Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Ncm 100 dosage calculations

5,941 views

Published on

  • Be the first to comment

Ncm 100 dosage calculations

  1. 1. DRUG ADMINISTRATION: Standards, Practices and Principles Fundamentals in Nursing Practice
  2. 2. LEARNING OBJECTIVESLEARNING OBJECTIVES  At the end of the lecture discussion, RNs are expected to:  Enumerate principles, standards, guidelines in drug preparation and administration  Identify vital functions, roles & responsibilities as RNKs in drug preparation and administration  Calculate with 100 percent accuracy, completeness & organization based on standardized conversion system, equation and units of measurement  Appreciate the value and virtue of patience, humility, cooperation, respect and dignity for human life in congruence with drug preparation and administration
  3. 3. FLORENCE NIGHTINGALE’SFLORENCE NIGHTINGALE’S PLEDGEPLEDGE  I solemnly pledge myself before God and the presence of this assembly to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious to mind and body and not take or knowingly administer any harmful drugs. I will do all in my power to hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my profession.  With loyalty will I endeavor to aid the physician in his work and devote myself to the welfare of those committed to my care”. Thus…
  4. 4. KNOWLEDGE, SKILLS, ATTITUDES AND VALUESKNOWLEDGE, SKILLS, ATTITUDES AND VALUES • Promotion of health • Prevention of illness • Restoration of physiologic processes • Provision of palliative effect • Maintenance & sustenance of wellness • Aid in diagnosis • Treatment of diseases Pharmacologic aspects in nurses’ contextualities
  5. 5. Rules and Techniques for Giving MedicinesRules and Techniques for Giving Medicines  Verify all new or questionable orders on the medication administration record (MAR) against the physician orders for completeness  Prepare medications in a quiet environment  Wash hands thoroughly before measuring or preparing a medication  Collect all necessary equipments  Review MAR carefully (medication, dosage, route, expiration, date and frequency)  Research drug compatibilities, purposes, contraindications, S/E, & appropriate routes  Find medication for individual client  Accurate calculation is needed  Check expiration dates and signs of decomposition
  6. 6. Rules and Techniques for Giving Medicines  Compare labels three times • When removing package from drawer • Before preparing the medication • After preparing the medication  Be sure medications are identified for each client  Check for any allergies and perform special assessment before administration  Confirm patient’s identity • Ask the name  Check the identification wrist band • Check the bed tag (least reliable) • Check the photo in bed
  7. 7. Rules and Techniques for Giving Medicines
  8. 8. Rules and Techniques for Giving Medicines  Observe 10 Rights in giving each medication  Do not give medicine that someone else prepared. • Institution policies may require having a colleague double check medication such as insulin or heparin  If using a computer – controlled dispensing system, follow agency policy
  9. 9. Guides to the Administration of Some Specific AgentsGuides to the Administration of Some Specific Agents  Cough syrups are given undiluted in small amount and in frequent doses  Laxatives or cathartics are given between meals and on an empty stomach; those that act quickly be given just before breakfast or those requiring a longer time for action should be given at night (laxative lubricant 12-18 hours action)  Bitter or unpleasant tasting drugs are given in capsule form as a coated pill or in effervescent preparations  Oils taken in liquid form should be chilled • Castor oils taken with a lemon juice ¼ NAHCO3 in effervescing action
  10. 10. Guides to the Administration of Some Specific AgentsGuides to the Administration of Some Specific Agents  Drugs that are destroyed by digestive juices are given in enteric coated pills  Drugs are given several hours after meals for rapid action  Drugs to aid digestion are given one half before meals  Fe and Iodine preparations are given diluted and given with a straw  Sedatives are given with warm milk to increase and hasten desired effect of the drug  Bitter stomachaches, given to stimulate appetite should be given undiluted and with no attempt to disguise the taste
  11. 11. Rules for Measuring Medications  Measure the amount of drug ordered, using a calibrated measure  Do not converse while preparing the medication  Make sure that medicine glasses are dry before pouring or measuring a medication  Cleanse the mouth of every bottle after use before replacing it  Measure drops  Hold the medicine glass at eye level
  12. 12. Rules on Labels  Give medication only from a clearly labeled container  Read the label three times  Never give a drug from an unmarked bottle or box  Pour medicine from the bottles on the side opposite the label  Labels on medicine containers should be changed only by the pharmacists  If a drug has two commonly used names, both names should appear on the label
  13. 13. Rules for Giving MedicationsRules for Giving Medications  Give the medication at the time for which it is ordered  Always identify the patient before giving the medication  If medication is refused or cannot be administered, notify the lead head nurse  Remain at the bedside until the patient has taken the medication  Administer only those medicines which you have measured, poured and prepared  Never give two drugs together, unless ordered to do so  When a patient goes to the OR, all orders for medication are DC  When special tests are being done, medications due at the particular time are omitted they are resumed when next due  A mistake in medication must be reported immediately to the lead head nurse or charge nurse
  14. 14. Rules for Recording Drugs AdministeredRules for Recording Drugs Administered  Record if an ordered medication is refused or if cannot be administered  Record each dose of medicine soon after it is administered  Use standard abbreviations in recording medications  Record only those medicines which you have administered  Record time, kind and dose of drug given  Record effect, especially any unusual effect  Never record a medication as given before it has been administered “IF IT WAS NOT DOCUMENTED, IT WAS NOT DONE.”
