ncm 100 dosage calculations

DRUG ADMINISTRATION:

Standards, Practices and Principles

Fundamentals in Nursing Practice

LEARNING OBJECTIVESLEARNING OBJECTIVES

At the end of the lecture discussion, RNs are expected to: Enumerate principles, standards, guidelines in drug preparation and

administration Identify vital functions, roles & responsibilities as RNKs in drug

preparation and administration Calculate with 100 percent accuracy, completeness & organization

based on standardized conversion system, equation and units of measurement

Appreciate the value and virtue of patience, humility, cooperation, respect and dignity for human life in congruence with drug preparation and administration

FLORENCE NIGHTINGALE’SFLORENCE NIGHTINGALE’S PLEDGE PLEDGE

I solemnly pledge myself before God and the presence of this assembly to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious to mind and body and not take or knowingly administer any harmful drugs. I will do all in my power to hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my profession.

With loyalty will I endeavor to aid the physician in his work and devote myself to the welfare of those committed to my care”.

Thus…

KNOWLEDGE, SKILLS, ATTITUDES AND KNOWLEDGE, SKILLS, ATTITUDES AND VALUESVALUES

• Promotion of health• Prevention of illness• Restoration of physiologic processes• Provision of palliative effect• Maintenance & sustenance of wellness• Aid in diagnosis• Treatment of diseases

Pharmacologic aspects in

nurses’ contextualities

Rules and Techniques for Giving Rules and Techniques for Giving MedicinesMedicines

Verify all new or questionable orders on the medication administration record (MAR) against the physician orders for completeness

Prepare medications in a quiet environment Wash hands thoroughly before measuring or preparing a medication Collect all necessary equipments Review MAR carefully (medication, dosage, route, expiration, date and

frequency) Research drug compatibilities, purposes, contraindications, S/E, &

appropriate routes Find medication for individual client Accurate calculation is needed Check expiration dates and signs of decomposition

Rules and Techniques for Giving Medicines

Compare labels three times

• When removing package from drawer

• Before preparing the medication

• After preparing the medication Be sure medications are identified for each client Check for any allergies and perform special assessment before

administration Confirm patient’s identity

• Ask the name Check the identification wrist band

• Check the bed tag (least reliable)

• Check the photo in bed


Observe 10 Rights in giving each medication

Do not give medicine that someone else prepared. • Institution policies may require

having a colleague double check medication such as insulin or heparin

If using a computer – controlled dispensing system, follow agency policy

Guides to the Administration of Some Specific Guides to the Administration of Some Specific AgentsAgents

Cough syrups are given undiluted in small amount and in frequent doses

Laxatives or cathartics are given between meals and on an empty stomach; those that act quickly be given just before breakfast or those requiring a longer time for action should be given at night (laxative lubricant 12-18 hours action)

Bitter or unpleasant tasting drugs are given in capsule form as a coated pill or in effervescent preparations

Oils taken in liquid form should be chilled• Castor oils taken with a lemon juice ¼ NAHCO3 in

effervescing action

Guides to the Administration of Some Specific Guides to the Administration of Some Specific AgentsAgents

Drugs that are destroyed by digestive juices are given in enteric coated pills

Drugs are given several hours after meals for rapid action Drugs to aid digestion are given one half before meals Fe and Iodine preparations are given diluted and given with a

straw Sedatives are given with warm milk to increase and hasten

desired effect of the drug Bitter stomachaches, given to stimulate appetite should be

given undiluted and with no attempt to disguise the taste

Rules for Measuring Medications

Measure the amount of drug ordered, using a calibrated measure

Do not converse while preparing the medication

Make sure that medicine glasses are dry before pouring or measuring a medication

Cleanse the mouth of every bottle after use before replacing it

Measure drops Hold the medicine glass at eye level

Rules on Labels

Give medication only from a clearly labeled container

Read the label three times Never give a drug from an

unmarked bottle or box Pour medicine from the bottles

on the side opposite the label Labels on medicine containers

should be changed only by the pharmacists

If a drug has two commonly used names, both names should appear on the label

Rules for Giving MedicationsRules for Giving Medications

Give the medication at the time for which it is ordered Always identify the patient before giving the medication If medication is refused or cannot be administered, notify the lead

head nurse Remain at the bedside until the patient has taken the medication Administer only those medicines which you have measured, poured

and prepared Never give two drugs together, unless ordered to do so When a patient goes to the OR, all orders for medication are DC When special tests are being done, medications due at the particular

time are omitted they are resumed when next due A mistake in medication must be reported immediately to the lead

head nurse or charge nurse

Rules for Recording Drugs Rules for Recording Drugs AdministeredAdministered

Record if an ordered medication is refused or if cannot be administered

Record each dose of medicine soon after it is administered Use standard abbreviations in recording medications Record only those medicines which you have administered Record time, kind and dose of drug given Record effect, especially any unusual effect Never record a medication as given before it has been

administered “IF IT WAS NOT DOCUMENTED, IT WAS NOT DONE.”

