.
RL&5> ?IR IRA& (I>AG5> . ,. .. Inly scored tablets can be divided accurately. Administer the least number of tablets, capsules, etc. possible to obtain the correct dosage. !f the ordered medication specifies a number of pills without a designated strength, the order can only be carried out if the drug is manufactured in a single strength. There can only be a $C margin of difference between the or!ere! and the a!ministere! dosage to be considered within a safe range.

/.

To calculate oral dosages you will use the previously discussed method of ratio and proportion. >et the problems up Oust as you did in Lnit !!. 5xample: IR(5R5(: Amoxicillin "$$ mg p.o. A#A!&AJ&5: Amoxicillin ,"$ mg tablets ,"$ mg : ,"$ % * "$$ % * "$$ ,"$ % * , tablets tab :: "$$ mg : , tab tablet :: "$$ mg : % tablets

'hecB your answer: ,"$ mg :

,2

,"$ x , * 0++

x "$$ * 0++ 5xample: IR(5R5(: Aembutal .$ mg p.o. A#A!&AJ&5: Aembutal scored tablets gr. ! >ince the ordered form of the medication and the available form of the medication are values from different systems of measurement, you must first change the ordered form of the medication to the available form of the medication. #is t&%e o( a %roblem is al9a&s going to re;uire < ste%s= Ste% >$ <The Bnown ratio is -$ mg * grain= -$ mg : -$ % * .$ % * .$ -$ %* , grain or $." grain grain :: .$ mg : % grain

Ste% <$ Aow put this answer into an equation and determine how many tablets you should administer. grain : tablet :: $." grain : % tablet

% * $." Dou would administer of a tablet.

CALCULA ION OF PAREN ERAL DOSA)ES 6arenteral means inOection of drugs into the tissue or fluids of the body. The various routes for this include+ !ntradermal <!.(.=, >ubcutaneous <>.'. or sq=, !ntramuscular <!.).= and !ntravenous <!.#.=. The calculation of these dosages is no different from oral
,3

dosage calculations. Dou will use ratio and proportion to solve the problems. Heep your conversion charts handyR Practice Problems 'alculate the correct amount of oral or parenteral medications to be administered: . Irder : (emerol ,$ mg !) Available: (emerol "$ mg per cc ,. Irder: >copolamine gr 8.$$ !) Available : >copolamine $./ mg per ml .. Irder : Amoxil $." gm p.o. Available: Amoxil ,"$ mg per " ml /. Irder: 6roNac liquid /$ mg p.o. Available: 6roNac liquid ,$ mg per "ml ". Irder: Aitrostat 8 $$ gr p.o. Available: Aitrostat $.. mg per tablet -. Irder: #@'illin H 3$$,$$$ units p.o. Available: #@'illin H /$$,$$$ units per tablet 2. Irder: 'ylert 2" mg. p.o. Available: 'ylert 3.2" mg per tablet 3. Irder: Aeupogen $.. mg sq Available: Aeupogen .$$ mcg per ml 4. Irder: ?entanyl /" mcg !.). Available: ?entanyl $.$" mg per ml $. Irder: H@&or -$ m5q p.o. Available: H@&or ,$ m5q per " cc . $./cc ,. $."ml .. $ ml
,4

/. $ ml

". , tabs

-. , tabs 2. / tabs 3. ml 4. $.4ml $. " cc 6lease see Aursing ?aculty if you need further homeworB. Practice Problems 'alculate the correct amount of medication to administer. !nterpret the labels to determine the available dosage. . Irder: H@Tab ." gm po bid with meals.

,. Irder: Peparin 3$$$ units sq q , hr.

.. Irder: 6rimaxin $." gm !) q , hr.

/. Irder: !nfergen , mcg sq q day.

.$

Answers: . , tabs ,. $.3 ml .. , ml /. $./ ml 6lease see Aursing ?aculty if you need further homeworB

UNI I7 1 AD7ANCED DOSA)E CALCULA IONS

This unit will cover the following topics+ reconstitution of powered drugs, insulin administration and calculating safe pediatric dosages of medications. RECONS I U ION OF PO"ERED DRU)S Reconstitution of powered drugs involves the addition of a sterile diluent, usually distilled water or normal saline, to a drug that is in the form of a powder. The pharmacist usually carries out this tasB, but in many areas of the hospital the tasB becomes that of the nurseSs. The pacBage insert or the container will contain the directions for reconstituting a particular drug. The diluent, as well as instructions for storage will be included. !f the vial is a multi@use vial it is the nurseSs responsibility to date and time the container. 5xample: Irdered: 6rimaxin 2"$ mg !). Available: 6rimaxin 2"$ mg vial. (issolve in .ml of C lidocaine P'l solution. Pow many ml of diluent should you addM .ml 0hat amount of the medication will you administerM All that is in the vial. <The whole vial * 2"$ mg=. 5xample: Irdered: )andol ,"$ mg !). Available: )andol gm vial. Add . ml of normal saline to obtain a concentration of gm per / cc. Pow many ml of diluent should you addM . ml 0hat amount of medication will you administerM
.

