Medication Assessment
Study Guide
June 2006
1
Information
The medication assessment emphasizes essential, basic knowledge required for safe
practice. It is a multiple choice format and, evaluates:
1. Dosage Calculations
2. Principles of drug administration
3. Nursing implications
4. Effects and side effects of common medications
5. Medication safety concerns
6. JCAHO unacceptable abbreviations
7. Patient teaching
There are 50 questions on the assessment and an 80% is required to pass. Those who
receive a score less than 80% are remediated and retake the assessment. This study
guide is for your review.
Medication Safety
In 1999, the Institute of Medicine published the report “To Err is Human”. In this
report, they identified that patient safety issues and especially medication safety issues
were responsible for between 40,000-90,000 deaths a year. Most of which were
preventable. The report identified that lack of adherence to the five rights of medication
safety, poor patient identification, lack of attention to details, poor infection control
measures, and lack of understanding of how medications affect the elderly were some
of the major safety issues.
2
5 Rights of Medication Administration
1.
2.
3.
4.
5.
Right Medication
Right Patient
Right Time
Right Route
Right Dose
JCAHO Patient Safety Goals relating to Medication Safety
1) Improve the accuracy of patient identification. Use at least two patient identifiers
(neither to be the patient's room number) whenever taking blood samples or administering
medications or blood products.
2) Improve the safety of using high-alert medications.
a) Remove concentrated electrolytes (including, but not limited to, potassium chloride,
potassium phosphate, sodium chloride >0.9%) from patient care units.
b) Standardize and limit the number of drug concentrations available in the organization.
c) Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in
the organization, and take action to prevent errors involving the interchange of these
drugs.
3) Improve the safety of using infusion pumps. Ensure free-flow protection on all generaluse and PCA (patient controlled analgesia) intravenous infusion pumps used in the
organization.
4) Accurately and completely reconcile medications across the continuum of care.
a) Develop a process for obtaining and documenting a complete list of the patient's current
medications upon the patient's admission to the organization and with the involvement of the
patient. This process includes a comparison of the medications the organization provides to
those on the list.
b) A complete list of the patient's medications is communicated to the next provider of service when
it refers or transfers a patient to another setting, service, practitioner or level of care within or
outside the organization.
5) Improve the effectiveness of communication among caregivers.
a) Implement a process for taking verbal or telephone orders or critical test results that
require a verification "read-back" of the complete order or test result by the person
receiving the order or test result.
b) Standardize the abbreviations, acronyms and symbols used throughout the organization,
including a list of abbreviations, acronyms and symbols not to use.
3
Unacceptable Abbreviations
Abbreviation
U (for unit)
IU (for international unit)
Q.D.,
Q.O.D.
(Latin abbreviation for once
daily and every other day)
Trailing zero (X.0 mg)
[Note: Prohibited only for
medication-related notations];
Lack of leading zero (.X mg)
Reason for not using
Mistaken as zero, four or
cc
Mistaken as IV
(intravenous) or 10 (ten)
Mistaken for each other.
The period after the Q can
be mistaken for an "I" and
the "O" can be mistaken
for "I".
Decimal point is missed.
Alternative
Write "unit"
Write "international unit"
Write "daily" and "every
other day"
Never write a zero by
itself after a decimal
point (X mg), and
always use a zero
before a decimal point
(0.X mg)
MS
MSO4
MgSO4
Confused for one another.
Can mean morphine
sulfate or magnesium
sulfate.
Write "morphine
sulfate" or "magnesium
sulfate"
μg
(for microgram)
Mistaken for mg
(milligrams) resulting in
one thousand-fold dosing
overdose.
Write "mcg"
H.S.
(for half-strength or Latin
abbreviation for bedtime)
Mistaken for either halfstrength or hour of sleep
(at bedtime). q.H.S.
mistaken for every hour.
All can result in a dosing
error.
Write out "halfstrength" or "at
bedtime"
T.I.W.
(for three times a week)
Mistaken for three times a
day or twice weekly
resulting in an overdose.
Mistaken as SL for
sublingual, or "5 every".
Write "3 times weekly"
or "three times weekly"
D/C
(for discharge)
Interpreted as discontinue
whatever medications
follow (typically discharge
meds).
Write "discharge"
c.c.
(for cubic centimeter)
Mistaken for U (units)
when poorly written.
Write "ml" for milliliters
A.S., A.D., A.U.
(Latin abbreviation for left,
right, or both ears)
Mistaken for OS, OD, and
OU, etc.).
Write: "left ear," "right
ear" or "both ears"
S.C. or S.Q.
(for subcutaneous)
Write "Sub-Q", "subQ",
or "subcutaneously"
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ANTI-INFECTIVES
Mechanism of Action: Inhibit growth and replication of susceptible bacterial
organisms.
Use: For infections of susceptible organisms
Side Effects: Nausea, vomiting, diaherrea, bone marrow depression,
anaphylaxis
Contraindications: Allergy to drug. Cross sensitivity can occur. Patients
allergic to penicillin may also be allergic to cephalosporins. Aminoglycosides
(Gentamycin and Tobramycin) can be ototoxic and nephrotoxic.
Precautions: Impaired renal and liver function.
Nursing Implications: Assess for nephrotoxicity, bowel pattern, allergic
reactions, bleeding, yeast infection, overgrowth of infection. Monitor peak and
trough levels of gentamycin, tobramycin and vancomycin. Trough levels are
drawn prior to the next dose. Peak levels are drawn 30-60 minutes after
administration. Maintain dose schedules patient was started on.
Patient Education: Take all of the prescribed antibiotic. Report sore throat,
bruising or joint pain.
Aminoglycosides
Penicillins (PCN)
Tetracyclines
Extended
Spectrum
Penicillins
Carbenicillin
(Geopen)
Mezlocillin (Mezlin)
Amikacin sulfate
Amoxicillin (Amoxil)
Doxycycline
Azithromycin
(Zithromax)
Gentamicin
(Garamycin)
Neomycin (oral)
Amoxicillin/Clavulanat
e (Augmentin)
Ampicillin (Omnipen)
Minocycline
(Minocin)
Tetracycline
Piperacillin (Pipracil)
Ampicillin/Sulbactam
(Unysyn)
Imipenem/cilastatin
(Primaxin)
Penicillin G & V
Sulfonamides
Oxytetracycline
Ticarcillin (Ticar)
Sulfamethoxazole/
trimethoprim
(Bactrim)
Sulfacetamide
(Cetamide)
Sulfamethoxazole
Sulfadiazine
Chloramphenicol
(Chlormycetin)
Nitrofurantoin
(Furadantin)
Clindamycin
(Cleocin)
Erythromycin
Metronidazole
(Flagyl)
Trimethoprim
Streptomycin
Tobramycin
Penicillinase
Resistant PCN
Cloxacillin
Dicloxacillin
Nafcillin
Oxacillin
Misc.
