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BERT RODGERS SCHOOLS CONTINUING EDUCATION COURSE

Computation of
Dosage and Solutions
2 H r s $12.95

C O U R S E A B S T R A C T
This course teaches one simple method of calculating all dosages without the need to memorize
cumbersome and easy-to-forget rules. The method presented is called dimensional analysis.
Dimensional analysis simply, easily, and systematically converts one unit of measurement to another
by using a conversion factor.
The course provides an opportunity to see how dimensional analysis works for a wide variety of oral,
intramuscular, subcutaneous, and intravenous calculations. It provides practice calculations and a one-
step, no-rules method for calculating the number of drops per minute at which an intravenous solution
should be run. Alene M. Burke,
This course is highly useful to nurses with “math phobia,” student nurses, those studying for the NCLEX RN, MSN
exam, and others who are preparing to take a pre-employment medication or pharmacology exam.
Ms. Burke serves
as Nursing
Bert Rodgers Schools of Continuing Education is accredited as a provider of continuing education Consultant and
in nursing by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. Instructor for Bert
Bert Rodgers Schools is also approved by the Florida Board of Nursing, Provider FBN # 2783, by the Rodgers Schools
Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health of Continuing
Counseling, Provider # BAP–570–Exp. 3/2005, and by the California Board of Registered Nursing, Education. Her
Provider # CEP 12763. See Provider Approval Summary page for other professions. degrees in nursing
were granted by
Queensborough
Learning Objectives Community
College of New
1. Use dimensional analysis to solve a 3. Compute intramuscular and subcutane- York (ASN), State
wide variety of dosage and solution ous dosages using dimensional analysis. University of New
problems. 4. Determine intravenous (IV) flow rates York, Regents Col-
2. Calculate oral dosages using using dimensional analysis and the one- lege (BSN), and
dimensional analysis. step, no-rules method of calculation. Adelphi Univer-
sity (MSN).
Alene has served
as an innovative
INTRODUCTION
that they are easily forgotten. Now, finally, and creative nurs-
In nursing school, most nurses learned how there is a method to easily and accurately ing staff develop-
to calculate, or compute, drug dosages and calculate all dosage and solution problems ment director for
IV flow rates. Not too many of us were great using one step and no rules for each type of more than 15
mathematicians, and few enjoyed or looked dosage and solution problem that you need years for major
forward to our medication or pharmacology to calculate. The method used for this metropolitan New
exam every semester. As we prepared for course is called dimensional analysis. York medical cen-
these tests, we spent many hours memoriz- Dimensional analysis is a method that ters. She has, for
ing rules, such as “desired over have times converts one unit of measurement to the last several
quantity,” and the correct method of calcu- another unit of measurement using a conver- years, presented
lating dosage and solution rates using ratio sion factor or factors. seminars and
and proportion. Once you have mastered this method workshops to
The primary reason we studied and you do not have to remember multiple cum- large groups of
restudied all of these cumbersome rules is bersome rules and steps. Instead, you will be healthcare

© 2004 Bert Rodgers Schools of Continuing Education • (800) 432-0320 • w w w. b e r t r o d g e r s . c o m


2 Bert Rodgers Schools Continuing Education Course

professionals, able to line up all the necessary information 9 ft  12 in = 108 in