$$$ mg : / cc :: ,"$ mg : % cc $$$ % * $$$ - 5 >cc Practice Problems >olve the following reconstitution problems. (etermine what amount of the medication you will administer. . Irder: 'efobid 2"$ mg !). Available: 'efobid gm vial. Add ,.- ml of sterile water to obtain a concentration of ,"$ mg8ml. ,. Irder: 6ipracil ." gm !) Available: A , gm vial of 6ipracil. Add / ml of normal saline to obtain a concentration of gm 8,." ml. .. Irder: 'laforan gm !) Available: A , gm vial of 'laforan. Add " ml normal saline to obtain a concentration of ..$ mg8ml. /. Irder: &orabid /$$ mg p.o. Available: Jottle containing &orbid gm powder. Add ,"cc water to obtain a concentration of ,$$ mg8 "cc. ". Irder: &ibrium ," mg !). Available: &ibrium $$ mg ampule. Add , ml of enclosed diluent to obtain a concentration of $$ mg8 ,ml. -. Irder: HefNol .$$ mg !). Available: HefNol "$$ mg vial. Add , ml normal saline to obtain a concentration of ,," mg8 ml. Answers: . . ml /. $ cc ,. ..2" ml ". $." ml
.,

.. . ml -. .. ml

6lease see Aursing ?aculty if you need further homeworB. INSULIN ADMINIS RA ION !nsulin is a natural hormone produced by the pancreas to maintain the bodySs blood sugar within the normal range of 3$@ ,$ mg8d&. Dou will learn much more about this during lecture. The purpose of this unit is to teach you how to safely calculate and administer insulin to patients. The insulin that is used for replacement therapy is obtained from animal and human sources. This is important for the nurse to Bnow because the patient needs to remain on the same source of insulin between home care and hospitaliNation. The label on the insulin bottle will tell whether the insulin is from an animal source or human source. !n addition to various sources of insulin, there are different categories of insulin. The categories are short, intermediate, and long acting insulin and the bottles will be labeled accordingly. This means that the effect the insulin has on the body varies in terms of time. Ince again, this will be taught in detail at a later time in the curriculum. The nurse needs to use caution that he8she is giving the correct type of insulin because a patient may be receiving more than one type of insulin at various times throughout the day. !nsulin is measured by a standard that is called L>6 units. !t is supplied in concentrations of >++ units %er milliliter= <)emoriNe thisR= This is true for all sources and all categories of insulin.
An insulin s&ringe can onl& be use! (or measuring insulin= Units are not interc#angeable= A unit o( insulin is not t#e same as a unit o( %enicillin= Do not use a uberculin s&ringe to measure insulin= Insulin s&ringes .. in t#e #ub o( t#e are !esigne! 9it# less !ea! s%ace s&ringe=

6I!AT> TI R5)5)J5R 0P5A A()!A!>T5R!AG !A>L&!A . ,. .. /. ". 0hen mixing categories of insulin in the same syringe, always draw up the short@acting <itSs clear in appearance= first. <'lear to cloudy=. Gently roll the bottle of insulin to mix it before drawing up the dose. (o not shaBe the bottle vigorously. Always have another nurse verify that you have drawn up the correct amount and type of insulin. Inly Regular <short acting= insulin can be given intravenously. !f not given correctly, insulin can be a lethal drug.