Vancomycin
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Cephalosporins
1st Generation
Cefadroxil (Duricef)
Cefazolin (Ancef, Kefzol)
Cephalexin (Keflex)
Cephapirin (cefadyl)
Cephradine (Velosef)
Ciprofloxacin (cipro)
Enoxacin
Cephalosporins
2nd Generation
Cefaclor (Ceclor)
Cefamandole (Mandol)
Cefditoren pivoxil
(Spectracef)
Cefonicid (Monocid)
Cefotetan (Cefotan)
Cefoxitin (Mefoxin)
Cefprozil (Ceftin, Zinacef)
Loracarbef (Lorabid)
Fluoroquinolones
Levofloxacin (Levaquin)
Cephalosporins
3rd Generation
Cefdinir (Omnicef)
Cefepime (Maxipime)
Cefixime (Suprax)
Cefoperazone (Cefobid)
Cefotaxime (Claforan)
Cefpodoxime (Vantin)
Ceftazidime (Fortaz)
Ceftibuten (Cedax)
Ceftizoxime (cefizox)
Ceftriaxone (Rocephin)
Lomefloxacin
Anti-Anginals
Action: Dependent on the type of angina.
Nitrates: dilate coronary arteries reducing preload and dilate systemic arteries
decreasing after load.
Calcium Channel Blockers: dilate coronary arteries, decrease SA/AV node
conduction. Dipyridamole selectively dilates coronary arteries increasing
coronary blood flow.
Beta-adrenergic blockers: Decrease heart rate, which decreases myocardial O2
use.
Use: Chronic stable angina pectoris, unstable angina, vasospastic angina and
dysrhythmias and hypertension.
Side Effects: Postural Hypotension, headache, dizziness, edema, drowsiness, rash,
dysrhythmias, fatigue.
Contraindications: Increased intracranial pressure, cerebral hemorrhage.
Nursing Implications: Assess orthostatic blood pressure, history of chest pain,
Patient Teaching: Do not use OTC medications without consulting physician, report
dizziness, confusion or depression, monitor pulse at home and report when bradycardic,
avoid alcohol, smoking and salt, comply with weight control, dietary regime, and
exercise program, make position changes gradually top prevent fainting. For NTG if 3
sublinqual tabs in 15 minutes does not relieve pain, seek immediate medical attention.
Nitrates
Beta-Adrenergic Blockers
Calcium Channel Blockers
Amyl nitrate
Atenolol
Amlodipine
Isosorbide
Dipyridamole
Bepridil
nitroglycerine
Metoprolol
Diltiazem
Nadolol
Nicardipine
propranolol
Nifedipine
Verapamil
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Anticoagulants
Actions: Prevents blood clot formation.
Uses: Deep vein thrombosis, pulmonary emboli, myocardial infarction, stroke, open
heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with
embolization, transfusion, dialysis.
Contraindications: Hemophilia, leukemia with bleeding, peptic ulcer disease,
thrombocytopenic purpura, acute nephritis, subacute bacterial endocarditis
Side effects: hemorrhage, agranulocytosis, leukopenia, eosinophilia,
thrombocytopenia, rash, diaherrea, fever
Precautions: Elderly, alcoholism, pregnancy
Interactions: Salicylates, steroids, NSAIDS
Nursing Considerations: Monitor H/H and coags closely, watch for hypertension,
report any bleeding, administer at the same time each day,
Patient Teaching: Check with physician before taking OTC medications. Use soft
bristle toothbrush. Report any signs of bleeding.
MedsDrug
Labs to be monitored
Antidote
Coumadin (Warfarin)
PT, INR
Vitamin K
Lovenox (Enoxaparin)
Protamine Sulfate
Heparin
PTT
Protamine Sulfate
Anticonvulsants
Actions: Dependent on the type of anticonvulsant. Hydantoins inhibit seizure activity
in the motor cortex. Succinimides inhibit spike and wave formation and decrease
amplititude, frequency, duration, and spread of seizure activity.
Uses: Hydantions are used for generalized tonic-clonic seizures, status epilepticus,
and psychomotor seizures. Succinimides are used for petit mal seizures. Barbituates
are used in tonic-clonic seizures and cortical focal seizures.
Side Effects: Bone marrow depression, GI symptoms, gingival hyperplasia,
nystagmus, ataxia, slurred speech, mental confusion.
Contraindications: Allergies and hypersensitivities.
Precautions: Liver and renal disease.
Interactions: Decreased effects of estrogen and oral contraceptives.
Nursing Interventions: Monitor renal and liver function, assess mental status, blood
dyscrasias and toxicity. Give with meals to decrease GI side effects. Provide good oral
hygiene.
Patient Teaching: Carry medic alert bracelet, avoid activities, which require alertness.
7
Meds
Hydantoins
Fosphenytoin
(Cerebryx)
Phenytoin (Dilantin)
Succinimides
Ethosuximide
(Didronel)
Methsuximide
Miscellaneous
Acetazolamide
Paramethadione
(Diamox)
Carbamazepine
Phenacemide
(Tegretol)
Clonazepam
Phenobarbital
(Klonopin)
Diazepam (Valium) Primidone (Mysoline
Felbamate
Tiagabine (Gabatril)
Gabapentin
Topiramate
(Neurontin)
(Topamax)
Lamotrigine
Valproic acid
(Lamictal)
(Depekote)
Magnesium sulfate
Zonisamide
(Zonegran)
paraldehyde
Antidepressants
Actions: Tricyclics block the reuptake of norepineprine and serotonin. MAOI’s act by
increasing the concentration of epinephrine and norepinephrine, serotonin and
dopamine by inhibiting MAO. The SSRI’s act by decreasing the uptake serotonin.
Uses: Depression
Side Effects: Constipation, acute renal failure, hypertension, dizziness, drowsiness, dry
mouth, urinary retention, orthostatic hypotension
Contraindications: Convulsive disorders, prostatic hypertrophy, severe renal or
cardiac disease.
Precautions: Suicidal patients, schizophrenia, hyperactivity, diabetes
Interactions: Dependent on the drug. Many interactions.