  15. 15. Care of Drugs and Medicine CabinetCare of Drugs and Medicine Cabinet Bottles, boxes & other containers Must be kept closed Ointments, liniments, talcum powder, rubbing alcohol Must be kept in a separate environment Oils, serums, vaccines, liver extracts Must be placed in a refrigerator Extreme colds prevents them from becoming rancid and makes the oil a little more palatable Emergency Drugs Must be kept in a box or tray, readily attainable Labels Defaced or soiled should be changed by the pharmacists Medicines in unusual appearance Returned to the pharmacy & discarded
  16. 16. Care of Drugs and Medicine CabinetCare of Drugs and Medicine Cabinet Floor Drugs Checked twice daily Two containers for each floor drug Unused drugs for a patient being dismissed Should be sent back to the pharmacy Medicines sent home for patients Complete directions are employed Medicine Cabinet Individual basis (UNIT DOSE FORM) Opiates & narcotics Poison Adjacent to sink Adequate light Shallow Proper drug classification of drug supplies Drug per container/patient Separate compartment & locked Narcotic nurse with the key Label POISON, separate and roughened surface DRUG SUPPLY - UNIT DOSE FORM System of packaging and labeling each dose by pharmacy supplied in a 24 hour time period Replacement, constant monitoring of availability DRUG SUPPLY – STOCK SUPPLIED Dispensed and labeled in large quantities Stock supplies kept in a secured area
  17. 17. RNKs CAN ALLAY PATIENT’S SUFFERING THROUGH WRONG MEDICATION AND NON COMPLIANCE TO STANDARDS, PRINCIPLES AND GUIDELINES D I G N I F I E D D E A T H
  18. 18. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 1. A nurse makes a medication error. The best action is to A. Document in the patient’s record the error by either noting the omission of a drug or adding the drug given if it does not appear on the medication record B. Document in the patient’s record the error by either noting the omission of a drug or adding the drug as given even if it does not appear on the medication record; describe the circumstances surrounding the error. C. Do not document any error on the patient’s record. Document only on the incident or quality assurance report. D. Document in the patient’s record the error by either noting the omission of a drug or adding the drug as given if it does not appear on the MAR; also document on the incident or quality assurance report.
  19. 19. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 2. Among the following patient’s right, which is not included? A. Right route B. Right medicine C. Right site of administration D. Right patient
  20. 20. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 3. Which of the following nursing actions is most helpful for the patient with dysphagia? A. Placing the patient in a sitting position B. Mixing the medication with food C. Turning the patient toward you D. Dissolving the medication in a glass of water
  21. 21. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 4. It is important not to leave medication at the bedside because A. You will not be able to document that the patient actually took the medication B. It may fall on the floor C. The patient may forget to take it D. It takes time to return and check with the patient later
  22. 22. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL ANDAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONRECOGNITION 5. Buccal medications are those A. Placed between the cheek and the gum B. Placed under the tongue C. Injected into the buttocks D. Swallowed with water
  23. 23. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 6. Topical rinses have of the following actions: A. Systemic effect when swallowed B. Decreased microorganisms and tooth decay C. Increased the ability to taste D. Local effect through exposure to the mucous membrane
  24. 24. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 7. Administration of which of the following requires the use of sterile technique? (1) Ophthalmic medications (2) Nasal medications (3) Vaginal medications (4) Rectal medication A. 1 only B. 1, 2, and 3 C. 1 and 3 D. 2, 3, and 4
  25. 25. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 8. For safety and accuracy of medication being administered to the patient, one of the considerations is the three checks. Which of the following is not applicable? A. Reading the label after the medications has been administered. B. Reading the label before preparing. C. Reading the label before picking the medication in the locker. D. Reading the label after withdrawing the medication from the container.
  26. 26. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL ANDAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONRECOGNITION 9. Which is the following route has the faster effect? A. Sublingual B. Intravaginal C. Inhalers D. Intravenous
  27. 27. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 10. It is a medication order that is to be given once at specified time. A. Stat order B. Single order C. Standing order D. PRN order 11. “Multivitamins 1 tab daily” is an example of: A. Stat order B. Single order C. Standing order D. PRN order 12. A finely divided drug particles dispersed in liquid medium, when suspension is left standing, particles settle at the bottom of container A. Aqueous B. Suspension C. Syrup D. Powder
  28. 28. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 13. Requires that the effectiveness of the medication be administered by client’s response to the medication; it is appropriate to determine the extent of side effects and adverse reaction supports which of the following medication golden rule? A. Right evaluation B. Right assessment C. Right education D. Right documentation 14. Which of the following is not a principle for giving medications? A. Be knowledgeable about medications that you administer. B. Do not leave medication at bedside. C. When a medication error is made, report it immediately to the nurse in charge and/or physician. D. Practice clean technique.
  29. 29. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 15. The following are rules for measuring medications, except: A. Wash hands thoroughly before measuring medications. B. Do not converse with anyone while preparing a medication. C. Cleanse the bottom of each medicine bottle before replacing it after use. D. Make sure that the medicine glasses are dry before pouring the medication. 16. Mrs. Brown is to receive a medication PO qid. This means A. by mouth every other day B. before meals every day C. after meals every day D. by mouth four times a day
  30. 30. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 17. When the client resists taking a liquid medication that is essential to treatment, the nurse demonstrates critical thinking by doing which of the following first? A. Omitting this dose of medication and waiting until the client is more cooperative B. Suggesting the medication can be diluted in a beverage C. Asking the nurse manager about how to approach the situation D. Notifying the physician that the nurse was unable to give the client this medication 18. The nurse is administering medication in an extended care facility. The client answers to Mr. Smith and Mr. Brown. What is the best way for the nurse to correctly identify the client before administering the medications? A. Ask the client's name. B. Check the arm band. C. Check the name on the bed. D. Check the name on the room door.