Jecause insulin is supplied as $$ units8ml and the insulin syringe is measured in units8ml, there is no calculation required for insulin administration. !f the order states "L Pumulin !nsulin R, you would administer " units of regular insulin via a ml insulin syringe. )any times the patient will receive a long@acting insulin once or twice daily, as well as a short acting insulin every / hours depending upon his blood sugar. To determine the amount of the short@acting insulin to administer, the nurse will have to refer to the physicianSs sliding scale order. 5xample: Irder: Regular insulin sq q / hr according to sliding scale below. The patientSs blood sugar was ,.". Pow much insulin will the nurse administerM
Jlood >ugar <mg8d&= $ 7 "$ " 7 ,$$ ,$ 7 ,/$ ,/ @ ,3$ ,3 7 ..$ over ..$ Regular !nsulin Ao insulin , units / units - units 3 units 'all )(

./

Jased on the above sliding scale, you administer / units. Practice Problems Lse the sliding scale above to determine how much Regular insulin should be administered based on the following blood sugar results: . ,-" mg8d& * 1111111111111111111 ,. , , mg8d& * 1111111111111111111 .. 44 mg8d& * 1111111111111111111 * 1111111111111111111 /. 2" mg8d&

". ,/ mg8d& * 1111111111111111111 -. ./" mg8d& * 1111111111111111111 2. .$$ mg8d& * 1111111111111111111 3. ." mg8d& Answers: . ,. .. /. ". -. 2. 3. * 1111111111111111111 - units / units , units $ units - units call )( 7 blood sugar too #ig# 3 units $, call )( 7 blood sugar too lo9 <remember the normal 3$ 7 ,$=

."

Are you beginning to feel liBe a nurseM Aow we are getting into the fun stuffR !f you are feeling overwhelmed, please see a member of the Aursing ?aculty for one@on@one assistanceR

CALCULA IN) SAFE PEDIA RIC DOSA)ES !nfants and children require smaller quantities of drugs than adults. Their medications are commonly ordered in milligrams or micrograms per Bilogram of body weight. Jelow are the steps to determine a safe pediatric medication dosage: . 0eigh the child ,. 'onvert pounds to Bilograms as you did in Lnit !!. .. 'alculate the ordered dose using ratio and proportion. /. (etermine if the dose is safe according to the manufacturers safe dosage range.

5xample: Irder: (emerol ." mg8Bg !). The child weighs ,$ pounds. Ste% >$ 'onvert pounds to Bilogram ,., lb : Bg :: ,$ lb : % Bg

,., % * ,$ % * 4.$4$4 <Round to the hundredth place for children=

.-

% * 4.$4 Bg Ste% <$ 'alculate the ordered dose of (emerol. Bg : % * % * ." mg :: 4.$4 Bg : % mg ..-." <Round to the hundredth place for children= ..-/ mg (emerol

Aow that you Bnow how to determine the amount of medication to administer based on weight, you need to learn how to determine if that dose is within the safe range. (rug manufacturers will include the safe pediatric ranges for medications. Dou have to insert the dosage for your pediatric patient into the equation and use ratio and proportion, to determine if it is a safe dose. !f it is, you administer the drug. !f it is not, you call the ordering physician. )any times a range will be given rather than one specific safe dosage amount. 5xample: Irder: Tegretol /$$ mg po J!(. The recommended dose is " 7 ,$ mg8Bg. The child weighs "" lbs. !s the ordered dose a safe doseM Ste% >$ 'onvert pounds to Bilograms ,., lb : Bg :: "" lbs : % Bg % * ," Bg Ste% <$ 'alculate to determine if the dose is safe. Bg : " mg :: ," Bg : % mg an! % * .2" mg % * "$$ mg
.2

Bg : ,$ mg :: ," Bg : % mg

This tells you the safe range per dose is .2" 7 "$$ mg. As stated above, the )( ordered /$$ mg. >ince /$$ falls within the safe range, you would determine that /$$ mg is a safe dose. !f, for example, the )( had ordered -$$ mg Tegretol then you would determine that not to be a safe dose and you would notify the ordering physician. Another variation of this principle, is that the nurse may have to determine if a dose is safe in terms of a ,/ hour period. >ome medications will list a ,/@hour safe dose range and the nurse has to determine if the number of doses of a medication to be given in ,/ hours falls within that range. 5xample: Irder: 5rythromycin -,." mg, po q- hr for an infant that weighs lbs. >afe dose range is .$ 7 "$ mg8Bg8,/ hrs. Ste% >$ 'onvert lbs to Bg ,., lb : % * " Bg Ste% <$ (etermine safe dose range for ,/@hr period. Bg : .$ mg :: " Bg : % mg % * "$ mg Bg : "$ mg :: " Bg : % mg % * ,"$ mg Sa(e !osage range (or <*?#r %erio! 5 >0+ mg 1 <0+ mg Bg :: lbs : % Bg

.3

Ste% @$ (etermine if the ordered dosage for the ,/@hr period is safe. The ordered medication is ordered every - hours. The nurse determines that the child will receive / doses in a ,/@ hr period. -,." mg % / doses * ,"$ mg of 5rythromycin in a ,/@hr period. The nurse determines this to be a safe ,/@hr period dose by comparing this number to the safe range in step ,.
&etSs try some practice problemsR These will be a little bit different from what you have had so far. They will require you to thinB about what the question is asBing.