Care of Drugs and Medicine Care of Drugs and Medicine CabinetCabinet

Bottles, boxes & other containers Must be kept closed

Ointments, liniments, talcum powder, rubbing alcohol

Must be kept in a separate environment

Oils, serums, vaccines, liver extracts

Must be placed in a refrigeratorExtreme colds prevents them from becoming rancid and makes the oil a little more palatable

Emergency Drugs Must be kept in a box or tray, readily attainable

Labels Defaced or soiled should be changed by the pharmacists

Medicines in unusual appearance Returned to the pharmacy & discarded

Care of Drugs and Medicine Care of Drugs and Medicine CabinetCabinet

Floor Drugs Checked twice daily Two containers for each floor drug

Unused drugs for a patient being dismissed Should be sent back to the pharmacy

Medicines sent home for patients Complete directions are employed

Medicine Cabinet

Individual basis (UNIT DOSE FORM)

Opiates & narcotics

Poison

Adjacent to sinkAdequate lightShallowProper drug classification of drug supplies

Drug per container/patient

Separate compartment & lockedNarcotic nurse with the key

Label POISON, separate and roughened surface

DRUG SUPPLY - UNIT DOSE FORM System of packaging and labeling each dose by pharmacy supplied in a 24 hour time periodReplacement, constant monitoring of availability

DRUG SUPPLY – STOCK SUPPLIED Dispensed and labeled in large quantitiesStock supplies kept in a secured area

RNKs CAN ALLAY PATIENT’S SUFFERING

THROUGH WRONG MEDICATION AND NON COMPLIANCE TO

STANDARDS, PRINCIPLES AND GUIDELINES

DIGNIFIED

DEATH

TEST DRILL TEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND APPLICATION, CRITICAL THINKING, RECALL AND

RECOGNITIONRECOGNITION

1. A nurse makes a medication error. The best action is to

A. Document in the patient’s record the error by either noting the omission of a drug or adding the drug given if it does not appear on the medication record

B. Document in the patient’s record the error by either noting the omission of a drug or adding the drug as given even if it does not appear on the medication record; describe the circumstances surrounding the error.

C. Do not document any error on the patient’s record. Document only on the incident or quality assurance report.

D. Document in the patient’s record the error by either noting the omission of a drug or adding the drug as given if it does not appear on the MAR; also document on the incident or quality assurance report.



2. Among the following patient’s right, which is not included?

A. Right route

B. Right medicine

C. Right site of administration

D. Right patient



3. Which of the following nursing actions is most helpful for the patient with dysphagia?

A. Placing the patient in a sitting position

B. Mixing the medication with food

C. Turning the patient toward you

D. Dissolving the medication in a glass of water



4. It is important not to leave medication at the bedside because

A. You will not be able to document that the patient actually took the medication

B. It may fall on the floor

C. The patient may forget to take it

D. It takes time to return and check with the patient later



5. Buccal medications are thoseA. Placed between the cheek and the gum

B. Placed under the tongue

C. Injected into the buttocks

D. Swallowed with water



6. Topical rinses have of the following actions:

A. Systemic effect when swallowed

B. Decreased microorganisms and tooth decay

C. Increased the ability to taste

D. Local effect through exposure to the mucous membrane



7. Administration of which of the following requires the use of sterile technique?

(1) Ophthalmic medications (2) Nasal medications

(3) Vaginal medications (4) Rectal medication

A. 1 only

B. 1, 2, and 3

C. 1 and 3

D. 2, 3, and 4



8. For safety and accuracy of medication being administered to the patient, one of the considerations is the three checks. Which of the following is not applicable?

A. Reading the label after the medications has been administered.

B. Reading the label before preparing.

C. Reading the label before picking the medication in the locker.

D. Reading the label after withdrawing the medication from the container.



9. Which is the following route has the faster effect?

A. Sublingual

B. Intravaginal

C. Inhalers

D. Intravenous



10. It is a medication order that is to be given once at specified time.

A. Stat order

B. Single order

C. Standing order

D. PRN order

11. “Multivitamins 1 tab daily” is an example of:

A. Stat order

B. Single order

C. Standing order

D. PRN order

12. A finely divided drug particles dispersed in liquid medium, when suspension is left standing, particles settle at the bottom of container

A. Aqueous

B. Suspension

C. Syrup

D. Powder



13. Requires that the effectiveness of the medication be administered by client’s response to the medication; it is appropriate to determine the extent of side effects and adverse reaction supports which of the following medication golden rule?

A. Right evaluation

B. Right assessment

C. Right education

D. Right documentation

14. Which of the following is not a principle for giving medications?

A. Be knowledgeable about medications that you administer.

B. Do not leave medication at bedside.

C. When a medication error is made, report it immediately to the nurse in charge and/or physician.

D. Practice clean technique.



15. The following are rules for measuring medications, except:

A. Wash hands thoroughly before measuring medications.

B. Do not converse with anyone while preparing a medication.

C. Cleanse the bottom of each medicine bottle before replacing it after use.

D. Make sure that the medicine glasses are dry before pouring the medication.

16. Mrs. Brown is to receive a medication PO qid. This means

A. by mouth every other day

B. before meals every day

C. after meals every day

D. by mouth four times a day



17. When the client resists taking a liquid medication that is essential to treatment, the nurse demonstrates critical thinking by doing which of the following first?

