es
Celsius and Fahrenheit
Temperature Equivalents
oc
Comparison of Standard and International/ Military Time
OF
STANDARD
INTERNATIONAL/
MILITARY
STANDARD
INTERNATIONAL/
MILITARY
AM
AM
PM
PM
1:00
0100
1 :00
1300
2:00
0200
2:00
1400
34.........................................
93.2
35.........................................
95.0
36 .........................................
96.8
37.........................................
98.6
3:00
0300
3:00
1500
38.........................................
100.4
4:00
0400
4:00
1600
5:00
0500
5:00
1700
6:00
0600
6:00
1800
7:00
0700
7:00
1900
39.........................................
102.2
40.........................................
104.0
41.........................................
105.8
8:00
0800
8:00
2000
42.........................................
107.6
9:00
0900
9:00
2100
43.........................................
109.4
10:00
1000
10:00
2200
11:00
1100
11 :00
2300
12:00 noon
1200
12:00 midnight
2400
• To convert °C to 0 P, multiply
by 1.8 and add 32.
• To convert 0 P to °C, subtract
32 and divide by 1.8.
Acceptable Drug Administration Abbreviations
In recent years, abbreviations l1ave been identified as a major cause
of medication e1Tors. At tl1e present time, only tl1ose listed have not
been targeted for deletion. Read Cl1apter 7 for additional details.
a.c.
before meals
ad lib
as desired
b.i.d.
two times a day
cap
capsule
elix.
elixir
ext
extract
IM
intramuscular
IV
intravenous
nigl1tly
every nigl1t at bedtime
NS (N/S)
normal saline
OD
right eye
OS
left eye
OU
both eyes
p.c.
after meals
per
by
PO; orally
by moutl1
p.r.n.
w l1en necessary/required
soln.
solution
stat.
at once; immediately
subcut.
subcutaneous
supp.
suppository
.
susp.
suspension
syp.
syrup
tab
tablet
tr. or tinct.
tincture
ung
ointment
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CURR EN'S
DOSAGES & SOLUTIONS
ELE E TH EDIT
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Cengage
Curren's Ma th for Meds: Dosages and
© 2015, 2009, 2004, 2001, 1997 Cengage Learning, Inc. ALL RIGHTS RESERVED.
Solutions, Eleventh Edition
Anna M . Curren, RN, MA, and Margaret
Witt, BSN, MPT, DPT
No part of th is work covered by the copyright herein may be reproduced or
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Preface
•
XI
•••
Introduction for the Learner
X 111
•
Introduction for the Instructor
XIV
Using the Learning Package
xv
•••
Using the Online Student Practice Software
A Letter from the Author
Honorarium
xix
xx
Refresher Math Pretest
s E c TI o N }
CHAPTER
XVI 11
••
XXI I
Refresher Math
I
Relative Value, Addition , and Subtraction of Decimals
Relative Value of Decimals I 2
Summary I 8
Addition and Subtraction of Decimals I 6
Summary Self-Test I 8
CHAPTER
2
2
Multiplication and Division of Decimals
11
Multiplication of Decimals I 11
Using a Calculator I 17
Division of Decimal Fractions I 13
Expressing to the Nearest Tenth I 17
Elimination of Decimal Points I 13
Expressing to the Nearest Hundredth I 18
Reduction of Fractions I 14
Summary I 19
Reduction of Numbers Ending in Zero I 16
Summary Self-Test I 20
CHAPTER
3
Solving Common Fraction Equations
22
Whole-Number Equations I 22
Summary I 31
Decimal Fraction Equations I 26
Summary Self-Test I 31
Multiple-Number Equations I 29
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s E c TI o N
2 Introduction to Drug Measures
CHAPTER
4
Metric/International (SI) System
36
Basic Units of the Metric/SI System I 36
Con·version between Metric/SI Units I 40
Metric/SI Prefixes I 37
Common Errors in Metric/SI Dosages I 43
Metric/SI Abbreviations I 38
Summary I 44
Metric/SI Notation Rules I 39
Summary Self-Test I 44
CHAPTER
5
Unit, Percentage, Milliequivalent, Ratio, and Household Measures
International Units (units) I 46
Household Measures I 49
Percentage(%) Measures I 47
Apothecary Measures I 49
Milliequivalent (mEq) Measures I 47
Summary I SO
Ratio Measures I 48
Summary Self-Test I 50
s E c TI o N
► 46
3 Reading Medication Labels and
Syringe Calibrations
CHAPTER
6
Oral Medication Labels and Dosage Calculation
54
Tablet and Capsule Labels I 55
Summary I 68
Tablet/Capsule Dosage Calculation I 59
Summary Self-Test I 68
Oral Solution Labels I 64
Measurement of Oral Solutions I 66
CHAPTER
7
Safe Medication Administration
77
Medication Administration Records I 77
Common Medication Errors I 83
The Six Rights of Medication Administration I 79
Summary I 85
The Seventh Rigl1t: Partnering with
The Patient I 82
Summary Self-Test I 86
CHAPTER
8
Hypodermic Syringe Measurement
87
Standard 3 mL Syringe I 87
20 mL and Larger Syringes I 98
Safety Syringes I 91
Summary I 99
Tuberculin (TB) Syringe I 92
Summary Self-Test I 100
5 and 10 mL Syringes I 95
•
VI
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CHAPTER
9
Parenteral Medication Labels and Dosage Calculation
102
Reading Metric/SI Solution Labels I 102
Solutions Measured as Milliequivalents (mEq) I 108
Percent(%) and Ratio Solution Labels I 105
Summary I 110
Solutions Measured in International Units I 107
Summary Self-Test I 110
CHAPTER
10
Reconstitution of Powdered Drugs
129
Reconstitution of a Single-Strength Solution I 129
Summary I 138
Reconstitution from Package Insert
Directions I 134
Summary Self-Test I 138
Reconstitution of Multiple-Strength Solutions
CHAPTER
136
11
Measuring Insulin Dosages
► 144
Types of Insulin I 144
Insulin Action Times I 155
Insulin Vial and Insulin Injection Pen Label
Identification I 145
Insulin Injection Sites and Techniques I 156
Summary I 157
Insulin Syringes I 150
Summary Self-Test I 158
Combining Insulin Dosages I 154
s E c TI o N
4 Dosage Calculations
CHAPTER
12
Ratio and Proportion
► 164
Ratios I 164
Ratio and Proportion Expressed Using Common
Fractions I 165
Dosage Calculation Using Ratio and Proportion
Expressed as Common Fractions I 167
Ratio and Proportion Expressed Using
Colons I 171
CHAPTER
Dosage Calculation Using Ratio and Proportion
Expressed with Colons I 173
Calculations when Dosages are in Different Units
oflVIeasure I 176
Summary I 178
Summary Self-Test I 179
13
Dimensional Analysis/Units Conversion
194
Clinical Ratios I 194
Summary I 203
The Basic DA Equation I 195
Summary Self-Test I 204
Equations Requiring Metric Conversions I 200
••
VII
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CHAPTER
14
219
Formula Method
Basic Formula I 219
Summary I 223
Use with Metric Conversions I 221
Summary Self-Test I 224
Use with Units and mEq Calculations I 222
s E c TI o N
5 Dosage Calculation from Body Weight
and Body Surface Area
CHAPTER
15
Adult and Pediatric Dosages Based on Body Weight
228
Converting lb to kg I 228
Calculating Dosages from Drug Literature I 232
Converting kg to lb I 229
Summary I 236
Calculating Dosages from Drug Label
Information I 230
Summary Self-Test I 237
CHAPTER
16
Adult and Pediatric Dosages Based on Body Surface Area
243
Calculating BSA from kg and cm I 243
Assessing Orders Based on BSA I 246
Calculating BSA from lb and in I 245
Summary I 250
Dosage Calculation Based on BSA I 246
Summary Self-Test I 251
s E c TI o N
6 Intravenous Calculations
CHAPTER
17
Introduction to IV Therapy
254
Primary Line I 254
Patient-Controlled Analgesia (PCA) Devices I 263
Secondary Line I 256
Introduction to IV Fluids I 264
Volume-Controlled Burettes I 259
Percentages in IV Fluids I 265
Indwelling Infusion Ports/ Intermittent Locks I 259 Parenteral Nutrition I 266
Volumetric Pumps I 261
Summary I 266
Syringe Pumps I 262
Summary Self-Test I 267
CHAPTER
18
IV Flow Rate Calculation
269
IV Tubing Calibration I 269
Division Factor Method I 279
Using Ratio and Proportion to Calculate gtt/ min
Flow Rates I 271
Regulating Flow Rate I 282
Using Dimensional Analysis to Calculate gtt/ min
Flow Rates I 273
Summary I 286
Co1Tecting Off-Schedule Rates I 283
Summary Self-Test I 287
Formula and Division Factor Metl1ods of Flow
Rate Calculation I 277
•••
VIII
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CHAPTER
19
Calculating IV Infusion and Completion Times
Calculating Infusion Time from mL/hr
Ordered I 289
Calculating Infusion Completion Times
289
Labeling Solution Bags with Infusion and
Completion Times I 294
Summary I 297
291
Summary Self-Test I 298
International/Military Time Calculations I 291
Standard Time Calculations I 292
CHAPTER
20
IV Medication and Titration Calculations
302
Using Ratio and Proportion to Calculate mL/hr
Rate for Dosage Ordered I 303
Using Dimensional Analysis to Calculate mL/hr
Rate for Dosage Per kg Ordered I 311
Using Ratio and Proportion to Calculate mL/hr
Rate for Dosage Per kg Ordered I 305
Using Dimensional Analysis to Calculate Infusion
Titrations I 316
Using Ratio and Proportion to Calculate Infusion
Titrations I 307
Summary I 318
Summary Self-Test I 319
Using Dimensional Analysis to Calculate mL/hr
Rate for Dosage Ordered I 310
CHAPTER
21
Heparin Infusion Calculations
322
Heparin IV and Vial Labels I 322
Calculation Using Ratio and Proportion I 327
Calculating mL/hr IV Flow Rate from units/hr
Ordered I 324
Calculation Using Dimensional Analysis I 328
Summary I 329
Calculation Using Ratio and Proportion I 324
Summary Self-Test I 330
Calculation Using Dimensional Analysis I 325
Calculating units/hr Infusing from mL/h.r
Flow Rate I 327
s E c TI o N
7 Pediatric Medication Calculations
CHAPTER
22
Pediatric Oral and Parenteral Medications
332
Oral Medications I 332
Summary
334
Intramuscular and Subcutaneous
Medications I 334
Summary Self-Test I 335
CHAPTER
23
Pediatric Intravenous Medications
338
Iviethods of IV Medication Administration I 338
Medication Administration via Burette I 339
Comparing IV Dosages Ordered with Average
Dosages I 343
Using Dimensional Analysis I 342
Summary I 346
Summary Self-Test I 347
•
IX
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APPENDIX
A
Apothecary Measures
APPENDIX
►
351
B
ISMP's List of Error-Prone Abbreviations, Symbols, and
Dose Designations
352
Index
355
X
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Lany suppres.i;;ed content does nol materially affec-L Lheoverall learning expe.rie.nce. Ce.ngage Leaming re.i;erves Lhe righL Lo remove additional contenLal any time if subscquenLrig hts restrictions req uire it.
Currens Math for Meds: Dosages & Solutions, eleventh edition, is your best partner for
success in the dosage calculations arena. With a growing record of positive instruction with hundreds of thousands of u sers, its fully self-instructional approach fosters
achievement and confidence as the ideal choice for both learners and instructors.
A large part of the credit for this successful journey lies in the fact that Currens Math
for Meds, eleventh edition, has kept up with the times, while never losing sight of tl1e
beginning students it was designed to teach. Currens Math for Meds is the only calculations text of its kind that is completely focused to teach from simple to complex.
It eliminates the unnecessary, keeps instruction consistently geared toward clinical
realities, and offers a solid and seamless learning process from day one until program
completion.
ORGANIZATION
Currens Math for Meds allows for self-paced study, progressing from basic to more complex information. All learners are invited to complete the Refresher Math Pretest on
page xvii to determine their competence in basic math skills. Section 1, Refresher Math,
is also recommended for all learners, as the numerous shortcuts and memory cues
included in this section are used in examples throughout the text. Calculators are used
routinely in clinical facilities and on the NCLEX exam, and theil· use is encouraged in
tllis text. Bear in mind that fractional variations in answers due to rounding of numbers
may occur and should be considered correct.
Once the fundamental skills are mastered, the learner will move on to the basics
needed for calculating dosages and administering medications; metric system units
and milliequivalent dosages; reading dosage labels and syringe calibrations; and working with reconstituted drugs and insulin. Hundreds of sample dosage problems will
cement these learnings.
With these basic skills solidified, students are prepared for the advanced calculations
presented in the second half of the text. Bodyweight and body surface area dosage calculations, as well as intravenous and heparin calculations, are thoroughly covered and
tested. Pediatric medication calculations round out the learner's education.
FEATURES
Currens Math for Meds, eleventh edition, offers examples and review tests throughout to
enhance comprehension, and running answers allow the learner to receive immediate
feedback on deficits and strengths. An icon
is used throughout the chapters to allow learners to easily identify important information. The most up-to-date equipment
and safety devices are depicted in color, and real, full-color drug labels and syringes are
included with explanations and dosage problems. With the goal of helping students
become safe and effective practitioners, Currens Math for Meds works through basic
and advanced calculations in detail, including intravenous and pediatric calculations,
so that students are fully equipped to safely prepare and administer medications in a
clinical setting.
.
XI
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NEW TO THIS EDITION
Many new, current drug labels have been added to reflect the most up-to-date information on the market. Medications nurses are likely to encounter in practice are
included throughout
Content related to apothecary measurement has been placed in an appendix to offer
more discussion space for current measurement systems.
New online tools and interactive resources, as described below, have been added to
enhance the student's experience and develop stronger dosage calculation skills.
Learning Package for the Student
Premium Website
The Premium Website is available to purchasers of the text, and is accessed at
www.CengageBrain.com. Enter your passcode, found on the card in the front of the
book, and the Premium Website will be added to your bookshelf. Here you can access
the Student Practice Software, which includes tutorials, practice questions, and tests
for every chapter in the text, as well as interactive syringe exercises.
Teaching Package for the Instructor
Instructor Companion Website
The Instructor Companion Website is a complete teaching tool to aid instructors in
preparing lessons, creating lectures, developing quizzes, and outlining presentations.
The following components are included in this resource, which is complementary to
adopters of Currens Math for Meds, eleventh edition:
Lecture Slides, created in PowerPoint®, facilitate classroom instruction by offering
ready-made presentation outlines, tools, and procedures.
A Test Bank offers several hundred new questions designed for testing and evaluation.
A Solutions Manual includes step-by-step solutions to all problems and self-tests
included in the text.
••
XII
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Lany suppres.i;;ed content does nol materially affec-L Lheoverall leaming expe.rie.nce. Ce.ngage Leaming re.i;erves Lhe righL Lo remove additional contenL al any time if subscquenL rig hts restrictions req uire it.