Practice Problems . Irder: Tylenol elixir $ mg8Bg po. 'hild weight is $ pounds. Available: Tylenol elixir -$ mg8 "ml. Pow much Tylenol will you administerM ,. Irder: Amoxicillin $$ mg po q- hr. 'hild weighs " lbs. >afe range is ," 7 .$ mg8Bg8,/ hr. a. 0hat is the safe ,/@hr rangeM b. !s the ordered dose safe for a ,/@hr periodM .. Irder: ?errous >ulfate 4 mg po tid. 'hild weighs . lbs. The safe dosage is . 7- mg8Bg8,/ hrs. a. 0hat is the safe ,/@hr rangeM b. !s the ordered dose safe for a ,/@hr periodM
.4

/. Irder: &anoxin 3 mcg po bid. 'hild weighs 2 lbs. The safe range is $ 7 , mcg8Bg8,/ hrs. a. 0hat is the safe ,/@hr rangeM b. !s the ordered dose safe for a ,/@hr periodM c. !f the medication is supplied "$ mcg8ml, how many ml will you administer per dose ". Irder: (ilantin /$ mg po q 3 hr. 'hild weighs ,2 lb. The safe range is 37 $ mg8Bg8,/ hr a. 0hat is the safe ,/@hr rangeM b. !s the dose safe for a ,/@hr periodM c. !f the medication is supplied ," mg8" ml, how many ml will you administer per doseM -. Irder: 6rednisone "$ mg po bid. 'hild weighs , lb. The safe range is $."@/$ mg8Bg8,/hr a. 0hat is the safe ,/@hr rangeM b. !s the dose safe for a ,/@hr periodM c. !f the medication is supplied " mg8ml, how many ml will be required for a ,/ hour periodM 2. Irder: 'eclor 3$ mg po q 3 hr. 'hild weighs $ lb. The safe dose is " mg8Bg8dose. a. 0hat is the safe dose for this childM b. !s the ordered dose safeM c. !f the medication is supplied ," mg8 " ml, how many ml will you administerM Answers:
/$

. ./, ml ,. a. 2$." 7 ,$/.- mg b. no $$ % / * /$$ mg .. a. 2.2. 7 ."./- mg b. yes 4 % . * ,2 mg /. a. . .3 7 .3. - mcg b. yes 3 % , * .-mcg c.$..-ml ". a. 43. - 7 ,,.2 mg b. yes /$ % . * ,$mg c. .-ml -. a. /.23 @ .3, mg b. yes "$ % , * .$$mg c. -$ ml 2. a. -3.," mg b. no c. (onSt administer dose call )( 6lease see Aursing ?aculty if you need further homeworB.

UNI 7 1 Intra'enous Pre%aration 9it# Clinical Calculations

!ntravenous fluids are used in health care settings to rehydrate patients or to give medicines. 'alculation of !# flow rates ensures that fluids do not infuse too fast, which could overload the patient or too slowly, delaying treatment. This unit will explain how to calculate and administer !# fluids and medications. The topics to be discussed include+ calculating flow rates for electronic and manual !# flow regulators, calculating hourly !# heparin dosages and calculating !# flow rates in order to administer a specific concentration of a medication per minute or hour. ELEC RONIC I7 FLO" RE)ULA ORS 5lectronic pumps are used in all health care settings. !n some instances, it is mandatory policy to use these devises. >uch is the case when administering narcotics, heparin or various heart medications via continuous !# drip. !n addition, very small amounts of fluid can be infused over an extended period of time by using these electronic pumps.
/

The Bey concept to memori8e about these electronic pumps is that they are designed to infuse the !# fluid8medication in milliliters %er #our <some of the newer pumps can be set to administer tenths of a milliliter per hour=. The physician will order the flow rate in milliliters <cc= per hour or specify the amount of time necessary to infuse the !# fluid8medication.