including nursing at one time in an orderly, systematic manner 1 ft
educators, about to get the correct answer every time without
the adult teaching having to memorize multiple rules and In the equation below, the unit of dollars
and learning formulas. in the starting factor cancels out the dollar
process, the Joint
unit in the conversion factor, and the
Commission on
STARTING DIMENSIONAL remaining unit of measurement, nickels, is
the Accreditation
identical to the measurement unit used in
of Healthcare ANALYSIS CALCULATIONS the answer. Multiplying 20 by 3 gives the
Organizations’
In dimensional analysis, you set up an equa- answer, 60 nickels.
(JCAHO’s) require-
ments for
tion that consists of a starting factor, one or
education and
more conversion factors, and the answer Starting  conversion = answer
competency, the
unit. For example, if you want to know how factor factor unit
assessment of
many nickels there are in $3.00, you have to
consider the number of nickels in each dol- 3 dollars  20 nickels = _____ nickels
educational needs
lar, which is the known conversion factor, 1 dollar
using data, the
and what you want to know, that is, the num-
basing of
ber of nickels in $3.00. To determine how 3 dollars  20 nickels = 60 nickels
educational activi- 1 dollar
ties for entire
many inches there are in 9 feet, you have to
organizations on
consider the number of inches in 1 foot, the
actual needs
known conversion factor, and what you are
rather than
trying to find out, that is, the number of In more complex calculations, once all
tradition, and the
inches in 9 feet. the units of measurement that can be can-
evaluation of the
Below is an example of how to set up a celed have been struck out, the remaining
impact of
dimensional analysis equation using a start- numerators are multiplied and this product,
education in
ing factor, a conversion factor, and the or answer, is then divided by the product of
terms of patient
answer unit, or the measurement unit and all the remaining denominators. If the num-
outcome and
number that you are trying to calculate. erators and denominators can be divided by
other aggregated a common number, or reduced, the multipli-
data variables. cation of the numerators and denominators
Starting  conversion = answer as well as the final division will be somewhat
She has simpler and less mathematically challenging.
developed an factor factor unit
You will be taught how to reduce in this
organization-wide
9 ft  12 in = ______ in course.
education and The conversion factors that are used to
1 ft
competency calculate dosages and IV flow rates can consist
model, published of either established mathematical conversion
in the February equivalents, such as 20 nickels in a dollar, or
2000 issue of When you set up the equation, each
manufacturers’ equivalents. Some examples of
Nursing Manage- numerator label should cancel out the
manufacturers’ equivalents are 1 tablet = 250
ment. Alene has denominator label that follows it. The
mg, 5 gr per kg, and 20 gtt = 1 mL.
written numerous numerator is the number on top of a fraction
Many dosage calculations require knowl-
other publica- and the denominator is the number on the
edge of mathematical conversion equivalents
tions, has spoken bottom of a fraction. When you have feet as
to move from one measurement system to
at national confer- a numerator and feet in one of the denomi-
another. We use metric, apothecary, and house-
ences, has nators of the equation, the word feet can be
hold measurement systems in pharmacology.
received several crossed off, or canceled out in both the
It is suggested that you refer to a table of
grants, and has numerator and the denominator because
equivalents for the less frequently used
also conducted they are identical. In the example above, the
mathematical conversion equivalents (see
research studies in only remaining unit of measurement is
Table 1) and memorize the ones that you use
her primary area inches because the feet labels were cancelled
most often. Some of the commonly used
of expertise, out. In this example, Inches should match
conversion equivalents are as follows:
nursing and the unit of measurement used in the answer.
healthcare As shown below, the unit of feet in the start- 1 gr = 60 mg
education. ing factor cancels out the foot unit in the 1g = 15 gr
conversion factor. The final answer is com- 1 kg = 2.2 lb
puted by simply multiplying 12 by 9. 1 oz = 30 mL
Computation of Dosage and Solutions 3

10
TABLE 1: CALCULATION EQUIVALENTS:
500 mg  1 mL = _____ mL
AN EASY REFERENCE 50 mg
1 gr 60 milligrams (mg) 1
15 gr 1 g or 1000 mg
1000 mcg 1 mg Multiply the numerators (10  1) and the denom-
inators (1), and finally divide the product of the
1 kg 2.2 pounds (lbs) numerators by the denominator to get the final
1 mL or 1 cc 15 minims (m) answer:

4 mL or 4 cc 1 dram (dr) 10  1 = 10 mL =10 mL


1 1
5 mL or 5 cc 1 teaspoon (tsp or t)
30 mL or 30 cc 1 ounce (oz), Example 2
2 tablespoons (T),
6 t or 8 dr teaspoons, or 8 dr Doctor’s order: Lanoxin 0.5 mg po

500 mL or 500 cc 1 pint (pt) or 16 ounces (oz) Medication label: Lanoxin 0.25 mg per tablet

1000 mL or 1000 cc 1 liter (L), 1 quart (qt), or How many tablets should you give?
32 ounces (oz) The starting factor is 0.5 mg, the conversion fac-
tor is 0.25 mg/1 tablet, and the answer unit is the
Source: Joanne M. Daniels and Loretta M. Smith. Clinical number of tablets you would give.
Calculations: A Unified Approach. 4th Edition. Delmar Publishers:
Albany et al. 1994 Starting  conversion = answer
factor factor unit
0.5 mg  1 tablet = _____ tablets
CALCULATING ORAL DOSAGES USING 0.25 mg
DIMENSIONAL ANALYSIS
Cancel out and reduce the numerators and
The following examples show how to compute oral
denominators:
dosage calculations using dimensional analysis.
Example 1 0.5 mg  1 tablet = _____ tablets
Doctor’s order: tetracycline syrup 500 mg po 0.25 mg

Medication label: tetracycline syrup 50 mg/mL 2


0.5  1 tablet = _____ tablets
How many mL should you administer? 0.25
In this example, the starting factor is the dosage in 1
the doctor’s order, that is, 500 mg. The conversion
factor is 50 mg/1 mL, the number of mg that are con- Multiply the numerators and the denominators
tained in each mL of the syrup. The answer unit is and divide their products to get the final answer:
the number of mL that you would administer to the
patient. 2  1 = 2 = 2 tablets
1 1
Starting  conversion = answer
factor factor unit Example 3
500 mg  1 mL = _____ mL Doctor’s order: flucytosine 50 mg/kg/day in four
50 mg divided doses. The patient weighs 80 kg.
All dimensional analysis problems are set up in the Medication label: flucytosine 250 mg/cap
same way and performed in the same manner. Cancel
How many capsules should you give for each of
out and reduce the numerators and denominators,
the four doses?
multiply all the remaining numerators and denomina-
tors, and then divide to get the final answer. The starting factor is 80 kg. In this example, the
Cancel out and reduce these numerators and starting factor is 80 kg because the ordered dosage is
denominators by dividing each by 50: based on the patient’s weight and there are two
4 Bert Rodgers Schools Continuing Education Course