Welcome to what we anticipate will be one of the more enjoyable texts in your bookbag.
Currens Math for Meds: Dosages & Solutions, eleventh edition, is about to reassure you
that math is nothing to be afraid of, and that on completion of your instruction you
will have the calculation skills you need to practice safely in your profession. You don't
have to be a math expert to be successful in dosage calculations; what you do need is a
desire for accuracy and a motivation to learn. If you have not used your math skills for
a number of years, Section 1, Refresher Math, will quickly bring you up to date. Currens
Math for Meds is fully self-instructional and lets you move at your own pace through the
content. Hundreds of examples and problems will keep your learning on track. Here are
some tips to help you get started.
1. Gather a calculator, pencil or pen, and plenty of scratch paper.
2. Start by completing the Refresher Math Pretest on page xvii. This will alert you to
those areas in Section 1, Refresher Math, that will need your particular attention.
Some of the items in the Pretest and Refresher Math section were designed to be
completed without using a calculator, but the choice is entirely yours; when you
need a calculator, use one. You must remember, however, that calculator settings
vary. All answers in this text were checked with a calculator set to hundredths. If
you use one with a different setting, you may experience small differences in your
answers in the tenths or hundredths.
3. Record the answers to calculations on the scratch paper as well as in your text. This
makes checking your answers against those we provide much easier.
4. As you work your way through the chapters, do exactly as you are instructed to
do. Programmed learning proceeds in small steps, and jumping ahead may cause
confusion. All chapters are designed to let you move at your own speed, and if you
already know some of the basics, you will move through them more quickly than
•
•
you can rmagme.
5. Once you have completed your instruction, keep Currens Math for Meds in your
personal library. As you move to different clinical areas during your career, you will
encounter different types of calculations. A quick refresher with Currens Math for
Meds will be i11valuable when that occurs.
• ••
XIII
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Welcome to the eleventh edition of Currens Math for Meds. Whether you are a seasoned
user of this text or are becoming acquainted with it for the first time, we would like to
share a few ideas on how to most effectively incorporate this bestselling text into your
curriculum. Currens Math for Meds is designed to be used starting early in the students'
beginning semester. Many instructors assign the entire Section 1, Refresher Math, to be
completed before the semester starts, and test on it within the first two weeks. Or, chapters can be assigned on a weekly basis at a pace fitting your students' profiles.
Students l1ave many pressures on their time, and experience has shown that they
learn best when their progress is routinely both encouraged and monitored. A short
weekly test of about ten questions on the content assigned is the ideal way to do this.
If a student struggles with the first test, provide a makeup opportunity. If a second
test is unsuccessful, you will need to delve more deeply to determine the exact problem and help the student establish a study plan. The content in Section 1 is ideally
suited to bring students up to the level of math skills required for success in dosage
calculations.
Because testing and reinforcement are such vital components of learner success,
encourage learners to use the Student Practice Software available on the Pre1niu1n
Website. Each module in this valuable electronic resource opens with a short tutorial
designed to reinforce text concepts. Interactive problems and self-tests for each module
reinforce accuracy and offer feedback as the student works at an individual pace.
As an instructor, you will also have access to valuable electronic resources that will
enhance your students' success. Lecture slides created in PowerPoint®, calculation
solutions, and a test bank are all included on our Instructor Companion Website, witl1
the goal of facilitating classroom preparation and allowing you to focus as much time as
possible on student interaction and competence. With Currens Math for Meds, both you
and your students are prepared for success!
•
XIV
amiog. All Rig hL, Reserved May noLbecopied,sc:mned, or d upli« 11ed, in whole or in part. Due to elec.tronic righl.'i, some Lhird party conLe nLmay be s uppressed from tl1ee8 ook and/or e ChapLet~s).
Lany suppres.i;;ed content does noL materially affecLLheoverall leaming e xpe.rie.nce. Ce.ngage Leaming re.i;erves Lhe righL Lo remove additional conte nt al any time if subsequent rig hts restrictions require it.
An icon designates impor,. Volumes larg th
tant reminders to help with
or a single IM . . .
er an 3 mL are diffi ul
3£
1n1ection site to b
ic t
calculations and to highlight
mL volume can be used a
a . sor~, and the 0.5 to
important safety consideru cutaneous dosages.
ations. As you study for your
exams, locate these Keys
and make sure you know
and understand them. Consider making
flash cards of the Keys to be certain you
EXAMPLE 2
know them.
Example icons walk you through each
concept in a step-by-step manner,
showing the calculation and mathematical processes. Focus on these areas to be sure you understand how to
do each different type of calculation.
A
dosage
strength of 40 m Eq 10
. :>
r=
pare
30 mEq·
mL is available· v,ou are to pre30 mEq
40 mEq X 5 mL = X mL
30
40 X 5 = 3.75 = 3-8 mL
A volume of 3 . 8 mL .is necessary to pre
The dosage ordered 30 m£ .
pare a 30 m_Eq dosage.
contained in a smaller
• volume
q, isthan
less than
m£ans,ver
5 mL,the
q dosage
and40the
3 8strength
L . availabl
.
e. It must be
• . m ' indicates that it is.
Problems are sprinkled throughout each chapter. This is your opportunity to put your skills to the test, to
identify your areas of strength, and to also
acknowledge those areas where you need
additional study. Answers to all problems
are printed in the accompanying shaded
box. Double-check your calculations if you
have difficulty, or talk to your instructor for
►►►
PROBLEMS l l . a
For each of the follo,vin co
.
total volume oflhe comg. mb1ned Regular and NPB i
.
prepare it; 30, 50, and l O
bOme~ dosage and the smallest cos uhn_dosages, inrucate the
urut capa city
• syringes are available.
apaci ty """·
-, . mge you can use lo
Total Volun1e
Syringe Size
I. 28 units Regu Iar, 64 units NPH
2. 16 uruts
· ~WH, 6 tmils Regular
3. 33 units Reg ular, 41 units NPH
additional help.
4. 2 I units Regular, 52 units I PH
5. L3 units Re guJ ar, 27 units NPH
Answers 1. 92 units · 100 ·1
· ~ und$; 100
s.
40 uni~; SO unit •
...,, 2. 22 unit$; 30 1.11il 3 7 '
.
L....----------------~~
un~,1 ~4~
. :7 3 uni~ ; 100 1.11il
xv
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,,;,.., .,;,w ,,_ , .... <-' M, ,,,,...,.,,. - •~ ·~ •• •"""'"' """'.,_.-• .-.. «~0<« ""'"' W•'"'...,,., .. ,,. <• ,~•• ~a,;oo,, ~ ••· •,., -~ ; < -
Actual full-color labels are used to support the problems and examples. Challenge
yourself to read the labels carefully and accurately; are you a ble to understand the
quantity, strength,
form, dosing, and administration guidelines for every la bel you
encounter
?
NOC 0093.-41 27-73
PENICILLIN V
POTASSIUM
for Oral Solution, USP
250 mg (400,000 U) per 5 ml
WARNING: NOT FOR INJECTION
] } only
100 ml (when ml1ed)
I"----------
TiEUn
FIGURE 6-15
Photos of syringes are depicted in actual size so that you can gain confidence in perfecting the real-life skill of accurately reading and interpreting syringe calibrations
and m edication levels.
-- 1
-
----- 1
-
-- 2
-- 3
-- 4
- 2
---- 3
- 4
---
5
6
-"'
"'
5
~
N
co
C:
co
C:
2
E.
i
.....,
.....,i-
i
i'
"
J
_____ 9
19
A
8
FIGURE 8 -6 A 5 ml (A) and a 10 ml (B) syringe.
•
XVI
=•· " .... ''"""' ""'
•••
~
....
--.,
.........
......
""·
..
'".,_.,
,
...
.,.
~
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.,,
.
..
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,
~ ......, "'"'"""'"""'•--· "-'•'-'• ,.,,,. '"·--~, __," ..,,._.,_...,__ ""'"~-
'·,--~-
....
__
....
--.
Summary Self-Tests round out each chapter. Complete these as you finish studying the material, identify areas where you need to focus, and review the content
again until you are confident in your calculating ability. Many of these test s include
combined label and syringe questions, where you must calculate a dosage and then
measure the dosage on a syringe. This is an excellent tool to test how well you apply
your knowledge.
Sununary SeJf-Test
Calculate th •
ese dosages usin r .
tenth (or hundi•ed tJ1 I
. g atio and p ropor tion E
th d
· w Jere 1ndi
)
· xpress mL
' e ?sages Yo u calculate o n ti cate~ using the medication I bela:1s,ve~s to tJ1e nearest
}O U.r UJStru ctor to be sur
ie syringes provided. Hav
a s proVJded. Meas1"·e
e you have calcula ted and
e your ans,vers checked b·
Dosage Ordered
measured tJ1e dosages
Y
correctly.
1. terbtttaline sulfate 800 mcg
mLNeeded
-
-- mg -
2. furosemide 15
ND( 00000· 0000-00
=o
0
_...,'
0
0
0
'
FUROSEMIDE
INJECTION USP
fl•liH•tlAhl■
!10 mg/ml)
For IM or rv Use
DILi/TE BEFORE rv use
2 ml Singfe Dose Vial ~ x onfy1
3. VistariJ• 70 ing
ittCO,,um,11,
Vistarll
1
_ flritf
,_ l~dnt lrfdrOtlltorllltJ p ,i
_ . , _ 1411111...
j
--
Online Resources are available at your fingertips. Visit the Premium Website for
valuable course content, including the Student Practice Software and additional
•
•
qu1zzmg.
••
XVII
CopyrigbL 20 15 Ceng age Leaming. AU Rig hL'i Reserved May noLbe copied. scanned, or d uplicated, in whole o r in part. Due Lo elec.tronic rig hts• .some Lhird party conlenl may be suppressed fro m Lhe
Edilori.al review has deemed thal any suppres.i;;ed contcnl does nol materially affee-LLheoverall learning expe.rie.nce. Ce.ngage Leaming re.lierves Lhe rig hL Lo remove additional conlenl al any time if subscqu
The Online Student Practice Software is a built-in learning tutor. After studying each
chapter, be sure to also work with the online software. This valuable resource will help
cement understanding of key rules and math explanations, and continuously expand
skills and confidence in performing dosage calculations.
ORGANIZATION AND FEATURES
Main Menu
The main menu is organized by units and chapters that correspond to the units and
chapters in the core book
Tutorials
Tutorials open each chapter. These provide a quick review of the text content to ensure
complete understanding of the material in these first few screens before moving on to
the problems and self-tests.
Problems
Each chapter includes practice problems that incorporate labels and syringes for the
most realistic and challenging practice experience. Practice problems allow two tries to
obtain the correct answer. If the correct answer is not obtained on the second try, the
answer and solution will appear on the screen.
Scoring
Problem answers are scored for assessment of strengths and weaknesses and to determine which topics need further study.
Interactive Syringes
Some questions include the use of interactive syringes. The computer mouse can be
used to click and drag the syringe plunger to the correct syringe measurement. All
syringes are duplicated in actual size.
Summary Self-Tests
Comprehensive tests follow each chapter, providing a single opportunity to correctly
answer to simulate a true testing environment. Answers and solutions are provided .
•••
XVIII
amiog. All Rig hL, Reserved May noLbecopied, sc:mned, or d upli«11ed, in whole o r in part. Due Lo elec.tronic rig hl.'i, some Lhird pany conLe nLmay be s uppressed fro m tl1ee8 ook and/or eChapLet~s).
Lany suppres.i;;ed content does noL materially affecLLheoverall leaming expe.rie.nce. Ce.ngage Leaming re.i;erves Lhe righL Lo remove additional conte nt al any time if subsequent rig hts restrictions require it.
Dear Educators:
The first edition of Math for Meds was welcomed as the text that "eliminates the unnecessary:' It did just that, and it introduced the clinically focused approach to dosage
calculation instruction that is now the standard in the field. The frrst edition had only
56 pages. Adoption and support from appreciative educators made Math for Meds the
leading text on dosage calculations continent-wide, a distinction it still holds.
The explosion of relevant information in subsequent years makes Math for Meds'
original 56-page count seem like a myth. But more is not necessarily better. In fact,
"more" has reached a competitive stage where the slogan "eliminates the unnecessary"
is again a critical issue in dosage calculations instruction.
Math for Meds has never lost sight of the beginning students it is designed to
teach. What is really needed is a clear presentation of the solid basics that students can
build on throughout their programs and in their clinical experience. The size and depth
of this new eleventh edition makes it the perfect vehicle for accomplishing this.
Currens Math for Meds: Dosages & Solutions, eleventh edition, is the only text that
teaches first to the over 90% of average dosages that the beginning student will learn
from. It THEN introduces the advanced calculations that require the use of ratio and
proportion, dimensional analysis, or the formula method. All three calculation methods are presented in the new Currens Math for Meds, eleventh edition.
Refresher math is limited to the essentials needed. Metric and other dosage
measures are succinct yet complete; hundreds of dosage label and syringe calibration
photos are incorporated into clinically realistic calculations. The more advanced calculations are properly positioned to build on basic calculation skills as instruction moves
to its logical completion.
The format and content of Currens Math for Meds is not an accident. It is the result
of the combined close working relationship between the author and educators over
more than a 40-year period. More than a million students can attest to its effectiveness.
I thank you for choosing Currens Math for Meds, eleventh edition, and invite you
to evaluate its content and clarity. Suggestions from educators continue to be my most
important revision tool; I solicit ongoing input from both educators and learners, sent
care of Cengage Learning, in continuing to make future editions even more fitting to
your needs.
Margaret Witt
•
XIX
CopyrigbL20 15 Cengage Leaming. AU Rig hL'i Reserved May noLbe copied.scanned, or d uplica ted, in whole o r in part. Due Lo elec.tronic rig hts• .some Lhiltl party conlenl may be s uppressed fro m Lhe
Edilori.al review has deemed thal any s uppres.i;;ed contcnl does nol materially affee-LLheoverall learning expe.rie.nce. Ce.ngage Leaming re.i;erves Lhe righL Lo remove additional conle nl al any time if s ubscqu
j
.,
"'
.,c::
-c:,
(!)
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C.
~
en
0
15
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Cl...
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. !!!
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.!=
c::
Anna M. Curren, BN, MA
With this edition of Currens Math for Meds, Cengage Learning honors Anna M. Curren's
40 years of inspired authorship of her texts. By permanently identifying Math for Meds
as "Curren's:· Anna will experience what she calls her "Gray's Anatomy moment," referencing British author Henry Gray's 1858 authorship and ongoing identification with his
first anatomy text.
Anna's authorship began when, as an Associate Professor of Nursing at Long
Beach City College in California, she was assigned to teach from a programmed math
text that bore no relationship to her students' clinical needs. Anna, who was pursuing
an MA in Instructional Design, immediately enrolled in a Programmed Instruction
course and began to write her own clinically focused text. Testing her text step by
step with her students resulted in an immediate and dramatic improvement in her
students' clinical math skills. At her students' insistence, Anna decided to submit her
text to a national publisher. Undeterred by the rejection of her manuscript, and already
recognizing the need for vital instructional products for injection skill training, Anna
began exploring both self-publication of her text as well as production possibilities for
these products.