0hen the physician orders the specific ml per hour, the nurse simply hangs the correct !# fluid8medication and sets the pump to the ordered flow rate. There are AI calculationsRRR Powever, if the physician only specifies the duration of time to taBe to infuse an amount of !# fluid8medication and does not order ml per hour, the nurse must calculate the flow rate. Dou will use ratio and proportion to calculate the flow rate. 5xample: Irder: $$$ cc A> !# to infuse over 3 hrs. 3 hr : $$$ cc :: hr : % cc 3% * $$$ % * ," cc8hr This is the flow rateR

S#ortcut$ Actually all you have to do is divide the total amount of fluid by the number of hours. !f the infusion time is not in whole hours, you must calculate using -$ minutes rather than hour. 5xample: Irder: Tofran $ mg in $$ cc A> !#6J q 3 hr. !nfuse over .$ minutes. .$ min : $$ cc :: -$ min : % cc
/,

.$ % * -$$$ % * ,$$ cc8hr The nurse sets the electronic pump to deliver ,$$ cc8hr and after .$ minutes the $$ cc of medication would have been infused.

PereSs another example similar to the one above: Irder: Ampicillin "$$ mg in $$ cc A> !#6J q 3 hr. !nfuse over ,$ minutes. ,$ min : $$ cc :: -$ min : % cc ,$ % * -$$$ % * .$$ cc8hr !n this example, the nurse sets the electronic pump to deliver .$$ cc8hr, and after ,$ minutes the $$ cc of medication would have been infused. Note$ The mg of medication has nothing to do with calculating the flow rate. (onSt be confused and try to use this number in your calculationR Practice Problems$ 'alculate the flow rate when using an electronic pump: . !nfuse "$$ cc A> over ,/ hours. ,. !nfuse $$$ cc ("0 over " hours. .. !nfuse $$$ cc A> over $ hours. /. !nfuse -$$ cc &R over . hours. ". !nfuse ,$$$ cc A> over ,/ hours. -. !nfuse Tagamet .$$ mg !#6J mixed in $$ cc A> over /" minutes. 2. !nfuse Lnasyn "$$ mg !#6J mixed in "$ cc A> over $ minutes. 3. !nfuse Hytril ,$ mg !#6J mixed in 2" cc A>
/.

over /" minutes. 4. !nfuse Ampicillin "$$ mg !#6J mixed in "$ cc A> over .$ minutes. $. !nfuse .$ cc of .C A> !#6J over " minutes. Answers: . -. cc8hr ,. -2 cc8hr .. $$ cc8hr /. ,$$ cc8hr ". 3. cc8hr -. .. cc8hr 2. .$$ cc8hr 3. $$ cc8hr 4. $$ cc8hr $. ,$ cc8hr 6lease see Aursing ?aculty if you need further homeworB MANUAL I7 FLO" RE)ULA ORS Aurses are using fewer and fewer manual !# flow regulators to administer !# fluids8medications in the health care setting. Another term used to describe these regulators is gravity drip !# infusions. This describes how manual flow regulators worB. The rate of infusion is dependant upon the gravity of the bag of !# fluid8medication. The rate of these infusions will always be calculated in !ro%sAgttsB %er minute= <There will not be a pumpR= !n order to calculate the accurate rate of infusion, the nurse must Bnow the type of tubing or administration set to be used. 5ach type of administration set has a drop chamber with either a macro drop set that delivers $, " or ,$ drops per milliliter while the micro drop set always delivers -$ drops per milliliter. This is referred to as the drip factor. To prevent errors in calculating the infusion rate, always checB the manufacturerSs label to verify the drip factor of the administration set. The nurse will have to manually regulate the flow of !# fluid8medication when using the above administration sets. There are two steps to this process. The first step is that the nurse must calculate the drop rate, which will always be gtts8min. The second step is that the nurse will adOust the roller clamp on the !# tubing and count the drops to insure accurate infusion. This type of infusion will have to be
//

monitored frequently because BinBed tubing or a change in arm position can slow or increase the rate of flow. There are various formulas to use to calculate the flow rates for manual !# regulators. The following formula needs to be memori8e!:
Amount of fluid % (rip factor Time <always in minutes=

5xample: Irder: .$$$ cc A> !# over ,/ hrs. (rip factor of tubing: " gtts8cc. .$$$ cc % " gtts8cc /"$$$ ,/ hr % -$ min * //$ * . .," * . gtts8min This number will have to be rounded to a whole number because a manual !# flow regulator cannot deliver a portion of a drop. !f the infusion time is less that one hour, you simply put this amount of time as the denominator. 5xample: Irder Ampicillin "$$ mg !#6J in $$ cc A> to infuse over .$ min. (rip factor: $ gtts8cc. $$ cc % $ gtts8cc .$ min * $$$ .$ * ..... * ..gtts8min