conversion factors. One of the conversion factors is 3. Doctor’s order: trimethoprim 5 mg/kg po. The
the number of mg ordered for each kg, or 50 mg/kg, patient weighs 70 kg.
and the other conversion factor is the manufacturer’s Medication label: trimethoprim 160 mg/tab. The
equivalent, or 250 mg/cap. The answer unit is the tabs are scored in half.
number of caps. How many tabs would you administer?
(The starting factor is 70 kg. The conversion fac-
Starting  conversion = answer tors are 5 mg for every kg of body weight and 1 tab
factor factor unit = 160 mg. The answer unit is the number of tabs.
Round off to the nearest half or whole tab.)
80 kg  50 mg  1 cap = _____ caps
1 kg 250 mg
4. Doctor’s order: nystatin 2.5 mg/kg po. The patient
weighs 115 lb.
Cancel out and reduce the numerators and
Medication label: nystatin 100 mg/tab
denominators:
How many tabs would you administer?
(The starting factor is 115 lb. There are three con-
1 version factors in this problem because you have to
80 kg  50 mg  1 cap = _____ caps convert lb to kg. The conversion factors are 1 kg =
1 kg 250 mg 2.2 lb, 2.5 mg for every kg of body weight, and 1
tab = 100 mg. The answer unit is the number of
5
tabs. These tabs are not scored, so round off to the
Multiply the numerators and the denominators nearest whole tab.)
and then divide their products:
5. Doctor’s order: nystatin 1,000,000 U po
80  1  1 cap = 80 = 16 caps/day Medication label: nystatin 500,000 U/tab
1 5 5 How many tabs would you administer?
(The starting factor is 1,000,000 U; the conversion
Because the doctor’s order read “flucytosine 50 factor is 1 tab = 500,000 U; and the answer unit is
mg/kg/day in four divided doses,” it is necessary to the number of tabs.)
divide the total of 16 caps by 4 to determine the num-
ber of capsules that would be given for each of the
Answers
doses:
1. 7.5 mL
16 = 4 caps for each dose 2. 1 tab
4 3. 2 tabs
4. 1 tab
5. 2 tabs
Practice Oral Dosages Here is how the problems were set up and solved:
Now try these oral dosage calculations. 1.
2
1. Doctor’s order: KCl 10 meq po 10 meq  11.25 mL = 22.5 = 7.5 mL
Medication label: KCl 15 meq/11.25 mL 15 meq 3
How many mL would you administer? 3
(The starting factor is 10 meq, the conversion fac-
tor is 15 meq/11.25 mL, and the answer unit is 2.
______ mL.) 1
500 mg  1g  1 tab = 1 = 1 tab
2. Doctor’s order: Gantrisin 500 mg po 1,000 mg 0.5 g 1
Medication label: Gantrisin 0.5 g/tab 2
How many tabs would you administer?
3.
(The starting factor is 500 mg. There are two con-
1
version factors: 1,000 mg = 1 g and 0.5 g/tab. In this
70 kg  5 mg  1 tab = 70 = 2.18 tabs,
calculation problem, you have an order for mg and
1 kg 160 mg 32
the available tabs are in g. It is therefore necessary
32
to convert mg into g so you can determine the num-
ber of tabs. The answer unit is the number of tabs.) which rounds off to 2 tabs.
Computation of Dosage and Solutions 5