The result was Anna's founding, in 1972, of Wallcur, Inc., now known throughout North America for its outstanding line of Practi-Products. Anna named her
company Wallcur to honor her father, Wallace Curren, whose financial gift made
xx
amiog. All Rig hL, Reserved May noLbecopied, sc:mned, or d upli« 11ed, in whole o r in part. Due to elec.tronic righl.'i, some Lhird pany conLe nLmay be suppressed fro m tl1ee8ook and/or eChapLet~s).
Lany suppres.i;;ed content does noL materially affecLLheoverall leaming expe.rie.nce. Ce.ngage Leaming re.i;erves Lhe righL Lo remove additional content al any time if subsequent rig hts restrictions require it.
her entrepreneurship possible. In its first year Wallcur introduced Injecta-Pad and
Practi-Amp, shortly followed by Anna's first edition of Math for Meds. In a few short
years, Math for Meds not only became the most adopted programmed text in its subject
area, but the definitive content and format guide now adopted by many other authors
in this subject area. Under Anna's direction, Wallcur enlarged its line of instructional
products to include Practi-Insulin Training Pack, Practi-Vial, Practi-Powder Vial,
Practi-Mini Vial, and Practi-Oral Med Pack.
In 1998 Anna authored her second dosage calculations text, Dimensional Analysis
for Meds, in which she introduced a simplified formula for the units conversion calculations method used in the physical sciences, which has also now been adopted by other
authors in this subject area.
In 2000 Anna moved her authorship of both texts to Cengage Learning. At the
same time, to ensure the future availability ofWallcur's essential nursing skill products,
Anna gifted the product line of her company to a nurse educator who had h elped her
build the company during the late '80s and '90s. In doing so, she secured the availability
of her vital instructional products for several decades.
Anna, a proud native of St. John's, Newfoundland, became a U.S. citizen in 1970.
She lives in San Diego, California. She wishes to take this final opportunity to thank the
many students and instructors who have contacted her with suggestions and feedback
throughout her career.
•
XXI
CopyrigbL 20 15 Cengage Leaming. AU RighL'i Reserved May noLbe copied.scanned, or d uplica ted, in whole o r in part. Due to elec.tronic rig hts. some Lhiltl party conlenl may be suppressed fro m Lhe
Edilori.al review has deemed thal any s uppressed content does noL materially affee-L Lheoverall leaming e xpe.rie.nce. Ce.ngage Leaming re.o;erves Lhe right Lo remove additional conte nt al any time if s ubscqu
REFRESHER MATH PRETEST
If you can complete the Pretest with 100% accuracy, you are off
to an exceptional start. However, don't be alarmed if you make
so1ne errors because the Refresher Math section that follows
is designed to bring your math skills up to date. Regardless
of your proficiency, it's important that you complete the
entire Refresher Math section. It includes memory cues and
shortcuts for simplifying and solving many of the clinical calculations that are included in the entire text, and you will need
to be familiar with these.
Identify the decimal fraction with the greatest
value in each set.
l. a) 4.4
2. a) 6.3
3. a) 0.18
4. a) 0.2
5. a) 0.15
6. a) 4.27
b) 2.85
b) 5.73
b) 0.62
b) 0.125
b) 0.11
b) 4.31
c) 5.3
c) 4.4
c) 0.35
c) 0.3
c) 0.14
c) 4.09
27.
28.
29.
30.
10.105 =
3.775 =
0.176 =
Define "product:·
Multiply these decimals. Express your ans,vers
to the nearest tenth.
31. 0.7 X 1.2 =
32. 1.8 X 2.6 =
33. 5.1 X 0.25 X 1.1 =
34. 3.3 X 3.75 =
Divide these fractions. Express your ans,vers
to the nearest hundredth.
35. 16.3 7 3.2 =
36. 15.l 7 1.1 =
37. 2 7 0.75 =
38. 4.17 7 2.7 =
39. Define "nu1nerator:·
Add these decimals.
7. 0.2 + 2.23 =
8. 1.5 + 0.07 =
9. 6.45 + 12.l + 9.54 =
10. 0.35 + 8.37 + 5.15 =
40. Define "denominator'.'
Subtract these decimals.
11. 3.1 - 0.67 =
12. 12.41 - 2.11 =
13. 2.235 - 0.094 =
14. 4.65 - 0.7 =
15. If tablets with a strength of 0.2 mg are available
and 0.6 mg is ordered, how many tablets must you give?
Solve these equations. Express your ans,vers
to the nearest tenth.
16. If tablets are labeled 0.8 mg and 0.4 mg is ordered, how
42. -X- =
1
2
many tablets must you give? _ _ _ __
17. If the available tablets have a strength of 1.25 mg and
2.5 mg is ordered, how many tablets must you give?
4
3
18. If 0.125 mg is ordered and the tablets available
are labeled 0.25 mg, how many tablets must you give?
Express these to the nearest tenth.
19. 2.17 =
20. 0.15 =
21. 3.77 =
22. 4.62 =
23. 11.74 =
24. 5.26 =
10. 13.87
11. 2.43
12. 10.3
13. 2.141
14. 3.95
15. 3 tab
16. 11.2 tab
17. 2 tab
18. 11.2 tab
19. 2.2
43.
44.
240 X 135
170
300
0.2 X 1.5
1.75
0.2
45. 2.1 X 1.7 =
3.6
1.3
46.
0.26 X 3.3 =
0.2
1.2
47.
750 X 300 X 'J...
1
50
2
48. 50 X 60 X 1 X 400
1
240
900
1
Express these to the nearest hundredth.
25. 1.357 =
26. 7.413 =
Answers
1. C
2. a
3. b
4. C
5. a
6. b
7. 2.43
8. 1.57
9. 28.09
41. Define "highest cormnon denominator:'
20. 0.2
21. 3.8
22. 4.6
23. 11 .7
24. 5.3
25. 1.36
26. 7.41
27. 10.11
28. 3.78
29. 0.18
49.
35,000 X 35 =
750
1
50. ~ X 450 X 1 X 114
40
40
900
1
30. The answer
obtained from
multiplication of
two or more
numbers
31. 0.8
32. 4.7
33. 1.4
34. 12.4
35. 5.09
36. 13.73
37. 2.67
38. 1.54
39. The top
number in a
common fraction
40. The bottom
number in a
common fraction
41. The greatest
number that
can be divided into two
numbers to
reduce them
to their lowest
terms (values)
42. 0.2
43. 0.6
44. 0.9
45. 0.8
46. 3.6
47. 15,750
48. 5.6
49. 1633.3
so. 1.8
••
XXII
Copyrighl 20 15 Ce ngage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplk a ted , in whole or in pan. Due to e lec.tronic rights. some Lhlrd party conle nl may be s upprcssOO from Lhe c Book and/or eChaple t1s).
Ed llorial re view has d eemed LhaLany suppressed content d oes noL materially affec t Lhe ove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional c ontent al any time if subsequent rig hts res trictions require iL
I
CHAPTER I
CHAPTER 2
CHAPTER 3
CHAPTER
I
I
In the course of administering medications, you will be dealing with
decimal fraction dosages on a daily basis. The first two chapters of this
text provide a complete refresher on everything you need to know about
decimals, including safety measures when you do calculations both
manually and with a calculator. We'll start with a review of the range of
decimal values you will see in dosages. This will enable you to recognize
which of two or more numbers has the greater (or lesser) value-a skill
you will use constantly in your professional career.
RELATIVE VALUE OF DECIMALS
The most helpful fact to remember about decimals is that our monetary
system of dollars and cents is a decimal system. The whole numbers
in dosages have the same relative value as dollars, and decimal fractions
have the same value as cents: the greater the number, the greater the
value. If you keep this in mind, you will have already learned the most
important safety measure of dealing with decimals in dosages.
The range of drug dosages, which includes decimal fractions, stretches
from millions on the whole number side, to thousandths on the decimal
side. Refer to the decimal scale in Figure 1-1, and locate the decimal point,
which is slightly to the right on this scale. Notice the whole numbers on
tl1e left of the scale, which rise increasingly in value from ones (units) to
millions, which is the largest whole-number drug dosage in current use.
&
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0,0 0 0 , 0 0 0
WHOLE NUMBERS
~
~
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~
~
~
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ff
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0 0 0
-
FRACTIONS
_,
i•Jl9d41i~M••l►
FIGURE 1-1
y noL be copied, scanned, or duplicated, in whole or in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the overall learning expe.rie.oce. Cengage Leaming reserves the righL Lo remove addiLional conle nl al any ti.me if subscquenl rig hls restricLions require it.
Lri
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RELATIVE VALUE, ADDITION , AND SUBTRACTION OF DECIMALS
EV paint: The first determiner of the relative value of decimals is the presence of whole numbers. The greater the whole number, the greater the value.
EXAMPLE 1
10.1 is greater than 9.15
EXAMPLE 2
3.2 is greater than 2.99
EXAMPLE 3
7.01 is greater than 6.99
►►► PRO BLEM S 1. 1
Choose the greatest value in each set.
1. a) 3.5
b) 2.7
c) 4.2
2. a) 6.15
3. a) 12.02
b) 5.95
b) 10.19
c) 4.54
c) 11.04
4. a) 2.5
b) 1.75
c) 0.75
5. a) 4.3
b) 2.75
c) 5.1
6. a) 6.15
b) 7.4
c) 5.95
7. a) 7.25
b) 8.1
c) 9.37
8. a) 4.25
b) 5.1
c) 3.75
9. a) 9.4
b) 8.75
b) 6.33
c) 7.4
c) 4.2
10. a) 5.1
Answers 1. c
2. a
3. a
4. a
6. b 7. c
5. c
8. b 9. a
10. b
If, however, the whole numbers are the same-for example, 10.2 and 10.7-or there are no
whole numbers-for example, 0.25 and 0.35-then the fraction will determine the relative
value. Let's take a closer look at the fractional side of the scale (refer to Figure 1-2 ).
~
~
~
0
•
1
~
,§
~
~
~
2
~
~
¥
~
~
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FIGURE 1-2
It is necessary to consider only three figures after the decimal point on the
fractional side, because drug dosages measured as decimal fractions do not contain more
than three digits; for example, 0.125 mg. Notice that a zero is used to replace the whole
number in this decimal fraction and in all dosages that do not contain a whole number.
EVpaint: If a decimal fraction is 11ot preceded by a whole number, a
zero is used in front of the decimal point to emphasize that the number is a
fraction.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplka ted, in whole or in part. Due Lo elec.tronic rig hts. some Lhlnl party conle nl may be .supprcs..,;,00 from Lhe cBook and/or eChapLer(s).
Ed llorial review b:is deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions req uire iL
3
4
REFRESHER MATH
0.125
EXAMPLE
0.1
0.45
Look again at Figure 1-2. The numbers to the right of the decimal point represent tenths,
hundredths, and thousandths, in that order. When you see a decimal fraction in which
the whole numbers are the same, or there are no whole numbers, stop and look first at
the number representing tenths.
KEV point: The fraction with the greater number representing tenths has
the greater value.
EXAMPLE 1
0.3 is greater than 0.27
EXAMPLE 2
0.4 is greater than 0.29
EXAMPLE 3
1.2 is greater than 1.19
EXAMPLE 4
3.5 is greater than 3.2
►►► PROBLEMS 1.2
Choose the greatest value in each set.
1. a) 0.4
2. a) 2.73
3. a) 0.19
4. a) 3.5
5. a) 0.3
6. a) 1.35
7. a) 2.5
8. a) 4.51
9. a) 0.8
10. a) 2.1
Answers
1. c.
2. c
b) 0.2
b) 2.61
b) 0.61
c) 0.5
c) 2.87
c) 0.34
b) 3.75
b) 0.25
c) 3.25
c) 0.4
b) 1.29
b) 2.7
c) 1.4
c) 2.35
b) 4.75
b) 0.3
b) 2.05
c) 4.8
c) 0.4
c) 2.15
3. b 4. b S. c
6. c
7. b 8. c
9. a
10. c
If in decimal fractions the numbers representing the tenths are identical-for example,
0.25 and 0.27-th en the num her representing the hundredths will determine the
relative value.
EV point: When the tenths are identical, the fraction with the greater
number representing hundredths will have the greater value.
EXAMPLE 1
0.27 is greater than 0.25
EXAMPLE 2
0.15 is greater than 0.1 (0.1 is the sam e as 0.10)
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RELATIVE VALUE, ADDITION , AND SUBTRACTION OF DECIMALS
EV point: Extra zeros on the end of decimal fractions are omitted in drug
dosages because they can easily be misread and lead to errors.
EXAMPLE 1
2.25 is greater than 2.2 (same as 2.20)
EXAMPLE 2
9.77 is greater than 9.7 (same as 9.70)
►►► PROBLEMS 1.3
Choose the greatest value in each set.
1. a) 0.12
b) 0.15
c) 0.17
2. a) 1.2
b) 1.24
c) 1.23
3. a) 0.37
b) 0.3
c) 0.36
4. a) 3.27
b) 3.25
c) 3.21
5. a) 0.16
b) 0.11
c) 0.19
6. a) 4.23
b) 4.2
c) 4.09
7. a) 3.27
b) 3.21
8. a) 2.75
b) 2.73
c) 3.29
c) 2.78
9. a) 0.31
b) 0.37
c) 0.33
10. a) 0.43
b) 0.45
c) 0.44
Answers
1. c 2. b
3. a
4. a
5. c 6. a
7. c
8. c 9. b
10. b
►►► PROBLEMS 1.4
Which fraction has the g.r eater value?
a) 0.125
b) 0.25
Answers If you chose 0.125, you have just made a serious drug dosage error. Look again at the numbers representing the tenths, and you will see that 0. 25 is greater than 0. 125. Remember that extra zeros are omitted
in decimal fraction dosages because they can lead to errors. In this fraction, 0.25 is the same as 0.250, which
is exactly double the value of 0 . 125. Check the tenths carefully, regardless of the total of numbers after the
decimal point.
EXAMPLE 1
0.15 (same as 0.150) is greater than 0.125
EXAMPLE 2
0.3 (sa1ne as 0.30) is greater than 0.15
EXAMPLE 3
0.75 (same as 0.750) is greater than 0.325
EXAMPLE 4
0.8 (sa1ne as 0.80) is greater than 0.16
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5
6
REFRESHER MATH
<EV paint: The number of figures on the right of the decimal point is not an
indication of relative value. Always look at the figure representing the tenths
first, and if these are identical, check the hundredths to determine which has
the greater value.
This completes your introduction to the relative value of decimals. The key points just reviewed will cover all situations in dosage calculations in which you will have to recognize
greater and lesser values. Test yourself more extensively on this information in the following problems.
►►► PROBLEMS 1.5
Choose the greatest value in each set.
