Chapter 9: Special Types of Intravenous Calculations
description
Transcript of Chapter 9: Special Types of Intravenous Calculations
![Page 1: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/1.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 9: Special Types
of Intravenous Calculations
Chapter 9: Special Types
of Intravenous Calculations
![Page 2: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/2.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Intravenous CalculationsIntravenous Calculations
• These are very potent medications.
• Small changes infusion rate can greatly affect body’s physiologic response.
• Pharmacy usually prepares medications and IV solutions.
![Page 3: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/3.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dosage CalculationsDosage Calculations
• D = Desired dose or order
• H = On hand or have
• S = Supply
![Page 4: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/4.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Three Methods of Dosage CalculationThree Methods of Dosage Calculation
• Proportion expressed as two fractions
• Proportion expressed as two ratios
• Formula method
![Page 5: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/5.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Proportion Expressed as Two FractionsProportion Expressed as Two Fractions
• SUPPLY = X HAVE DESIRE
![Page 6: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/6.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Proportion Expressed As Two RatiosProportion Expressed As Two Ratios
• SUPPLY : HAVE :: X : DESIRE
![Page 7: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/7.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Formula MethodFormula Method
• DESIRE x SUPPLY = X HAVE
![Page 8: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/8.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infusion Rates FormulasInfusion Rates Formulas
• Amount of Drug = Amount of Drug in 1 mL Amount of Fluid (mL)
• Total number of units/hour x X mL= mL/hour Number of units to run
• Total number of mg/hour x X mL= mL/hour Number of mg to run
• Total number of milliters ordered = hours Total number of milliters/hour
![Page 9: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/9.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
The physician has ordered regular insulin 21 units/hour IV. The medication is available 250 units in 250 mL normal saline. The insulin IV is being run on an infusion pump. What is the rate per hour?
A. 19
B. 20
C. 21
D. 22
![Page 10: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/10.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
C. 21
Total number of 21 units/hour x 250 mL= 21 mL/hour Number of 250 units to run
![Page 11: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/11.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infusion Formula for Drugs Ordered in mcg/minInfusion Formula for Drugs Ordered in mcg/min• Reduce the numbers in the standard solution to mg/mL.
• Change mg to mcg.
• Divide by 60 to get mcg/min.
• Use either the formula, ratio, or proportion method to solve for mL/hr.
![Page 12: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/12.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Infusion Formula for Drugs Ordered in mcg/kg/minInfusion Formula for Drugs Ordered in mcg/kg/min• Reduce the numbers in the standard solution to mg/mL.
• Change mg to mcg.
• Divide by 60 to get mcg/kg/min.
• Use either the formula, ratio, or proportion method to solve for mL/hr.
![Page 13: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/13.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
The physician has ordered Intropin (dopamine) 200 mcg/min IV. The medication is available 400 mg in 250 mL D5W. What is the rate in mL/hr?
A. 7 mL/hr
B. 7.5 mL/hr
C. 8 mL/hr
D. 8.5 mL/hr
![Page 14: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/14.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswerB. 7.5 mL/hr
• Reduce the numbers in the standard solution to mg/mL: 400 mg/250 mL = 1.6 mg/mL.
• Change mg to mcg: 1.6 mg x 1000 = 1600 mcg/mL.
• Divide by 60 to get mcg/min: 1600 mcg/60 min = 26.67 mcg/min.
• Use either the formula, ration, or proportion method to solve for mL/hr: 200 mcg/min x 1 mL/hr= 7.5 mL/hr 26.67 mcg/min
![Page 15: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/15.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Body Surface AreaBody Surface Area
• Antineoplastic drugs based on body surface area in square meters
• Mathematical formulas
– Square root of weight (kg) X height (cm) = BSA 3600
![Page 16: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/16.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Body Surface NomogramBody Surface Nomogram
• Mark the client’s height in first column.
• Mark the client’s weight in the third column.
• Draw a line between these two marks.
• Point at which the line intersects in the middle column indicates estimated body surface in meters squared.
![Page 17: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/17.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Body Surface NomogramBody Surface Nomogram
![Page 18: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/18.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Patient Controlled AnalgesiaPatient Controlled Analgesia
• Basal rate: amount of medication infused continuously every hour
• PCA dose: amount of medication infused when the client activates the button control
• Lockout time or delay: interval during which patient cannot initiate another dose after giving a self dose; prevents overdosage
• Total hourly dose: maximum amount of medication the client can receive an hour
![Page 19: Chapter 9: Special Types of Intravenous Calculations](https://reader036.fdocuments.us/reader036/viewer/2022081506/568158ec550346895dc62da3/html5/thumbnails/19.jpg)
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Heparin and Insulin ProtocolsHeparin and Insulin Protocols
• Protocols are based on a parameter, usually a lab test ordered by healthcare provider
• After receiving the lab test results, the nurse uses the protocol to determine the change in the dosage amount.