4. Following are some sample problems involving


0.1 intramuscular and subcutaneous dosages. These calcu-
115 lb  1 kg  2.5 mg  1 tab = 11.5 = 1.3 tabs, lations are set up and performed using dimensional
2.2 lb 1 kg 100 mg 8.8 analysis procedures in the same manner as that used
4 above for the oral dosage calculations.
which rounds off to 1 tab. Example 1
Doctor’s order: meperidine 20 mg IM q4h prn for
5. pain
2
1,000,000 U  1 tab = 2 = 2 tabs Medication label: 50 mg/mL
500,000 U 1 How many mL or cc would you give?
1
The starting factor is 20 mg, and the conversion
factor is 1 mL/50 mg. The answer unit is the number
of mL or cc.
CALCULATING INTRAMUSCULAR AND
SUBCUTANEOUS DOSAGES USING Starting  conversion = answer
DIMENSIONAL ANALYSIS factor factor unit
It is often necessary to round off when calculating 20 mg  1 mL = ______ mL
intramuscular and subcutaneous dosages. The dosage 50 mg
is rounded off to the nearest hundredth (0.01) of a mL
or cc when you are using a tuberculin syringe. When
20 mg  1 mL = 2 = 0.4 mL
you calculate such a dosage, it is necessary to perform
50 mg 5
the mathematical calculation to the thousandths place,
or the third decimal place, and round off the second
decimal place according to the number that holds the Example 2
thousandths place. If the number in the third decimal
place, or thousandths place, is 5 or higher, you round Doctor’s order: amikacin 5 mg/kg IM tid. The
up one number in the hundredths place to determine patient weighs 155 lb.
the dosage. For example, if you are calculating a Medication label: amikacin 500 mg/2 mL
dosage for a tuberculin syringe and your mathematical
calculation gives you 0.147 mL, you would round How many mL would you administer?
it off to 0.15 mL because the 7 is greater than 5. The starting factor is 155 lb. The conversion fac-
Heparin is usually given in a tuberculin syringe tors are 1 kg = 2.2 lb, 5 mg/1 kg, and 2 mL/500 mg.
employing the subcutaneous route. The answer unit is the number of mL.
Insulin is given in an insulin syringe and in a spec-
ified number of units. With rare exception, Units 100 Starting  conversion = answer
insulin is given in a Units 100 syringe that holds either factor factors unit
0.5 cc, equivalent to 50 units, or a 1 cc insulin syringe 155 lb  1 kg  5 mg  2 mL = _____ mL
that holds a maximum of 100 units of insulin. On 2.2 lb 1 kg 500 mg
some rare occasions Units 80 or 60 insulin may be
used. In these cases a Units 80 or Units 60 syringe 1 1
must be used, respectively. Units 80 syringes hold 80 155 lb  1 kg  5 mg  2 mL = 155 = 1.40,
units of Units 80 insulin in one cc. Units 60 syringes 2.2 lb 1 kg 500 mg 110 or
hold 60 units of Units 60 insulin in one cc. 1.1 100 1.4 mL
Most intramuscular injections are given in a 3 cc
syringe. Computations are carried out to the hun-
dredths and rounded off to the nearest tenth (0.1) of a Example 3
cc or mL. For example, if the calculation is performed Doctor’s order: heparin 3,500 U subcutaneously
and the answer is 1.33 mL, it is rounded off to 1.3 mL.
An additional consideration for intramuscular Medication label: 5,000 U/mL
injections is that many calculations, particularly those How many mL would you administer?
necessary to determine an antibiotic dosage, require a
conversion factor that reflects the amount of the drug The starting factor is 3,500 U. The conversion
per mL after a powder is reconstituted with sterile factor is 5,000 U/mL. The answer unit is the number
water or normal saline solution for injection. of mL.
6 Bert Rodgers Schools Continuing Education Course

Starting  conversion = answer 60  1  6  1 = 36 = 6.54 mL


factor factor unit 1.1 1 50 5.5
3,500 U  1 mL = ______ mL
5,000 U Because the doctor ordered 30 mg/kg over one
day in three divided doses, it is necessary to divide the
7 6.54 mL for the day by 3 to determine how many mL
3,500 U  1 mL = 7 = 0.7 mL would be given in each of the doses:
5,000 U 10 6.54 = 2.18, or 2.2 mL per dose
10 3

Example 4 Practice Intramuscular and Subcutaneous


Doctor’s order: ticarcillin 700 mg IM Dosages
Medication label: ticarcillin reconstituted with Now try these intramuscular and subcutaneous dosage
2 mL of sterile water to yield 1 g of ticarcillin in calculations:
2.6 mL of solution. 1. Doctor’s order: heparin 2,500 U subcutaneously
How many mL would you administer? Medication label: 4,500 U/mL
The starting factor is 700 mg. The conversion fac- How many mL would you administer?
tors are 1 g/2.6 mL and 1 g = 1,000 mg. The answer (The starting factor is 2,500 U, the conversion fac-
unit is the number of mL. tor is 1 mL = 4,500 U, and the answer unit is the
number of mL.)
Starting  conversion = answer
factor factors unit 2. Doctor’s order: cefuroxime 500 mg IM
700 mg  1g  2.6 mL = _____ mL Medication label: The addition of 3.2 mL of sterile
water yields a suspension of 750 mg in 3.6 mL.
1,000 mg 1g
How many mL would you administer?
7 (The starting factor is 500 mg, the conversion fac-
700 mg  1 g  2.6 mL = 18.2 = 1.82, or 1.8 mL tor is 750 mg/3.6 mL, and the answer unit is the
1,000 mg 1 g 10 number of mL.)
10
3. Doctor’s order: cephalothin 500 mg IM
Medication label: The addition of 4 mL of sterile
water yields 0.5 g in 2.2 mL of suspension.
Example 5
How many mL would you administer?
Doctor’s order: neomycin 30 mg/kg/day IM in (The starting factor is 500 mg, the conversion fac-
three divided doses. The patient weighs 120 lb. tors are 1g = 1,000 mg and 0.5 g/2.2 mL, and the
Medication label: neomycin 250 mg/mL answer unit is the number of mL.)