  31. 31. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 19. Zantac is ordered for an adult client. The nurse mistakenly administered Xanax. What is the most appropriate action for the nurse to take? A. Notify the physician and document in the nurse's notes that the physician was notified of the error. B. Notify the supervisor, complete a medication error incident report, and document in the nurse's notes that an incident report was completed. C. Notify the house supervisor, assess client carefully, and document only if adverse or untoward effects occur. D. Notify the physician, complete an incident report, and document the notification of the physician and any assessments made.
  32. 32. TEST DRILLTEST DRILL APPLICATION, CRITICAL THINKING, RECALL AND RECOGNITIONAPPLICATION, CRITICAL THINKING, RECALL AND RECOGNITION 20. While preparing to give a morning medication, the first nursing action is to: A. Read the label B. Check for the right dose C. Wash hands D. Check for the right time 21 – 25 FIVE RIGHTS OF DRUG ADMINISTRATION
  33. 33. DOSAGE AND SOLUTIONSDOSAGE AND SOLUTIONS
  34. 34. TEST DRILL 1TEST DRILL 1 Mastery, Recall and RecognitionMastery, Recall and Recognition PERFORMANCE INDICATORS ANSWERS 1-5 Functions of Medicine/drug/medication Curative, diagnostic, palliative, promotive 6. Drug that is placed under the tongue SL 7. Priority of drug preparation/administration Patient’s safety 8. Drug that is slowly absorbed in a specified period of time Timed release drug 9-12 Drug Nomenclature Brand, generic, official, chemical 13. OD Right eye 15. Used with other drug that potentiates one’s drug action Adjunctive/adjunct 16-20. 5 R’s of drug administration Route, dose, patient, time, CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  35. 35. TEST DRILL 2TEST DRILL 2 Mastery, Recall and RecognitionMastery, Recall and Recognition 1. A type of medication order which is carried out until the specified period of time, or until it is discontinued by another order. A. Single Order B. Stat Order C. Standing Order D. PRN Order 2. This type of medication order indicates that the medication is given immediately without cause of delay. A. Single Order B. Stat Order C. Standing Order D. PRN Order 3. This type of medication order is used for a medication given once at a specified time. A. Single Order B. Stat Order C. Standing Order D. PRN Order 4. This type of medication order permits the nurse to give a medication when in his/her judgment the patient requires it. A. Single Order B. Stat Order C. Standing Order D. PRN Order CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  36. 36. TEST DRILL 3TEST DRILL 3 Recall and RecognitionRecall and Recognition Write the corresponding LETTER to drugs ordered by the physician. A – Single order B – Stat order C – Standing order D – Prn order 1. Ampicin 250 mg IV q 8 hr ANST 2. Phenergan 50 mg @ 10 am before surgery. 3. Dulcolax 10 mg 4 tabs @ h.s. 4. Hemostan 250 mg IM q 6 hours for bleeding 5. Ponstan 500 mg p.o. TID x 6 doses 6. Biogesic 500 mg p.o. stat 7. Demerol 25 mg IM q 4 hr for 2 days 8. Claritin 10 mg p.o. BID 9. Multivitamins 1 tab daily 10. Ampicillin 500 mg IV push TID ANST 1. C 2. A 3. C 4. D 5. C 6. C 7. C 8. C 9. C 10. C CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  37. 37. DEFINITIONDEFINITION DOSAGE • Is the amount of a medicine or agent prescribed for a given patient or condition DOSE • Is the measured portion of medicine to be taken at one time CYRUZ POLERO TUPPAL RN MSN DMS ©
  38. 38. FACTORS AFFETCING DOSAGE  Age  Sex  Condition of the patient  Psychological factors  Environmental factors  Temperature  Methods of administration  Genetic factors  Body weight CYRUZ POLERO TUPPAL RN MSN DMS ©
  39. 39. PRESCRIPTIONPRESCRIPTION Ebers Papyrus – the real literature dealt with pharmacy Is an order written by a physician  Date  Patient’s name  Address  Inscription (name & quantities)  Subscriptions (instructions to the pharmacists)  Sig. (signa) gives directions to the patient  Physician signature, address, registry number CYRUZ POLERO TUPPAL RN MSN DMS ©
  40. 40. SAMPLE PRESCRIPTIONSAMPLE PRESCRIPTION CYRUZ POLERO TUPPAL RN MSN DMS © Arellano University and Medical Center Name of Patient Date Address Sex Calcidrine Expectorant 4 0z Sig ½ tsp q.4h for cough Dr. Juan dela Cruz Lic. # 9875043
