© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Parenteral Dosages and Other...
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Transcript of © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Parenteral Dosages and Other...
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
Chapter 14 Parenteral Dosages and Other Medication Administration Forms
PowerPoint® Presentation to accompany:
Math and Dosage Calculations for Healthcare ProfessionalsFourth Edition
Booth, Whaley, Sienkiewicz, and Palmunen
14-2
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
14.1 Calculate doses of parenteral medication in solution and select a syringe based on the dosage calculation.
14.2 Calculate doses of medication expressed in percent or ratio format.
Learning Outcomes
14-3
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14.3 Calculate doses of reconstituted parenteral medications.
14.4 Differentiate other medication administration forms and equipment.
Learning Outcomes
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Key Terms Absorption rate
Inhalant
Instillations
Metered dose Inhalers (MDIs)
14-5
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Introduction
Parenteral medications Bypass the digestive tract
Include Injections Inhalants Rectal drugs Transdermal drugs
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Introduction (cont.)
Injection types & absorption rates
Intravenous (IV) – 30 to 60 seconds
Intramuscular (IM) – 10 minutes or more
Subcutaneous (Subcut) – 15 minutes or more
Intradermal (ID) – sustained rate
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Calculating Parenteral Dosages in Solution Injections
mixtures that contain the drug dissolved in an appropriate liquid
Dosage or solution strength the amount of drug contained within a
volume of solution
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Calculating Parenteral Dosages In Solution (cont.) Dosage strength expressed
in milligrams per milliliter
as a percent
Lidocaine 1% = 1 g lidocaine /100 mL
as a ratio
Epinepherine 1:1000 = 1 g epinepherine / 1000 mL
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Calculating Parenteral Dosages In Solution (cont.)
Physician’s order – the amount of medication
Calculate – milliliters of solution that contains the desired dose
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Calculating Parenteral Dosages In Solution (cont.)
Follow the ABCs of dosage calculation.
Start with H, Q, and D
Step A: Convert
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Calculating Parenteral Dosages In Solution (cont.)
Step B: Calculate Proportion Dimensional Analysis Formula Method
Step C: Think!...Is It Reasonable?
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Syringe Sizes
After you determine the amount to give,
you must select the appropriate syringe
and needle.
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Syringe Sizes (cont.)
RRuleule 14-1 14-1 Selecting a syringe:
1. If the amount of injection to administer is 1 mL or more, use a standard 3 mL syringe.
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Syringe Sizes (cont.)
RRuleule 14-1 14-1 (cont.)
2. If the amount of injection to administer is less than 1 mL, use a 1-mL tuberculin syringe.
3. If the amount of injection to administer is less than 0.5 mL, use a 0.5-mL tuberculin syringe.
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Calculating Parenteral Dosages in Solution (cont.)
Amount to be administered is calculated at 0.6 mL. Which
syringe would you use?
Since this is less than 1 mL and greater than 0.5 mL, a tuberculin syringe should be used.
Example Example
14-16
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Calculating Parenteral Dosages in Solution (cont.)
Rule 14-2 Rule 14-2 Rounding the Amount to Administer:
1. Round volumes greater than 1 mL to the nearest tenth (one decimal).
2. Round volumes less than 1 mL to the nearest hundredth (two decimals).
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Calculating Parenteral Dosages in Solution (cont.)
Amount to be administered is calculated to be 1.66 mL
The volume is greater than 1 mL – round to the nearest tenth – 1.7 mL
ExampleExample
14-18
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Calculating Parenteral Dosages in Solution (cont.)
Amount to be administered is calculated to be0.532 mL.
The volume is less than 1 mL – round to the nearest hundredth – 0.53 mL.
Example Example
14-19
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Calculating Parenteral Dosages in Solution (cont.)
Can the amount to be administered be safely injected into one site?
If not, divide the amount into equal (or nearly equal) parts.
Administer them in separate sites.
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Calculating Parenteral Dosages in Solution (cont.)
Rule 14-3 Rule 14-3 Maximum volumes for injections:
Intramuscular Injections Adult 3 mL Adult Deltoid (arm) 1 mL Child (6-12 years old) 2 mL Child (0-5 years old) 1 mL Infant (premature) 0.5 mL
Subcutaneous injections 1 mL
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Calculating Parenteral Dosages in Solution (cont.)
Ordered: Compazine 7.5 mg IM
On hand: Compazine 5 mg/mL
Find the amount to administer and select the proper
syringe.
Example Example
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Calculating Parenteral Dosages in Solution (cont.)