1. a) 0.24
b) 0.5
c) 0.125
2. a) 0.4
b) 0.45
c) 0.5
3. a) 7.5
b) 6.25
c) 4.75
4. a) 0.3
b) 0.25
c) 0.35
5. a) 1.125
b) 1.75
c) 1.5
6. a) 4.5
b) 4.75
c) 4.25
7. a) 0.1
b) 0.01
8. a) 5.75
b) 6.25
c) 0.04
c) 6.5
9. a) 0.6
b) 0.16
c) 0.06
10. a) 3.55
b) 2.95
c) 3.7
Answers 1. b 2. c
3. a
4. c
5. b 6. b 7. a
8. c
9. a
10. c
ADDITION AND SUBTRACTION OF DECIMALS
Complex addition and subtraction of decimals should be done with a calculator, but, on
occasion, time can be saved by doing simple calculations without one. Let's start by looking
at a fe,-v key points that will make manual solution safer.
KEV paint: When you write down the numbers, line up the decimal points.
EXAMPLE
To add 0.25 and 0.27
0.25
+0.27 is safe
0.25
+ 0.27 is unsafe; it could lead to errors.
KEV paint: Always add or subtract from right to left.
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RELATIVE VALUE, ADDITION , AND SUBTRACTION OF DECIMALS
If you decide to write do,vn the numbers, do not confuse yourself by trying to ''eyeball''
the answer. Also, write any numbers carried or rewrite those reduced by borrowing if you
find this helpful.
EXAMPLE 1
When adding 0.25 and 0.27
1
0.25
+0.27
0.52
EXAMPLE 2
Add the 5 and 7 first, then the 2, 2, and
the 1 you carried; work from right to left
When subtracting 0.63 from 0.71
61
0.71
-0.63
0.08
Borrow 1 from 7 and rewrite as 6
Write the borrowed 1; subtract 3 from 11
Subtract 6 from 6; work from right to left
KEY point: Add zeros as necessary to make the fractions of equal length.
Adding zeros to make the fractions of equal length does not alter the value of the fractions,
and it helps prevent confusion and mistakes.
EXAMPLE
When subtracting 0.125 from 0.25
0.25
- 0.125
becomes
becomes
0.250
- 0.125
Answer = 0.125
If you follow these simple rules and make them a habit, you will automatically reduce calculation errors. The following problems will give you an excellent opportunity to practice
addition and subtraction.
►►► PROBLEMS 1.6
Add decimals.
1. 0.25 + 0.55 = - - - - -
6. 3.75 + 1.05 =
=
3. 1.74 + 0.76 = - - - - -
7. 6.35 + 2.05 =
4. 1.4 + 0.02
9. 0.33 + 2.42 =
5. 2.3 + 1.45
10. 1.44 + 3.06 = - - - - -
2. 0.1 + 2.25
8. 5.57 + 4.03 =
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7
8
REFRESHER MATH
Subtract decimals.
11. 1.25 - 1.125 =
16. 7.33 - 4.03
12. 3.25 - 0.65
17. 4.25 - 1.75
13. 2.3 - 1.45
18. 0.07 - 0.035 =
14. 0.02 - 0.01
19. 0.235 - 0.12 =
15. 5.5 - 2.5
20. 5.75 - 0.95
=
Answers 1. 0.8 2. 2.35 3. 2.5 4. 1.42 5. 3.75 6. 4.8 7. 8.4 8. 9.6 9. 2.75 10. 4.5
11. 0.125 12. 2.6 13. 0.85 14. 0.01 15. 3 16. 3.3 17. 2.5 18. 0.035 19. 0.115 20. 4.8
Note: If you did not add a zero before the decimal point in answers that do not conta in a whole number, or fa iled to eliminate
unnecessary zeros from the end of decimal fractions, your answers are incorrect.
Summary
This concludes the refresher on relative value, addition, and subtraction of simple
decimal fractions. The important points to remember from this chapter are:
If a decimal fraction contains a whole number, the value of the whole number is
the first determiner of relative value.
If a fraction does not include a whole number, a zero is placed in front of the
decimal point to emphasize that it is a fractional dosage.
If there is no whole number, or if the whole numbers are the same, the number
representing the tenths in the decimal fraction will be the next determiner of
relative value.
If the tenths in decimal fractions are identical, the number representing
hundredths will determine relative value.
When manually adding or subtracting decimal fractions, first line up the decimal
points, then add or subtract from right to left.
Extra zeros on the end of decimal fractions can be a source of error in drug
dosages, and are routinely eliminated.
Summary Self-Test
Choose the decimal with the greatest value.
1. a) 2.45
b) 2.57
c) 2.19
2. a) 3.07
b) 3.17
c) 3.71
3. a) 0.12
b) 0.02
c) 0.01
4. a) 5.31
b) 5.35
c) 6.01
5. a) 4.5
b) 4.51
c) 4.15
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RELATIVE VALUE, ADDITION , AND SUBTRACTION OF DECIMALS
6. a) 0.015
b) 0.15
c) 0.1
7. a) 1.3
b) 1.25
c) 1.35
8. a) 0.1
b) 0.2
c) 0.25
9. a) 0.125
b) 0.1
c) 0.05
10. a) 13.7
b) 13.5
c) 13.25
Use critical thinking to choose the best answer.
11. If you have medication tablets whose strength is 0.1 mg and
you must give 0.3 mg, you will need
a) 1 tab.
b) less than 1 tab.
c) more than 1 tab.
12. If you have tablets with a strength of 0.25 mg and you must give
0.125 mg, you will need
a) 1 tab.
b) less than 1 tab.
c) more than 1 tab.
13. If you have an order to give a dosage of 7.5 mg and the tablets
have a strength of 3.75 mg, you will need
a) 1 tab.
b) less than 1 tab.
c) more than 1 tab.
14. If the order is to give 0.5 mg and the tablet strength is 0.5 mg,
you will give
a) 1 tab.
b) less than 1 tab.
c) more than 1 tab.
15. The order is to give 0.5 mg and the tablets have a strength
of 0.25 mg. You must give
a) 1 tab.
b) less than 1 tab.
c) more than 1 tab.
Add the decimals manually.
16. 1.31 + 0.4
= ----17. 0.15 + 0.25 = - - - - 18. 2.5 + 0.75
19. 3.2 + 2.17
20. 1.3 + 1.04 = - - - - 21. 4.7 + 3.03 =
22. 0.5 + 0.5
23. 5.4 + 2.6
Use critical thinking to answer the following.
24. You have just given 2 tab with a dosage strength of 3.5 mg each.
What was the total dosage administered?
25. You are to give your patient 1 tab labeled 0.5 mg and one labeled
0.25 mg. What is the total dosage of these two tablets?
26. If you give 2 tab labeled 0.02 mg, what total dosage will
you administer?
27. You are to give 1 tab labeled 0.8 mg and 2 tab labeled 0.4 mg.
What is the total dosage?
28. You have two tablets: one is labeled 0.15 mg and the other 0.3 mg.
What is the total dosage of these two tablets?
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9
10
REFRESHER MATH
Subtract the decimals manually.
29. 4.32 - 3.1
33. 1.3 - 0.02
30. 2.1 - 1.91
34. 0.2 - 0.07
31. 3.73 - 1.93
35. 3.95 - 0.35
32. 5.75 - 4.05
36. 1.9 - 0.08
Use critical thinking to answer the following.
37. Your patient is to receive a dosage of 7.5 mg and you have only
1 tab labeled 3.75 mg. How many more milligrams must you give?
38. You have a tablet labeled 0.02 mg and your patient is to receive
0.06 mg. How many more milligrams must you give?
39. The tablet available is labeled 0.5 mg, but you must give a dosage
of 1.5 mg. How many more milligrams will you need to obtain the
correct dosage?
40. Your patient is to receive a dosage of 1.2 mg and you have 1 tab
labeled 0.6 mg. What additional dosage in milligrams will you need?
41. You must give your patient a dosage of 2.2 mg, but you have only
2 tab labeled 0.55 mg. What additional dosage in milligrams
will you need?
Determine how many tablets will be needed to give the dosages.
42. Tablets are labeled 0.01 mg. You must give 0.02 mg.
43. Tablets are labeled 2.5 mg. You must give 5 mg.
44. Tablets are labeled 0.25 mg. Give 0.125 mg.
45. Tablets are 0.5 mg. Give 1.5 mg.
46. A dosage of 1.8 mg is ordered. Tablets are 0.6 mg.
47. Tablets available are 0.04 mg. You are to give 0.02 mg.
48. The dosage ordered is 3.5 mg. The tablets available are 1.75 mg.
49. Prepare a dosage of 3.2 mg using tablets with a strength of 1.6 mg.
50. You have tablets labeled 0.25 mg and a dosage of 0.375 mg is ordered.
Answers
1. b
2, C
3. a
4, C
s. b
6. b
7, C
8, C
9. a
10. a
11, C
12. b
13, C
14. a
15, C
16. 1.71
17. 0.4
18. 3.25
19. 5.37
20. 2.34
21. 7.73
22. 1
23. 8
24. 7 mg
25. 0.75 mg
26. 0.04 mg
27. 1.6 mg
28. 0.45 mg
29. 1.22
30. 0. 19
31. 1. 8
32. 1.7
33. 1.28
34. 0.13
35. 3.6
36. 1.82
37. 3.75 mg
38. 0.04 mg
39. 1 mg
40. 0.6 mg
41. 1. 1 mg
42. 2 tab
43. 2 tab
44. ½ tab
45. 3 tab
46. 3 tab
47. ½ tab
48. 2 tab
49. 2 tab
so. 1½ tab
Note: If you did not add a zero before the decimal point in answers that did not contain a whole number, or fai led to
eliminate unnecessary zeros from the end of decimal fractions, your answers are incorrect.
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CHAPTER
Multiplication and division are integral parts of dosage calculations. As is
the case with addition and subtraction, some multiplication and division
problems involving dosages can be done manually, so the basic steps
in multiplication and division are reviewed in this chapter. In addition, a
number of shortcuts will be introduced that can make numbers easier to
work with, especially those containing decimal fractions. And for those
calculations that are more safely handled with a calculator, safety in calculator use will be discussed.
MULTIPLICATION OF DECIMALS
The main precaution in multiplication of decimals is the placement of
the decimal point in the answer, which is called the product.
The decimal point in the product of decimal
fractions is placed the same number of places to the left in
the product as the total of numbers following the decimal
points in the fractions multiplied.
•
EXAMPLE 1
in#-
Multiply 0.35 by 0.5
It is safer to begin by lining up the numbers to be multiplied on the right
side. Then, disregard the decimals during multiplication.
0.35
X 0.5
175
The product/ answer is 175; 0.35 has two numbers after the decimal
and 0.5 has one. Place the decimal point three places to the left in the
product to make it .175, then add a zero (0) in front of the decimal to
emphasize the fraction.
Answer = 0.175
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Edilorial review has deemed Lhal any suppressed content does noL m.at.erially affecL Lheoverall learning experience. Cengage Leaming reserves Lhe right Lo remove additi
12
REFRESHER MATH
EXAMPLE 2
Multiply 1.61 by 0.2
1.61
X 0.2
322
Line up the numbers on the right
The product is 322; 1.61 has two numbers after the decimal point and 0.2 has one. Place
the decimal point three places to the left in the product so that 322 becomes .322, then
add a zero in front of the decimal to emphasize the fraction.
Answer = 0 .322
KE paint: If the product contains insufficient numbers for correct
placement of the decimal point, add as many zeros as necessary to the left
of the product to correct this.
EXAMPLE 3
Multiply 1.5 by 0.06
1.5
X 0.06
90
Line up the numbers on the right
The product is 90; 1.5 has one number after the decimal point and 0.06 has two. To place
the decimal three places to the left in the product, a zero must be added, making it .090.
Eliminate the excess zero from the end of the fraction, and add a zero in front of the
decimal point.
Answer = 0 .09
EXAMPLE 4
Multiply 0.21 by 0.32
0.21
X 0.32
42
63
672
Indent second number multiplication
Add the totals
In this example, 0.21 has two numbers after the decimal point and 0.32 also has two. Add
a zero in front of 672 to allow correct placement of the decimal point, making it .0672,
then add a zero in front of the fraction to emphasize it.
Answer = 0 .0672
EXAMPLE 5
Multiply 0.12 by 0.2
0.12
X 0.2
24
In this example, there are a total of three numbers after the decimal points in 0.12 and 0.2.
Add a zero in front of 24 for correct decimal placement, making it .024, then add a zero in
front of .024 to emphasize the fraction.
Answer = 0 .024
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MULTIPLICATION AND DIVISION OF DECIMALS
►►► PROBLEMS 2.1
Multiply the decimal fractions without using a calculator.
1. 0.45 X 0.2
6. 2.14 X 0.03 = _____
2. 0.35 X 0.12
7. 1.4 X 0.4
3. 1.3 X 0.05
8. 3.3 X 1.2
4. 0.7 X 0.04
9. 2.7 X 2.2
5. 0.4 X 0.17
10. 2.1 X 0.3
Answers 1. 0.09 2 . 0.042
9 . 5.94 10. 0.63
3. 0.065
4 . 0.028
S. 0.068
6. 0.0642
7. 0.56
8. 3.96
DIVISION OF DECIMAL FRACTIONS
A calculator may also be used for division of complex decimal fractions. However, let's
start by reviewing the terminology of common fraction division, and three important
precalculator steps that may make final manual division easier: elimination of decimal
points, reduction of the fractions, and reduction of numbers ending in zero. The
following is a sample of a common fraction division seen in dosages.
EXAMPLE 1
0.25
numerator
0.125
denominator
You'll recall that the top number in a common fraction is called the numerator, whereas
the bottom number is called the denominator. If you have trouble remembering which
is which, think ofD, for down, for denominator. Tl1e denominator is on the bottom. With
this basic terminology reviewed, we are now ready to look at preliminary math steps that
can be used to simplify a fraction or actually solve an equation and eliminate the need for
calculator division.
ELIMINATION OF DECIMAL POINTS
Decimal points can be eliminated from numbers in a decimal fraction without changing its
value, if they are moved the same number of places in one numerator and one denominator.
KEVpoint. To eliminate the decimal points from decimal fractions, move
them the same number of places to the right in a numerator and a denominator until they are eliminated from both. Zeros may have to be added to
accomplish this.
EXAMPLE 1
0.25
0.125
beco1nes
250
125
The decimal point must be moved three places to the right in the denominator 0.125 to
make it 125. Therefore, it must be moved three places to the right in the numerator 0.25,
which requires the addition of one zero to make it 250.
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13
14
REFRESHER MATH
EXAMPLE 2
0.3
0.15
becomes
30
15
The decimal point must be moved two places in 0.15 to make it 15, so it must be moved
two places in 0.3, which requires the addition of one zero to become 30.
EXAMPLE 3
1.5
2
becomes
15
20
Move the decimal point one place in 1.5 to make it 15; add one zero to 2 to make it 20.
EXAMPLE 4
4.5
0.95
becomes
450
95
KE point: Eliminating the decimal points from a decimal fraction before
fmal division does not alter the value of the fraction, or the answer obtained
in the final division.
►►► PROBLEMS 2.2
Eliminate the decimal points from these common fractions.