5xample: Irder: #ancomycin gm !#6J in ,"$ cc A> to infuse over hrs. (rip factor: ,$ gtts8cc. ,"$ cc % ,$ gtts8cc ." hr % -$ min * "$$$ 4$ * ""."- * "-gtts8min

/"

Practice Problems (etermine the infusion rate for the following: . Irder: $$$ cc A> to infuse in 3 hours. (rip factor of administration set: " gtts8cc. ,. Irder: $$$ cc A> to infuse in - hours. (rip factor of administration set: ,$ gtts8cc. .. Irder: $$$ cc A> to infuse in $ hours. (rip factor of administration set: " gtts8cc. /. Irder: "$$ cc A> to infuse in / hours. (rip factor of administration set: " gtts8cc. ". Irder: 3" cc A> to infuse in hour. Administration set is a micro set. -. Irder: "$$ cc ("0 to infuse in $ hours. (rip factor of administration set: " gtts8cc. 2. Irder: $$$ cc A> to infuse in 3 hours. (rip factor of administration set: ,$ gtts8cc. 3. Irder: 6epcid /$ mg !#6J mixed in $$ cc A> to infuse over .$ minutes. (rip factor: ,$ gtts8cc. 4. Irder: #ibramycin ,$$ mg !#6J mixed in $$ cc A> to infuse over .$ minutes. (rip factor: $ gtts8cc. $. Irder: (extran /$ mg !#6J in ,"$ cc to infuse over /" minutes. (rip factor: " gtts8cc. Answers: . . gtts8min ,. "- gtts8min .. ," gtts8min
/-

/. . gtts8min ". 3" gtts8min -. .3 gtts8min 2. /, gtts8min 3. -2 gtts8min 4. .. gtts8min $. 3. gtts8min 6lease see Aursing ?aculty if you need further homeworB. CALCULA IN) 2OURL3 I7 2EPARIN DOSA)ES The administration of continuous !# heparin is a common practice in the hospital setting. !t is vital that the nurse Bnow how to calculate an accurate infusion rate since the margin is very small and can easily result in death. !# heparin will always be administered via an electronic pump, thus it will be calculated in milliliters per hour. The dosage of heparin is measured in units. Ratio and proportion are used to calculate the dosage. 5xample: Irder: Peparin 3$$ units8hr via continuous !# infusion. )edication comes mixed from pharmacy: Peparin ,",$$$ units in ,"$ml A>. ,",$$$ units : ,"$ cc :: 3$$ units : % ml ,",$$$ % * ,$$,$$$ % * ,$$,$$$ * 3 ml8hr ,",$$$

5xample: Irder: Peparin ,$$ units8hr via continuous !# infusion. )edication comes mixed from pharmacy: Peparin $,$$$ units in ,"$ ml A>.
/2

$,$$$ units : ,"$ cc :: $,$$$ % * .$$,$$$ % * .$ ml8hr

,$$ units : % ml

Remember, you can checB your answer to verify it is correct: <multiply outside USs and they will * inside USs= $,$$$ % .$ * .$$,$$$ ,"$ % ,$$ * .$$,$$$ Practice Problems (etermine the flow rate <ml8hr= for the following: . Irder: Peparin "$$ units per hr via !# infusion . )edication comes mixed from pharmacy: Peparin ,",$$$ units in ,"$ cc A>. ,. Irder: Peparin 3$$ units per hr via !# infusion. )edication comes mixed from pharmacy: Peparin ,$,$$$ units in ,"$ cc A>. .. Irder: Peparin ,$$ units per hr via !# infusion. )edication comes mixed from pharmacy: Peparin ,",$$$ units in ,$$ cc A>. /. Irder: Peparin 3$$ units per hr via !# infusion. )edication comes mixed from pharmacy: Peparin ,$,$$$ units in $$ cc A>. ". Irder: Peparin $$$ units per hr via !# infusion. )edication comes mixed from pharmacy: Peparin ,$,$$$ units in "$ cc A>. -. Irder: Peparin $$ units per hr via !# infusion. )edication comes mixed from pharmacy: Peparin $,$$$ units in $$ cc A>.
/3