Nursing Interventions: Orthostatic vital signs, weight q week, mental status
assessments, urinary retention, constipation, alcohol consumption. Give with food.
Gum and hard candy can help reduce the dry mouth.
Patient Teaching: Full effect of the medication can take up to two weeks. Avoid
activities requiring alertness until adjusted to the medication. Make position changes
gradually. Avoid alcohol and other central nervous system depressants. Do not
discontinue the medication abruptly. Wear sunscreen due to photosensitivity.
Meds
Tricyclics
Tetracyclics
SSRIs
Amitriptyline (Elavil)
Mirtazapine (Remeron)
Citalopram (Celexa)
Amoxapine (Asendin)
Escitalopram (Lexapro)
Miscellaneous
Clomipramine (Anafranil)
Bupropion (Wellbutrin)
Fluoxetin (Prozac)
Desipramine
Nefazodone (Serzone)
Fluvoxamine (Luvox)
Doxepin (Sinequan)
Trazodone (Desyrel)
Paroxetine (Paxil)
8
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Trimipramine
Venlafaxine (Effexor)
MAOIs
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Sertraline (Zoloft)
Antidiabetics
Actions: Antidiabetics are classified as insulin and oral hypoglycemics. The insulin’s
work by increasing the availability of insulin to the cells. Oral hypoglycemics work by
either reducing the cells resistance to insulin or by stimulating the beta cells of the
pancreas to produce more insulin.
Side Effects: Hypoglycemia, blood dyscrasias, hepatotoxicity, cholestatic jaundice
Contraindications: Hypersensitivity. Oral agents should not be used in brittle
diabetics, diabetic ketoacidosis, and severe renal or hepatic disease.
Precautions: Use in the elderly or with alcohol.
Interactions: Check individual medications.
Nursing Interventions: Assess blood sugar levels frequently. Rotate injections sites.
When mixing insulin’s always draw up the shortest acting insulin first. Never mix
Lantus.
Patient Teaching: Avoid alcohol and salicylates. Symptoms of hypoglycemia and
hyperglycemia. Test blood sugars per physician’s orders. Continue weight control, diet
and exercise programs. Obtain annual eye exams.
Meds:
Oral Hypoglycemics
Classification/Action
Sulfonylureas-Stimulate the pancreas to
produce more insulin.
Prandins- Increase the amount of insulin
in the bloodstream.
Biguanide- Decreases the liver’s
production of sugar
Thiazolinidinedione-Reduces the cells
insulin resistance.
Acarbose-Prevents the absorption of
sugar from the GI tract.
Drugs
1st Generation- chlorpropamide,
(Diabenese), tolbutamide (Orinase),
tolazimide (Tolinase)
2nd Generation- Glipizide (Glucotrol
amary,), glyburide (diabeta, micronase)
Repaglinide (Prandin)
Metaformin (glucophage)
Piolglitazone (actos), Rosiglitazone
(Avandia)
Acarbose (Precose)
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Diabetes Mellitus - Oral Medications
Class
Generic Name
Drug Name
Max Dose
Onset
Duration
Sulfonylurea
Chlorpropamide
Glyburide
Diabinese
Diabeta
Micronase
Glynase
Prestabs
Glucotrol
0.5g
20 mg
1 hr
1.5 hr
40 mg
Glucotrol XL
Amaryl
Tolinase
Orinase
Glucophage
20 mg
8 mg
1000 mg
3g
2550 mg
Glucophage XR
2000 mg
Riomet
Glumetza
Fortamet
2550 mg
1000 mg
Biguanide
Glipizide
Glipizide
(long acting)
Glimepiride
Tolazamide
Tolbutamide
Metformin
Metformin
(long-acting)
Metformin
(liquid)
Metformin HCl
Metformin
Sulfonylurea +
Biguanide
Glucosidase
Inhibitor
TZD
TZD+ Biguanide
Meglitinide
Glyburide +
Metformin
Glipizide +
Metformin
Acarbose
Glucovance
Metaglip
Precose
Miglitol
Pioglitazone
Rosiglitazone
Rosiglitazone +
Metformin
Nateglinide
Repaglinide
72 hr
24 hr
Suggested
Dose
0.1 - 0.5 g
1.25 - 10 mg
Dose per
Day
1
1-2
Relation
to Meals
30 min bef. meal
30 min
Before meal
15 – 30 min
12 – 24 hr
2.5 – 20 mg
1–2
30 min bef. meal
2 - 3 hr
2 - 3 hr
24 hr
24 hr
2.5 – 20 mg
1 - 4 mg
100-500 mg
1
1
1
not dose
dependent
~ 6 hr
500 - 850 mg
2-3
w/ meals
30 min bef. meal
w/ meal
30 min bef. meal
w/ meals
24 hr
500-2000 mg
1
w/ meals
24 hr
24 hr
500-850 mg
500-1000 mg
500-1000 mg
1-2
1
1
w/ meals
w/ meals
w/ meals
1-2
w/ meals
1-2
3
1.5 hr
24 hr
20mg/2000mg
300 mg
1 hr
Immediate
~ 6 hr
1.25mg/250mg
to 5mg/500mg
2.5/250 mg –
5/500 mg
25 - 100 mg
Glyset
Actos
Avandia
300 mg/day
45 mg
8 mg
Immediate
30 min
30 min
24 hr
> 24 hr
25-50mg
15 - 45 mg
2 - 8 mg
3
1
1-2
w/ meals
w/ 1st bite
of ea main meal
w/ 1st bite
Doesn’t matter
Doesn’t matter
Avandamet
Starlix
Prandin
8 mg/2000 mg
360 mg
16 mg
60 - 120 mg
0.5 - 4 mg
2
3
2-4
w/ meals
immed bef. ea meal
15 min bef. meal
20 mg/
2000 mg
20 min
15 min after
start of meal
4 hr
4 hr
10
Onset, Peak and Duration of Human Insulin Preparations
Insulin Preparation
Rapid-acting
Lispro or Aspart insulin
Combinations of Rapid-acting
Humalog 75/25 Lispro/NPH)
Novolog 70/30 (Aspart mix)
Short-acting
Regular
Intermediate-acting
NPH
Lente
Long-acting
Ultralente
Insulin Glargine (Lantus)
Combinations of
Regular/NPH
70/30 and 50/50
Onset of
Action
Peak Action
Effective Duration
of Action
Maximum
Duration of Action
10-15 min
30-90 min
3-4 hrs
4-6 hrs
10-15 min
10-15 min
Dual
2.4 hrs
10-16 hrs
10-16 hrs
14-18 hrs
24 hrs
30-60 min
2-3 hrs
3-6 hrs
6-8 hrs
2-4 hrs
3-4 hrs
6-10 hrs
6-12 hrs
10-16 hrs
12-18 hrs
14-18 hrs
16-20 hrs
6-10 hrs
1 hr
10-16 hrs
N/A
18-20 hrs
24 hrs
20-24 hrs
24+ hrs
30-60 min
Dual
10-16 hrs
14-18 hrs
St. David’s Medical Center/Diabetes Center
Antihypertensives
Drug
Ace Inhibitors- benazepril, enalapril,
fosinopril, quinapril, ramipril, trandolapril
Angiotension II Receptor Blockercandesartan, irbesartan, losartan,
telmisartan, valsartan
Centrally acting adrenergics- clonidine,
guanabenz, guanfacine, methyldopa
Peripherally acting anitadrenergicsguanadrel, guanethidine, prazosin,
reserpine, terazosin
Vasodilators- diazoxide, fenoldopam,
hydralazine, minoxidil, nitroprusside
Action
Reduce conversion of angiotension I to
angiotension II resulting in dilation of
arterial and venous vessels.