  41. 41. CYRUZ POLERO TUPPAL RN MSN DMS © a.d. or A.D. Right ear a.s. or A.S. Left ear a.u. or AU each ear or both ears HHN Hand held nebulizer I.D. Intradermal route I.M. or IM Intramuscular route I.T. Intrathecal route I.V. or IV Intravenous route IVP Intravenous push IVPB Intravenous piggyback NGT Nasogastric tube od or O.D. Right eye os or O.S. Left eye ou or O.U. Each eye or both eyes po or P.O. or PO By mouth P.R. or PR By rectum SQ, sub q, subcut Subcutaneous route SL or s.l. Sublingual route S & S Swish and swallow V or P.V. Vaginal route
  42. 42. CYRUZ POLERO TUPPAL RN MSN DMS © Ac or P.C. Before meals ad lib As desired / needed ASAP As soon as possible b.i.d. or BID Twice daily (not the same as q 12 °) h.s. or HS At bedtime (hour of sleep) NOC Nighttime [archaic usage] pc or P.C. After meals p.r.n. or PRN As needed q or Q Every q AM Every morning q hr Every hour q.d. or QD Every day q.i.d. or QID Four times a day q.o.d. or QOD Every other day q (Q) 1°, 2°, 3°, 4°, 6°, 8°, or 12°, etc Every 1, 2, 3, 4, 6, 8, 12 hours. (Concept is based on a day and administering on a routine sequential basis to maintain therapeutic blood levels.) stat or STAT Immediately! [not when you can get around to it] t.i.d. or TID Three times daily (not the same as q 8°)
  43. 43. CYRUZ POLERO TUPPAL RN MSN DMS © amp Ampule cap(s) Capsule(s) DS Double-strength elix Elixir LA Long-acting liq Liquid sol Solution supp Suppository S.R Sustained release susp Suspension syr Syrup tab Tablet tinct or tr Tincture ung Ointment
  44. 44. CYRUZ POLERO TUPPAL RN MSN DMS © Dram (Notice "2 humps".) (Docs should not be using this, but you may see it. There is a significant difference in the volume between this [4 ml] and ounce [30 ml].) Ounce (Notice "3 humps".) (Docs should not be using this, but you may see it.) cc or CC Cubic centimeter gm Gram gr Grain gtt (s) Drop (s) IU International units (best to write out) kg Kilogram L Liter mcg or µg Microgram (should be written out--safety issue) mg Milligram mEq Milliequivalent ml Milliliter [preferable for volume] Mn, m Minim [rarely used, except in some math exams] oz Ounce __ ss or ss One-half (archaic use) sliver in NICU, a small slice of a suppository T or Tbs Tablespoon tsp Teaspoon U Unit (best to write out)
  45. 45. CYRUZ POLERO TUPPAL RN MSN DMS © AMA (Leave) against medical advice _ c with D/C or DC Discontinue G Gauge (of needle) HO House officer (doctor on call) KVO Keep vein open. LOC Laxative of choice (Look for context when written, ie., could be "level of consciousness" when related to neurological exam.) MR x _ May repeat (x) times [This should be written out due to risk for error.] MOC In peds, mother of child FOC In peds, father of child (may also be frontal occiputal circumference) (read the context) NKA No known allergies N.P.O., NPO, or npo Nothing by mouth OTC Over the counter qs A sufficient quanity Rx Prescription, sometimes Treatment ® Right _ s Without (if must abbreviate, use w/o) __ ss One-half (should avoid this form) TO Telephone order (Need to follow the hospital policy re this.) TRA To run at (IV flow rate) VO Verbal order (What is hospital policy re this?)
  46. 46. CYRUZ POLERO TUPPAL RN MSN DMS © The interdisciplinary health care team should limit abbreviations to standard acceptable use. Sometimes Doctor's orders and notes and nurse's transcription of doctor's orders and their narrative notes contain so many shortcuts (abbreviations) that it is difficult to interpret safely. µg Micrograms should be written out, insist on it! __ ss or ss Write out one-half or 1/2 clearly. OD Ordered daily? Write out daily. QD, if legible, should be acceptable. n or N Nightly? QN? Write out nightly or use hs. d or D Daily? Write out how many days. BT Ordered at bedtime? Write out bedtime or use the standard hs. w/o Without? (See Miscellaneous use page.) Numerical numbers should be carefully written. Nurses should pay attention to use ofNumerical numbers should be carefully written. Nurses should pay attention to use of the decimal in designating dosages, ie, Ativan 0.5 mg, not Ativan .5 mg. [If one fails tothe decimal in designating dosages, ie, Ativan 0.5 mg, not Ativan .5 mg. [If one fails to note the decimal, then it could be interpreted as 5 mg.] Capoten 50 mg should not benote the decimal, then it could be interpreted as 5 mg.] Capoten 50 mg should not be written as Capoten 50.0 mg. [If one fails to note the decimal, then it could bewritten as Capoten 50.0 mg. [If one fails to note the decimal, then it could be interpreted as 500 mg.]interpreted as 500 mg.] Another issue to consider is use of the international designation of the number 7 ( ) toAnother issue to consider is use of the international designation of the number 7 ( ) to prevent mistaking it for the number 1.prevent mistaking it for the number 1.