1. 17.5 2
2. 0.5
25
6. 0.1
0.05
7. 0.9
0.03
3. 6.3
0.6
4. 3.76 =
0.4
8. 10.75 2.5
9. 0.4
0.04
5. 8.4
0.7
10. 1.2
0.4
Answers
1.
175 2. 5 3. 63 4. 376
20
250
6
40
s. 84
7
1075
8, _
_ 9. 40
250
4
10. Q
4
REDUCTION OF FRACTIONS
Once the decimals are eliminated, a second simplification step is to reduce the numbers as
far as possible using common denominators/ divisors, the largest number that will divide
both a numerator and a denominator.
KEYpoint. To further reduce fractions, divide numbers by their greatest
common denominator (the largest number that will divide into both a
numerator and a denominator).
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MULTIPLICATION AND DIVISION OF DECIMALS
The greatest common denominator is usually 2, 3, 4, 5, or multiples of these
numbers, such as 6, 8, 25, and so on.
EXAMPLE 1
175
20
The greatest common denominator is 5
35
- 4
EXAMPLE 2
63
6
-
EXAMPLE 3
The greatest common denominator is 3
21
- -2
1075
250
The greatest common denominator is 25
W7'5 - -43
WO 10
There is a second way you could have reduced the fraction in Example 3, and it is equally
as correct. Divide by 5, then by 5 again.
W7'5
-250
215
-50
43
10
KEYpoint: If the greatest common denominator is difficult to determine,
reduce several times by using smaller common denominators.
EXAMPLE 4
Or divide by 4, then 2
376
40
47
5
Divide by 8
47
5
Or divide by 2, then 2,
then 2
Remember that simple numbers are easiest to work with, and the time spent in extra
reductions may be well worth the payoff in safety.
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15
16
REFRESHER MATH
►►► PROBLEMS 2.3
Reduce the fractions in preparation for final division.
1. 84
6. 40
8
14
2. 20
16
7. 82
28
3. 250 =
325
8. 100 =
75
4. 96
34
9. 50
75
--
5. 175 =
20
Answers 1.
10. 60
88
21
2
2. -5
4
3. -
10
13
4. -
48
17
s. -35
4
20
41
6 . - 7. 7
14
8. -
4
3
2
9. 3
15
22
10. -
REDUCTION OF NUMBERS ENDING IN ZERO
The third type of simplification is not solely related to decimal fractions but is best covered
at this time. This concerns reductions in a common fraction when both a numerator and a
denominator end ,vith zeros.
KEV paint: Numbers that end in a zero or zeros may be reduced by crossing
off the same number of zeros in both a numerator and a denominator.
EXAMPLE 1
800
250
In this fraction, the numerator, 800, l1as two zeros, but the deno1ninator, 250, has one zero.
The number of zeros crossed off must be the same in both numerator and denominator,
so only one zero can be eliminated from each.
800
250
EXAMPLE 2
80
25
2400
24
-- - 2000 20
16
Reduce by 5 =
5
Reduce by 4 =
6
5
Two zeros can be eliminated from the denominator and the numerator in this fraction.
EXAMPLE 3
15,000 - -15
30,000 30
Reduce by 15 =
1
2
In this fraction, three zeros can be eliminated.
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MULTIPLICATION AND DIVISION OF DECIMALS
►►► PROBLEMS 2.4
Reduce the fractions to their lowest terms.
1. 50
250
6. 110
100
2. 120
50
7. 200,000 =
150,000
3. 2500
1500
8. 1000
800
4. 1,000,000 =
750,000
9. 60
5. 800
150
10. 150
200
Answers 1. -
l
5
40
2. -
12
5
5
3. -
3
4. -
4
3
s. -16
3
6. -
11
10
7. -
4
3
8. -
5
4
9. -
3
2
10. -
3
4
USING A CALCULATOR
Calculators vary in how addition, subtraction, division, and multiplication must be entered, and in the number of fractional numbers displayed after the decimal point. The first
precaution in calculator use is to ensure you know how to use the one available to you.
If you must do frequent calculations, it would be wise to buy and use your own. The next
precaution-and this is critical-is to enter decimal numbers correctly, which includes
entering the decimal points. This is not as easy to remember as it sounds, and this is a
step where dosage calculation errors can occur.
KEV point: Calculator entry errors tend to be repetitive, so visually check
each entry before entering the next.
EXPRESSING TO THE NEAREST TENTH
When a fraction is reduced as much as possible, it is ready for final division. If necessary, this
is done using a calculator to divide the numerator by the denominator. Dosage answers
are most frequently rounded off and expressed as decimal fractions to the nearest tenth.
KEV point: To express an answer to the nearest tenth, the division is
carried to hundredths (two places after the decimal). When the number
representing hundredths is 5 or larger, the number representing tenths is
increased by one. If the number representing hundredths is less than 5,
the number representing tenths remains unchanged.
EXAMPLE 1
0 35
· = 0.35 7 0.4 = 0.87
0.4
Answer= 0.9
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17
18
REFRESHER MATH
The number representing hundredths is 7, so the number representing tenths is increased
by one: 0.87 becomes 0.9.
05
· = 0.5 ---:- 0.3 = 1.66 = 1.7
0.3
EXAMPLE 2
The number representing hundredths, 6, is larger than 5, so 1.66 becomes 1.7.
0 16
· = 0.53 = 0.5
0.3
EXAMPLE 3
The number representing hundredths, 3, is less than 5, so the number representing
tenths, 5, remains unchanged.
EXAMPLE 4
02
· = 0.66 = 0.7
0.3
EXAMPLE 5
An answer of 1.42 remains 1.4
EXAMPLE 6
An answer of 1.86 becomes 1.9
►►► PROBLEMS 2.5
Use a calculator to divide the common fractions. Express answers to the nearest tenth.
1. 5.1 =
2.3
6. 2.7
2. 0.9 =
0.7
7. 4.2
5
3. 3.7 =
2
8. 0.5
2.5
4. 6
1.3
9. 5.2
0.91
5. 1.5 =
2.1
10. 2.4
2.7
1.1
Answers 1. 2.2
2. 1.3
3. 1.9 4 . 4.6
5 . 0.7
6 . 2.5
7 . 0.8
8. 0.2
9. 5.7
10. 0.9
EXPRESSING TO THE NEAREST HUNDREDTH
Some drugs are administered in dosages carried to the nearest hundredth. This is common in
pediatric dosages, and in ch·ugs that alter a vital function of the body, for example, heart rate.
KEVpaint: To express an answer to the nearest hundredth, the division
is carried to thousandths (three places after the decimal point). When the
number representing thousandths is 5 or larger, the number representing
hundredths is increased by one.
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MULTIPLICATION AND DIVISION OF DECIMALS
EXAMPLE 1
0.736
becomes
0.74
The number representing thousandths, 6, is larger than 5, so the number representing
hundredths, 3, is increased by one to become 4.
EXAMPLE 2
0.777
becomes
O. 78
EXAMPLE 3
0.373
remains
0.37
The number representing thousandths, 3, is less than 5, so the number representing hundredths, 7, remains unchanged.
EXAMPLE 4
0.934
•
remains
0.93
►►► PROBLEMS 2 .6
Express the numbers to the nearest hundredth.
1. 0.175 =
7. 1.081 =
2. 0.344 =
8. 1.327 =
3. 1.853 =
9. 0.739 =
4. 0.306 =
10. 0.733 =
5. 3.015 =
11. 2.072 =
6. 2.154 =
12. 0.089 =
Answers 1.0.18 2. 0.34 3. 1.85 4. 0.31
10. 0.73 11. 2.07 12. 0.09
S. 3.02
6. 2.15
7.1 .08 8.1.33 9. 0.74
Summary
This concludes the chapter on multiplication and division of decimals. The important
points to remember from this chapter are:
When decimal fractions are multiplied manually, the decimal point is placed the
same number of places to the left in the product as the total of numbers after the
decimal points in the fractions multiplied.
Zeros must be placed in front of a product if it contains insufficient numbers for
the correct placement of the decimal point.
Excess trailing zeros are eliminated in dosages.
To simplify fractions for final division, the preliminary steps of eliminating decimal
points, reducing the numbers by common denominators, and reducing numbers
ending in zeros can be used.
To express to tenths, increase the answer by one if the number representing the
hundredths is 5 or larger.
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19
20
REFRESHER MATH
To express to hundredths, increase the answer by one if the number representing
the thousandths is 5 or larger.
Practice using a calculator until proficiency is achieved.
All calculator entries and answers must be double-checked.
Calculator running totals should be disregarded because they can cause confusion.
A personal calculator is a must if frequent calculations are necessary.
Summary Self-Test
Multiply the decimals. A calculator may be used.
1. 1.49 X 0.05 =
6. 5.3 X 1.02
2. 0.15 X 3.04 =
7. 0.35 X 1.25 =
3. 0.025 X 3.5 =
8. 4.32 X 0.05 =
=
5. 1.31 X 2.07 =
9. 0.2 X 0.02
4. 0.55 X 2.5
10. 0.4 X 1.75
Use critical thinking to answer the following.
11. You are to administer 4 tab with a dosage strength of 0.04 mg
each. What total dosage are you giving?
12. You have given 2½ (2.5) tab with a strength of 1.25 mg
per tablet. What total dosage is this?
13. The tablets your patient is to receive are labeled 0.1 mg,
and you are to give 3½ (3.5) tab. What total dosage is this?
14. You gave your patient 3 tab labeled 0.75 mg each, and
he was to receive a total of 2.25 mg. Did he receive the
correct dosage?
15. The tablets available for your patient are labeled 12.5 mg,
and you are to give 4½ (4.5) tab. What total dosage
will this be?
16. Your patient is to receive a dosage of 4.5 mg. The tablets
available are labeled 3.5 mg, and there are 2½ tab
in his medication drawer. Is this a correct dosage?
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MULTIPLICATION AND DIVISION OF DECIMALS
Divide the fractions. Express answers to the nearest tenth. A calculator may be used.
17. 1.3
0.7
24. 2,000,000 =
1,500,000
18. 1.9
3.2
25. 4.1
2.05
19. 32.5
9
20. 0.04 0.1
26. 7.3
12
27. 150,000
120,000
21. 1.45 1.2
28. 0.15
0.08
22. 250 1000
29. 2700
900
23. 0.8
0.09
30. 0.25
0.15
Divide the fractions. Express answers to the nearest hundredth. A calculator may be used.
31. 900
1700
41. 0.13
0.25
32. 0.125
0.3
42. 0.25
0.7
33. 1450
1500
43. 3.3
5.1
34. 65
175
44. 0.19
0.7
35. 0.6
1.35
45. 1.1
1.3
36. 0.04
0.12
37.
46. 3
4.1
750
10,000
47. 62
240
38. 0.65
0.8
48. 280,000 =
300,000
39. 3.01
4.2
49. 115
255
40. 4.5
6.1
Answers
1. 0.0745
2. 0.456
3. 0.0875
4. 1.375
5. 2.7117
6. 5.406
7. 0.4375
8. 0.216
50. 10
14.3
9. 0.004
10. 0.7
11. 0.16 mg
12. 3.125 mg
13. 0.35 mg
14. yes
15. 56.25 mg
16. no
17. 1.9
18. 0.6
19. 3.6
20. 0.4
21. 1.2
22. 0.3
23. 8.9
24. l. 3
25. 2
26. 0.6
27. 1.3
28. l. 9
29. 3
30. 1.7
31. 0.53
32. 0.42
33. 0. 97
34. 0.37
35. 0.44
36. 0.33
37. 0.08
38. 0.81
39. 0.72
40. 0.74
41. 0.52
42. 0.36
43. 0.65
44. 0.27
45. 0.85
46. 0.73
47. 0.26
48. 0.93
49. 0.45
so. 0.7
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21
CHAPTER
The majority of clinical drug dosage calculations involve solving an
equation containing one to five common fractions. Two examples are:
2
3
5
4
- X -
and
20 X
1000
X 1200 X
1
1
60,000
1
60
Two options are available to solve common fraction equations: calculator
use throughout, or initial fraction reduction followed by calculator use
for final division. Both options are presented in this chapter, and you may
use whichever you wish, or whichever your instructor requires.
" Common fraction equations are solved by
dividing the numerators by the denominators.
It is important that you do the calculations for each example and then compare them with the math provided. Just reading the examples will not teach
you the calculation skills you need. The examples and problems provided
incorporate all the content covered in the first two chapters. They represent the full range of calculations you will be doing on a continuing basis.
·"., Calculator solution of equations is most safely
done by concentrating only on the entries being made, not
the numbers that register and change throughout
the calculation.
WHOLE-NUMBER EQUATIONS
EXAMPLE 1
Option 1: Calculator Use Throughout
2
3
5
4
- X -
2 X 3 -:- 5 -:- 4
Multiply the numerators,
2 and 3, and then divide by
the denominators, 5 then 4,
in continuous entries
= 0.3
Answer= 0.3 (tenth)
y noL be copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig bi.o;, some Lhird party conLenLmay be suppressed rmm Lhe eBook and/or eChapLet~s).
m.at.eri.ally affecl the overall learning experience. Cengage Leaming reserves the rig hL Lo remove additional c.o nlenl al any time if subscquenl rig hLS restricLions require it.
SOLVING COMMON FRACTION EQUATIONS
Option 2: Initial Reduction of Fractions
2
3
- X5
4
Divide the numerator, 2, and the denominator,
4, by 2 (to become 1 and 2)
Use the calculator to divide the remaining numerator, 3, by the remaining
denominators, 5 and 2
= 0.3
Answer= 0.3 (tenth)
KEYpoint: Initial reduction of fractions in an equation can simplify final
calculator entries, especially if the numbers are large, or contain decimal
fractions or zeros.