Reduce conversion of angiotension I to
angiotension II resulting in dilation of
arterial and venous vessels.
Reduces impulses in the sympathetic
nervous system resulting in decreased BP,
pulse and cardiac output.
Inhibits sympathetic vasoconstriction by
inhibiting the release of norepinephrine.
Relaxes arteriolar smooth muscle resulting
in vasodilatation.
Side Effects: Hypotension, bradycardia, tachycardia, headache. Ace inhibitors can cause a
rise in the serum potassium.
11
Nursing Interventions: Monitor response to medication, daily edema checks, monitor renal
function tests, monitor electrolytes. ACE inhibitors may result in a rise in the potassium
level. For drugs causing hypotension, administer these medications at bedtime.
Patient Education: Comply with medication schedule even when feeling better. Change
positions carefully to prevent orthostasis.
Beta Blockers
Action: B-Blockers are antianginals, antiarrhythmics, and antihypertensives. Decrease the
excitability of the heart, cardiac workload and O2 consumption, and lower BP Used to treat
hypertension, angina pectoris caused by atherosclerosis, and for migraine headaches
Prevention of reinfarction in clinically stable patients 1-4 wk after MI.
Side Effects: Orthostatic hypotension, bradycardia, blood dyscrasias.
Nursing Interventions: Do not stop drug abruptly after chronic therapy; taper over 2 weeks.
Give oral drug with food to facilitate absorption. For diabetic patients: be aware that the
normal signs of hypoglycemia (sweating, tachycardia) may be blocked by this drug; monitor
blood/urine glucose carefully
Patient Education: Comply with drug regime even when feeling better. Make position
changes gradually to prevent orthostasis. Take pulse and report if bradycardic. Do not
discontinue the drug abruptly.
Common Names: Atenolol (Tenormin), Metoprolol (Lopressor), Lebetolol (Normodyne),
Nadolol (Corgard), Propanolol (Inderal), Timolol (Timoptic)
Calcium Channel Blockers
Uses and Actions: Used for the management of angina and hypertension. Depresses
myocardial contractility and dilates coronary arteries and arterioles and peripheral arterioles;
these effects lead to decreased cardiac work. Acts on slow calcium channels in vascular
smooth muscle and myocardium.
Side Effects: Dysrhythmias, edema, headache, fatigue, drowsiness, flushing.
Nursing Interventions: Do not chew or divide sustained-release tabs. Protect drug from
light and moisture. Small frequent meals with GI upset.
Patient Education: Take pulse prior to administration. Avoid hazardous activity until
stabilized. Do not divide sustained release tabs. Protect from light and moisture. Take with
food. Eat small frequent meals if GI upset occurs.
Common Names: Nifedipine (Procardia), Verapamil (Isoptin, Calan), Diltiazem (Cardizem)
12
Corticosteriods
Actions & Uses: Glucocorticoids decrease inflammation and are immunosuppressive.
Mineralocorticoids are used for adrenal insufficiency.
Side Effects: Insomnia, euphoria, GI irritation, hypokalemia, hyperglycemia, sodium and
fluid retention, swelling, elevated WBC
Nursing Implications: Assess potassium, blood sugar, edema and intake and output.
Weigh daily. Report changes in mental status.
Patient Education: Do not discontinue medication abruptly. Take with foods to prevent GI
side effects. Increases susceptibility to infections.
Common Names: Glucocorticoids- beclomethasone (Vanceril), betamethasone (Celestone),
cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone,
triamcinolone. Mineralocorticoid-fludrocortisone
Diuretics
Uses and Actions: Divided into several subgroups:
• Thiazide and Related Diuretics: inhibit reabsorption of sodium and chloride –
increasing excretion of sodium, chloride, and water by kidney
• Loop Diuretics: act in the loop of Henle and distal renal tubule – more potent
• Potassium-sparing Diuretics: overall effect is much weaker but conserve
potassium while promoting sodium excretion within the body.
• Osmotic Diuretics: pull fluid out of the tissues with a hypertonic effect
Used in adjunctive therapy in edema associated with CHF, cirrhosis, corticosteroid and
estrogen therapy, renal dysfunction, HTN
Side Effects: Hypokalcemia, hyperuricemia, hyperglycemia, blood dyscrasias, volume
depletion
Nursing Interventions: Administer early in the day so increased urination will not disturb
sleep. Measure and record body weight. Monitor labs for serum electrolyte, glucose and
BUN imbalance. Increased dose of anti-diabetic agents may be needed.
Patient Education: Take drug early in the day.
13
Pain Medications
Nonopoid analgesics- used for the relief of mild to moderate pain.
AcetaminophenActions-Blocks peripheral pain impulses and blocks prostaglandin synthesis.
Dose- 650-1000 mg every four hours to a maximum dose of 4000 mg in a 24 hour
period.
Precautions- Use with caution in liver disease but may still be used but lower doses
and less frequent dosing required. Renal or liver damage will result after chronic long-term
use.
Interactions-carbamazepine, hydantoins, barbiturates, rifampin, sulfinpyazone.