Answers: . " cc8hr ,. ,,." or ,. cc8hr .. 4.- or $ cc8hr /. / cc8hr ". 2." or 3 cc8hr -. cc8hr 6lease see Aursing ?aculty if you need further homeworB. I7 ADMINIS RA ION B3 CONCEN RA ION Lsually !# fluids8medications are ordered to be infused at a certain rate or time period as has already been taught. Powever, some !#Ss, especially in the critical care areas, are ordered to be administered with a specific concentration of the medication per hour, per minute or per milliliter. This is a difficult calculation to master, but if you will learn the basic steps of the calculation, and thinB about what the problem is asBing, you will have no problemsR Jelow are the basic steps to these types of problems. Remember, you may not have to use all of the steps for each problem. Ste% >$ 'onvert pounds to Bilograms. Ste% <$ (etermine the correct dosage based on the patients weight <in Bilograms= Ste% @$ 'onvert the ordered unit to the unit you have on hand. Ste% *$ 'alculate the U of cc8min to administer. Ste% 0$ 'alculate the U of cc8hr to administer. <This usually has to be done because these medications
/4

are administered via electronic pump.=

RememberC &ou ma& not al9a&s #a'e to go t#roug# all 0 ste%s= #ink t#roug# t#e %roblem an! !etermine t#e ste%s nee!e!DDD

5xample: Irder: Jretylol "mcg8Bg8min. )edication comes mixed $.$" g in "$ cc A>. 6atients weight is 32 lbs. Ste% >$ 'onvert lbs to Bg ,., lb : Bg :: % * 3" Bg 32 lb : % Bg

Ste% <$ (etermine the correct dosage based on pts weight Bg : " mcg :: 3" Bg : % Bg % * /," mcg Ste% @$ 'onvert the ordered unit to the unit on hand. g : ,$$$,$$$ mcg :: $.$" g : % mg % * "$,$$$mcg <there are "$,$$$ mcg in "$ cc A>= Ste% *$ 'alculate the U of cc8min to administer. "$,$$$ mcg : "$ cc :: /," mcg : % cc % * $./," cc8min
"$

Ste% 0$ 'alculate the U of cc8hr to administer. min : $./," cc :: -$ min : % cc % * ,"." cc8hr or ,- cc8hr Remember, some newer pumps can administer fluids to the tenth of a cc. The nurse must be familiar with the equipment and Bnow whether to set the pump at ,"." cc8hr or ,- cc8hr. 5xample: Irder: Aitroprusside "$ mg in "$$ cc ("0 at "$ mcg8min. >et the pump at1111cc8hrM Ste% >$ 'onvert to Bilograms. 7 AIT A55(5(RRR Ste% <$ (etermine the correct dosage based on the patients weight. @ AIT A55(5( RRR Ste% @$ 'onvert the ordered unit to the unit on hand. mg : $$$ mcg :: "$ mg : % mcg % * "$,$$$ mcg <"$,$$$ mcg in "$$ cc ("0= Ste% *$ 'alculate the U of cc8min to administer. "$,$$$ mcg : "$$ cc :: "$ mcg : % cc % * $." cc8min Ste% 0$ 'alculate the U of cc8hr to administer. min : $." cc :: -$ min : % cc % * .$ cc8hr

Practice Problems (etermine the rate AccE#rB for the following:

"

. Irder: Administer 'leocin !# at a rate of $ mg8min. Available: 'leocin 4$$ mg in $$ cc A>. ,. Irder: Administer $ m5q H'l per hour via !#. Available: "$ m5q H'l in $$ cc ("0. <Pint: this is already in cc8hr, you will not need to do step /= .. Irder: Administer (iuril at a rate of " mg8min. Available: (iuril ."$ mg in "$ cc A>. /. Irder: !suprel " mcg8min !#. Available: !suprel , mg in "$$ cc A>. ". Irder: &idocanine , mg8min !#. Available: &idocaine g in ,"$ cc ("0. -. Irder: Aitrostat !# $ mcg8min. Available: Aitrostat 3 mg in ,"$ cc A>. 2. Irder: Aipride !# $." mcg8Bg8min. 6t. weight * ," lb. Available: Aipride $mg in $$ ml ("0. 3. Irder: (obutrex - mcg8Bg8min. 6t. weight * "$ Bg. Available: (obutrex ,"$ mg in ,"$ cc A>. 4. Irder: !ntropin " mcg8Bg8min. 6t. weight * ., lb. Available: !ntropin ,$$ mg in ,"$ cc A>. $. Irder: Aminophylline $." mg8Bg8hr. 6t weight * "/ lb Available: Aminophylline "$$ mg in $$$ cc ("0. 6lease see Aursing ?aculty if you need further homeworB.