EXAMPLE 2
Option 1: Calculator Use Throughout
250
150
175
325
--X--
250 X 150 7 175 7 325
Multiply the numerators, 250 and 150, then
divide by the denominators, 175 and 325
= 0.659
Answer= 0.7 (tenth) or 0.66 (hundredth)
Option 2: Initial Reduction of Fractions
250
150
175
325
10
6
--X--
)BO X J,80
Divide the numerator, 250, and the denominator,
175, by 25 (to become 10 and 7); divide the
numerator, 150, and the denominator, 325, by 25
(to become 6 and 13)
,m
Y?5
13
7
10 X 6 7 7 7 13
Use the calculator to multiply the
numerators, 10 and 6, then divide by
the denominators, 7 and 13
= 0.659
Answer= 0.7 (tenth) or 0.66 (hundredth)
EXAMPLE 3
Option 1: Calculator Use Throughout
7
50
25
120
3
32
X-X
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23
24
REFRESHER MATH
7 X 25 X 120 -:- 50 -:- 3 -:- 32
Multiply the numerators, 7, 25,
and 120, then divide by the
denominators, 50, 3, and 32
= 4.375
Answer= 4.4 (tenth) or 4.38 (hundredth)
Option 2: Initial Reduction of Fractions
7
25
120
X - X
50
3
32
l
7
15
x,25 x,1-W
fa()
Divide 25 and 50 by 25, then divide 120 and
32 by 8
:Ji
3
2
4
7 X 15 -:- 2 -:- 3 -:- 4
= 4.375
Answer= 4.4 (tenth) or 4.38 (hundredth)
EXAMPLE 4
Option 1: Calculator Use Throughout
20
-
1
1000
1200
1
60, 000
1
60
X --- X -- X -
20 X 1000 X 1200 -:- 60,000 -:- 60
= 6.666
Answer= 6.7 (tenth) or 6.67 (hundredth)
Option 2: Initial Reduction of Fractions
20
1
X
1000
60,000
X
1200
1
X
l
l
20
,20
J,006
)206
1
X
ffe,-000
X
1
1
60
1
X fJO
3
l
20-:- 3
= 6.666
Answer= 6.7 (tenth) or 6.67 (hundredth)
EXAMPLE 5
Option 1: Calculator Use Throughout
2000
2500
1500
3000
-- X --
2000 X 2500-:- 1500-:- 3000
= 1.111
Answer = I.I (tenth) or 1.11 (hundredth)
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SOLVING COMMON FRACTION EQUATIONS
Option 2: Initial Reduction of Fractions
2000
2500
1500
3000
-- X --
5
X
_2500
_3000
3
2X5 7 3 7 3
= 1.111
Answer = I.I (tenth) or 1.11 (hundredth)
►►► PROBLEMS 3 . 1
Solve the equations. Express answers to the nearest tenth and hundredth. A calculator
maybe used.
3
6
8
3
1. - X -
3
10
2. - X 4
2
3
1050
3. - X - 5
40
10
750
1000
1
4. - X - - - X - - X 1
40,000
1
60
12
500
2000
1
5. - X - - X - - X 1
2700
1
60
1500 X 350
6.
750
600
7.
1000
1300
70
2700
500
50
--x --x -
15
2500
1000 X 1
8. - X - - X
1
20,000
1
60
1000
100
1
9. - X - - X - X 1
5000
1
60
8
750
250
10. - x 500
300
Answers 1. 0.8;0.75 2. 3.8;3.75 3. 15.8; 15.75 4. 3.1;3.13
7. 1.3; 1.35 8. 31.3; 31.25 9. 2.7; 2.67 10. 1.3; 1.25
5. 74.1;74.07
6. 1.2; 1.17
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Edilorial review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming expe rience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rights restrictions require iL
25
26
REFRESHER MATH
DECIMAL FRACTION EQUATIONS
Decimal fraction equations raise an inst ant warning flag in calculations, b ecause it is h ere
that most dosage errors occur. As with whole-number equations, simplifying the numbers
by eliminating decimal points and reducing the numbers is an optional first st ep . If you
elect to do the entire calculation with a calculator, b e sure to enter the decimal p oints carefully. Double-ch eck all calculator entries and answers.
KEV point: Particular care must be taken with calculator entry of decimal
numbers to include the decimal point. Each entry and answer must be routinely double-checked.
EXAMPLE 1
Option 1: Calculator Use Throughout
0.3
2.5
1.65
1
- -x0.3 X 2.5 + 1.65
Multiply 0.3 by 2.5, then divide by 1.65
= 0.454
Answer= 0.5 (tenth) or 0.45 (hundredth)
Option 2: Initial Elimination of Decimal Points and Reduction
of Fractions
0.3 X 2.5
1.65
1
30
25
-
X -
165
10
Move the decimal point two places in 0.3 and 1.65
(to become 30 and 165) and one place in 2.5 and 1
(to become 25 and 10)
3
5
,JOX~
J,65 }O
33
Divide 30 and 10 by 10, then divide 25 and 165 by 5
1
1
t X -5
)1'
1
Divide 3 and 33 by 3
ll
5 + 11
Divide the remaining numerator, 5, by the
denominator, 11
= 0.454
Answer = 0.5 (tenth) or 0.45 (hundredth)
EXAMPLE 2
Option 1: Calculator Use Throughout
0.3
2.1
-
X --
1.2
0.15
0.3 X 2.1 --:- 1.2 --:- 0.15 Multiply 0.3 by 2.1, then divide by 1.2 and 0.15
= 3.5
Answer= 3.5 (tenth) or 3.5 (hundredth)
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SOLVING COMMON FRACTION EQUATIONS
Option 2: Initial Elimination of Decimal Points and
Reduction of Fractions
0.3
2.1
-
x--
3
210
1.2
-
0. 15
X --
12
15
Eliminate the decimal points by moving them one
place in 0.3 and 1.2 (to become 3 and 12) and two
places in 2.1 and 0.15 (to become 210 and 15)
1
42
j X )ro
,12
,15
4
Divide 3 and 12 by 3, then divide 210 and 15 by 5
3
Divide 42 and 4 by 2
21 -:- 2 -:- 3
Use a calculator to divide the numerator, 21, by 2
and then by 3
= 3.5
Answer= 3.5 (tenth) or 3.5 (hundredth)
EXAMPLE 3
Option 1: Calculator Use Throughout
0.15
3.1
0.17
2
--X-
0.15 X 3.1 -:- 0.17-:- 2
Multiply 0.15 by 3.1, divide by 0.17, and
then divide by 2
= 1.367
Answer= 1.4 (tenth) or 1.37 (hundredth)
Option 2: Initial Elimination of Decimal Points and
Reduction of Fractions
0.15
3.1
0.17
2
--X-
15
-
17
31
X-
20
Move the decimal point two places in
0.15 and 0.17 and one place in 3.1 and 2
(requires adding a zero to 2)
3
,15 3 1
-x17
,20
Divide 15 and 20 by 5
4
3 X 31 -:- 17 -:- 4
Complete this with a calculator
= 1.367
Answer = 1.4 (tenth) or 1.37 (hundredth)
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28
REFRESHER MATH
EXAMPLE 4
Option 1: Calculator Use Throughout
2.5 X 1.2
1.5
1.1
2.5 X 1.2 7 1.5 7 1.1
= 1.818
Answer = 1.8 (tenth) or 1.82 (hundredth)
Option 2: Initial Elimination of Decimal Points and
Reduction of Fractions
2.5
1.2
1.5
1.1
25
12
15
11
-X-
-x5
,25' 12
X ),5 11
3
4
~x,11
:J
11
1
5 X 4 7 11
= 1.818
Answer = 1.8 (tenth) or 1.82 (hundredth)
►►► PROBLEMS 3.2
Solve the equations. Express answers to the nearest tenth and hundredth. A calculator
maybe used.
1.
2.1
1.15
3.1
X
0.9
1.2
2.2
6.
0.75
X
1.15
3
1.25
1.4
10.2 X 2
7.
1.5
5.1
3
0.3
X
3.
1.2
2.1
0.125 X 2.5
8.
0.25
1.5
2.
2.7
X
0.17 X 2.5
4.
0.3
1.5
9.
1.75 X 1.5
5.
0.95
2
10.
0.9
0.3
X
1.2
1.4
0.35 X 2.5
1.7
0.7
Answers 1. 1.4; 1.37 2. 1.8; 1.8 3. 0.4; 0.36 4. 0.9; 0.94
7 . 2.7; 2.67 8. 0.8; 0.83 9. 2.6; 2.57 10. 0.7; 0.7 4
S. 1.4; 1.38
6. 1.6; 1.57
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SOLVING COMMON FRACTION EQUATIONS
MULTIPLE-NUMBER EQUATIONS
The calculation st eps just practiced are also used for multiple-number equations, which
occur frequently in advan ced clinical calculations. Reduction of numbers may be of
particular benefit here because calculations of this type sometimes have numbers
that cancel and/ or reduce dramatically. Answers are expressed to the n earest wh ole
number in the examples and problem s th at follow to replicat e actual clinical calculations .
. EXAMPLE 1
Option 1: Calculator Use Throughout
60
1000
1
6
1
4
1000
1
-x--x--x60 X 1000 X 6 7 4 7 l 000
Multiply 60 by 1000, then by 6;
divide by 4 and 1000
= 90
Answer= 90
Option 2: Initial Reduction of Fractions
60
-
1000
1
6
4
1000
1
X -- X -- X -
1
1
3
60
J,006
1
ft
1 x
x J,006 x 1
I
2
1
60 X 3 7 2
Eliminate 1000 from a numerator
and denominator, then divide 6
and 4 by 2
Multiply 60 by 3, then divide by 2
= 90
Answer= 90
.EXAMPLE 2
Option 1: Calculator Use Throughout
_2 0 x~x 1
1
1
60
20 X 75 7 60
Multiply 20 by 75, then divide by 60
= 25
Answer= 25
Option 2: Initial Reduction of Fractions
20
-
75
X -
1
1
X -
1
60
Divide 20 and 60 by 20 to become
1 and 3, then divide 75 and 3 by 3
to become 25 and 1
= 25
Answer= 25
The answer is obtained by
cancellation alone
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29
30
REFRESHER MATH
EXAMPLE 3
Option 1: Calculator Use Throughout
2
1
275
X -- X -0.5
100
1
2 X 275 -=- 0.5 -=- 100
Multiply 2 by 275, then divide by 0.5 and 100
= 11
Answer = 11
Option 2: Initial Reduction of Fractions
2 X 1 X 275
0.5
100
1
20 X 1 X 275
5
100
1
1
Eliminate the decimal point by moving it one
place in 0.5 and one place in 2, which requires adding a zero to 2 (to become 5 and 20)
55
){J'XlX)?S
}5
)-06
l
1
Divide 20 and 100 by 20, then divide 275
and 5 by 5
5
11
1
ft5'
-x-
i
Divide 5 and 55 by 5
1
1
= 11
Answer= 11
EXAMPLE 4
The answer is obtained by
cancellation alone
Option 1: Calculator Use Throughout
1
1
10
750
- X - X - X -60
12
1
1
10 X 750-=- 60-=- 12
= 10.4
Answer= 10
Option 2: Initial Reduction of Fractions
1
1
10
750
-X-X-X-60
12
1
1
1
375
l
X l XJ-0 XJ-80
foO ~
1
1
6
6
375-=- 6-=- 6
= 10.4
Answer= 10
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SOLVING COMMON FRACTION EQUATIONS
►►► PROBLEMS 3.3
Solve the equations. Express answers to the nearest whole number.
15
350
1
1. - X - X 1
5
60
60
1
1
1.7
15.3
6.2
2.3
12.1
0.3
20
1200
1
16
60
1
Answers 1. 18
2. 5
1.5
60
8
1750
1
200
60
X -- X -
1
4. - X - - X -
X -- X -
1
7. -
3. - X - - X 1
24
60
5. -
1
100
X 2. - X
32
1
3.1
2500
320
6. - X - X -
7.5
10
5
_ 60 X 1150 X 1
1
200
100
25
1000
1
4
8
60
9. - X - - X -
18
120
9
10. - X
X10
7
17
3. 17 4. 19
5. 25
6 . 18
7. 15
8. 3
9. 1 3
10. 16
Summary
This concludes the chapter on solving common fraction equations. The important
points to remember from this chapter are:
Most clinical calculations consist of an equation containing one to five common
fractions.
In solving equations, all the numerators are multiplied, then divided by the
denominators.
Numbers in an equation may initially be reduced using common denominators/
divisors to simplify final multiplication and division.
Zeros may be eliminated from the same number of numerators and denominators
without altering the value.
Double-check all calculator entries and answers.
Answers may be expressed as whole numbers, or to the nearest tenth or hundredth,
depending on the calculation being done.
Summary Self-Test
Solve the equations. Express answers to the nearest tenth and hundredth. A calculator
maybe used.
1.
0 .8 X 1.2
0.65
1
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31
32
REFRESHER MATH
350 X 4.4
2.
1000
1
0.35
4.5
3. - - X - 1.3
1
0.4
2.3
1.5
1
1
500
0.15
1.45
0.12
1
4. - - X - -
5. - X - 75
1
6. - - X - -
100,000
1.7
80,000
1
7. - - - - X - -
1.45
1.5
8. - - X 2.1
1
1550 X 0.5
9.
500
1
4
0.25
10. - - - X - 0.375
1
0.08
2.1
O.I
1
1.5
1.45
0.5
0.35
11. - - X -
12. - - X - 1.25
1
13. - - X - 0.15
1
300,000
1.7
14. - - - - X - 200,000
1
13.5
1.8
15. - - X 10
1
1,000,000
1.4
16. - - - - - X - 800,000
1
17.
1.3
0.25
X--
0.2
1
1.5
0.25
18. - X - 0.1
1
1.9 X 3.2
19.
3.5
1.4
15,000 X 3.5
20.
7500
1.2
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SOLVING COMMON FRACTION EQUATIONS
4.7
50
4
8.2
21. - X - X - X 1.3
20
25
2.1
40 X 250 X 0.375
22.
24
5
7.5
6.9 X 250 X 0.75
23.
21.6
5
2.1
1
1
10
1000
24. - X - X - X - 60
25
1
1
50.5 X 4.7 X 31.7
25.
22.75
6.3
10.2
Solve the equations. Express answers to the nearest whole number. A calculator
maybe used.
104
20
63
26. - - X - X 95
15
1.6
40,000 X 30 X 3.7
27.
10,000
1
12.5
60
500
1
116
28. - X - - X - - X 1
50
1000
1
1.5
10
3.2
100
60
50
1
455
29. X - X X 0.6
14
5.3
2
30. -
X
1
X -
250
33.7
X -
100
19.2
1
2.9
X -31. - - X
15.9
2.6
3.85
20
32. -
100
X -
4
88
14
88
10
325
X
1200
10
X -
250
30
33. X 7.9
8
34. -
X -
X -
1
1
1.5
60
60
300
1
400
1
400
800
1
3.7
12
3.1
35. -
X -- X -- X --
5
36. X - X X 1.3
8
7.4
1
20
125
2
2 16
37. - X X -- X -2
25
750
1
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33
34
REFRESHER MATH
4
45 X 22.5
38. - X
3
1
37.8
7.5 X 55
23.2
X -39.
12.3
5
1.2
1000
X 50 X 20 X 1
40.
1
250
1
60
41. ~ X 1000 X 800 X ~
1
4000
1
60
42. ~x5oox~
1
3
60
25
43. -
750
X -
3
8
0.1
X -
1
40
X 250 X 1 X 154
44.
2
50
800
1
33
X 75 X 2 X 432
45.
4
40
150
1
_ 22.5 X 100 X 1 X 3 X 3150
46
7
5
700
80
1
100
50
27.5
47. - - X - X - 250
1
1.375
2.2
3.6 X 3.7
48. - - X
0.25
1
7.1
1.3 X 0.3 X 10.1
49.
0.21
2
0.75
27.5 X 40 X 8.5
50.
