pharma ppt
DESCRIPTION
nursing pharmacologyTRANSCRIPT
1
Levi Adriano Santana, RN
Academic Instructor BSU College Of NursingBSU College of Science
Chief NurseApalit Doctors’ Hospital Inc
Certified BLS/ ACLS ProviderPhilippine Heart Association/ Philippine College of
Cardiology
Emergency and Disaster ResponderMMDA Public Safety Division
NURSING PHARMACOLOGY
Dosages
Ways to calculate dosage:
Formula Method
VH
DAmount to Give
Challenge: Must remember the extra step of changing D and H to same unit of measurement. Also may have extra variables such as body weight, times per day, etc.
Ways to calculate dosage:
Ratio and ProportionLinear Ratio and Proportion
Fractional Ratio and Proportion
500mg : 1 tab :: 1 g : x tabsProduct of the means equals the product of the extremes.
xtabs
g
tab
mg 1
1
500
The products of cross multiplication in a proportion are always equal
Necessities for Student Success in Dosage Calculations Review of basic math functions – fractions
and decimalsAddingSubtractingMultiplicationDivision
Students must memorize equivalents
The 4 main questions
What is the order? What is on hand? Do you need any equivalents? Where are you going? (or what are you
being asked to give?)
Order: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 ml
Do you need any equivalents?
mg
ml
80
10
dose
mg
1
40
Order: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 ml
Where are you going? (or what are you being asked to give?)
mlmg
ml
dose
mg________
80
10
1
40
Order: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 ml
Begin by cross canceling labels
mlmg
ml
dose
mg________
80
10
1
40
Order: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 ml
Labels left should be “what you are looking for”
mlmg
ml
dose
mg________
80
10
1
40
Order: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 ml
Do the math
mlmg
ml
dose
mg________
80
10
1
40
1
2
55
1
What about problems with different units of measurement?
Order: digoxin elixir 0.05 mg PO dailyLabel: Digoxin 50 mcg per mlHow many milliliters will you give?
dose
mg
1
05.0mcg
ml
50
1
mg
mcg
1
1000 ml
1
20
1
Complex Problems
Order: Augmentin 12.5mg/kg PO every 12 hours. Child weighs 22 lbs. Pharmacy sends a 75 ml bottle of Augmentin labeled 125mg/5ml. How many milliliters will you pour from the bottle?
dosekg
mg
/
5.12
mg
ml
125
5
lbs
kg
2.2
1
.1
22
pt
lbs ml
5275
1375
1
22
2.2
1
125
5
1
5.12
5
What about IV problems?
Order: 250ml 5% D/W IV in 2.5 hours.Tubing package reads 15 gtts/ml.How many gtts/min will you adjust the IV?
hrs
ml
5.2
250ml
gtts
1
15
.min60
1hr
min___
gtts
25150
3750
60
1
1
15
5.2
250
25
Order: Estratab 1250mcg daily
mcg
mg
mg
tab
dose
mcg
1000
1
25.1
1
1
1250tab
11250
1250
1000
1
25.1
1
1
1250
1
Your patient may receive Dilaudid 3 mg IM q3h for pain. Dilaudid is supplied in 1-ml ampules containing 4 mg. How many milliliters will you administer?
3
1
mg
dose1
4
ml
mg ml¾= 0.75
The physician orders heparin 2500U subq. You have heparin, 5000U per ml. How many ml will you administer?
2500
1
u
dose1
5000
ml
u ml
1
2
1
2
Your patient needs morphine gr 1/6 SQ stat for chest pain. You have a 20 ml vial labeled 15mg/ml. How many milliliters will you give?
1 6
1
/ gr
dose 1
15
ml
mg60
1
mg
gr ml
1 6 60
15
60 6
15
10
150 67
/ /.
x
0.67
A patient with tachycardia has an order for Brevibloc to be started at 50 mcg/kg/min. The concentration is Brevibloc 5 g in 500ml of D5W. The patient weighs 176 pounds. How many ml/h should the IV pump be programmed for?
50mcg
kg / min500
5
ml
g ml/hr176
1
lbs
pt
.
.1
2 2
kg
lbs.
1
1000
mg
mcg
1
1000
g
mg60
1
min
hour
50
1
500
5
176
1
1
2 2
1
1000
1
1000
60
1
.
1
2
1
251
401
80
1
2
1
12
24
24
25
Reconstitution
Reconstitution problems ask the nurse to dissolve a drug (typically a powder) whose quantity is usually expressed in grams or
milligrams in:
a specific quantity of a liquid (usually measured in milliliters). Frequently, the liquid is normal saline (0.9% NS) or D5W.