  47. 47. CYRUZ P. TUPPAL RN MSN DMS © NLE REVIEW RESOURCE CENTER INC. MANILA CONVERSION EQUATION BASIC TECHNIQUES Metric, Household and Apothecary Measurement UNIVERSAL PRINCIPLE: The key is to clarify the 2 parts of the equation (what to give and what is available) Be guided with the conversion table and formula Basic arithmetic +, -, /, x SAFETY
  48. 48. Conversion within SystemsConversion within Systems  Metric System • Based on decimal system, basic unit is 10 • Units of measurement Meter (m) for Length, Gram (g) Kilogram (kg) Pounds (lbs) Milligram (mg) Microgram (mcg) for Weight Liter (l) Milliliter (ml) Cubic Centimeter (cc) for Volume • ZERO is placed in front of the decimal for values less than1 (0.7) • Basic arithmetic (division or multiplication) • mg to g or ml to l = divide the number by 1000 CYRUZ POLERO TUPPAL RN MSN DMS ©
  49. 49. Conversion within Metric SystemsConversion within Metric Systems  To convert within the metric system, set up a RATIO WITH THE CONVERSION FACTOR ON THE RIGHT AND DESIRED INFORMATION ON THE LEFT, CROSS MULTIPLY, DIVIDE TO FIND “X” and COMPLETE THE NEEDED MATH EQUATION.  REMEMBER: TO KEEP RATIOS EQUAL: WHATEVER IS DONE TO ONE SIDE MUST BE DONE TO THE OTHER  E.g. convert 5000 mg to gE.g. convert 5000 mg to g a.a. ______________== ______________ (skeleton)(skeleton) a.a. Conversion: 1000 mg = 1 gConversion: 1000 mg = 1 g b.b. 5000 mg = 1000 mg5000 mg = 1000 mg xx 1 g1 g c.c. (X) (1000 mg) = (5000 mg)/ 1 g(X) (1000 mg) = (5000 mg)/ 1 g d.d. (X) (1000 mg) = (5000 mg) (g)(X) (1000 mg) = (5000 mg) (g) (1000 mg) (1000 mg)(1000 mg) (1000 mg) e.e. X = (5) (1) gX = (5) (1) g f.f. X = 5 gX = 5 g CYRUZ POLERO TUPPAL RN MSN DMS ©
  50. 50. Test Drill 4Test Drill 4 Conversion EquationConversion Equation  Convert the ff using a sequential approach 1. 136 kg = lb 2. 476 kg = lbs 3. 666 mg = g 4. 1478 ml = L 5. 3758 L = ml 6. 9000 cc = L 7. 780 g = mcg 8. 14344 mg = mcg 9. 88 lb = kg 10. 7 L = cc CYRUZ POLERO TUPPAL RN MSN DMS © MATRIX GUIDE a. _______= _______ (skeleton) a. Conversion: 1000 mg = 1 g b. 5000 mg = 1000 mg x 1 g c. (X) (1000 mg) = (5000 mg)/ 1 g d. (X) (1000 mg) = (5000 mg) (g) (1000 mg) (1000 mg) e. X = (5) (1) g f. X = 5 g
  51. 51. Conversion within Systems:Conversion within Systems: HOUSEHOLD SYSTEMHOUSEHOLD SYSTEM  Least accurate  Used to inform of the size of a liquid dose  Calibrated oral syringe or dropper should be used instead for accuracy  Teaspoon (tsp) Tablespoon (tbsp) Ounce (oz) Cup Drop (gtt) Micro drop (mcgtt)  Convert 3 tsp to drop a. 60 gtts = 1 tsp b. 3 tsp = 1 tsp X 60 gtts c. (1tsp) (X) = (3 tsp) (60 gtts) d. (1tsp) (X) = (3 tsp) (60 gtts) 1 tsp 1 tsp e. X = 3 (60 gtts) f. X = 180 gtts CYRUZ POLERO TUPPAL RN MSN DMS ©
  52. 52. TEST DRILL 5TEST DRILL 5 Conversion EquationConversion Equation MATRIX GUIDE  Convert 3 tsp to drop a. 60 gtts = 1 tsp b. 3 tsp = 1 tsp X 60 gtts c. (1tsp) (X) = (3 tsp) (60 gtts) d. (1tsp) (X) = (3 tsp) (60 gtts) 1 tsp 1 tsp e. X = 3 (60 gtts) f. X = 180 gtts Convert the ff 1.70 tsp to drop 2.5 tbsp to oz 3.8 oz to tbsp 4.15 drops to tsp 5.12 tsp to oz CYRUZ POLERO TUPPAL RN MSN DMS ©
  53. 53. Conversion from One System to AnotherConversion from One System to Another  Conversions must be memorized by heart  Convert 90 gtts = ml a. 15 gtts = 1 ml b. 90 gtts = 15 gtts X 1 ml c. 15 gtts (X) = (90 gtts) (1 ml) 15 gtts 15 gtts d. X = 6 ml CYRUZ POLERO TUPPAL RN MSN DMS ©
  54. 54. Dosage Calculation  Calibrated containers are available for oral liquids & liquid injectables  Be sure all conversions are done first. The technique of using ratios is the same FORMULA Desired Amount of Drug_ = Unknown Quantity (X) Amount of Drug on Hand Known Quantity of Drug X = Desired Dosage(D) X Quantity (Q) Stock on Hand (S) CYRUZ POLERO TUPPAL RN MSN DMS ©
  55. 55. Dosage Calculation for Scored TabletDosage Calculation for Scored Tablet 1. 2000 mg of a drug is ordered. It is available as a scored tablet containing 4 g. How many tablet/s should the nurse administer? 2. Calculation a. 1000 mg = 1 g b. 2000 mg = X tablets 4000 mg 1 tablet c. 4000 mg (X) = 2000 mg (1) d. X = 0.5 tablet e. Give ½ tab  3000 mg of a drug is ordered. It is available as a scored tablet containing 7 g. How many tablet/s should the nurse administer? CYRUZ POLERO TUPPAL RN MSN DMS ©
  56. 56. Dosage Calculation for LiquidDosage Calculation for Liquid 1. The order is for potassium chloride (KCL) 20 mEq. The bottle is labeled KCL elixir 10 mEq./ml. How many ml will be given? a. Desired amount of drug is 20 mEq(D); amount of drug on hand is known (S) 10 mEq. b. Unknown quantity is (X), known quantity (Q) is 1 ml. 1. Calculations a. 20 mEq = X 10 mEq 1 ml b. (10 mEq) (X) = (20 mEq) (1 ml) 10 mEq 10 mEq c. X = 2 ml d. Give 2 ml of potassium chloride (KCL) CYRUZ POLERO TUPPAL RN MSN DMS ©