10
7
1.9
Answers
1. 1.5; 1 .48
2 . 1.5; 1 .54
3. 1 .2; 1. 21
4. 0.6; 0.61
s. 6.7; 6.67
6. 1.8; 1. 81
7. 2.1;2.13
8. 1; 1.04
9. 1.6; 1.55
10. 2.7; 2.67
11. 1 .7; 1.68
12. 1.7; 1.74
13. 1 .2; 1 . 17
14. 2.6; 2.55
15. 2.4; 2.43
16. 1 .8; 1 .75
17. 1.6; 1.63
18. 3.8; 3.75
19. 1.2; 1.24
20. 5.8; 5.83
21. 5.6; 5.65
22. 4.2; 4.17
23. 5.7; 5.7
24. 6.7; 6.67
25. 5. 1; 5. 15
26. 57
27. 36
28. 70
29. 54
30. 55
31. 12
32. 9
33. 19
34. 36
35. 23
36. 9
37. 29
38. 36
39. 130
40. 67
41 . 50
42. 42
43. 78
44. 19
45. 89
46. 11
47. 400
48. 17
49. 13
so. 70
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I
CHAPTER 4
CHAPTER 5
.-
CHAPTE
You are probably already familiar with the metric system, which is
the major system of weights and measures used in medicine. The
metric/international/SI (from the French Systeme International) system
was invented in France in 1875, and takes its name from the meter, a
length roughly equivalent to a yard, from which all other units of measure
in the system are derived. The strength of the metric system lies in its
simplicity, because all units of measure differ from each other in powers
of ten (1 O). Conversions between units in the system are accomplished
by simply moving a decimal point.
-
A major strength of the metric system is that
all its units of measure differ from each other in powers of
ten (10), and conversions between the units can be made by
simply moving the decimal point.
This is also one of the metric system's greatest hazards. This is because a
misplaced decimal point alters the value of a number by a multiple of at
least 10. It is not necessary for you to know the entire metric system to
administer medications safely, but you must understand its basic structure and become familiar with the units of measure you will be using in
tl1e clinical setting.
-... .,.. The greatest hazard of the metric system in
drug dosages is that a misplaced decimal point will alter a
dosage by a multiple of at least 10.
BASIC UNITS OF THE METRIC/SI SYSTEM
Three types of metric measures are in common clinical use: those
for length, volume (or capacity), and weight. The basic units of these
measures are:
length - meter
volume - liter
weight - gram
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METRIC/ INTERNATIONAL (SI) SYSTEM
Memorize the basic units if you do not already know them. In addition to the basic units,
there are both larger and smaller units of measure for length, volume, and weight.
Let's compare this concept with something familiar. The pound is a unit of weight that we
use every day. A smaller unit of measure is the ounce; a larger, the ton. However, all are
units measuring weighL
In the same way, there are smaller and larger units than the basic meter, liter, and
gram. In the metric system, however, there is one very important advantage: all other
units, whether larger or smaller than the basic units, have the name of the basic
unit incorporated in them. So when you see a unit of metric measure, there is no doubt
what it is measuring: meter-length, liter-volume, and gram-weight.
►►► PROBLEMS 4.1
Identify the metric measures with their appropriate category of weight, length, or
volume.
1. milligram
2. centimeter
3. milliliter
4. millimeter
5. kilogram
•
6. rrucrogram
7. kilometer
8. kiloliter
Answers 1. weight
2. length
3. volume
4. length
5. weight 6. weight 7. length
8. volume
METRIC/SI PREFIXES
Prefixes are used in combination with the names of the basic units to identify larger and
smaller units of measure. The same prefixes are used with all three measures. Therefore,
there is a kilometer, kilogram, and a kiloliter.
KEV paint: Identical prefixes are used to identify units that are larger or
smaller than the basic metric measures.
Prefixes also change the value of each of the basic units by the same amount. For example,
the prefix "kilo'' identifies a unit of measure that is larger than (or multiplies) the basic
unit by 1000.
1 kilometer
1 kilogram
1 kiloliter
1000 meters
1000 grams
1000 liters
Kilo is the only prefix you will be using in the clinical setting that identifies a measure
larger than the basic unit. Kilograms are frequently used as a measure for body weight,
especially for infants and children.
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37
38
INTRODUCTION TO DRUG MEASURES
You will see only three measures smaller than the basic unit in common clinical use.
The prefixes for these are:
milli-as in milligram-for weight
micro-as in microgram- for weight
centi-as in centimeter-for length
The refore, you will actually be working with only four prefixes: kilo, which identifies a
larger unit of measure than the basic; and mi Iii, micro, and centi, which identify smaller
units than the basic.
METRIC/SI ABBREVIATIONS
In clinical u se, units of metric measure are abbreviated.
KE point: The basic units are abbreviated to their frrst initial and
printed in small (lowercase) letters, with the exception of liter, which is
capitalized (uppercase).
meter is abbreviated m
gram is abbreviated g
liter is abbreviated L
KE point: The abbreviations for the prefixes used in combination with the
basic units are all printed using small letters.
kilo is k (as in kilogram-kg)
milli is m (as in milligram-mg)
micro is me (as in microgram-mcg)
centi is c ( as in centimeter-cm)
Micro has an additional abbreviation, the symbol µ,, but its u se has been discontinued in
medication dosages. This became necessary because medication errors were made when
handwritten µg was misread as mg, a dosage 1000 times the mcg dosage ordered.
KEV point: Micro is always abbreviated using the prefix me rather than the
symbolµ, which has a11 i11here11t safety risk.
In combination, liter remains capitalized. Therefore, milliliter is mL and kiloliter is kL.
►►► PROBLEMS 4.2
Abbreviate the following metric units .
•
1. rmcrogra1n
2. liter
3. kilogram
4. milliliter
5. centimeter
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METRIC/ INTERNATIONAL (SI) SYSTEM
6. milligram
7. meter
8. kiloliter
9. millimeter
10. gram
Answers 1. mcg
2. l
3. kg
4. ml
5. cm
6. mg
7. m 8. kl 9. mm
10. g
METRIC/SI NOTATION RULES
To remember the rules of metric notations, in which a unit of measure is expressed with
a quantity, it is helpful to memorize some prototypes (examples) that incorporate all the
rules. For the metric system, the notations for one-half, one, and one and one-half milliliters
incorporate all the official notation rules.
Prototype Notations:
0.5 ml,
I ml,
1.5 ml,
RULE 1 • The quantity is written in Arabic numerals: 1, 2, 3, 4, and so forth.
Example: 0.5
1
1.5
RULE 2 • The numerals representing the quantity are placed in front of the
abbreviations.
Example: 0.5 mL
1 mL
1.5 mL
(not mL 0.5, mL 1, mL 1.5)
RULE 3 • A full space is used between the numeral and the abbreviation.
Example: 0.5 mL 1 mL 1.5 mL (not 0.5mL, lmL, l .5mL)
RULE 4 • Fractional parts of a unit are expressed as decimal fractions.
Example: 0.5 mL 1.5 mL (not½ mL, l ½ mL)
RULE 5 • A zero is placed in front of the decimal when it is not preceded
by a whole number, to emphasize the decimal point.
Example: 0.5 ml, (not .5 mL)
RULE 6 • Excess zeros following a decimal fraction are eliminated.
Example: 0.5 ml, 1 mL 1.5 mL (not 0.50 mL, 1.0 mL, 1.50 mL)
►►► PROBLEMS 4.3
Write the metric measures using official abbreviations and notation rules.
1. two grams
2. five hundred milliliters
3. five-tenths of a liter
4. two-tenths of a milligram
5. five-hundredths of a gram
6. two and five-tenths kilograms
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39
40
INTRODUCTION TO DRUG MEASURES
7. one hundred micrograms
8. two and three-tenths milliliters
9. seven-tenths of a milliliter
10. three-tenths of a milligram
11. two and four-tenths liters
12. seventeen and five-tenths kilograms
13. nine-hundredths of a milligram
14. ten and two-tenths micrograms
15. four-hundredths of a gram
Answers 1. 2 g 2. 500 ml 3. 0.5 l 4. 0.2 mg S. 0.05 g 6. 2.5 kg 7. 100 mcg 8. 2.3 ml
9. 0.7 ml 10. 0.3 mg 11. 2.4 l 12. 17.5 kg 13. 0.09 mg 14. 10.2 mcg 15. 0.04 g
CONVERSION BETWEEN METRIC/SI UNITS
When you administer medications, you will be routinely converting units of measure
within the metric system; for example, g to mg and mg to mcg. Learning the relative value
of the units with which you will be working is the first prerequisite for accurate conversions.
There are only four metric weights commonly used in medicine. From greater to
lesser value, these are:
kg
g
mg
mcg
kilogram
gram
milligram
•
rmcrogram
Only two units of volume are frequently used. From greater to lesser value, these are:
L
mL
liter
milliliter
KE point: Each of these clinical metric measures differs from the next
by 1000.
1 kg
1g
1 mg
1L
1000 g
1000 mg
1000 mcg
1000 mL
Once again, from greater to lesser value, the units are, for weight: kg-g-mg-mcg; for
volume: L-mL. Each unit differs in value from the next by 1000, and all conversions will
be between touching units of measure; for example, g to mg, mg to mcg, and L to mL.
►►► PROBLEMS 4.4
Choose true {T) or false {F) for each conversion.
1. T F
lOOOmL
1000 L
4. T F
1000 mg
1 mcg
2. T F
1000 mg
lg
5. T F
lOOOmcg
lg
3. T F
1000 g
1 kg
6. T F
1kg
1000 g
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METRIC/ INTERNATIONAL (SI) SYSTEM
7. T F
1 mg
1000 g
9. T F
1g
100 mcg
8. T F
1000 mcg
1mg
10. T F
1000 L
1 kL
8. T 9.F
10.T
Answers 1.F 2 . T 3.T 4.F
5.F
6.T
7.F
Because the metric system is a decimal system, conversions between the units are
accomplished by moving the decimal point. Also, because each unit of measure in
clinical use differs from the next by 1000, if you lmow one conversion, you know them all.
Bow far do you move the decimal point? There is an unforgettable memory cue
that can be used with all metric conversions. There are three zeros in 1000. The decimal
point moves three places, the same number of places as the zeros in the conversion.
EVpoint: In metric conversions between touching units of clinical
measures differing by 1000, the decimal point is moved three places, the
same as the number of zeros in 1000.
This rule holds true for all decimal conversions in the metric system. If the difference in
value was 10, which has one zero, it would move one place. If the difference was 100,
which has two zeros, it would move two places. When the difference is 1000, as in clinical
conversions, which has three zeros, the decimal point moves three places.
Which way do you move the decimal point? If you are converting to a smaller unit
of measure-for example, g to mg or L to mL-the quantity must get larger. The decimal
point must move three places to the right.
EXAMPLE 1
0.5 g = _ ______ mg
You are converting to smaller units of measure, from g to mg, so the quantity will be
larger. Move the decimal point three places to the right. To do this, you must add two
zeros to the end of the quantity, and eliminate the zero in front ofit. The larger 500 mg
quantity indicates that you have moved the decimal point in the correct direction.
Answer 0 ~ mg
EXAMPLE 2
Move the decimal three places to the right
2.5 L = _ _ _ _ _ _ mL
You are converting to smaller units of 1neasure, so the quantity will be larger. Move the
decimal point three places to the right. To do this, you must add two zeros. The larger
2500 mL quantity indicates that you have moved the decimal point in the correct direction.
Answer 2.5 L = 2.500 mL
►►► PROBLEMS 4.5
Convert the metric measures.
1. 7mg=
mcg
4. 0.03 kg=
g
2. 1.7 L =
mL
5. 0.4 mg=
mcg
3. 3.2 g =
mg
6. 1.5 mg=
mcg
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41
42
INTRODUCTION TO DRUG MEASURES
7. 0.7 g =
_ _ _ _ _ _ mg
9. 7 kg
______ g
8. 0.3 L =
_ _ _ _ _ m.L
10. 0.01 mg=
_ _ _ _ _ _ mcg
Answers 1. 7000 mcg 2. 1700 ml 3. 3200 mg
7. 700 mg 8. 300 ml 9. 7000 g 10. l O mcg
4. 30 g
5. 400 mcg
6. 1500 mcg
In metric conversions from smaller to larger units of measurement, such as mL to L and
mcg to mg, the quantity will be smaller. The decimal point is moved three places to the left.
EXAMPLE 1
200 mL = _ _ _ _ _ _ L
You are converting to a larger unit of measure, ml, to L, s o the quantity will be smaller.
Move the decimal point three places to the left.
.200. mL = .200 L
~
Eliminate the two unnecessary zeros at the end of the quantity (to make it .2), then add a
zero in front of the decimal point to correctly write the dosage as 0.2 L.
Answer .200. mL = 0.2 L
~
EXAMPLE 2
1500 mcg = _ _ _ _ _ _ mg
You are converting to a larger unit of measure, s o the quantity will be smaller. Move the
decimal point three places to the left. Place a decimal point in front of the 5, and
eliminate the two zeros after the 5.
Answer 1.500. mcg = 1.5 mg
~
EXAMPLE 3
300 mcg = _ _ _ _ _ _ mg
You are converting to a larger unit of measure, mcg to mg, so the quantity will be
smaller. Move the decimal point three places to the left
- ~ mcg = .300 mg
Two zeros will need to be eliminated from the end of this decimal fraction (to make it .3),
and a zero must be placed in front of the decimal point to complete the decimal fraction.
Answer 300 mcg = 0.3 mg
►►► PROBLEMS 4 .6
Convert the metric measures.
1. 3500 mL
L
6. 250 mcg
mg
2. 520mg
g
7. 1200 mg
g
3. 1800 mcg
mg
8. 600 mL
L
4. 750 mL
L
9. 100mg
g
5. 150 mg
g
10. 950 mcg
mg
Answers 1. 3.5 l 2. 0.52 g
9. 0.1 g 10. 0.95 mg
3. 1.8 mg
4. 0.75 l
5, 0.15 g
6. 0.25 mg
7. 1.2 g
8. 0.6 l
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METRIC/ INTERNATIONAL (SI) SYSTEM
COMMON ERRORS IN METRIC/SI DOSAGES
Most errors in the metric system occur because orders are not written using correct notation rules, or they are not transcribed correctly. Errors usually involve decimal fractions. Even though you have just finished learning metric notation rules, let's review the
most common errors.
One error is the failure to enter a zero in front of a decimal point; for example,
.2 mg instead of 0.2 mg. Regardless of the presence of a zero in front of the decimal in a written order, one must be added when the order is transcribed to a medication administration
record.
EYpoint: Fractional dosages in the metric system are transcribed with a
zero in front of the decimal point.
Another common error is to include zeros where they should not be; for example,
2.0 mg instead of 2 mg or 0.20 mg instead of 0.2 mg. Each error can be misread as 20 mg, a
dosage greatly in excess of the intended dosage.
EVpoint: Unnecessary zeros are eliminated when metric dosages are
transcribed.
Errors are also more likely to occur in calculations that include decimal fractions.
The presence of a decimal fraction in a calculation raises a warning flag to slow down and
double-check all math. Use your reasoning powers. If a decimal is misplaced, the answer
will be a minimum of 10 times too large or 10 times too small. Question quantities that
seem unreasonable. A 1.5 mL IM injection dosage makes sense, but a 0.15 mL or 15 mL
does not, and this is the type of error you might see.
EVpoint: Question orders and calculations that seem unreasonably large
or small.
