Chapter 015

1Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Chapter 15

Reconstitution and Dosages Measured in Units


Objectives

Calculating drug dosage problems that first require reconstitution of a powdered drug into a liquid form

Using a proportion to solve problems involving drugs measured in unit dosages

Drawing a line through an insulin syringe to indicate the number of units desired


Units

Common drugs measured in units: Penicillin Heparin Insulin


Penicillin

Ask patients whether they have had previous allergic reactions to penicillin.• Find out what reaction they may have. Just

because family members are allergic does not mean they are

Observe patients for signs of allergic reactions.


Heparin

Doses that are too large might cause hemorrhage. Doses that are too small might not produce the

desired result.


Insulin

Doses that are too large might cause insulin shock.

Doses that are too small might result in a diabetic coma.

Available in prefilled insulin pens.


Powder Reconstitution

Required when medication is unstable over long periods of time in its liquid form• Common sterile diluents include water, normal

saline solution, and 5% dextrose solution. Must be performed before administration using a

sterile diluent


Powder Reconstitution (cont’d)

Method: Read information and directions on drug label

carefully. Identify the type of diluent, amount of diluent,

and route of administration. Note the drug strength or concentration after

reconstitution.



Method (cont’d): Note the length of time that medication is usable

after reconstitution. Note the directions for storage of reconstituted

medication. the total reconstituted amount can be greater than

the amount of diluent added.



Place on drug label after reconstituting: Your initials Date and time of preparation Date and time of expiration


Oral-Dosage Problems (Dosages Measured in Units)

Example:

The physician orders penicillin V 300,000 units po four times a day. Penicillin V 500,000 units/2 mL is available. How many milliliters of penicillin V will be administered?


Parenteral-Dosage Problems (Dosages Measured in Units)

Example:

The order states heparin 8000 units subcutaneous q8 h. Heparin 6500 units/mL is available. How many milliliters of heparin will be administered?


Insulin Given with a Lo-Dose Insulin Syringe

Example:

The order states Lantus U-100 insulin 36 units subcutaneous in AM. You have 10 mL of Lantus U-100 insulin and a U-100 Lo-Dose syringe. Draw a vertical line through the syringe to indicate the correct dose.


Insulin Given with a Lo-Dose Insulin Syringe (cont’d)

Lo-Dose

5 15 25 35 45 0.5 mL

10 20 30 40 50 units


Mixed Insulin Administration

Guidelines: Inject air into each vial. Draw insulin from regular insulin bottle first. The practice of mixing insulins is decreasing

with the rise in use of Lantus insulin.


Mixed Insulin AdministrationPhysicians sometimes prescribe two types of insulin to be administered at the same time. The two types of insulin are drawn into the same syringe to reduce the number of times that the patient needs to be injected.

The air that is injected into each vial should be equal to the amount of insulin that will be withdrawn. Do NOT touch the insulin solution with the tip of the needle when injecting air into the vials.

When drawing insulin from the regular insulin bottle, use the same syringe that was used for injecting air into the vials.

Always draw up clear insulin (Regular) before any other insulin


Mixed Insulin Administration (cont’d)

Guidelines (cont’d): Remove any air bubbles found in syringe. Draw insulin from cloudy insulin bottle. Have another nurse check your insulin.



Example:

Physician orders Humulin L Lente U-100 insulin 46 units plus regular Humulin R U-100 20 units subcutaneous every morning. You have 10 mL of Humulin L Lente insulin and 10 mL of regular Humulin R insulin. A U-100 insulin syringe is available. Draw vertical lines through the syringe to indicate the correct doses.



Insulin

20 40 60 80 100 units

10 30 50 70 90

RegularLente

46 units 20 units

Chapter 015

Education

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