Nursing Interventions- Monitor liver and renal function tests. Document type, source
and intensity of pain. Monitor reaction to medication
Patient Education-Do not exceed maximum daily dose of 4000 mg a day. Acute
toxicity symptoms include, nausea, vomiting, abdominal pain and fever. Report pain or fever
that persists for longer than three days.
Nonsteriodal anti-inflammatory drugs (NSAIDS)
Actions: Decrease pain receptor sensitivity and inhibit prostaglandin synthesis.
Dose: IBUPROFEN-200-400 mg every four to six hours with a maximum dose of of
1200 mg a day. NAPROXEN 250-500 mg twice a day not to exceed 1000 mg a day.
INDOMETHACIN 25-50 mg a day not to exceed 200 mg a day. KETOROLAC (Toradol) 20
mg PO initially then 10 mg every 4-6 hours not to exceed 40 mg a day. 30 mg IV or IM as a
single dose or, 15 mg every 6 hours to a maximum of 60 mg a day for no more than 5 days.
Precautions: GI bleeding, decreased renal function, hyponatremia, decreased liver
function.
Interactions: Lithium, methotrexate, digoxin. Increased PT times with Coumadin,
ACE inhibitors, thiazide diuretics, beta-blockers.
Opiods-used for the relief of chronic and severe pain.
Actions: Depresses pain impulse transmission at the spinal cord by binding to the opiod
receptors.
Dose: Mu Opioids Morphine 2-20 mg IM/IV/PO titrated for adequate pain relief. Fentanyl 25100 micrograms titrated for adequate pain relief. Dilaudid 2-4 mg IV/PO titrated for adequate
pain relief. Mild Opioids Hydrocodone- 5-10 mg PO q 4 hrs prn. Oxycodone- 10-30 mg PO q
4 hrs prn. Codeine 15-60 mg PO/IM q 4 hrs titrated for adequate pain relief.
Precautions: Increased intracranial pressure, severe heart disease, pulmonary disease,
seizure disorders
Interactions: Barbituates, hypnotics, antipsychotics, alcohol.
Nursing Interventions: I&O to assess for urinary retention, respiratory rate, CNS
assessment, allergic reactions, pain scoring by patient, evaluate therapeutic response
Patient Education: Report any symptoms CNS changes, if used for extended periods
14
Antidotes
Flumazenil (Romazicon)
Actions: Reverses the effects of benzodiazepines such as Versed on the CNS.
Dose: 0.2 mg IV over 15 seconds. May repeat at 60-second intervals to a max dose of 3
mg/hour until respiratory depression is adequately reversed.
Precautions: Renal disease, seizure disorders, head injuries, pregnancy, liver disease,
panic disorder, drug and alcohol dependency.
Nursing Interventions: Continuous cardiac monitoring, assess for seizures, give over 15
seconds into a running IV.
Patient Teaching: Amnesia may continue, avoid hazardous activities for 24 hours after
administration, do not consume alcohol for 24 hours.
Naloxone (Narcan)
Actions: Competes with opioids at opiate receptor sites thereby reversing the effects of
opioids and subsequent respiratory depression.
Dose: 0.4-2.0 mg titrated until adequate respiratory response is achieved. May repeat
every 2-3 minutes until adequate response is achieved.
Precautions: Cardiovascular disease, opioid dependency, pregnancy, lactation
Nursing Interventions: withdrawal symptoms may occur in opioid dependent individuals
up to 2 hours after administration, continuous cardiac monitoring for tachycardia, frequent
respiratory assessments, use only when resuscitative equipment is nearby.
Moderate Sedation
Patient Care
Pre Sedation-Assess height, weight, diagnoses, review history and physical. Obtain
baseline vital signs, pulse oximeter reading and level of consciousness ASA risk
category. Patient teaching.
Class 1
Class 2
Class 3
Class 4
Class 5
American Society of Anesthesiologists Risk Classifications
Normal healthy patient. No systemic disease.
Mild to moderate systemic disease
Severe systemic disease with functional limitations that are nonincapacitating.
Severe systemic disease that is incapacitating and life-threatening.
A moribund patient not expected to survive 24 hours without surgery.
Sedation-Continuous pulse oximeter readings assess level of consciousness, vital
signs every 5 minutes, cardiac monitoring.
15
Modified Ramsay Scale
Awake States
Sleep States
1. Patient Anxious, agitated or restless 4. Patient asleep, sluggish response to
loud auditory stimulus.
2. Patient cooperative, oriented and
5. Patient has no response to loud
tranquil.
auditory stimulus but responds to pain.
3. Patient asleep but with brisk
6. Patient does not respond to painful
response to loud auditory stimulus. stimuli.
Post Sedation- Close monitoring of vital signs, cardiac rhythm, pulse oximeter, level of
consciousness. Patient may not be discharged to home until discharge criteria have
been met.
PARSAP-Post Anesthesia Recovery Scores for Ambulatory Patients
Activity
Able to move all extremities voluntarily on command.
Able to move 2 extremities voluntarily on command
Able to move no extremities on command
Respiration
Able to breathe deeply and cough freely.
Dyspnea or limited breathing.
Apneic
Circulation
BP +20 of preanesthetic level
BP +21-49 of preanesthetic level
BP + 50 of preanesthetic level
Consciousness
Fully awake.
Arousal on calling.
Not responding.
Oxygen Saturation Able to maintain O2 sats > 90% on room air.
Needs oxygen to maintain O2 sats > 90% on room air.
Unable to maintain O2 sats >90% even with oxygen
Dressing
No dressing or, dry.
Wet but no additional drainage accumulating.
Wet with new drainage accumulating.
Pain Free
Pain free
Mild Pain
Pain requiring parental medications.
Ambulation
Able to stand up and walk straight.
Vertigo when erect.
Dizziness when supine.
Oral Intake
Able to drink fluids
Nauseated
Nausea with vomiting.
Urine Output
Has urinated a sufficient quantity.
Unable to void but comfortable.
Unable to void and uncomfortable.
Score of 18-20 indicates readiness for discharge.
2
1
0
2
1
0
2
1
0
2
1
0
2
1
0
2
1
0
2
1
0
2
1
0
2
1
0
2
1
0
16
Moderate Sedation Pharmacological Agents
Drug
Benzodiazpines
Versed
(midazolam)
Onset
IV: 1-5 mins
IM:5-15 mins
Peak
IV:2 mins
IM:15-60 mins
Duration
IV:20-40 mins
IM:1-6 hrs
Antagonist
Romazicon
(Flumazenil)
Valium
(diazepam)
IV: 10 mins
1-8 hrs
Romazicon
(Flumazenil)
Ativan
(lorazepam)
IV: 1-5 mins
PO:15-16
mins
IV: 5-10 mins
IM:15-30 mins
Usual Dose
0.5-2 mgs over 2
mins. May repeat
half dose every 5
mins not exceeding
4 mg.