A. Omitting this dose of medication and waiting until the client is more cooperative

B. Suggesting the medication can be diluted in a beverage

C. Asking the nurse manager about how to approach the situation

D. Notifying the physician that the nurse was unable to give the client this medication

18. The nurse is administering medication in an extended care facility. The client answers to Mr. Smith and Mr. Brown. What is the best way for the nurse to correctly identify the client before administering the medications?

A. Ask the client's name.

B. Check the arm band.

C. Check the name on the bed.

D. Check the name on the room door.



19. Zantac is ordered for an adult client. The nurse mistakenly administered Xanax. What is the most appropriate action for the nurse to take?

A. Notify the physician and document in the nurse's notes that the physician was notified of the error.

B. Notify the supervisor, complete a medication error incident report, and document in the nurse's notes that an incident report was completed.

C. Notify the house supervisor, assess client carefully, and document only if adverse or untoward effects occur.

D. Notify the physician, complete an incident report, and document the notification of the physician and any assessments made.



20. While preparing to give a morning medication, the first nursing action is to:

A. Read the label

B. Check for the right dose

C. Wash hands

D. Check for the right time

21 – 25 FIVE RIGHTS OF DRUG ADMINISTRATION

DOSAGE AND SOLUTIONSDOSAGE AND SOLUTIONS

TEST DRILL 1TEST DRILL 1Mastery, Recall and RecognitionMastery, Recall and Recognition

PERFORMANCE INDICATORS ANSWERS

1-5 Functions of Medicine/drug/medication Curative, diagnostic, palliative, promotive

6. Drug that is placed under the tongue SL

7. Priority of drug preparation/administration Patient’s safety

8. Drug that is slowly absorbed in a specified period of time

Timed release drug

9-12 Drug Nomenclature Brand, generic, official, chemical

13. OD Right eye

15. Used with other drug that potentiates one’s drug action

Adjunctive/adjunct

16-20. 5 R’s of drug administration Route, dose, patient, time,

CYRUZ POLERO TUPPAL RN MSN DMS © CYRUZ POLERO TUPPAL RN MSN DMS ©

TEST DRILL 2TEST DRILL 2Mastery, Recall and Mastery, Recall and

RecognitionRecognition1. A type of medication order which is

carried out until the specified period of time, or until it is discontinued by another order.

A. Single Order

B. Stat Order

C. Standing Order

D. PRN Order

2. This type of medication order indicates that the medication is given immediately without cause of delay.

A. Single Order

B. Stat Order

C. Standing Order

D. PRN Order

3. This type of medication order is used for a medication given once at a specified time.

A. Single Order

B. Stat Order

C. Standing Order

D. PRN Order

4. This type of medication order permits the nurse to give a medication when in his/her judgment the patient requires it.

A. Single Order

B. Stat Order

C. Standing Order

D. PRN Order


TEST DRILL 3TEST DRILL 3Recall and Recognition Recall and Recognition

Write the corresponding LETTER to drugs ordered by the physician.

A – Single order

B – Stat order

C – Standing order

D – Prn order

1. Ampicin 250 mg IV q 8 hr ANST

2. Phenergan 50 mg @ 10 am before surgery.

3. Dulcolax 10 mg 4 tabs @ h.s.

4. Hemostan 250 mg IM q 6 hours for bleeding

5. Ponstan 500 mg p.o. TID x 6 doses

6. Biogesic 500 mg p.o. stat

7. Demerol 25 mg IM q 4 hr for 2 days

8. Claritin 10 mg p.o. BID

9. Multivitamins 1 tab daily

10. Ampicillin 500 mg IV push TID ANST

1. C

2. A

3. C

4. D

5. C

6. C

7. C

8. C

9. C

10. C


DEFINITIONDEFINITION

DOSAGE• Is the amount of a

medicine or agent prescribed for a given patient or condition

DOSE• Is the measured

portion of medicine to be taken at one time

CYRUZ POLERO TUPPAL RN MSN DMS ©

FACTORS AFFETCING DOSAGE

Age Sex Condition of the patient Psychological factors Environmental factors Temperature Methods of administration Genetic factors Body weight


PRESCRIPTIONPRESCRIPTION

Ebers Papyrus – the real literature dealt with pharmacy

Is an order written by a physician

Date Patient’s name Address Inscription (name &

quantities) Subscriptions (instructions

to the pharmacists) Sig. (signa) gives directions

to the patient Physician signature,

address, registry number


SAMPLE PRESCRIPTIONSAMPLE PRESCRIPTION


Arellano University and Medical Center

Name of Patient DateAddressSex

Calcidrine Expectorant 4 0z

Sig ½ tsp q.4h for cough

Dr. Juan dela CruzLic. # 9875043


a.d. or A.D. Right ear

a.s. or A.S. Left ear

a.u. or AU each ear or both ears

HHN Hand held nebulizer

I.D. Intradermal route

I.M. or IM Intramuscular route

I.T. Intrathecal route

I.V. or IV Intravenous route

IVP Intravenous push

IVPB Intravenous piggyback

NGT Nasogastric tube

od or O.D. Right eye

os or O.S. Left eye

ou or O.U. Each eye or both eyes

po or P.O. or PO By mouth

P.R. or PR By rectum

SQ, sub q, subcut Subcutaneous route

SL or s.l. Sublingual route

S & S Swish and swallow

V or P.V. Vaginal route


Ac or P.C. Before meals

ad lib As desired / needed

ASAP As soon as possible

b.i.d. or BID Twice daily (not the same as q 12 °)

h.s. or HS At bedtime (hour of sleep)