",

Bonus Problem$ >ee if you can use what you have learned to solve this problem. !ntropin is infusing at ,"cc8hr. The concentration of !ntropin is ,$$ mg in ,"$ cc ("0. The patientSs weight is /. lb. 0hat is the mcg8Bg8min the patient is receivingM <Dou basically have to worB bacBwards through the steps.=

Answers: !f you need further instruction of how to arrive at the answer, please contact one of the Aursing ?aculty. . 4$$ mg : $$ cc :: $ mg : %cc % * . cc8min <you determined cc8min= min : . cc :: -$ min : % cc - 5 FF=F or F/ ccE#r <you determined cc8hr= ,. "$ m5q : $$ cc :: $ m5q : % cc - 5 <+ ccE#r <the question was already in cc8hr= .. ."$ mg : "$ cc :: % * ,. / cc8min " mg : %

min : ,. / cc :: -$ min : % cc - 5 ><G=* or ><G ccE#r /. $$$ mcg : mg :: " mcg : % mg % * $.$$" mg <you converted to liBe units= , mg : "$$ cc :: $.$$" mg : % cc % * .," cc8min min : .," cc :: -$ min : % cc
".

- 5 /0 ccE#r ". $$$ mg : gm :: , mg : % gm % * $.$$, gm <you converted to liBe units= gm : ,"$ cc :: $.$$, gm : % cc % * $." cc8min min : $." cc :: -$ min : % cc - 5 @+ ccE#r -. $$$ mcg : mg :: $ mcg : % mg % * $.$ mg <you converted to liBe units= 3 mg : ,"$ cc :: $.$ mg : % cc % * $.. ," cc8min min : $.. ," cc :: -$ min : % cc - 5 >G=G or >H ccE#r 2. ,., lb : Bg :: % * "-.3, Bg ," lb : % Bg

Bg : $." mcg :: "-.3, Bg : % mcg % * ,3./ mcg <this is the correct dosage based on Bg= $$$ mcg : mg :: ,3./ mcg : % mg % * $.$,3/ mg <you converted to liBe units= $ mg : $$ cc :: $.$,3/ mg : % cc % * $.,3/ cc8min min : $.,3/ cc :: -$ min : % cc - 5 >/=+* 5 >/ ccE#r 3. Bg : - mcg :: "$ Bg : % mcg
"/

% * .$$ mcg <this is the correct dosage based on Bg= $$$ mcg : mg :: .$$ mcg : % mg % * $.. mg <you converted to liBe units= ,"$ mg : ,"$ cc :: $.. mg : % cc % * $.. cc8min min : $.. cc :: -$ min : % cc - 5 >G ccE#r 4. 'onvert lb to Bg * -$ Bg Bg : " mcg :: -$ Bg : % mcg % * .$$ mcg <this is the correct dosage based on Bg= $$$ mcg : mg :: .$$ mcg : % mg % * $.. mg <you converted to liBe units= ,$$ mg : ,"$ cc :: $.. mg : % cc % * $..2" cc8min min : $..2" cc :: -$ min : % cc - 5 <<=0 or <@ ccE#r $. 'onvert lb to Bg * 2$ Bg Bg : $." mg :: 2$ Bg : % mg % * ." mg <this is the correct dosage based on Bg= "$$ mg : $$$ cc :: ." mg : % cc - 5 /+ ccE#r <the order was written per hr= Bonus 6uestion$ 'onvert lb to Bg * -" Bg
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mg : $$$ mcg :: ,$$ mg : % mcg % * ,$$$,$$$ mcg <you converted to liBe units= ,"$ cc : ,$$,$$$ mcg :: ," cc : % mcg % * ,$,$$$ mcg <you determined mcg8hr= -$ min : ,$,$$$ mcg :: min : % mcg % * ...... mcg <you determined mcg8min= -" Bg : ...... mcg : Bg : % mcg % * ". ,3 * 0=>@ mcgEkgEmin References: 'raig, G.6. <,$$ =. 'linical calculations made easy. <,nd ed.=. &ippincott: 6hiladelphia. Pegstad, &. A. and PayeB, 0. <,$$ =. 5ssential drug dosage calculations. </th ed.=. 6rentice@Pall, !nc. : Lpper >addle River, Aew Versey. Vanney, '. and ?lahive, V. <,$$ =. 'alculation of drug dosages. <-th ed.=. T. V. (esigns: >an &uis Ibispo, 'A. >mith, 6. &. and Iffutt, >. A. Jasic calculation for nurses 7 )odule @". Lniversity of Tennessee, Hnoxville.

GR5AT VIJRRR

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0ritten Jy: Tammy R. (ean R.A., ).>.A. Assistant 6rofessor of Aursing &incoln )emorial Lniversity Vuly ,$$
Revised Vuly ,$$,

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