H = 5 mg
Q = 1 mL
D = 7.5 mg
Step A No conversion is needed.
Example (cont.) Example (cont.)
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Calculating Parenteral Dosages in Solution (cont.)
Step B Use method of choice to calculate
amount to administer.
7.5 mg / 5 mg x 1 mL = A
1.5 x 1 mL = 1.5 mL = A
Example (cont.) Example (cont.)
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Calculating Parenteral Dosages in Solution (cont.)
Step C Desired dose is 1.5 times the dose on hand, so it is reasonable.
Standard 3 cc syringe is used since amount to administer is greater than 1 cc.
Example (cont.) Example (cont.)
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Medications Expressed in Percent or Ratio Format
Medications labeled as percents or ratios must be converted before calculating amount to administer.
Percent (per 100) means grams per 100 mL.
Ratio means gram per mL.
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Medications Expressed in Percent or Ratio Format
Rule 14-4Rule 14-4 When a solution strength is expressed as a percent or ratio:
1. Convert the percent or ratio to a dosage strength of g/mL, mg/mL, or units/mL.
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Medications Expressed in Percent or Ratio Format
Rule 14-4Rule 14-4 (cont.)
2. Calculate the amount to administer; then apply Rules 14-1 to 14-3.
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Medications Expressed in Percent or Ratio Format (cont.)
Find the amount to administer and select the proper syringe.
Ordered: magnesium sulfate 300 mg IM
On hand: magnesium sulfate 10% solution
Patient: 75 pound 8 year-old female
Example Example
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Medications Expressed in Percent or Ratio Format (cont.)
H = 10 g Q = 100 mL D = 300 mgStep A Convert
10 % solution = 10 g (H) / 100 mL (Q)
D : 300 mg = 1 g : 1000 mg
300 x 1 g = D X 1000
300 g/1000= 0.3 g = D
Example (cont.) Example (cont.)
0.3 g
14-30
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Medications Expressed in Percent or Ratio Format (cont.)
Step B Calculate using method of choice.
0.3 g / 10 g x 100 mL = A
0.03 x 100 mL = A
3 mL = A
Example (cont.)Example (cont.)
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Medications Expressed in Percent or Ratio Format (cont.)
Step C The concentration of the medication is 1 to 10, so the volume to be administered should be 10 times the desired dose.
3 is 10 times larger than 0.3, so it is reasonable.
Example (cont.) Example (cont.)
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Medications Expressed in Percent or Ratio Format (cont.)
The amount to administer is 3 cc, so a standard 3 cc syringe can be used.
However, because the patient is 8 years old, the medication must be given in divided doses.
Example (cont.)Example (cont.)
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Practice
Find the amount to administer, and select appropriate syringe.
Answer: 0.4 mL
Ordered: 0.4 mg Epinephrine stat
On Hand: Epinephrine 1 : 1000 Solution
Use a 0.5 mL tuberculin syringe.
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Practice
Find the amount to administer.
Ordered: Zinacef 500 mg IM
On Hand: Zinacef (cefuroxime for injection) 750 mg reconstituted with 3mL sterile water.
Dosage strength after reconstitution is 225 mg/mL
Answer: 2.2 mLin a standard 3 mL syringe
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Reconstituting Powdered Medications Medications that lose potency quickly in
solution are supplied in powdered form;
are reconstituted using an appropriate diluent.
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Reconstituting Powdered Medications (cont.)
Determine the solvent to be used to dilute medication. Sterile water Saline Bacteriostatic solution
Some meds are packaged with the appropriate solvent.
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Reconstituting Powdered Medications (cont.)
Some medications are mixed with lidocaine. This decreases pain on injection.
Label or package insert indicates when lidocaine can be used.
Must have a physician’s order to use it.
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Reconstituting Powdered Medications (cont.)
Rule 14-5Rule 14-5 To reconstitute a powdered medication:
1. find the directions;
2. use a sterile syringe and aseptic technique to draw up the diluent;
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Reconstituting Powdered Medications (cont.)
Rule 14-5Rule 14-5 (cont.)
3. inject the diluent into the medication vial;
4. agitate the mixture by rolling, inverting, or shaking the vial.
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Reconstituting Powdered Medications (cont.)
Rule 14-5Rule 14-5 (cont.)
5. make sure the powdered medication is completely dissolved.
The solution must be free of visible particles.
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Reconstituting Powdered Medications (cont.)
Use the specified amount of diluent.
Too much – Dosage strength will be incorrect.
Too little
Powder may not dissolve completely.
Dosage strength will be incorrect.
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Reconstituting Powdered Medications (cont.)