NOC Nighttime [archaic usage]

pc or P.C. After meals

p.r.n. or PRN As needed

q or Q Every

q AM Every morning

q hr Every hour

q.d. or QD Every day

q.i.d. or QID Four times a day

q.o.d. or QOD Every other day

q (Q) 1°, 2°, 3°, 4°, 6°, 8°, or 12°, etc Every 1, 2, 3, 4, 6, 8, 12 hours. (Concept is based on a day and administering on a routine

sequential basis to maintain therapeutic blood levels.)

stat or STAT Immediately! [not when you can get around to it]

t.i.d. or TID Three times daily (not the same as q 8°)


amp Ampule

cap(s) Capsule(s)

DS Double-strength

elix Elixir

LA Long-acting

liq Liquid

sol Solution

supp Suppository

S.R Sustained release

susp Suspension

syr Syrup

tab Tablet

tinct or tr Tincture

ung Ointment


Dram (Notice "2 humps".) (Docs should not be using this, but you may see it. There is a significant difference in the volume between this [4 ml] and ounce [30 ml].)

Ounce (Notice "3 humps".) (Docs should not be using this, but you may see it.)

cc or CC Cubic centimeter

gm Gram

gr Grain

gtt (s) Drop (s)

IU International units (best to write out)

kg Kilogram

L Liter

mcg or µg Microgram (should be written out--safety issue)

mg Milligram

mEq Milliequivalent

ml Milliliter [preferable for volume]

Mn, m Minim [rarely used, except in some math exams]

oz Ounce

__ ss or ss

One-half (archaic use)

sliver in NICU, a small slice of a suppository

T or Tbs Tablespoon

tsp Teaspoon

U Unit (best to write out)


AMA (Leave) against medical advice

_ c

with

D/C or DC Discontinue

G Gauge (of needle)

HO House officer (doctor on call)

KVO Keep vein open.

LOCLaxative of choice (Look for context when written, ie., could be "level of consciousness"

when related to neurological exam.)

MR x _ May repeat (x) times [This should be written out due to risk for error.]

MOC In peds, mother of child

FOC In peds, father of child (may also be frontal occiputal circumference) (read the context)

NKA No known allergies

N.P.O., NPO, or npo Nothing by mouth

OTC Over the counter

qs A sufficient quanity

Rx Prescription, sometimes Treatment

® Right

_ s

Without (if must abbreviate, use w/o)

__ ss

One-half (should avoid this form)

TO Telephone order (Need to follow the hospital policy re this.)

TRA To run at (IV flow rate)

VO Verbal order (What is hospital policy re this?)

> Greater than

< Less than


The interdisciplinary health care team should limit abbreviations to standard acceptable use. Sometimes Doctor's orders and notes and nurse's transcription of doctor's orders and their narrative notes contain so many shortcuts (abbreviations) that it is difficult to

interpret safely.

µg Micrograms should be written out, insist on it!

__ ss or ss Write out one-half or 1/2 clearly.

ODOrdered daily? Write out daily. QD, if legible, should be acceptable.

n or N Nightly? QN? Write out nightly or use hs.

d or D Daily? Write out how many days.

BTOrdered at bedtime? Write out bedtime or use the standard hs.

w/o Without? (See Miscellaneous use page.)

Numerical numbers should be carefully written. Nurses should pay attention to use of the Numerical numbers should be carefully written. Nurses should pay attention to use of the decimal in designating dosages, ie, Ativan 0.5 mg, not Ativan .5 mg. [If one fails to note decimal in designating dosages, ie, Ativan 0.5 mg, not Ativan .5 mg. [If one fails to note the decimal, then it could be interpreted as 5 mg.] Capoten 50 mg should not be written the decimal, then it could be interpreted as 5 mg.] Capoten 50 mg should not be written as Capoten 50.0 mg. [If one fails to note the decimal, then it could be interpreted as 500 as Capoten 50.0 mg. [If one fails to note the decimal, then it could be interpreted as 500

mg.]mg.]

Another issue to consider is use of the international designation of the number 7 ( ) to Another issue to consider is use of the international designation of the number 7 ( ) to prevent mistaking it for the number 1. prevent mistaking it for the number 1.

CYRUZ P. TUPPAL RN MSN DMS ©NLE REVIEW RESOURCE CENTER INC. MANILA

CONVERSION EQUATION

BASIC TECHNIQUES

Metric, Household and Apothecary Measurement

UNIVERSAL PRINCIPLE:

The key is to clarify the 2 parts of the equation (what to give and what is available)

Be guided with the conversion table and formula

Basic arithmetic +, -, /, x

SAFETY

Conversion within SystemsConversion within Systems

Metric System• Based on decimal system, basic unit is 10• Units of measurement Meter (m) for Length, Gram (g) Kilogram

(kg) Pounds (lbs) Milligram (mg) Microgram (mcg) for Weight

Liter (l) Milliliter (ml) Cubic Centimeter (cc) for Volume• ZERO is placed in front of the decimal for values less than1 (0.7)• Basic arithmetic (division or multiplication)• mg to g or ml to l = divide the number by 1000


Conversion within Metric Conversion within Metric SystemsSystems

To convert within the metric system, set up a RATIO WITH THE CONVERSION FACTOR ON THE RIGHT AND DESIRED INFORMATION ON THE LEFT, CROSS MULTIPLY, DIVIDE TO FIND “X” and COMPLETE THE NEEDED MATH EQUATION.