2.5-10 mgs. Max
dose 20 mg.
Up to 40 mins
4-6 hrs
Romazicon
(Flumazenil)
0.5-2 mg. Max 2 mg
IV, 4 mg IM.
Opiods/Narcotic
Fentanyl
(Sublimaze)
IV:1-3 min
IM:7-8 min
TD:5-15 min
IV:5-15 min
IM:15-20 min
TD:1-2 hrs
IV:20-60 min
IM:1-2 hrs
TD:1-2 hrs
Narcan
(Naloxone)
25-50 mcg. May
repeat 25 mcg every
5 mins.
Morphine
IV:1-3 mins
IM:10-45 min
PO:50-60 min
IV:2-5 min
IM:10-45 min
PO: 15-45
min
IV:1-2 mins
IV:10-20 min
IM:30-60 min
PO: 1-2 hrs
IV:5-35 min
IM:35-50 min
PO: 60-90 min
IV:1-4 hrs
IM:4-5 hrs
PO: 4-5 hrs
3-4 hrs
Narcan
(Naloxone)
1 min
3-10 min
NONE
2.5-10 mg IV slowly
may repeat 2-5 mg
every 5 mins.
20-50 mg IV over 2
mins. May repeat
10-15 mg every 5-10
min.
25-100 mcg/kg/min
may be as an
infusion.
IV: < 15 secs
IM:3-4 min
IV:1 min
IM:12-25 min
IV:5-15 min
IM12-25 min
NONE
Demerol
(meperidine)
Sedative
Hypnotics
Diprivan (propofol)
Dissociative
Ketalar
(Ketamine)
Narcan
(Naloxone)
IV: 0.5-1 mg/kg
IM:2.5-5 mg/kg
Oral:5-6 mg/kg
Notes
Give slowly.
Elderly may have
paradoxical
excitement.
May repeat at 5-10
min intervals with 1
mg.
May repeat at 5-10
min intervals.
Causes prolonged
sedation.
Give slowly to
prevent chest wall
rigidity. Apnea may
occur. 2nd peak
possible. Use with
caution in asthma &
COPD.
Give slowly. Assess
pain level and BP.
Use cautiously in
liver and renal dz.
Do not use if pt is
using MAO inhibitors
Watch for low BP,
low pulse and resp
depression. May
mix with Lidocaine to
decrease pain on
injection.
Pediatric pts may
need atropine prior
to administration.
17
Complications of Moderate Sedation:
Over or under sedation
Respiratory insufficiency
Airway obstruction
Aspiration
Hemodynamic instability
Dysrhythmias
Cardiac arrest
Pain
Nausea and vomiting
Malignant hyperthermia
Paradoxical reactions
General St. David’s Healthcare Partnership Requirements for administering Moderate
sedation.
Must have had advanced training and competency checks completed for
moderate sedation.
ACLS certified.
TPN and Lipids
General Information / Use
⊥ TPN or total parental nutrition – is nutritional support supplying glucose, protein, vitamins,
electrolytes, trace elements, and sometimes fats to maintain body’s growth, development
and tissue repair. Sometimes you may also hear this therapy referred to as intravenous
hyperalimentation.
⊥ Lipids or Fat Emulsions - are a natural product consisting of a mixture of neutral
triglycerides of predominantly unsaturated fatty acids; permits inclusion of the fat calories
in the intravenous regimen.
⊥ TPN modalities for nutritional support:
Peripheral parental nutrition
Central parental nutrition
Two-in-one therapy solutions
Three-in-one therapy solutions
Cyclic therapy
Specialized parental formulas
Purpose
⊥ The purpose of TPN and lipids is to offer an alternative way to provide nutritional support
for someone that is unable to obtain or sustain their nutritional need in the normal manner.
Patient conditions that warrant candidacy for TPN
⊥ Patients who would be good candidates for TPN are those who suffer from a multiplicity of
problems and whose clinical course can be complicated by malnutrition and depletion of
body protein.
18
⊥ Candidates for TPN include but are not limited to:
Delayed wound healing
Postoperative complications
Predisposition to intraoperative complications
Difficulty in refeeding
GI problems such as Crohn’s disease, short bowel syndrome, bowel obstruction,
fistulas, pancreatitis, inflammatory bowel disease, malabsorption, and radiation
enteritis, Ulcerative colitis
Acquired Immuniodeficiency Syndrome (AIDS)
Trauma
Severe burns
Anorexia nervosa
Immunocompromised states such as bone marrow transplants
Cancer cachexia
Hyperemesis associated with pregnancy
Standard of Practice for Nutritional Support
⊥ Parental formulations shall be prepared according to established guidelines for safe and
effective nutritional therapy
1.
2.
3.
4.
Parental formulations shall be sterile.
Parental formulations should be stored at 4 degrees C.
Nothing should be added to the TPN once it is infusing
Always verify placement of a central line prior to administering (x-ray is a good way to do
this).
5. After TPN has been initiated:
- Start TPN slowly
- Check temperature and vital signs every 6 hours
- Monitor blood sugar every 6 hours
- Maintain strict I&O
- Daily weights
- Decrease TPN solutions gradually
- Change TPN and Lipid administration sets every 24 hours
6. Laboratory parameters to check twice weekly:
- Liver function
- Electrolyte profile
- BUN and creatinine
7. Intravenous Nursing Society Standards of Practice (1990)
- All parental nutritional solutions should be filtered with a 0.22-micron filter except when
lipid emulsions are added to these solutions, at which time a 1.2-micron filter should
be used.
- Solutions should be mixed and obtained from Pharmacy
- No medications should be added to these solutions once they are infusing.
- Except for lipid emulsions, no IV push or piggyback medications should be added to
this line.
- All TPN and Lipid administration sets should be changed every 24 hours, coinciding
with solution bag changes.
19
Characteristics of Parental Nutrition:
Carbohydrates
Fats
Vitamins
Protein (amino acids)
Electrolytes
Trace elements
a. Carbohydrates – provide energy and spare the body protein. When Glucose is provided
parenterally, it is completely bioavailable to the body without any effects of malabsorption.