  57. 57. Dosage Calculation for LiquidDosage Calculation for Liquid MATRIX GUIDE a. 20 mEq = X 10 mEq 1 ml b. (10 mEq) (X) = (20 mEq) (1 ml) 10 mEq 10 mEq c. X = 2 ml d. Give 2 ml of potassium chloride (KCL) The order is for potassium chloride (KCL) 50 mEq. The bottle is labeled KCL elixir 35 mEq./ml. How many ml will be given? CYRUZ POLERO TUPPAL RN MSN DMS ©
  58. 58. A. Dosage Calculation for a CapsuleA. Dosage Calculation for a Capsule 1. The order is for Nembutal gr XX. The bottle contains Nembutal 100 mg/capsule. How many capsules should RNK give to ease the patient’s suffering? 2. Calculations A. First convert to EQUAL MEASUREMENTS a. 1 gr = 60 mg b. 1 gr = 1.5 gr 60 mg X c. (X) (1 gr) = (60 mg) (1.5 gr) d. (X) (1 gr) = (60 mg) (1.5 gr) 1 gr 1 gr e. X = 90 mg CYRUZ POLERO TUPPAL RN MSN DMS ©
  59. 59. B. Dosage Calculation for a CapsuleB. Dosage Calculation for a Capsule B. Desired amount of drug is 90 mg (D); amount of drug on hand is 100 mg (S) C. Unknown quantity is (X); known quantity is 1 capsule (Q) D. Calculate the dosage a. 90 mg = X 100 mg 1 capsule b. (100 mg) (X) = (90 mg) (1 capsule) 100 mg 100 mg c. X = 0.9 capsule d. The RNK will administer 0.9 capsule to kill the patient E. Since part of a capsule, drop or suppository cannot be given (0.9 capsule), RNK WILL ADMINISTER 1 CAPSULE TO KILL THE PATIENTRNK WILL ADMINISTER 1 CAPSULE TO KILL THE PATIENT CYRUZ POLERO TUPPAL RN MSN DMS ©
  60. 60. Dosage Calculation for a CapsuleDosage Calculation for a Capsule MATRIX GUIDEMATRIX GUIDE A. CONVERT TO EQUAL MEASUREMENTS a. 1 gr = 60 mg b. 1 gr = 1.5 gr 60 mg X c. (X) (1 gr) = (60 mg) (1.5 gr) d. (X) (1 gr) = (60 mg) (1.5 gr) 1 gr 1 gr e. X = 90 mg B. CALCULATE THE DOSE a. 90 mg = X 100 mg 1 capsule b. (100 mg) (X) = (90 mg) (1 capsule) 100 mg 100 mg c. X = 0.9 capsule 1. The order is for Nembutal gr XX. The bottle contains Nembutal 100 mg/capsule. How many capsules should RNK give to ease the patient’s suffering? 2. The order is codeine sulfate gr 20. The container labeled as Codeine Sulfate 50 mg/capsule. How many capsule/s should YOU give so as the patient’s suffering will end? CYRUZ POLERO TUPPAL RN MSN DMS ©
  61. 61. Dosage Calculation for ParenteralDosage Calculation for Parenteral MedicationsMedications 1. The order reads codeine gr ss. The vial reads codeine 60 mg/cc. How many ml should be given?  Convert to equal measurements a. 60 mg = 1 gr b. 60 mg = 60 mg X 1 gr c. (60 mg) (X) = (60 mg) (1 gr) 60 mg 60 mg d. X = 1 gr 2. Then calculate the dosage  D = 0.5 gr S = 1 gr Q = 1 ml a. 0.5 gr = X 1 gr 1 ml b. (X) (1 gr) = (0.5 gr) (1 ml) c. X = 0.5 ml CYRUZ POLERO TUPPAL RN MSN DMS ©
  62. 62. Dosage Calculation for Reconstituted PowderDosage Calculation for Reconstituted Powder Critical vs. Extraneous InformationCritical vs. Extraneous Information 1. Mefoxin 1 g is ordered. Mefoxin 2 g is on hand. Add 4.3 ml to equal 5 ml solution. Critical Information? -The dosage (1 g) -The end concentration (2 g/5 ml) Extraneous Information not needed for calculating? - Mixing instructions (Adding the 4.3 ml to the vial tells you that this is the volume necessary to add to the powder to yield a specific concentration) Can you figure how much volume the powder has in the vial? (0.3 ml) 2. Desired amount (D) is 1 g, Amount of drug on hand (S) is 2 g 3. Unknown quantity is X, known quantity is 5 ml a. 1 g = X 2 g 5 ml b. (2.0 g) (X) = (5 ml) (1 g) 2 g 1 ml c. X = 2.5 ml CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  63. 63. Dosage Calculation in ChildrenDosage Calculation in Children (Pediatric Dosages)(Pediatric Dosages) RulesRules DescriptionDescription FormulaFormula Young’s Rule - Not valid after 12 y/o. If the child is small enough, dosage reduction be computed with Clark’s Rule Age of child____ X Ave Adult Dose Age of child + 12 Clark’s Rule Weight of child X Ave Adult Dose 150 Fried’s Rule - Calculates dosages for infants less than 2 y/o Age In Months X Ave Adult Dose 150 CYRUZ POLERO TUPPAL RN MSN DMS © THESE RULES ONLY GIVE APPROXIMATE DOSAGES. Thus… USE
  64. 64. Dosage Calculation in ChildrenDosage Calculation in Children (Pediatric Dosages)(Pediatric Dosages)  Body Surface Area (BSA): most accurate method for calculating pediatric dosages • West nomogram = if BSA is not known, draw a line from height on the nomogram; the point intersection on surface area is the BSA • FORMULA USING SURFACE AREA (mm) 150 lbs or 1.73 mm – average BSA of an adult CHILD DOSE = surface area (mm) x ADULT DOSE 1.73 mm CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  65. 65. Dosage Calculation in ChildrenDosage Calculation in Children (Pediatric Dosages)(Pediatric Dosages) FORMULA CHILD DOSE = surface area (m2) x ADULT DOSE 1.73 mm The adult dose is 100 mg Demerol; the child weighs 20 kg and is 40 inches a. .77 m2 X 100 mg = X 1.73 m2 b. 0.45 X 100 mg = X c. 45 mg = X CYRUZ POLERO TUPPAL RN MSN DMS ©