REMEMBER: TO KEEP RATIOS EQUAL: WHATEVER IS DONE TO ONE SIDE MUST BE DONE TO THE OTHER

E.g. convert 5000 mg to gE.g. convert 5000 mg to g

a.a. ______________== _______ _______ (skeleton) (skeleton)

a.a. Conversion: 1000 mg = 1 gConversion: 1000 mg = 1 g

b.b. 5000 mg = 1000 mg5000 mg = 1000 mg

xx 1 g 1 g

c.c. (X) (1000 mg) = (5000 mg)/ 1 g(X) (1000 mg) = (5000 mg)/ 1 g

d.d. (X) (1000 mg) = (5000 mg) (g)(X) (1000 mg) = (5000 mg) (g)

(1000 mg) (1000 mg) (1000 mg) (1000 mg)

e.e. X = (5) (1) gX = (5) (1) g

f.f. X = 5 gX = 5 g


Test Drill 4Test Drill 4Conversion EquationConversion Equation

Convert the ff using a sequential approach

1. 136 kg = lb

2. 476 kg = lbs

3. 666 mg = g

4. 1478 ml = L

5. 3758 L = ml

6. 9000 cc = L

7. 780 g = mcg

8. 14344 mg = mcg

9. 88 lb = kg

10. 7 L = cc


MATRIX GUIDE

a. _______= _______ (skeleton)

a. Conversion: 1000 mg = 1 g

b. 5000 mg = 1000 mg

x 1 g

c. (X) (1000 mg) = (5000 mg)/ 1 g

d. (X) (1000 mg) = (5000 mg) (g)

(1000 mg) (1000 mg)

e. X = (5) (1) g

f. X = 5 g

Conversion within Systems: Conversion within Systems: HOUSEHOLD SYSTEMHOUSEHOLD SYSTEM

Least accurate Used to inform of the size of a

liquid dose Calibrated oral syringe or

dropper should be used instead for accuracy

Teaspoon (tsp) Tablespoon (tbsp) Ounce (oz) Cup Drop (gtt) Micro drop (mcgtt)

Convert 3 tsp to drop

a. 60 gtts = 1 tsp

b. 3 tsp = 1 tsp

X 60 gtts

c. (1tsp) (X) = (3 tsp) (60 gtts)

d. (1tsp) (X) = (3 tsp) (60 gtts)

1 tsp 1 tsp

e. X = 3 (60 gtts)

f. X = 180 gtts


TEST DRILL 5TEST DRILL 5Conversion EquationConversion Equation

MATRIX GUIDE Convert 3 tsp to drop

a. 60 gtts = 1 tsp

b. 3 tsp = 1 tsp

X 60 gtts

c. (1tsp) (X) = (3 tsp) (60 gtts)

d. (1tsp) (X) = (3 tsp) (60 gtts)

1 tsp 1 tsp

e. X = 3 (60 gtts)

f. X = 180 gtts

Convert the ff

1.70 tsp to drop

2.5 tbsp to oz

3.8 oz to tbsp

4.15 drops to tsp

5.12 tsp to oz


Conversion from One System Conversion from One System to Anotherto Another

Conversions must be memorized by heart Convert 90 gtts = ml

a. 15 gtts = 1 ml

b. 90 gtts = 15 gtts

X 1 ml

c. 15 gtts (X) = (90 gtts) (1 ml)

15 gtts 15 gtts

d. X = 6 ml


Dosage Calculation

Calibrated containers are available for oral liquids & liquid injectables

Be sure all conversions are done first. The technique of using ratios is the same

FORMULA

Desired Amount of Drug_ = Unknown Quantity (X)

Amount of Drug on Hand Known Quantity of Drug

X = Desired Dosage(D) X Quantity (Q)

Stock on Hand (S)


Dosage Calculation for Scored Dosage Calculation for Scored TabletTablet

1. 2000 mg of a drug is ordered. It is available as a scored tablet containing 4 g. How many tablet/s should the nurse administer?

2. Calculationa. 1000 mg = 1 g

b. 2000 mg = X tablets

4000 mg 1 tablet

c. 4000 mg (X) = 2000 mg (1)

d. X = 0.5 tablet

e. Give ½ tab

3000 mg of a drug is ordered. It is available as a scored tablet containing 7 g. How many tablet/s should the nurse administer?


Dosage Calculation for LiquidDosage Calculation for Liquid

1. The order is for potassium chloride (KCL) 20 mEq. The bottle is labeled KCL elixir 10 mEq./ml. How many ml will be given?

a. Desired amount of drug is 20 mEq(D); amount of drug on hand is known (S) 10 mEq.

b. Unknown quantity is (X), known quantity (Q) is 1 ml.