How many mL would you administer for each of 4. Doctor’s order: neomycin 30 mg/kg/day IM in
the three doses? three divided doses. The patient weighs 120 lb.
Medication label: neomycin 250 mg/mL
The starting factor is 120 lb. The conversion fac-
tors are 30 mg/1 kg, 1 kg = 2.2 lb, and 250 mg/1 mL. How many mL would you administer for each of
The answer unit is the number of mL. the three doses?
(The starting factor is 120 lb; the conversion fac-
Starting  conversion = answer
tors are 30 mg/1 kg, 1 kg = 2.2 lb, and 250 mg/1
factor factors unit
mL; and the answer unit is the number of mL.)
120 lb  1 kg  30 mg  1 mL = _____ mL
5. Doctor’s order: 400,000 U of ampicillin
2.2 lb 1 kg 250 mg Medication label: 250,000 U/mL
60 6 How many mL would you administer?
120 lb  1 kg  30 mg  1 mL = _____ mL (The starting factor is 400,000 U, the conversion
2.2 lb 1 kg 250 mg factor is 250,000 U/1 mL, and the answer unit is
1.1 50 the number of mL.)
Computation of Dosage and Solutions 7

Answers CALCULATING IV FLOW RATES USING


1. 0.55 mL DIMENSIONAL ANALYSIS AND THE ONE-
2. 2.4 mL
STEP, NO-RULES METHOD
3. 2.2 mL
4. 2.2 mL The final portion of this course will teach you how to
5. 1.6 mL calculate, or compute, IV flow rates and other IV
dosage calculations using dimensional analysis. It will
Here is how each of the problems was set up and
also present a one-step, no-rules IV flow rate method
solved:
to determine the number of drops per minute when
you know the ordered number of cc per hour.
1.
5 Calculating IV Flow Rates Using Dimensional
2,500 U  1 mL = 0.555 mL, which rounds off to Analysis
4500 U 0.55 mL IV tubing is manufactured by a number of companies.
9 Each tubing set has a drop factor that indicates
whether it delivers 10, 15, 20, or 60 drops (gtt) per mL
2. of solution. The 60 gtt per mL tubing, which is often
2 referred to as microdrop tubing or pediatric tubing,
500 mg  3.6 mL = 7.2 = 2.4 mL or delivers the smallest drops of all the sets. The 10
750 mg 3 gtt/mL tubing delivers the largest drops of solution.
3 Drops are rounded off to the nearest whole drop when
calculations are performed.
2 1.2 The IV flow rate calculations immediately below
500 mg  3.6 mL = 2.4 = 2.4 mL are set up and performed using dimensional analysis.
750 mg 1 Example 1
3
1 Doctor’s order: 0.9% NaCl solution at 90 mL per
hour
3. How many gtt per minute would you give if the
tubing delivered 20 gtt/mL?
1 1.1
500 mg  1g  2.2 mL = 2.2 mL The starting factor is 1 min; the conversion
1,000 mg 0.5 g factors are 1 hour [h] = 60 min, 90 mL/1 h, and
2 20 gtt/1 mL; and the answer unit is the number of
1 gtt per min, or gtt.

4. Starting  conversion = answer


60 6 factor factors unit
120 lb  1 kg  30 mg  1 mL = 36 = 6.54 mL
2.2 lb 1 kg 250 mg 5.5 1 min  1 h  90 mL  20 gtt = ___ gtt
1.1 50 60 min 1h 1 mL

Because the doctor ordered 30 mg/kg over one 3 10


day in three divided doses, it is necessary to divide the 1 min  1 h  90 mL  20 gtt = 30 gtt
6.54 mL for the day by 3 to determine how many mL 60 min 1h 1 mL
would be given in each of the doses: 2
6.54 mL = 2.18, which rounds off to 2.2 mL per dose 1
3

Example 2
5.
Doctor’s order: 1,000 mL of 5% D 0.45 normal
8
saline solution to infuse over 5 hours
400,000 U  1 mL = 8 = 1.6 mL
250,000 Units 5 How many gtt per minute would you give if the
5 tubing delivered 10 gtt/mL?
8 Bert Rodgers Schools Continuing Education Course