  66. 66. Dosage Calculation in ChildrenDosage Calculation in Children (Pediatric Dosages)(Pediatric Dosages) 1. Pediatric dosages can also be calculated by weight (mg/kg) 2. The order is Phenobarbital 2 mg/kg of body weight, for the patient weighs 25 kg. 3. Calculations a. 2 mg = 1 kg X 25 kg b. (1 kg) (X) = (2 mg) (25 kg) 1 kg 1 kg c. X = 50 mg CYRUZ POLERO TUPPAL RN MSN DMS ©
  67. 67. What if ? Need to perform an “ACCURATE I & O" and the infant does not have a foley? What to do?What to do? CYRUZ POLERO TUPPAL RN MSN DMS ©
  68. 68. What if? RationaleRationale WEIGH DIAPERWEIGH DIAPER In gram and milliliter?In gram and milliliter? When weighing diapers, the measurement is "grams". When we think about volume of urine output we think "ml". A 'gram' and a 'ml' are equivalent when measuring water. In the clinical setting, however, we use gram and ml as equivalent when measuring urine by diaper weights. It is the best noninvasive method we currently have and is close enough for clinical decision making. The process is to weigh the diaper on a gram scale, but record the output in 'ml'. CYRUZ POLERO TUPPAL RN MSN DMS ©
  69. 69. Safety Related Issues in Pedia PatientsSafety Related Issues in Pedia Patients Most Pediatric nursing units have a policy that children under a certain age with IV fluids / IV medications will be placed on an infusion pump. Buretrol Microtubing Infusion Pump Sometimes critical thinking is required to deliver the medication/fluid in the most expedient, safe manner for the individual child's needs. Children cannot tolerate adult doses.
  70. 70. CYRUZ POLERO TUPPAL RN MSN DMS © Child's Weight Data / Volume to be given 1)  6.5 kg ? ml / day (maintenance) ? ml / hour (maintenance) ? 2/3 maintenance (ml/day) ? 2/3 maintenance (ml/hr) ? 1.5 maintenamce (ml/day) ? 1.5 maintenamce (ml/hr)
  71. 71. Dosage Calculations for IV MedicationsDosage Calculations for IV Medications  To calculate know the flow rate, need to know the drop factor (10, 15, 20 gtts/ml)  Micro drop is always 60 gtts.ml  FORMULA gtts/min = Amount of Solution (V) X Drop Factor (gtts/ml) Time in Minutes cc/hr = Volume/Hour = akin to micro drop/minute computation CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  72. 72. Dosage Calculations for IV MedicationsDosage Calculations for IV Medications gtts/min = Amount of Solution (V) X gtts factor Time in Minutes cc/hr = Volume/Hour  The nymphomaniac doctor quack ordered 3 L of PNSS for a dying patient. The IV is set to run for 24 hours. The RNK will regulate the IV to how many (a) ml/hr, (b) gtts/min if the drop factors are: (c) 10, (d) 15, (e) 20. CYRUZ POLERO TUPPAL RN MSN DMS ©
  73. 73. TEST DRILL 5TEST DRILL 5 Dosage EquationDosage Equation  THREE GROUPS IN A CLASS  Choose one member per group to show computation. 5 point added per correct answer  Two – minute time allotment  Group test drill grade = individual test drill grade  The order reads codeine gr ss. The vial reads codeine 60 mg/cc. How many ml should be given?  The order is penicillin 750 000 units. The vial reads 300 000 u/2 ml. How many ml will be given?  The order is 1000 ml NSS over 8 h; drop factor is 10 gtts/ml. Regulate the IV to how many gtts/min? CYRUZ POLERO TUPPAL RN MSN DMS ©
  74. 74. TEST DRILL 6TEST DRILL 6  The order is 1000 ml D5NS over 24 hours. Drop factor is 60 mcgtts/ml and an hour of 60 minutes.  The order reads Digoxin 0.375 mg once daily. The bottle reads Digoxin 0.25 mg per tablet. How much should the nurse administer?  The order is chloral hydrate 200 mg. The bottle reads chloral hydrate 0.1 g/cap. Give ______ cap CYRUZ POLERO TUPPAL RN MSN DMS ©
  75. 75. TEST DRILL 7  The order is penicillin 50 000 units. The vial reads penicillin 500 000 units. Add 4.3 ml to yield 5 ml. Give _________ ml.  The order is for 1.2 million units of penicillin G (Bicilin) IM. Available is 600 000 units/ml. How much should the nurse administer?  Order is 2000 ml D5W over 24 hours. Drop factor is 15 gtts/ml. Run IV at ____ gtts/min. CYRUZ POLERO TUPPAL RN MSN DMS ©
  76. 76. TEST DRILL 8TEST DRILL 8  Enoxaparin sodium (Lovenox) 30 mg SC q.12 hours is ordered. The label reads 30 mg/0.3 ml. How much should the nurse administer?  The order is for meperidine 50 mg IM q. 4 hours prn. The label reads meperidine 7 mg/ml. How much the nurse should administer? CYRUZ POLERO TUPPAL RN MSN DMS ©