1. Calculations

a. 20 mEq = X

10 mEq 1 ml

b. (10 mEq) (X) = (20 mEq) (1 ml)

10 mEq 10 mEq

c. X = 2 ml

d. Give 2 ml of potassium chloride (KCL)


Dosage Calculation for LiquidDosage Calculation for Liquid

MATRIX GUIDE

a. 20 mEq = X

10 mEq 1 ml

b. (10 mEq) (X) = (20 mEq) (1 ml)

10 mEq 10 mEq

c. X = 2 ml

d. Give 2 ml of potassium chloride (KCL)

The order is for potassium chloride (KCL) 50 mEq. The bottle is labeled KCL elixir 35 mEq./ml. How many ml will be given?


A. Dosage Calculation for a A. Dosage Calculation for a CapsuleCapsule

1. The order is for Nembutal gr XX. The bottle contains Nembutal 100 mg/capsule. How many capsules should RNK give to ease the patient’s suffering?

2. Calculations

A. First convert to EQUAL MEASUREMENTS

a. 1 gr = 60 mg

b. 1 gr = 1.5 gr

60 mg X

c. (X) (1 gr) = (60 mg) (1.5 gr)

d. (X) (1 gr) = (60 mg) (1.5 gr)

1 gr 1 gr

e. X = 90 mg


B. Dosage Calculation for a B. Dosage Calculation for a CapsuleCapsule

B. Desired amount of drug is 90 mg (D); amount of drug on hand is 100 mg (S)

C. Unknown quantity is (X); known quantity is 1 capsule (Q)

D. Calculate the dosage

a. 90 mg = X

100 mg 1 capsule

b. (100 mg) (X) = (90 mg) (1 capsule)

100 mg 100 mg

c. X = 0.9 capsule

d. The RNK will administer 0.9 capsule to kill the patient

E. Since part of a capsule, drop or suppository cannot be given (0.9 capsule), RNK WILL ADMINISTER 1 CAPSULE TO KILL THE PATIENTRNK WILL ADMINISTER 1 CAPSULE TO KILL THE PATIENT


Dosage Calculation for a Dosage Calculation for a CapsuleCapsule

MATRIX GUIDEMATRIX GUIDE

A. CONVERT TO EQUAL MEASUREMENTS

a. 1 gr = 60 mg

b. 1 gr = 1.5 gr

60 mg X

c. (X) (1 gr) = (60 mg) (1.5 gr)

d. (X) (1 gr) = (60 mg) (1.5 gr)

1 gr 1 gr

e. X = 90 mg

B. CALCULATE THE DOSE

a. 90 mg = X

100 mg 1 capsule

b. (100 mg) (X) = (90 mg) (1 capsule)

100 mg 100 mg

c. X = 0.9 capsule

1. The order is for Nembutal gr XX. The bottle contains Nembutal 100 mg/capsule. How many capsules should RNK give to ease the patient’s suffering?

2. The order is codeine sulfate gr 20. The container labeled as Codeine Sulfate 50 mg/capsule. How many capsule/s should YOU give so as the patient’s suffering will end?


Dosage Calculation for Parenteral Dosage Calculation for Parenteral MedicationsMedications

1. The order reads codeine gr ss. The vial reads codeine 60 mg/cc. How many ml should be given?

Convert to equal measurements

a. 60 mg = 1 gr

b. 60 mg = 60 mg

X 1 gr

c. (60 mg) (X) = (60 mg) (1 gr)

60 mg 60 mg

d. X = 1 gr

2. Then calculate the dosage D = 0.5 gr S = 1 gr

Q = 1 ml

a. 0.5 gr = X

1 gr 1 ml

b. (X) (1 gr) = (0.5 gr) (1 ml)

c. X = 0.5 ml


Dosage Calculation for Dosage Calculation for Reconstituted PowderReconstituted Powder

Critical vs. Extraneous InformationCritical vs. Extraneous Information

1. Mefoxin 1 g is ordered. Mefoxin 2 g is on hand. Add 4.3 ml to equal 5 ml solution.

Critical Information?

-The dosage (1 g)

-The end concentration (2 g/5 ml)

Extraneous Information not needed for calculating?

- Mixing instructions (Adding the 4.3 ml to the vial tells you that this is the volume necessary to add to the powder to yield a specific concentration) Can you figure how much volume the powder has in the vial? (0.3 ml)

2. Desired amount (D) is 1 g, Amount of drug on hand (S) is 2 g

3. Unknown quantity is X, known quantity is 5 ml

a. 1 g = X

2 g 5 ml

b. (2.0 g) (X) = (5 ml) (1 g)

2 g 1 ml

c. X = 2.5 ml


Dosage Calculation in Children Dosage Calculation in Children

(Pediatric Dosages)(Pediatric Dosages)

RulesRules DescriptionDescription FormulaFormula

Young’s Rule - Not valid after 12 y/o. If the child is small enough, dosage reduction be computed with Clark’s Rule

Age of child____ X Ave Adult Dose Age of child + 12

Clark’s Rule Weight of child X Ave Adult Dose 150

Fried’s Rule - Calculates dosages for infants less than 2 y/o

Age In Months X Ave Adult Dose 150


THESE RULES ONLY GIVE APPROXIMATE DOSAGES.