Conceptually, this is identical to dissolving 1 teaspoon of table salt in 1 cup of hot water.
26
Reconstitution
Order: 350 mg of the drug to be given q8h IV. How many mL will you give per dose?
Supply: The drug is available in 500 mg containers. The label tells the nurse to dissolve the powder in 25 mL of normal saline (NS).
27
Reconstitution
Which pairs of data do you find in the problem? 350 mg every 8 hours. (every 8 hours means:
1 dose.) 500 mg of the powder is dissolved in 25 mL of
NS.
What is the answer’s label for your calculation? How many mL/dose?
Can you isolate all of the components that are required to solve this problem? (YES, of course you can do this!)
29
Reconstitution
Order: 250 mg of the drug to be given q8h IV. How many mL will you give per dose?
Supply: The drug is available in 1g containers. The label tells the nurse to dissolve the powder in 50 mL of normal saline (NS).
31
Reconstitution
Order: 20 mg/Kg of the drug to be given q8h IV. Patient weighs 50 pounds. How many mL will you give per dose?
Supply: The drug is available in 500 mg containers. The label tells the nurse to dissolve the powder in 5 mL of normal saline (NS).
With which data pair is the “dose” a factor? Why?
32
Answer – Reconstitution
mL/dose = (5 mL/500 mg) * (20 mg/1 Kg/1 dose) *
(1 Kg/2.2 lbs) * (50 lbs/1)
= 4.545 rounds up to 4.55 mL/dose
Dose is only related mg/Kg.
33
Reconstitution Graphic
5
million Units in 3.2
mL
1 million Units/1 mL
The patient
Which medication source DIRECTLY affects the patient?
10-34
Intravenous (IV) fluidsDelivered directly into the bloodstream
via a vein
IncludesSolutionsMedications Blood
Rapid effect
Results can be fatal if wrong medication or
dosage is given.
IV Solutions
10-35
IV Solutions – FUNCTIONS
ReplacementElectrolytes Fluids
Maintenance Fluid balanceElectrolyte
balance
KVO fluidsKeep Vein OpenMaintain an IV
line
Therapeutic – Delivers medication to patient
10-37
IV Solutions – IV LABELS (cont.)
Rule 10-1 In abbreviations for IV solutions:
Letters identify components
Numbers identify concentration
10-38
IV Solutions – IV LABELS (cont.)
5% dextrose in Lactated Ringer’s solution might be abbreviated in any of the following ways:D5LRD5LR5% D/LR D5%LR
ExampleExample
10-39
IV Solutions – COMMONLY USED ABBREVIATIONS
ABBREVIATION SOLUTION
D10W 10% dextrose in water
D5W 5% dextrose in water
W; H2O Water
NS; NSS Normal saline (0.9% NaCl)
LR Lactated ringer’sRL Ringer’s lactate
10-40
IV Solutions – COMMONLY
USED ABBREVIATIONS (cont.)ABBREVIATION SOLUTION
½ NS; ½ NSS One-half normal saline solution (0.45% NaCl)
1/3 NS; 1/3 NSS One-third normal saline solution (0.3% NaCl)
¼ NS; ¼ NSS One-fourth normal saline solution (0.225% NaCl)
10-41
IV Solutions – IV CONCENTRATIONS
5% Dextrose – contains 5 g of dextrose per 100 mL
Normal saline 0.9% saline Contains 900 mg, or
0.9 g, of sodium chloride per 100 mL.
½ Normal saline 0.45% saline Contains 450 mg, or
0.45 g, of sodium chloride per 100 mL
10-42
IV Solutions – IV CONCENTRATIONS (cont.)
Choice of solution is based on patient requirements
Isotonic IV solutionsDo not affect fluid
balance of cells and tissues
D5W, NS, LR
10-43
IV Solutions – IV CONCENTRATIONS (cont.)
Hypotonic IV solutionsMove fluid into surrounding cells and tissues
Restore proper fluid level in cells and tissues
Used to correct dehydration
0.45% NS, 0.3% NS
10-44
IV Solutions – IV CONCENTRATIONS (cont.)
Hypertonic IV solutionsDraw fluid from cells and tissues into blood
stream
Used to correct severe fluid shifts (burns)
3% Saline
10-45
IV Solutions – IV CONCENTRATIONS (cont.)
Rule 10-2Patients with normal electrolyte levels are likely to receive isotonic solutions.
