Chapter 015
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Chapter 015

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  • What is a unit? A unit is the amount of a drug needed to produce a particular result. Penicillin is an antibiotic that is used to reduce the number of bacteria in the body. Heparin is an anticoagulant that is used to inhibit the clotting of blood. Insulin is a hormone secreted by the pancreas that is used to lower the blood glucose level.
  • How is penicillin administered? Penicillin can be administered either orally or parenterally. What sort of syringes should be used to administer penicillin parenterally? Only syringes marked in milliliters can be used to administer penicillin parenterally. Even if the physician’s order or drug label lists the penicillin dosage in units, do NOT use syringes marked in units. Syringes marked in units should be used only for administering insulin.
  • Nurses should observe patients dosed with heparin for signs of hemorrhaging. What sort of syringes should be used to administer heparin parenterally? Only syringes marked in milliliters can be used to administer heparin parenterally. Even if the physician’s order or drug label lists the heparin dosage in units, do NOT use syringes marked in units. Syringes marked in units should be used only for administering insulin.
  • Nurses should be able to recognize the symptoms of both insulin shock and a diabetic coma so that immediate treatment can be initiated to stabilize the patient. What is the definition of U-100 insulin? U-100 insulin is 100 units of insulin dissolved in 1 mL of liquid. U-100 insulin is a universal standard preparation that all people requiring insulin can use.
  • What are some common sterile diluents? Common sterile diluents include water, normal saline solution, and 5% dextrose solution.
  • What should you do if no directions are available with the medication? Consult the Physicians’ Desk Reference (PDR), hospital drug formulary, pharmacology text, or hospital pharmacy.
  • Will the total reconstitution amount always be equal to the amount of diluent added? No, it will not. Sometimes the total reconstituted amount can be greater than the amount of diluent added.
  • Is it necessary to write the drug strength or concentration after reconstitution on the drug label if it is already written on the multidose vial? No, it is not. However, if the drug strength already appears on the label, then the strength should be circled on the drug label after reconstitution.
  • How many milliliters of penicillin V will be administered? the total reconstitution amount always be equal to the amount of diluent added? No, it will not. Sometimes the total reconstituted amount can be greater than the amount of diluent added.
  • How many milliliters of heparin will be administered? 6500 units : 1 mL :: 8000 units : x mL 6500 x = 8000 x = 8000 ÷ 6500 x = 1.23 mL The nurse will administer 1.23 mL.
  • Draw a vertical line through the syringe to indicate the correct dosage. In this case, the dose is 36 units of U-100 insulin. Therefore, find the 30-units mark on the units scale of the Lo-Dose syringe. Counting the number of marks between the 30-unit mark and the 40-unit mark, it can be seen that each of the shorter marks indicates 1 unit. Therefore, the line should be drawn six shorter marks to the right (closer to the plunger) of the 30-units mark.
  • What is the other scale marked on the Lo-Dose syringe? The other scale marked on the Lo-Dose syringe is the scale measured in milliliters. Which numbers are associated with the other scale? All of the numbers are associated with both scales in this example because 50 units equal 0.5 mL. This means that 1 unit is equal to 0.01 mL, so the numbers all represent hundredths of milliliters and represent single units.
  • Physicians 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.
  • When the desired amount of insulin has been withdrawn from the regular insulin bottle, remove the syringe before checking it for any air bubbles. The same syringe should be used throughout this process. Therefore, the same syringe that was used to draw up the regular insulin also should be used to draw up the cloudy insulin. Some hospitals require nurses to have another nurse check the insulin before injecting patients.
  • The regular insulin should be drawn up first. The dose of regular insulin requested is 20 units. This amount is indicated in blue on the syringe shown. The Lente insulin should be drawn up second. The dose of Lente insulin requested is 46 units. This amount is indicated in yellow on the syringe shown. Therefore the total volume of insulin to be administered should be 66 units.
  • Note that the regular insulin is closer to the plunger because it was drawn up into the syringe first. Also, note that on this syringe the shorter marks indicate 2 units of insulin rather than 1 unit of insulin.

Chapter 015 Chapter 015 Presentation Transcript

  • 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.
  • Powder Reconstitution (cont’d)
      • 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 .
  • Powder Reconstitution (cont’d)
      • 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 Administration Physicians 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.
  • Mixed Insulin Administration (cont’d)
        • 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.
  • Mixed Insulin Administration (cont’d) Insulin 20 40 60 80 100 units 10 30 50 70 90 Regular Lente 46 units 20 units