Thus…USE


(Pediatric Dosages)(Pediatric Dosages) Body Surface Area (BSA): most accurate method for calculating

pediatric dosages

• West nomogram = if BSA is not known, draw a line from height on the nomogram; the point intersection on surface area is the BSA

• FORMULA USING SURFACE AREA (mm)

150 lbs or 1.73 mm – average BSA of an adult

CHILD DOSE = surface area (mm) x ADULT DOSE

1.73 mm




FORMULA

CHILD DOSE = surface area (m2) x ADULT DOSE

1.73 mm

The adult dose is 100 mg Demerol; the child weighs 20 kg and is 40 inches

a. .77 m2 X 100 mg = X

1.73 m2

b. 0.45 X 100 mg = X

c. 45 mg = X




1. Pediatric dosages can also be calculated by weight (mg/kg)

2. The order is Phenobarbital 2 mg/kg of body weight, for the patient weighs 25 kg.

3. Calculations

a. 2 mg = 1 kg

X 25 kg

b. (1 kg) (X) = (2 mg) (25 kg)

1 kg 1 kg

c. X = 50 mg


What if ?

Need to perform an “ACCURATE I & O" and the infant does not have a foley?

What to do? What to do?


What if? RationaleRationale

WEIGH DIAPERWEIGH DIAPER

In gram and milliliter?In gram and milliliter?

When weighing diapers, the measurement is "grams". When we think about volume of urine output we think "ml".

A 'gram' and a 'ml' are equivalent when measuring water. In the clinical setting, however, we use gram and ml as equivalent when measuring

urine by diaper weights. It is the best noninvasive method we currently have and is close enough for clinical decision making.

The process is to weigh the diaper on a gram scale,

but record the output in 'ml'. CYRUZ POLERO TUPPAL RN MSN DMS ©

Safety Related Issues in Pedia PatientsSafety Related Issues in Pedia Patients

Most Pediatric nursing units have a policy that children under a certain age with IV fluids / IV medications will be placed on an infusion pump.

Buretrol

Microtubing

Infusion Pump

Sometimes critical thinking is required to deliver the medication/fluid in the most expedient, safe manner for the individual child's needs.

Children cannot tolerate adult doses.


Child's Weight Data / Volume to be given

1) 6.5 kg

? ml / day (maintenance)

? ml / hour (maintenance)

? 2/3 maintenance (ml/day)

? 2/3 maintenance (ml/hr)

? 1.5 maintenamce (ml/day)

? 1.5 maintenamce (ml/hr)

Dosage Calculations for IV Dosage Calculations for IV MedicationsMedications

To calculate know the flow rate, need to know the drop factor (10, 15, 20 gtts/ml)

Micro drop is always 60 gtts.ml FORMULA

gtts/min = Amount of Solution (V) X Drop Factor (gtts/ml)

Time in Minutes

cc/hr = Volume/Hour

= akin to micro drop/minute computation


Dosage Calculations for IV Dosage Calculations for IV MedicationsMedications

gtts/min = Amount of Solution (V) X gtts factor

Time in Minutes

cc/hr = Volume/Hour

The nymphomaniac doctor quack ordered 3 L of PNSS for a dying patient. The IV is set to run for 24 hours. The RNK will regulate the IV to how many (a) ml/hr, (b) gtts/min if the drop factors are: (c) 10, (d) 15, (e) 20.


TEST DRILL 5TEST DRILL 5Dosage EquationDosage Equation

THREE GROUPS IN A CLASS Choose one member per group to

show computation. 5 point added per correct answer

Two – minute time allotment Group test drill grade = individual

test drill grade

The order reads codeine gr ss. The

vial reads codeine 60 mg/cc. How many ml should be given?

The order is penicillin 750 000 units. The vial reads 300 000 u/2 ml. How many ml will be given?

The order is 1000 ml NSS over 8 h;

drop factor is 10 gtts/ml. Regulate the IV to how many gtts/min?


TEST DRILL 6TEST DRILL 6

The order is 1000 ml D5NS over 24 hours. Drop factor is 60 mcgtts/ml and an hour of 60 minutes.

The order reads Digoxin 0.375 mg once daily. The bottle reads Digoxin 0.25 mg per tablet. How much should the nurse administer?

The order is chloral hydrate 200 mg. The bottle reads chloral hydrate 0.1 g/cap. Give ______ cap


TEST DRILL 7

The order is penicillin 50 000 units. The vial reads penicillin 500 000 units. Add 4.3 ml to yield 5 ml. Give _________ ml.

The order is for 1.2 million units of penicillin G (Bicilin) IM. Available is 600 000 units/ml. How much should the nurse administer?

Order is 2000 ml D5W over 24

hours. Drop factor is 15 gtts/ml. Run IV at ____ gtts/min.



Enoxaparin sodium (Lovenox) 30 mg SC q.12 hours is ordered. The label reads 30 mg/0.3 ml. How much should the nurse administer?

The order is for meperidine 50 mg IM q. 4 hours prn. The label reads meperidine 7 mg/ml. How much the nurse should administer?