The starting factor is 1 min; the conversion fac- 1


tors are 1 h = 60 min, 1,000 mL/5 h, and 10 gtt/1 mL; 1 min  1 h  45 mL  60 gtt = 45 gtt
and the answer unit is the number of gtt. 60 min 1h 1 mL
1
Starting  conversion = answer
factor factors unit Did you notice that the last two calculations,
1 min  1 h  1,000 mL  10 gtt = ___ gtt which use the microdrop, or 60 gtt/mL, IV tubing,
60 min 5h 1 mL yield the same number of gtt per minute as the num-
ber of mL per hour that was ordered?
Specifically, the first doctor’s order was for 25 mL
200 1 per hour. You would have to run the IV solution at 25
1 min  1 h  1,000 mL  10 gtt = 200 = gtt per minute to deliver 25 mL per hour. The second
60 min 5h 1 mL 6 doctor’s order called for 45 mL per hour. You would
6 1 have to run the IV solution at 45 gtt per minute in
order to deliver 45 mL an hour.
If you look closely at these two calculations, you
= 33.3, or 33 gtt will see that the conversion factor of 60 min = 1 h can-
cels out the conversion factor of 60 gtt per mL. We
will now move one step further with this observation.
Example 3
Doctor’s order: 25 mL/h of 5% D 0.45 normal Calculating IV Flow Rates Using the One-
saline solution Step, No-Rules Method
How many gtt per minute would you give if the In order to calculate using the one-step, no-rules
tubing delivers 60 gtt/mL? method, you need to know the number of mL per
hour ordered. Occasionally, the doctor’s order clearly
The starting factor is 1 min; the conversion fac-
states the number of mL per hour, which is the easiest
tors are 1 h = 60 min, 25 mL/1 h, and 60 gtt/1 mL;
scenario. If the doctor’s order specifies the number of
and the answer unit is the number of gtt.
mL per 8, 12, or any other number of hours rather
than each hour, it is necessary to first determine the
Starting  conversion = answer number of mL to be administered per hour.
factor factors unit For example, if the doctor orders 1,000 mL in 8
1 min  1 h  25 mL  60 gtt = ___ gtt hours, you must divide 1,000 mL by 8 to determine
the number of mL per hour. The answer is 125 mL/h.
60 min 1h 1 mL
Likewise, if the doctor orders 2 liters of IV fluid over
12 hours, the calculation to determine the number of
1 mL per hour is as follows:
1 min  1 h  25 mL  60 gtt = 25 gtt 2,000 mL/12 = 166.6 mL,
60 min 1h 1 mL which rounds off to 167 mL/h.
1 Once you have observed that the number of mL/h
is identical to the number of gtt/min, something that
Example 4 never changes when you are using a 60 gtt/mL tubing,
Doctor’s order: 45 mL/h of 5% D 0.45 normal it soon becomes apparent that for tubing with other
saline solution drop factors (10 gtt/mL, 15 gtt/mL, and 20 gtt/mL),
you must simply look at the relationship of the drop
How many gtt per minute would you give if the factor to the ever-present 60, the never-changing
tubing delivers 60 gtt/mL? number of minutes in an hour.
The starting factor is 1 min; the conversion fac- For example, if you are using IV tubing with a 20
tors are 1 h = 60 min, 45 mL/1 h, and 60 gtt/1 mL; gtt/mL drop factor, you have to look at the relation-
and the answer unit is the number of gtt. ship between the 20 in the tubing drop factor and the
ever-present 60, the number of minutes in an hour.
The relationship between 60 and 20 is 3; in other
Starting  conversion = answer
words, 60/20 = 3.
factor factors unit
Similarly, if you are using IV tubing with a 10
1 min  1 h  45 mL  60 gtt = ___ gtt gtt/mL drop factor, you have to look at the relation-
60 min 1h 1 mL ship between the 10 in the tubing drop factor and the
Computation of Dosage and Solutions 9

number 60. The relationship between 60 and 10 is 6: tions that you will also have to know. These include
60/10 = 6. Finally, if you are using IV tubing that calculating the following:
delivers 15 gtt/min, the relationship of 60 to 15, or 4,
• total infusion time;
requires you to divide the number of mL an hour by 4.
Now that you know all the possible relationships, • the concentration of a medication in an IV solution
it is only necessary to divide the number of mL an that should be given; and
hour by 3 for a 20 gtt/mL drop factor tubing, by 6 for • IV flow rates based on body weight.
a 10 gtt/mL drop factor tubing, and by 4 for a 15
gtt/mL drop factor tubing. All you have to do is one Calculating Total Infusion Time
step. There are no rules to forget, no complicated for-
mulas, and no unnecessary steps! When you have adjusted an IV solution to run at a
Here are some examples: certain number of drops per minute, you will want to
know when the solution is due to finish infusing so
If you are using a 10 gtt/mL set, the number of that you can anticipate the need to hang another bag
drops per minute will always be the number of mL an of solution, if so ordered. You must, therefore, be able
hour divided by 6. to calculate the total infusion time for the presently
100 mL/h: 100/6 = 16.6 = 17 gtt/min rounded off infusing bag.
125 mL/h: 125/6 = 20.8 = 21 gtt/min rounded off Following is an example of how this type of calcu-
150 mL/h: 150/6 = 25 gtt/min lation is accomplished using dimensional analysis.
Total volume of IV fluid: 1,000 mL
If you are using 20 gtt/mL IV tubing, the number
of drops per minute will always be the number of mL Infusion rate: 23 gtt/min
an hour divided by 3. Drop factor: 10 gtt/mL
100 mL/h: 100/3 = 33.3 = 33 gtt/min rounded off When will the liter of fluid run out?
125 mL/h: 125/3 = 41.6 = 42 gtt/min rounded off The starting factor is 1,000 mL; the conversion
150 mL/h: 150/3 = 50 gtt/min factors are 10 gtt/1 mL and 23 gtt/1 min; and the
answer unit is time, that is, the number of hours
And, finally, if you are using 15 gtt/mL tubing, the and/or minutes.
number of drops per minute will be the number of mL
an hour divided by 4.
Starting  conversion = answer
100 mL/h: 100/4 = 25 gtt/min factor factors unit
125 mL/h: 125/4 = 31.2 = 31 gtt/min rounded off
1,000 mL  10 gtt  1 min  1 h = ___ h
150 mL/h: 150/4 = 37.5 = 38 gtt/min
1 mL 23 gtt 60 min
This one-step, -no-rules- method of calculating
the number of IV drops per minute works all the time 1
because there are always 60 minutes in an hour. The 1,000 mL  10 gtt  1 min  1 h = 1,000 =
one step involved in calculating the number of drops 1 mL 23 gtt 60 min 138
per minute consists of dividing the relationship num- 6
ber for the specific IV tubing set into the number of
mL per hour ordered by the doctor. Pediatric (60 = 7.24 h (7 h 14 min)
gtt/mL) tubing has an identity relationship; therefore,
the number of drops per minute will always exactly
match the number of mL per hour. Calculating the Concentration of a
This one-step method is particularly useful Medication in an IV Solution
because nurses caring for patients with IV infusions
should count and verify the number of drops per On some occasions, a physician may order an hourly
minute at the bedside with each patient contact. dosage of a medication that has been diluted in an IV
Volumetric controllers and pumps are not always fluid. For example, the doctor may order an hourly
accurate and do not always function properly. dosage of 1,200 units of heparin that has 20,000 units
of heparin diluted in 1,000 mL of normal saline solu-
tion. The nurse must then be able to calculate the flow
rate of the fluid based not on the volume of the fluid
OTHER IV CALCULATIONS ordered but on the dosage of the medication.
Calculating the number of drops per minute, or the The starting factor is 1 h; the conversion factors
flow rate, is perhaps the most frequently encountered are 1,200 U/1 h and 20,000 U/1,000 mL; and the
IV calculation; however, there are other IV computa- answer unit is the number of mL.
10 Bert Rodgers Schools Continuing Education Course