Note: when infusing 20 to 50% dextrose solutions the rate must be kept within 10% of the
prescribed order. The pancreas secretes extra insulin to metabolize infused glucose. If
20 to 50% dextrose is discontinued suddenly, a temporary excess of insulin in the body
may cause symptoms of hypoglycemia.
During the critical phase of illness or injury, carbohydrate metabolism is radically altered.
Hyperglycemia is a hallmark of stress.
b. Protein – is a body building nutrient that functions to promote tissue
Growth and repair, wound healing and replace body cells. Protein is also a
component in antibodies, scar tissue, and clots. Enzymes, hormones, and carrier
substances also require protein for development. Protein contributes to energy needs,
however this is not its major purpose.
Amino acids – are the basic unit of protein. There are 8 essential amino acids for adults,
with newborns requiring a 9th.
c. Fats (Lipid Emulsions) – is the primary source of heat and energy. Fat provides twice as
many energy calories per gram as either protein or carbohydrate. Fat is essential for
structural integrity of all cell membranes. Linoleic acid is the only fatty acids essential to
humans. These two acids prevent essential fatty acid deficiency (EFAD).
Note: the primary purpose of fat emulsions is TPN is to prevent or treat EFAD with
infusions of 2-3 500 ml bottles of 10-20% fat emulsions per week.
d. Electrolytes – are infused either as a component already contained in the amino acid
solution or as a separate additive. The electrolytes necessary for long-term TPN include
potassium, magnesium, calcium, sodium, chloride, and phosphorus. Electrolytes must be
individually compounded and can be highly variable in the patient receiving TPN.
Choice of each of these salts depends on renal and cardiac functioning, diseasespecific needs, acid base balance, and any abnormal losses during the course of
the illness.
e. Vitamins – are necessary for growth and maintenance, along with multiple metabolic
processes. The exact vitamin requirements are controversial, and certain disease states
can alter vitamin requirements.
f. Trace elements – are found in the body in minute amounts. Basic requirements are very
small and measured in milligrams. Each trace element is a single chemical, and each has
an associated deficiency state. The many functions of trace elements are often
synergistic.
20
Peripheral Parental Nutrition (PPN)
ο
Designed for mildly stressed patients who fall into the following categories:
a. Patients in whom central venous access is either impossible or
contraindicated.
b. Patients with no fluid restrictions.
c. Patients able to tolerate fat emulsions.
d. Patients expected to resume enteral feeding within 7-10 days.
Generally, PPN provides dextrose in percentages below 20% with 500ml of amino acids and
fat emulsions via the peripheral line. Usually used less than 3 weeks. PPN can be delivered
via an over-the–needle catheter (OTN) or by a PICC line. Because this is delivered
peripherally, it is recommended that the osmolarity not exceed 900mOsm to prevent phlebitis.
ο
ADVANTAGES OF PPN:
Avoid insertion and maintenance of a central catheter.
Delivers less hypertonic solutions than central venous TPN.
Reduces the chance of metabolic complications compared to central
venous TPN
Increases calorie source, along with fat emulsions.
ο
DISADVANTAGES OF PPN:
Cannot be used in nutritionally depleted patients.
Cannot be used in volume-restricted patients, as higher volumes of
Solutions are needed to provide adequate calories.
Does not generally increase a patient’s weight.
May cause phlebitis owing to the osmolarity of the solution.
Central Parental Nutrition (CPN)
TPN by central line reverses starvation and adequately achieves tissue synthesis, repair, and
growth. TPN solutions are usually or always administered through a central vein because of
the high concentration of dextrose and the hypertonicity and hyperosmolarity of the solution.
By infusing this solution into the central venous system there is less incidence of phlebitis,
and the highly concentrated formula can be rapidly diluted.
ο
ADVANTAGES OF CPN:
Dextrose solutions of 20% to 70% administered as calorie source.
Useful for long-term therapy (usually longer than 3 weeks).
Useful for patients with large caloric intake and nutrient needs.
Provides calories, restores nitrogen balance, replaces essential vitamins,
electrolytes, and minerals.
Promotes tissue synthesis, wound healing, and normal metabolic function.
Allows bowel rest and healing.
Improves tolerance to surgery.
Is nutritionally complete.
21
ο
DISADVANTAGES OF CPN:
Requires a minor surgical procedure to insert the central line.
May cause metabolic complications: glucose intolerance, electrolyte
imbalances, EFAD.
Fat emulsions may not be used effectively in severely stressed patients
(Especially burn patients).
Risk of pneumothorax or hemothorax with central line insertion.
Two-in-One and Three-in-One Solutions
⊥ The two-in-one solution mixes dextrose and amino acids; while the three-in-one solutions
mix fats, amino acids and dextrose in one container. This has been found to be efficient
and cost-effective. This 3-liter container is mixed in the pharmacy and is to be infused
over 24 hours. These admixtures have been shown to be stable and well tolerated by
patients via central line administration.
⊥ The three-in-one solution is white and should be observed for pink discoloration and for
separations of oils this could indicate bacterial growth.
Cyclic Therapy - (C-TPN)
⊥ This is for patients requiring long-term parenteral nutritional support. This therapy delivers
concurrent dextrose, amino acids, and fats over a regimen of reduced time frame, usually
12-18 hours, versus a 24-hour continuous infusion.
Metabolic Complications
Hyperglycemia and Hyperosmolar Syndrome
Because the dextrose concentration in TPN is high, hyperglycemia is a common metabolic
occurrence.
Nursing Considerations
1. Begin TPN infusion at a slow rate (40-60 ml’s per hour).
2. Gradually increase the rate 25ml per hour until maximum infusion rate.
3. Maintain a steady rate of infusion (within 10% of the prescribed rate).
4. Use a rate control device to monitor the infusion (pumps are ideal).
5. Blood sugar checks should be performed every 6 hours, particularly during the first week
of infusion.
6. Accurate I&O recording every 8 hours.
7. Measure hourly urine output if urinary losses are above 250ml/hr.
8. Check daily weights using the same scale. Ideally the weight gain for patients receiving
TPN is approximately
2 lb/wk.
9. Monitor vital signs at regular intervals. Look for signs of hypovolemia.
22
Post infusion Hypoglycemia
This can occur if the TPN is DC’d abruptly.
Always wean patients from TPN in increments of 25-40 ml/hr over 24-48 hours.
If using C-TPN, gradually initiate and decrease the solution.
Electrolyte Imbalance
The complications associated with metabolic imbalances when administering TPN are either
avoidable or controllable. Major electrolyte imbalances occur when excessive or deficient
amounts of electrolytes are supplied in the daily fluid allowance.