  77. 77. TEST DRILL 9  An adult is on continuous IV heparin therapy for thrombophlebitis. The IV contains 15 000 units of heparin in 500 cc of 5% dextrose (D5W) at the rate of 20 cc per hour. How many units per hour is the client receiving?  The order is for Ancef 1 gram IV in 50 cc 5% dextrose to run in over 30 minutes every 6 hours. The administration set delivers 10 gtts/cc. What should the drip rate be? CYRUZ POLERO TUPPAL RN MSN DMS ©
  78. 78. TEST DRILL 10  Physician orders Garamycin 60 mg IM. Dose on hand is 40 mg/ml.  Dose ordered 250 000 units of Penicillin G. Available dosage 300 000 units per 1.2 ml.  Dose ordered Gantrisin 2 g. Dose on hand is 500 mg/tab.  Dose ordered Aspirin 600 mg. Dose on hand is gr V.  Dose ordered Keflin 250 mg. Dose on hand Keflin 6 g.  Dose ordered Meperidine 25 mg. Dose on hand Meperidine 0.05 g/ml.  Dose ordered Rubrumin 1 mg. Dose on hand 1000 mcg/cc.  Dilantin suspension is labeled 100 mg/4 cc. How many cc is required to give a 250 mg per dose?  The doctor orders ATSO4 0.0006 g. The dose available is 0.4mg/cc.  The doctor orders Ephedrine 100 mg. The dose is 0.05 g/cc. CYRUZ POLERO TUPPAL RN MSN DMS ©
  79. 79. TEST DRILL 11TEST DRILL 11  The doctor orders Atropine Sulfate 0.2 mg. Dose available is 0.4mg/cc.  Dose ordered Sodium Salicylate 0.6 g. Dose on hand is 300 mg in each scored tablet.  The doctor orders Codeine SO4 15 mg. The dose available is 0.03 g in each scored tablet.  The doctor orders Benadryl 50 mg. Dose on hand 0.025 g in each capsule.  The medication order is Meprobomate 0.2 g. Dose on hand is 400 mg per scored tablet.  Morphine SO4 15 mg is ordered. Dose on hand is 0.005 g per tablet.  NAHCO3 is ordered 1 g. Dose on hand is 400 mg/ 4 ml.  The doctor orders sodium salicylate 1200 mg. Dose on hand is 0.6 g in 4 ml.  The order is to administer 150 mg sodium benzoate. Dose on hand is an ampule labeled 0.5 g in 2 ml.  The order reads 500 mg penicillin. Dose on hand is in solution 3 g per 6 ml. CYRUZ POLERO TUPPAL RN MSN DMS ©
  80. 80. TEST DRILL  Order of an initial cortisone acetate of 425 mg. Dose on hand is in suspension labeled as 25 mg/ml.  Dose ordered is Lanoxin 0.125 mg. Dose on hand is 0.062 mg per cc.  Dose ordered Vistaril 15 mg. Dose on hand is 25 mg/cc.  Dose order is 250 mg Chloromycetin liquid. Dose available is 32 mg/ml.  Phenobarbital gr ss is ordered. Dose available is Phenobarbital 0.30 mg.  A physician orders 1 L of NS to infuse over 12 hrs. The drop factor is 15 gtts per 1 ml. A nurse prepares to set the flow rate at how many drops per minute?  Cefuroxime (Axetil) 1 g in 50 ml NS is to be administered over 30 minutes, a drop factor is 15 drops per 1 ml. A nurse sets the flow rate at how many drops per minute?  A physician orders 1 unit of PRBC to infuse over 4 hrs. The unit contains 250 ml, the drop factor is 10 drop per 1 ml. A nurse prepares to set the flow rate at how many drops per minute?  The order reads PNSS 1000 ml to run for 12 hrs. How ml/hr should the nurse monitor and the accurate flow rate? If the nurse started to run the infusion at 10:30 in the morning, at what time should the IVF be consumed?  D5 0.3 NACL 1 L to run for 8 hrs is ordered. Compute for the ml/hr and the flow rate the nurse should regulate the IVF if the drop factor is 20 drops per 1 ml. CYRUZ POLERO TUPPAL RN MSN DMS ©
  81. 81. LAST TOPICS FOR MIDTERM PERIODLAST TOPICS FOR MIDTERM PERIOD FRIDAY  Medication Administration Routes  Parts of Syringes  Medication Cards  Special Consideration in Various Routes/Sites of DA • Oral • Parenteral and various routes • Intramuscular • Intradermal • Subcutaneous MONDAY  EXAMINATION (TWO SETS) • SET ASET A • 1: 00 PM – 1:45 PM • Application, mastery, recall and recognition (100 items) 1:45 PM – 2: 00 PM Break • SET BSET B • 2:00 PM – 3:00 PM • Dosage and Calculations (100 items) CYRUZ POLERO TUPPAL RN MSN DMS ©CYRUZ POLERO TUPPAL RN MSN DMS ©
  82. 82. WEDNESDAY Orientation, Review & Checking of Examination, Activity WorkOrientation, Review & Checking of Examination, Activity Work TOPICS DISCUSSEDTOPICS DISCUSSED 1. TERMS 2. DEFINITION 3. ABBREVIATIONS 4. STANDARDS, GUIDELINES, PRINCIPLES DP/DA 5. DOSAGE AND CALCULATION TOPICS FOR FINAL PERIODTOPICS FOR FINAL PERIOD • Administration of medication in various routes • Lecturers: 1. Mrs. Norma F. Arobel, MAN, RN 2. Mrs. Delia T. Bromo, MAN, RN 3. Mrs. Alicia Lopez, MAN, RN • Performance Evaluation Checklist • Return Demonstration • Submitted and signed Waiver Statement prior to RETDEM • Group assignment or individual basis for various equipments, supplies and materials used in drug administration CYRUZ POLERO TUPPAL RN MSN DMS ©

×