Starting  conversion = answer Practice IV Rates


factor factors unit
1. Total volume of IV fluid at the beginning of your
1h  1,200 U  1,000 mL = ___ mL shift: 375 mL
1h 20,000 U Infusion rate: 21 gtt/min
Drop factor: 15 gtt/mL
60 When will this fluid run out?
1h  1,200 U  1,000 mL = 60 mL (The starting factor is 375 mL; the conversion fac-
1h 20,000 U tors are 15 gtt/1 mL, 21 gtt/1 min, and 1 h = 60
1 min; and the answer unit is the number of hours
and/or parts thereof.)
2. How many mL/h would you administer if the doc-
tor orders 25 U/h of a medication that has been
diluted in a solution with a total of 250 U in 1,000
mL?
Calculating IV Flow Rates Based on Body
(The starting factor is 25 U, the conversion factor
Weight
is 250 U/1,000 mL, and the answer unit is the num-
When a doctor’s order specifies a volume of fluid or a ber of mL/h.)
dosage of a diluted medication over a period of time
3. If your patient weighs 100 lb and the doctor orders
based on body weight, the calculation is similar to
5 mcg/kg/min of a medication intravenously in-
those described above with the addition of a conver-
fused via 500 mL of an IV fluid that contains
sion factor that allows for body weight.
250 mg of the medication, how many mL/min and
For example, if you are caring for a patient that
mL/h would you administer?
weighs 200 lb and the doctor orders 5 mcg [µg,]
/kg/min of a medication intravenously infused via 500 Answers
mL of an IV fluid that contains 250 mg of the medica- 1. 4 h 28 min
tion, you would perform the following computation to 2. 100 mL
determine the number of mL per minute or hour that 3. 0.45 mL/min and 27 mL/h
the patient will receive.
The starting factor is 200 lb; the conversion fac-
tors are 1 kg = 2.2 lb, 5 mcg/1 kg, 1 mg = 1,000 mcg, 1.
and 250 mg/500 mL. The answer unit is the number 375 mL  15 gtt  1 min  1 h = _____ h
of mL to be administered per minute. If you want to 1 mL 21 gtt 60 min
determine how many mL to administer per hour, you
would simply multiply the answer by 60. 1
375 mL  15 gtt  1 min  1 h = 375 =
1 mL 21 gtt 60 min 84
Starting  conversion = answer 4
factor factors unit
= 4.46 h (4 h 28 min)
200 lb  1 kg  5 mcg  1 mg  500 mL = __ mL
2.2 lb 1 kg 1,000 mcg 250 mg 2.
25 U  1,000 mL = ____ mL
1 1 2 250 U
200 lb  1 kg  5 mcg  1 mg  500 mL = 2 =
1
2.2 lb 1 kg 1,000 mcg 250 mg 2.2
25 U  1,000 mL = 1,000 = 100 mL
5 1 250 U 10
1 10

= 0.9 mL
3.
Per minute:
The number of mL to be administered per hour = 100 lb  1kg  5 mcg  1 mg  500 mL = __ mL
0.9  60 = 54. 2.2 lb 1 kg 1,000 mcg 250 mg
Computation of Dosage and Solutions 11

1 SUMMARY
1 1 10
Dimensional analysis is a highly useful way to calcu-
100 lb  1kg  5 mcg  1 mg  500 mL = 1 = late dosage and solution problems of all types. It is an
2.2 lb 1 kg 1,000 mcg 250 mg 2.2 orderly and systematic mathematical process that
10 50 results in consistent accuracy, provided the equation is
1 1 set up correctly and careless mathematical errors are
avoided.
= 0.45 mL
Per hour:
0.45  60 = 27 mL