Nursing considerations
1. Observe for signs and symptoms of hypophosphatemia, hypokalemia,
hypomagnesaemia, and hypernatremia. Refer to a nursing textbook for review of signs
and symptoms.
2. Chemistry panels should be drawn every 3 days to check electrolyte levels.
Essential Fatty Acid Deficiency (EFAD)
Fat administration is important for the delivery of essential fatty acids. If fats are not included
in the nutritional support regimen, the patient is at risk for EFAD.
Parental Injections
¤
Parenteral administration of medications is given by injection into body tissues. There
are four common routes: Subcutaneous (SQ); Intradermal (ID); Intramuscular (IM); and
Intravenous (IV).
•
•
•
•
Subcutaneous: medication is placed into the loose connective tissue under the
dermis. If circulatory status is normal then drug absorption from this site is
complete. The patient’s body weight will indicate the depth of the SQ layer. This
route should give only water-soluble medications.
Intradermal: is typically used for skin testing.
Intramuscular: the greater the vascularity of muscle tissue allows for speedier
absorption of medication. In this procedure, weight is a determining factor in
choosing the length of the needle to be used.
• Z-track Method: used for medications, which are known tissue irritants.
Displacing the skin laterally prior to injection creates a zigzag path. Then the
medication is deposited deep within the muscle. After injection of
medication and needle is removed, release the tissue. A zigzag path is
created which keeps the medication deposited where it was initially placed.
IV Administration: Typically, three different methods are used: as an admixture
with large volumes of IV fluids, as an injection or bolus of a small amount of
medication usually through an existing IV line or heparin or saline lock, or as a
piggyback infusion. The tissue circulation is the most important factor affecting
the rate of drug absorption from the parenteral route.
Advantages
23
-
-
-
fast acting
drugs may
be
delivered
quickly
constant
therapeutic levels of a drug may be maintained
some medications which are highly irritating to tissues would not be
administered comfortably either by the IM or SQ routes
A
A Intradermal
B Subcutaneous
C Intramuscular
D Intravenous
A Intradermal: 26 or 27-gauge, ½ 5/8 inch needle inserted at 10 - 15º
angle.
Subcutaneous: 25 or 27 gauge, ½ 5/6 inch needle inserted at 45 - 90º
angle
24
Intramuscular: 20 or 23 gauge, 1 - 3
inch needle inserted into a relaxed
muscle at a 90º angle with a dartthrowing kind of hand movement.
A Guide to Intramuscular Injection
Muscle
Injection
Needle Size
Comments
Volume
1.0 ml – 5.0
20 – 23 gauge,
Deep IM, Z-track,
ml
1½ - 3 in
large volume, any
drug that can be
given IM
Gluteus medius or minimus
Vastus
1.0 ml – 5.0
22 – 25 gauge,
Any drug that can
lateralis
ml
1½ - 2 in
be given IM – not
Z-track
Rectus femoris
1.0 ml – 2.0
22 – 25 gauge,
Small-volume
ml
½ - 1 in
injections; used for
infants
Deltoid (not
0.5 ml – 1.5
23 – 25 gauge,
Small volume;
used in
ml
5/8 - 1 in
often used for
children under
opioids, sedatives
3 years of age
or vaccines
25
Z-Track
26
Conversions
Weight
1 grain
60 mg.
1 gram
15-16 grains
1 ounce
30 grams
1000 micrograms
1 mg
1000 mg
1 gram
16 oz.
1 lb.
1kg.
2.2lbs.
1000
kilo
100
hecto
10
deca
1.0
meter,
liter,
gram
1ml
1000ml
1000 liters
1 pint
1 teaspoon
1 drop
1 tablespoon
1 glass
0.1
0.01
deci
centi
Volume
0.001 liters
1 liter
1 kiloliter
16 fluid ounces
60 drops
1 minim
4 teaspoons
8 ounces
0.001
0.000001
milli
millionth
Practice Problems:
1. 1000 cc = _________ liter(s)
6.
10 g = _________ kg
2. 60 ml = ___________ liter (s)
7.
500 l = _________ ml
3. 25 mm = __________ m
8.
6 g = __________ mg
4. 250 mg = __________ g
9.
250 cc = _______ ml
5. 20000g = __________ kg
10. 500 mg = ______ g
Calculations
IV Calculation:
(amount x gtt factor) = gtts
time in minutes
min
Medication Infusion:
(medication dose per hour x total volume) = amount
medication on hand
hour
Medication Calculation:
(ordered dose x total volume) = dose
available dose
27
Formulas:
Dimensional analysis:
gtts X
cc/ml
cc/ml
hour
X
Ratio Proportion:
hour
min
Amount of fluid X gtt factor = gtts/min
time in minutes
Complete the following problems and show your work:
1.
Ordered:
Heparin 1200u per hour
Available:
IV mixture 25,000U/500cc D5W
Answer:
2.
cc / hr
Ordered:
Lanoxin 0.25mg IVP
Available:
Ampule contains 500mcg / 2cc
Answer:
3.
Ordered:
cc s
Kefzol 500mg in 50cc D5W over 30 minutes
Drip factor is 20 gtts / cc
Answer:
4.
gtts / minute
Ordered:
Ceclor 500mg via PEG tube every 6 hours
Available:
Elixir is 375mg / 5cc
Answer:
cc s
28
5.
Ordered:
Timentin 3gm IVPB in 100cc D5W every 4
hrs
Gtt factor is 15 gtts / minute over 15 minutes
Answer:
6.
gtts / minute
Ordered:
Synthroid 0.150mg qd
Available:
Synthroid 100mcg tablets
Answer:
7.
Ordered:
tabs
KCl 40mEq in 100cc D5W via pump
Administer over 90 minutes
Answer:
8.
Ordered:
cc / hr
Timentin 3gm IVPB in 100cc D5W every 4
hrs
Administer over 40 minutes per pump
Answer:
cc/hr
29
Answer Key
Conversions
1.
2.
3.
4.
5.
1 Liter
0.06 liter
0.025 m
0.25 g
20 kg
6. 0.01 kg
7. 500,000 ml
8. 6000 mg
9. 250 ml
10. 0.5 g
Calculations
1.
2.
3.
4.
24 cc /hr
1 cc
33.3 gtts / min
6.6 cc
5.
6.
7.
8.
100 gtts / min
1.5 tablets
66 cc / hr
150 cc / h
30
NOTES
31