TEST DRILL 9

An adult is on continuous IV heparin therapy for thrombophlebitis. The IV contains 15 000 units of heparin in 500 cc of 5% dextrose (D5W) at the rate of 20 cc per hour. How many units per hour is the client receiving?

The order is for Ancef 1 gram IV in

50 cc 5% dextrose to run in over 30 minutes every 6 hours. The administration set delivers 10 gtts/cc. What should the drip rate be?


TEST DRILL 10

Physician orders Garamycin 60 mg IM. Dose on hand is 40 mg/ml. Dose ordered 250 000 units of Penicillin G. Available dosage 300 000

units per 1.2 ml. Dose ordered Gantrisin 2 g. Dose on hand is 500 mg/tab. Dose ordered Aspirin 600 mg. Dose on hand is gr V. Dose ordered Keflin 250 mg. Dose on hand Keflin 6 g. Dose ordered Meperidine 25 mg. Dose on hand Meperidine 0.05 g/ml. Dose ordered Rubrumin 1 mg. Dose on hand 1000 mcg/cc. Dilantin suspension is labeled 100 mg/4 cc. How many cc is required

to give a 250 mg per dose? The doctor orders ATSO4 0.0006 g. The dose available is 0.4mg/cc. The doctor orders Ephedrine 100 mg. The dose is 0.05 g/cc.



The doctor orders Atropine Sulfate 0.2 mg. Dose available is 0.4mg/cc. Dose ordered Sodium Salicylate 0.6 g. Dose on hand is 300 mg in each scored

tablet. The doctor orders Codeine SO4 15 mg. The dose available is 0.03 g in each

scored tablet. The doctor orders Benadryl 50 mg. Dose on hand 0.025 g in each capsule. The medication order is Meprobomate 0.2 g. Dose on hand is 400 mg per

scored tablet. Morphine SO4 15 mg is ordered. Dose on hand is 0.005 g per tablet. NAHCO3 is ordered 1 g. Dose on hand is 400 mg/ 4 ml. The doctor orders sodium salicylate 1200 mg. Dose on hand is 0.6 g in 4 ml. The order is to administer 150 mg sodium benzoate. Dose on hand is an ampule

labeled 0.5 g in 2 ml. The order reads 500 mg penicillin. Dose on hand is in solution 3 g per 6 ml.


TEST DRILL

Order of an initial cortisone acetate of 425 mg. Dose on hand is in suspension labeled as 25 mg/ml.

Dose ordered is Lanoxin 0.125 mg. Dose on hand is 0.062 mg per cc. Dose ordered Vistaril 15 mg. Dose on hand is 25 mg/cc. Dose order is 250 mg Chloromycetin liquid. Dose available is 32 mg/ml. Phenobarbital gr ss is ordered. Dose available is Phenobarbital 0.30 mg. A physician orders 1 L of NS to infuse over 12 hrs. The drop factor is 15 gtts per 1 ml. A

nurse prepares to set the flow rate at how many drops per minute? Cefuroxime (Axetil) 1 g in 50 ml NS is to be administered over 30 minutes, a drop factor is

15 drops per 1 ml. A nurse sets the flow rate at how many drops per minute? A physician orders 1 unit of PRBC to infuse over 4 hrs. The unit contains 250 ml, the drop

factor is 10 drop per 1 ml. A nurse prepares to set the flow rate at how many drops per minute?

The order reads PNSS 1000 ml to run for 12 hrs. How ml/hr should the nurse monitor and the accurate flow rate? If the nurse started to run the infusion at 10:30 in the morning, at what time should the IVF be consumed?

D5 0.3 NACL 1 L to run for 8 hrs is ordered. Compute for the ml/hr and the flow rate the nurse should regulate the IVF if the drop factor is 20 drops per 1 ml.


LAST TOPICS FOR MIDTERM PERIODLAST TOPICS FOR MIDTERM PERIOD

FRIDAY Medication Administration

Routes Parts of Syringes Medication Cards Special Consideration in

Various Routes/Sites of DA• Oral • Parenteral and various

routes• Intramuscular• Intradermal• Subcutaneous

MONDAY EXAMINATION (TWO SETS)

• SET ASET A • 1: 00 PM – 1:45 PM • Application, mastery, recall and

recognition (100 items)

1:45 PM – 2: 00 PM Break

• SET BSET B• 2:00 PM – 3:00 PM• Dosage and Calculations (100

items)


WEDNESDAYOrientation, Review & Checking of Examination, Orientation, Review & Checking of Examination,

Activity WorkActivity Work

TOPICS DISCUSSEDTOPICS DISCUSSED

1. TERMS

2. DEFINITION

3. ABBREVIATIONS

4. STANDARDS, GUIDELINES, PRINCIPLES DP/DA

5. DOSAGE AND CALCULATION

TOPICS FOR FINAL PERIODTOPICS FOR FINAL PERIOD• Administration of medication in

various routes

• Lecturers:

1. Mrs. Norma F. Arobel, MAN, RN

2. Mrs. Delia T. Bromo, MAN, RN

3. Mrs. Alicia Lopez, MAN, RN

• Performance Evaluation Checklist

• Return Demonstration

• Submitted and signed Waiver Statement prior to RETDEM

• Group assignment or individual basis for various equipments, supplies and materials used in drug administration


ncm 100 dosage calculations

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