Patients with high electrolyte levels will receive hypotonic solutions.
Patients with low electrolyte levels will receive hypertonic solutions.
10-46
IV Solutions – COMPATIBILITY
Additives Medications, electrolytes, and nutrientsIf not prepackaged, will have to mix.
10-47
IV Solutions –
COMPATIBILITY (cont.)
Rule 10-3
Before combining any medications, electrolytes, or nutrients with an IV solution, be sure the components are compatible.
10-48
IV Solutions –
COMPATIBILITY (cont.)
Examples of incompatible medications/solutions
Ampicillin D5W
Cefotaxime sodium Sodium bicarbonate
Diazepam Potassium chloride
Dopamine HCl Sodium bicarbonate
Penicillin Heparin
Penicillin Vitamin B complex
Sodium bicarbonate Lactated Ringer’s
Tetracycline Calcium chloride
10-49
IV Equipment
Primary LineBag or bottle of IV solution –
500 mL or 1000 mL
TubingDrip chamberClamp – regulate IVInjection ports
Add medication or compatible fluid Attach a second line
10-51
IV Equipment (cont.)
TubingMacrodrip
Larger drops in drip chamberInfusion rates of 80 mL/h or more
MicrodripSmaller drops in drip chamberInfusion rates less than 80 mL/h and KVOPediatric and critical care IV’s
10-52
IV Equipment – MONITORING
ManuallyHang the bag hung 36 inches above
patient’s heart
Adjust flow rate using roller or screw clamps
Usually adjusted in gtt/min
10-53
IV Equipment –MONITORING
(cont.) Electronic devices
Rate controllersGravity
Pincher maintains flow rate
Alarm sounds when preset flow rate is not maintained
10-54
IV Equipment – MONITORING (cont.)
Infusion pumpsApply pressure to deliver set volume
per minute
Sensor /alarmImproper rateEmpty bag
Must monitor site for infiltration
10-55
IV Equipment – MONITORING (cont.)
Syringe pumpsSyringe is inserted into pump
Incompatible medications or fluids
Pediatric doses
Provide precise controlover rate
10-56
Patient-Controlled Analgesia (PCA) DevicePatient controls medication
within preset limits per physician’s order
Records number of times button is pushed
Used to monitor effectiveness of pain relief prescription
IV Equipment – MONITORING (cont.)
10-57
IV Equipment – MONITORING (cont.)
Volume control setsImprove accuracy of
Manual IV setupsElectronic rate controllersSmall volumes of fluids or
medicationsUses: pediatric or critical care
IVsExamples: Buretrol, Soluset, and
Volutrol
10-58
Peripheral and Central IV Therapy
Peripheral IV TherapyAccesses the circulatory system through a
peripheral veinHand, forearm, foot, legScalp vein in infants
10-59
Peripheral and Central IV Therapy (cont.)
Central IV TherapyCentral line
provides direct access to major veins
Used when patient needs:
Large amounts of fluids
A rapid infusion of medication
Infusion of highly concentrated solutions
Long-term IV therapy
10-60
Peripheral and Central IV Therapy (cont.)
Central IV TherapyPICC – peripherally inserted central catheter
Inserted into arm vein and threaded into a central vein
Port-A-CathSurgically placed under the skin for access to
central veinAccessed through the skinFor intermittent use
10-61
Peripheral and Central IV Therapy (cont.)
Rule 10-4
Never flush a sluggish IV with a syringe.
May push a clot into the circulatory system
10-62
Peripheral and Central IV Therapy (cont.)
Pain or swelling at the siteInfiltration
Needle or catheter becomes dislodged from the vein
Fluid infuses into the surrounding tissues
SignsSwellingDiscomfortCoolness at the
infiltration siteSizeable decrease
in flow rate
10-63
Peripheral and Central IV Therapy (cont.)
PhlebitisInflammation of the vein
CausesIrritation by IV
additivesMovement of
needle or catheterLong-term IV therapy
Signs / SymptomsPain at or near
siteHeatRednessSwelling at site
10-64
Peripheral and Central IV Therapy (cont.)
Treatment of infiltration or phlebitisStop IV infusionRestart in a different site
10-65
Practice
Isotonic
Hypotonic
Hypertonic
Central line
Phlebitis
Infiltration
PCA
Macrodrip
Microdrip
A. 60 gtt/mL
B. Patient controls medication
C. Fluid infuses into tissues
D. For normal electrolyte levels
E. PICC
F. For high electrolyte levels
G. 15 gtt/min
H. Inflammation of a vein
I. For low electrolyte levels
Matching:
I
H
G
F
A
C
B
E
D
10-66
Calculating Flow Rates
Flow rate - how fast the IV infusesCalculated from
• Amount of fluid to be infused
• Length of time for infusion
Expressed as milliliters per hour
10-67
Calculating Flow Rates (cont.)