Rule 14-6Rule 14-6 When storing a medication after reconstitution:
1. record the date, the time of expiration, and your name or initials;
2. for multiple-dose medications, also record the solution strength.
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Reconstituting Powdered Medications (cont.)
Amount of diluent = 5 mL
Route = IV only
Diluent = 0.9% NaCl without preservatives
Instructions = shake to dissolve
Solution strength = 38 mg/mL
Storage = no refrigeration
Example Example
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Reconstituting Powdered Medications (cont.)
Ordered: Gemcitabine HCl
125 mg IVSS
On hand: see label
H = 38 mg
Q = 1 mL
D = 125 mL
Example (cont.) Example (cont.)
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Reconstituting Powdered Medications (cont.)
Step A No conversion is necessary.
Step B Calculate amount to administer using preferred method.
125 mg / 38 mg x 1 mL = A
3.29 x 1 mL = A
3.3 mL = A
Example (cont.) Example (cont.)
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Reconstituting Powdered Medications (cont.)
Step C Dose ordered (125 mg) is greater than 3 time that of dose on hand (38 mg),so 3.3 mL is reasonable.
Example (cont.) Example (cont.)
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Error Alert!
Select the correct instructions for the strength and route ordered.
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PracticeHow much diluent should you add to this vial?
What are the storage instructions?
Answer: 1 mL
Answer: store between 2° and 8° C
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Practice
Ordered: Synagis 75 mg IM Q8H
On hand:
What is the amount to administer?
Answer: 0.75 mL
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Other Medication Administration Forms
Intradermal (ID) injections Small doses given under first layer of skin
0.1mL or less administered with tuberculin syringe
Most often used for diagnostic testing
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Other Medication Administration Forms (cont.)
Drops Also called instillations Deliver medication to
nose, eyes, and ears Administered with droppers Administered with
plastic squeeze bottles
Use equipment that comes with drugs that are administered as drops or sprays.
Sprays Deliver medication
to nose and throat Administered with
plastic squeeze bottles
Administered with atomizers
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Other Medication Administration Forms (cont.)
Mists Inhaled by patient
Delivered with the
following equipment Vaporizers Nebulizers Meter dose inhalers (MDIs)
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Other Medication Administration Forms (cont.)
Inhalants Metered dose inhalers
(MDI) An MDI is a
measured doseof medication in a puff.
Read manufacturer’s instructions.
Techniques for use Closed mouth Open mouth Closed mouth
with spacer
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Nebulizers Liquids mixed with sterile saline solution
Single doses (sterile saline must be added)
Single doses premixed with saline Multiple-dose containers (come with
special droppers)
Physician specifies solution strength and amount to administer.
Other Medication Administration Forms (cont.)
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Other Medication Administration Forms (cont.)
Vaginal Medications
Douche
Tablet or suppository
Rectal Medications
Enema
Suppository
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Other Medication Administration Forms (cont.)
Topical medications Applied directly to the skin
Gels Creams Ointments Pastes
Follow manufacturer’s instructions.
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Other Medication Administration Forms (cont.)
Transdermal Systems Patches
Release liquid medication at a constant rate Dosage strength expressed in mg or mcg per
hour
Ointments and creams
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Practice
Ordered: Transderm Nitro 0.8 mg/h top
On hand: 0.1 mg/h, 0.2 mg/h and 0.6 mg/h
What is the amount to administer?
Answer: 2 patches; 1 – 0.2 mg/h and 1 – 0.6 mg / h
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In Summary
In this chapter you learned to: calculate doses of parenteral medication in
solution and select syringes based on dose calculation.
14-60
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In Summary
In this chapter you learned to: calculate doses of medication expressed in
percent or ratio format;
calculate doses of reconstituted parenteral medications.
14-61
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In Summary
In this chapter you learned to:
differentiate other medication administration forms and equipment.
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Apply Your Knowledge
How would you interpret a label that reads as follows?
Heparin 1:5000
Answer: Each 1 mL contains 5000 units of heparin.
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Apply Your Knowledge
What kind of syringe would you use to administer 0.4 mL IM?
What kind of syringe would you use to administer 2.3 mL IM?
Answer: 0.5 mL tuberculin syringe
Answer: 3 mL standard syringe
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Apply Your Knowledge
What is the maximum amount of medication that can be administered IM in one site to an adult?
Answer: 3 mL
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Apply Your Knowledge
A 20% solution means that there is 20 g in how many mL?
Answer: 100 mL
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End of Chapter 14
The best
way to escape
from a problem is
to solve it.
-- Alan
Saporta