P O S T T E S T

1. How many mL would you 4. If the doctor has ordered 200 8. If the doctor orders
administer if the doctor mg of aminophylline po and gentamicin 3 mg/kg/day in
orders 300 mg of ferrous each tablet contains 0.1 g, four equal doses, the patient
sulfate elixir and the label on how many tablets would you weighs 77 kg, and the label
the elixir states that there are give to the patient? reads 40 mg/mL, how many
220 mg/5 mL? mg would you give for each
a. 1
⁄2 tablet
dose?
a. 1.4 mL b. 1 tablet
b. 5.5 mL c. 11⁄2 tablets a. 0.4 mL
c. 6.2 mL d. 2 tablets b. 1.4 mL
d. 6.8 mL c. 4 mL
5. If the doctor orders 1.8 mg of d. 14 mL
2. How many sulfamethoxazole betamethasone and you have
tablets per dose would you tablets that contain 0.6 mg, 9. How many drops per minute
administer to a patient weigh- how many tablets would you would you deliver if the
ing 154 lb if the doctor has administer? doctor has ordered 700 mL
ordered 100 mg/kg/day in q8h and the drop factor of the
a. 1
⁄3 tablet
three divided doses? The IV tubing is 20 gtt/mL?
b. 3 tablets
label on the sulfamethoxazole
c. 1
⁄4 tablet a. 29 gtt/min
bottle states that there are
d. 4 tablets b. 87 gtt/min
800 mg per tablet.
c. 158 gtt/min
a. 1 tablet 6. If the doctor has ordered 15 d. 233 gtt/min
b. 2 tablets mg/kg/day in four equal doses
c. 3 tablets and the patient weighs 155 lb, 10. How many mL/h would you
d. 4 tablets how many mL would you administer if the doctor
administer for each dose if orders 50 U/h of a medication
3. If the doctor has ordered there are 500 mg/2 mL? that has been diluted in a
phenobarbital gr 1⁄2 orally and solution with a total of 250 U
a. 0.5 mL
there are 15 mg per tablet, in 1,000 mL?
b. 1 mL
how many tablets would you
c. 1.5 mL a. 50 mL
administer?
d. 2.5 mL b. 100 mL
a. 2 tablets c. 150 mL
b. 1 tablet 7. If the doctor orders d. 200 mL
c. 1
⁄4 tablet streptomycin 1 g and you
d. 1
⁄2 tablet have added 12 mL to a
powdered streptomycin to
yield 400 mg/mL, how many
mL would you give?
a. 2.5 mL
b. 2 mL
c. 1.5 mL
d. 0.5 mL
ANSWER SHEET

Student Name: Daytime Phone: ( )


Please write in your name and daytime phone number for each answer sheet you submit.
Course #: 119 Tuition: $12.95
Course Title: Computation of Dosage and Solutions Contact Hours: 2
FOR OFFICE USE ONLY
Course Expiration Date: October 31, 2006 0404COM
Instructions
Read the course material. Answer the Post Test Questions at the end of the course. Transfer your answers to the Post Test
Questions section below. Remember to fill in the number of hours and minutes it took to read and review the course and take the
test. Also please include your signature. Fill out the Course Evaluation section below, indicating the extent to which you agree or
disagree that you achieved each objective. Complete the Registration Form and mail or fax it to us with your Answer Sheet(s).

Post Test Questions:


1. ❍ a ❍ b ❍ c ❍ d 6. ❍ a ❍ b ❍ c ❍ d It took ______ hours and ______
2. ❍ a ❍ b ❍ c ❍ d 7. ❍ a ❍ b ❍ c ❍ d minutes to read and review the
course and take the test.
3. ❍ a ❍ b ❍ c ❍ d 8. ❍ a ❍ b ❍ c ❍ d
____________________________
4. ❍ a ❍ b ❍ c ❍ d 9. ❍ a ❍ b ❍ c ❍ d Signature

5. ❍ a ❍ b ❍ c ❍ d 10. ❍ a ❍ b ❍ c ❍ d

Course Evaluation:
I achieved the following learning objectives: Agree Disagree

1. Use dimensional analysis to solve a wide variety of dosage and solution problems. ❍ ❍ ❍ ❍
2. Calculate oral dosages using dimensional analysis. ❍ ❍ ❍ ❍
3. Compute intramuscular and subcutaneous dosages using dimensional analysis. ❍ ❍ ❍ ❍
4. Determine intravenous (IV) flow rates using dimensional analysis and the one-step, ❍ ❍ ❍ ❍
no-rules method of calculation.
The objectives stated above related to the overall goals of the course. ❍ ❍ ❍ ❍
The teaching/learning method was effective. ❍ ❍ ❍ ❍

Notes:
Certificates of Completion are dated the day our School receives and processes your Answer Sheet, Registration Form, and
payment. Duplicate Certificates of Completion are available at no charge! There is no charge for processing a re-exam.

Bert Rodgers Schools of Continuing Education • (800) 432-0320 • www.bertrodgers.com

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