Rule 10-5 To calculate flow rates in milliliters per hour, identify the following:
V (volume) – expressed in millilitersT (time) – expressed in hours (convert units as necessary)F (flow rate) – rounded to nearest tenth
Use the formula method with or dimensional analysis
to determine the flow rate in milliliters per hour.
10-68
Calculating Flow Rates (cont.)
Find the flow rate
Ordered: 500 mg ampicillin in 100 mL NS to infuse over 30 minutes
Convert minutes to hour: 30 ÷ 60 = 0.5 hr
Flow rate = 200 mL/hr
ExampleExample
10-69
Calculating Flow Rates (cont.)
Manually regulated IVsCalculated as gtt/min
MacrodripLarger dropsDrop factors: 10
gtt/mL, 15 gtt/mL, or 20 gtt/mL
Microdrip tubingSmaller dropsDrop factor: 60 gtt/mL
10-70
Calculating Flow Rates (cont.)
Rule 10-6 To determine the flow rate (f) in drops per minute:
1. Change the flow rate mL/h (F) to gtt/min (f) using
the formula:
F = flow rate; mL/hr
C = calibration factor of tubing; gtts/mL
60 = number of minutes in 1 hour
2. Round to nearest whole number.
10-71
Calculating Flow Rates (cont.)
Find the flow rate in drops perminute that is equal to 35 mL/hour using 60 gtt/mL microdrop tubing.
f = 35 gtt/min
ExampleExample
10-72
Calculating Flow Rates (cont.)
Counting drops is not preciseCheck IV hourly to see
if it is on schedule
Before adjusting the rate, check facility policy
10-73
Calculating Flow Rates (cont.)
Rule 10–7 To adjust the flow rate:
Recalculate the infusion using the volume remaining in the IV and the time remaining in the order.
Check the guidelines at your facility before adjusting the flow rate.
10-74
Calculating Flow Rates (cont.)
Original Order: 1500 mL NS over 12 hours
The IV was infusing at an original rate of 42 gtt/min using 20 gtt/mL macrodrip tubing.
After 3 hours, 1200 mL remain in the bag.
Flow rate adjustments must not exceed 25%.
ExampleExample
10-75
Calculating Flow Rates (cont.)
Use formula
f = 44 gtt/min
25% of original rate of 42 gtt/mL = 10.5
Rate can be adjusted up or down within a range of 32.5 to 52.5 gtt/min.
Rate can be adjusted to 44 gtt/min.
Example (cont.)
Example (cont.)
10-76
Practice
Calculate flow rate then determine if an adjustment is necessary.
Adjustment cannot exceed 25%.
Ordered: 250 mL NS over 2 hours (10 gtt/mL tubing)
After 30 minutes 100 mL infused.
10-77
Practice
Answer
25% of 21 = 5.25
Adjustment range = 15.75 to 26.75
You may adjust this infusion.
Original drop rate
f = 21 gtt/min
Adjusted rate
f = 17 gtt/min
10-78
Infusion Time and Volume
If not specified in the order you may have to calculate Duration – if fluid volume and flow rate is
known
Fluid volume – if the duration and flow rate is known
10-79
Infusion Time and Volume (cont.)
Rule 10-8 To calculate infusion time in hours (T), identify the:
V (volume) expressed in milliliters
F (flow rate) expressed in milliliters per hour
Fractional hours by multiplying by 60
F
VT
Use this formula or dimensional analysis to find T, the infusion time in hours.
10-80
Infusion Time and Volume (cont.)
Find the total time to infuse.
Ordered: 1000 mL NS to infuse at a rate of 75 mL/h
T = 13.3
Total time to infuse the solution = 13 hours and 20 minutes
ExampleExample
10-81
Infusion Time and Volume (cont.)
Find the total time to infuse.
Ordered: 750 mL LR to infuse at a rate of 125 mL/hr started at 11 p.m.
T = 6
The total time to infuse is 6 hours.
ExampleExample
10-82
Infusion Time and Volume (cont.)
Rule 10-9 To calculate the time when an infusion will be completed,
You must know:1. The time the infusion started in military time
2. The total time in hours and minutes to infuse the solution ordered
10-83
Infusion Time and Volume (cont.)
Rule 10-9 (cont.)
Since each day is only 24 hours long, when the sum is greater than 2400 (midnight), you must start a new day by subtracting 2400.
This will determine the time of completion, which will be the next calendar day.
10-84
Infusion Time and Volume (cont.)
Determine when the infusion will be completed.
Ordered: 750 mL LR to infuse at a rate of 125 mL/hr and was started at 11 p.m. on 02/04/14 Infusion time = 6 hours
11 p.m. = 2300 hrs
2300 + 6 hours = 0500 or 5:00 a.m. on 02/05/14
ExampleExample
10-85
Infusion Time and Volume (cont.)
Rule 10-10 To calculate infusion volume:Use the formula V = T x F or dimensional analysis to find V the infusion volume in mL.
T (time) must be expressed in hours
F (flow rate) must be expressed in milliliters per hour
10-86
Infusion Time and Volume (cont.)
Find the total volume infused in 5 hours if the infusion rate is 35 mL/h.
V = 5 h × 35 mL/h
V = 175 mL
175 mL will infuse in 5 hours
ExampleExample
10-87
Infusion Time and Volume (cont.)
Find the total volume infused in 12 hours if the infusion rate is 200 mL/h.
V = 12 h × 200 mL/h
V = 2400 mL
2400 mL will infuse in 12 hours
ExampleExample
10-88
Intermittent IV Infusions
IV medications may be administered intermittently with or without continuous IV therapy.
Delivered through IV secondary line SalineHeparin lock
10-89
Intermittent IV Infusions – SECONDARY LINES
“Piggyback” or IVPB
IV setup attaches to a primary line
Infuse medications or other compatible fluids on an intermittent basis
IVPB bags are smaller: 50, 100, or 150 mL
10-90
Intermittent IV Infusions – INTERMITTENT PERIPHERAL INFUSION DEVICES
Saline or heparin locks
An infusion port attached to an already inserted IV needle or catheter.
Allow direct injection of medication or infusion of IV medications.
10-91
Intermittent IV Infusions – INTERMITTENT PERIPHERAL INFUSION DEVICES (cont.)
No continuous flow of fluids
Requires flushing 2 to 3 times per day
Saline lock – uses saline as the flush
Heparin lock – uses heparin, an anticoagulant, as the flush
10-92
Intermittent IV Infusions (cont.)
Preparing and Calculating Intermittent InfusionsFlow rate is calculated the same as regular
IV infusions.Amount of fluid may be less and time to
infuse may be less than an hour.To calculate the flow rate you will need to
change the number of minutes into hours.
10-93
Intermittent IV Infusions (cont.)
Rule 10-11 When preparing medication for an intermittent IV infusion:
Reconstitute the medication using the label and package insert.
Calculate amount to administer and the flow rate.
10-94
Intermittent IV Infusions (cont.)
Ordered: Eloxatin 75 mg in 250 mL D5W IV piggyback over 90 minutes
Reconstitute with 20 mL of water for injection.
Dosage strength – see label
Calculate the amount to administer and the flow rate.
ExampleExample
10-95
Intermittent IV Infusions (cont.)
Amount to administer
Flow rate using15 mL + 250 mL
A = 15 mL
F = 177 mL/h
Example (cont.)
Example (cont.)
10-96
Practice
Find total infusion time:
Ordered: 650 mL 0.45 NS at 40 mL/h started at 0315 08/09/08
T = 16.25 hours
Total infusion time = 16 hr 15 min
When will this IV be completed?
7:30 p.m. 08/09/08
10-97
Practice
Find the volume to administer:
Ordered: D5NS at 65 mL/hr for 8 hours
V = 8 h x 65 mL/h V = 520 mL
Ordered: NS at 100mL/h for 45 min
V = 0.75 h x 100 mL/hV = 75 mL
10-98
Apply Your Knowledge
Identify four functions of IV fluids.
ANSWERS
1.Replacement
2.Maintenance
3.KVO
4.Therapeutic
10-99
Apply Your KnowledgeHow many mg of sodium chloride is in 100
mL of normal saline?
How many mg of sodium chloride is in 100 mL of 0.45% NS?
ANSWER 900 mg NaCl
ANSWER 450 mg NaCl
10-100
Apply Your Knowledge
When you adjust the IV flow rate, what percentage of the original flow rate should you not exceed?
Flushing a sluggish IV will not cause harm.
True / False
ANSWER 25%
Flushing may push a clot into the circulatory system causing an obstruction.