Additional errors to be aware of are in conversions within the metric system. Errors in
conversions can be eliminated by thinking three. All conversions between the g, mg, mcg,
mL, and L measures are accomplished by moving the decimal point three places. Always
and forever. There are not many things for which you can use the words "always" and "forever:• but converting between these units of measure in the metric system is one of those
rare instances.
EYpoint: Conversions between g, mg, mcg, mL, and L units of measure in
metric measures require moving the decimal point three places.
Be constantly mindful of these problem areas to become a safe clinical practitioner.
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43
44
INTRODUCTION TO DRUG MEASURES
Summary
This concludes the refresher on the metric system. The important points to
remember from this chapter are:
The meter (m), liter (L), and gram (g) are the basic units of metric measure.
Only liter is capitalized, L.
Larger and smaller units than the basics are identified by the use of prefixes.
The prefixes are printed using small (lowercase) letters.
The one larger unit you will be seeing is the kilo, whose prefix is k
The smaller units you will be seeing are milli (m), micro (me), and centi (c).
Each prefix changes the value of a basic unit by the same amount.
Converting from one unit to another within the system is accomplished by moving
a decimal point.
When you convert from larger to smaller units of measurement, the quantity will
•
mcrease.
To convert from larger to smaller units, the decimal point is moved to the right.
When you convert from smaller to larger units of measurement, the quantity will
get smaller.
To convert from smaller to larger units, the decimal point is moved to the left.
Conversions between g to mg, mg to mcg, and mL to L all require moving the
decimal point three places.
Fractional dosages are transcribed with a zero in front of the decimal point.
Unnecessary zeros are eliminated from dosages.
Summary Self-Test
List the basic units of measure of the metric system and the measure they are used for.
1.
Which of the following are official metric/SI abbreviations?
2. a) L
e) mg
b) g
f) kg
c) kL
g) ml
d) mgm
h) G
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METRIC/ INTERNATIONAL (SI) SYSTEM
Use official metric abbreviations and notation rules to express these as numerals.
3. six-hundredths of a milligram
4. three hundred and ten milliliters
5. three-tenths of a kilogram
6. four-tenths of a milliliter
7. one and five-tenths grams
8. one-hundredths of a gram
9. four thousand milliliters
10. one and t\.vo-tenths milligrams
List the four commonly used clinical units of weight and the two of volume from
greater to lesser value.
11. Weight
Volume
Convert the following metric measures.
12. 160 mg
g
27. 300 mg
g
13. 10 kg
g
28. 2.5 mg
mcg
14. 1500 mcg
mg
29. 1 kL
L
15. 750 mg
g
30. 3 L
mL
16. 200 mL
L
31. 2 L
mL
17. 0.3 g
mg
32. 0.7 mg
mcg
18. 0.05 g
mg
33. 4 g
mg
19. 0.15 g
mg
34. 1000 mL
L
20. 1.2 L
mL
35. 2500 mL
L
21. 1800 mL
L
36. 1000 mg
g
22. 2 mg
mcg
37. 0.2 mg
mcg
23. 900 mcg
mg
38. 2000 g
kg
24. 2.1 L
mL
39. 1.4 g
mg
25. 475 mL
L
40. 2.5 L
mL
26. 0.9 L
mL
Answers
1. gram-weight;
liter-volume;
meter-length
2. a, b, c, e, f
3. 0.06 mg
4. 310 ml
5. 0.3 kg
6. 0.4 ml
7. 1.5 g
8. 0.01 g
9. 4000 ml
10. 1.2 mg
11. kg, g, mg,
mcg, l, ml
12. 0.16 g
13. 10,000 g
14. 1.5 mg
15. 0.75 g
16. 0.2 l
17. 300 mg
18. 50 mg
19. 150 mg
20. 1200 ml
21. 1.8 l
22. 2000 mcg
23. 0.9 mg
24. 2100 ml
25. 0.475 l
26. 900 ml
27. 0.3 g
28. 2500 mcg
29. 1000 l
30. 3000 ml
31. 2000 ml
32. 700 mcg
33. 4000 mg
34. 1 l
35. 2 .5 l
36. 1 g
37. 200 mcg
38. 2 kg
39. 1400 mg
40. 2500 ml
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45
CHAPTE
I
I
I
Although metric measures predominate in medications, there are several
other measures frequently used, particularly in parenteral (injectable)
solutions, that are important for you to know. In addition, you must be
familiar with several measures in the household system because you may
occasionally see these.
INTERNATIONAL UNITS (units)
A number of drugs are measured in International Units. Insulin, penici]Jin,
and heparin are commonly seen examples. Antibiotics, such as penicillin,
have dosages in the hundredths, thousandths, and millionths, and heparin
has dosages in the thousandths. A unit measures a drug in terms of its
action, not its physical weight. The word "units" is not abbreviated; it
is written in lowercase using Arabic numerals in front of the measure, with a space between; for example, 2000 units or 1,000,000 units.
Commas are not usually used in a quantity unless it has at least five
numbers; for example, 45,000 units.
►►► PROBLEMS 5.1
Express the unit dosages in numerals.
1. two hundred and fifty thousand units
2. ten units
3. five thousand units
4. forty-four units
5. forty thousand units
y noL be copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig bi.o;, some Lhird party conLenLmay be suppressed rmm Lhe eBook and/or eChapLet~s).
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UNIT, PERCENTAGE, MILLIEQUIVALENT, RATIO, AND HOUSEHOLD MEASURES
6. one million units
7. one thousand units
8. twenty-five hundred units
9. thirty-four units
10. one hundred units
Answers 1. 250,000 units 2 . 10 units 3. 5000 units 4 . 44 units 5 , 40 ,000 units 6 . 1,000 ,000 units
7. 1000 units 8. 2500 units 9. 34 units 10. 100 units
PERCENTAGE(%)MEASURES
Percentage strengths are used extensively in intravenous solutions, and somewhat less
commonly for a variety of other medications, including eye and topical ( for external use)
ointments. Percentage(%) means parts per hundred. The greater the percentage
strength, the stronger the solution or ointment; for example, 3% is stronger than 1%.
Fractional percentages are expressed as decimal fractions; for example, 0.45%. Notice that,
unlike other written dosages, percentages are generally written with no space between
the quantity and percentage sign.
KEVpoint: In solutions, percent represents the number of grams of drug
per 100 mL of solution.
EXAMPLE 1
100 mL of a 1% solution will contain 1 g of drug.
EXAMPLE 2
100 mL of a 2.5% solution will contain 2.5 g of drug.
EXAMPLE 3
100 mL of a 10% solution will contain 10 g of drug.
EXAMPLE 4
100 mL of a 0.9% solution will contain 0.9 g of drug.
KEYpaint: These examples are included to point out that percentage
solutions contain a significant amount of drug or other solute, and that
reading percentage labels requires the same care as that used with other
drug dosages.
MILLIEQUIVALENT (mEq) MEASURES
Milliequivalents ( mEq) is an expression of the number of grams of a drug contained
in I ml, of a normal solution. This is a definition that is quite understandable to a pharmacist or chemist, but you need not memorize it. Milliequivalent dosages are also written
u sing Arabic numerals, with a space between the abbreviation that follows, for example, 30 mEq. You will see milliequivalents u sed in a variety of oral and parenteral solutions,
potassium chloride being a common intravenous example.
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47
48
INTRODUCTION TO DRUG MEASURES
►►► PROBLEMS 5.2
Express the milliequivalent dosages in numerals.
1. sixty milliequivalents
2. fifteen milliequivalents
3. forty milliequivalents
4. one milliequivalent
5. fifty milliequivalents
6. eighty milliequivalents
7. fifty-five milliequivalents
8. seventy milliequivalents
9. thirty milliequivalents
10. twenty milliequivalents
Answers 1. 60 mEq 2. 15 mEq 3. 40 mEq 4. l mEq 5. 50 mEq 6. 80 mEq 7. 55 mEq 8. 70 mEq
9. 30 mEq 1O. 20 mEq
RATIO MEASURES
Ratio strengths are u sed primarily in s olutions. Tl1ey represent parts of drug per parts
of solution; for example, 1 : 1000 (one part drug to 1000 parts s olution).
EXAMPLE 1
A 1 : 100 strength s olution has 1 part drug in 100 parts solution.
EXAMPLE 2
A 1 : 5 s olution contains 1 part drug in 5 parts s olution.
EXAMPLE 3
A s olution that is 1 part drug in 2 parts solution would be written 1 : 2.
KE paint: The less s olution a drug is dissolved in, t h e stronger t h e
solution.
For example, a ratio strength of 1 : 10 (1 part drug to 10 parts s olution) is much stronger
than a 1 : 100 (1 p art drug in 100 parts s olution).
Ratio strengths are always expressed in their simplest terms. For example, 2 : 10
would be incorrect because it can be reduced to 1 : 5. Notice that ratio dosages are written
separated by a colon, with a space between both numbers and the colon. Dosages using
ratio strengths are not common, but you do need to know what they represent.
►►► PROBLEMS 5 .3
Express as ratios.
1. 1 part drug to 200 parts solution
2. 1 part ch·ug to 4 parts s olution
3. 1 part drug to 7 parts solution
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UNIT, PERCENTAGE, MILLIEQUIVALENT, RATIO, AND HOUSEHOLD MEASURES
Identify the strongest solution.
4 a) 1: 20
b) 1: 200
c) 1 : 2
5 a) 1 : 50
b) 1 : 20
c) 1 : 100
6 a) 1 : 1000
b) 1 : 5000
c) 1 : 2000
Answers 1. 1 : 200 2. 1 : 4 3. 1 : 7 4. c 5. b 6. a
HOUSEHOLD MEASURES
Household measures are rarely used. They are only used in the home care setting, and their
clinical use is becoming less frequent. The measures you may occasionally see include the
ounce, tablespoon, teaspoon, dram, and drop. Abbreviations and/ or names for all of
these measures, except the drop, still appear on many disposable medication cups,
and care must be taken not to confuse them with metric dosages. It is quite possible that
these measures will be eliminated in the future because the health care industry has been
moving rapidly to improve dosage labeling and medication abbreviation guidelines to reduce the possibility of errors.
The various abbreviations for household dosages and their metric equivalents are as
follows:
Household
Measure
ounce
Abbreviation
Metric
Equivalent
30mL
tablespoon
oz
T, TBS, tbs
teaspoon
t, TSP, t sp
5mL
dram
dr
4mL
drop
gtt
lmL
15mL
KEVpoint. The volume of a drop depends 011 the size of the dropper
being used.
A drop is such an inaccurate and variable measure that medication droppers are now often included with small-volume liquid medication preparations; the dropper is specific to
that medication. The u se of drops is largely restricted to eye and ear drop use. One exception is in small-volume pediatric liquid medications, which are prepared with integral
(included with the medication) medicine droppers that are calibrated by volume,
or by actual dosage.
APOTHECARY MEASURES
Apothecary measures are officially obsolete. In Chapter 6 on oral medication labels it will
be pointed out that the labels of a few very, very old drugs, aspirin and nitroglycerine, may
still contain the apothecary abbreviation "gr" for grains. The grain was originally based on
the weight of a grain of wheat, which exposes its inaccuracy, and why this measure is now
obsolete. As drug manufacturers begin to adopt updated official abbreviations and drug
measures, "gr" will be deleted from the few remaining medication labels where it still appears. Appendix A includes some additional information on this obsolete system, in the
event your instructor feels it necessary for you to learn.
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49
50
INTRODUCTION TO DRUG MEASURES
Summary
This concludes your introductio11 to the additional measures you will see used in
dosages and in solutions. The important points to remember from this chapter are:
'Y International units measure a drug by its action rather than its weight.
There is no abbreviation for units, which is written in full, units, in lowercase
letters.
'Y Percentage(%) strengths are frequently used in solutions and ointments.
'Y Percent represents grams of drug per 100 mL of solution.
The greater the percentage strength, the stronger the solution.
Milliequivalent is abbreviated m.Eq and is frequently used in solution
measurements.
'Y Ratio strengths represent parts of drug per parts of solution.
The smaller the volume of solution, the greater the ratio strength.
Tor tbs is the abbreviation for tablespoon (15 mL), and tor tsp
for teaspoon (5 mL).
The abbreviation gtt is used for drop, and oz for ounce.
Summary Self-Test
Express the dosages using the official symbols/ abbreviations.
1. three hundred thousand units
2. forty-five units
3. ten percent
4. two and a half percent
5. forty milliequivalents
6. a one in two thousand ratio
7. a one in ten ratio
8. one percent
9. one drop
10. two thousand units
11. five milliequivalents
12. nine-tenths percent
13. ten units
14. a one in two ratio
15. five percent
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UNIT, PERCENTAGE, MILLIEQUIVALENT, RATIO, AND HOUSEHOLD MEASURES
16. t\venty milliequivalents
17. fourteen units
18. t\venty percent
19. t\vo million units
20. one htmdred thousand units
Answers
1. 300,000 units
2. 45 units
3. 10%
4. 2.5%
s. 40 mEq
6. 1 : 2000
7. 1 : 10
8. 1%
9. 1 gtt
10. 2000 units
11. 5 mEq
12. 0.9%
13. 10 units
14. 1 : 2
15. 5%
20. 100,000 units
16. 20 mEq
17. 14 units
18. 20%
19. 2,000,000 units
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51
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,
CHAPTER 6
CHAPTER 9
CHAPTER 7
CHAPTER 10
CHAPTER 8
CHAPTER 11
CHAPTE
In this chapter, you will be introduced to labels of oral medications for
both solid (tablet and capsule) and liquid (ml) medications. Medication
label information includes trade and generic drug names, metric dosage
strengths, manufacturer's name, and other details you need to be aware
of, primarily so that you can quickly locate the correct dosage strength
to calculate ordered dosages. You will then use actual drug labels to
calculate a full range of oral medication dosages. Average dosage cal-
culations require only the information you have already learned on
the metric system and in the Refresher Math Section on addition and
subtraction. They are routinely done mentally. Advanced calculations
are needed primarily in clinical specialty areas, and they will be covered
in later chapters.
•
Most oral dosages consist of one-half to
three tablets or capsules, or one-half to double the
milliliter volume of liquid medications, and are
done mentally.
We will begin with labels for solid drug preparations. These include
tablets, scored tablets (which contain an indented marking to make
breakage for partial dosages possible), enteric-coated tablets (which
delay absorption until the drug reaches the small intestine), capsules
(powdered or oily drugs in a gelatin cover), and sustained or controlledrelease capsules (action spread over a prolonged period of time; for
example, 12 hours). See Figure 6-1.
y noLbe copied, scanned, or d uplicated, in whole o r in part. Due Lo electronic rig bi.o;, some Lhird party conLenLmay be suppressed rmm Lhe eBook and/or eChapLet~s).
m.at.eri.ally affecL the overall learning experience. Cengage Leaming reserves the rig hLLo remove additional c.o nlenl al any time if subscquenLrighLS restricLions require it.
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
Scored Tablets
Tabelts
Enteric-Coated Tablets
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FIGURE 6-1
TABLET AND CAPSULE LABELS
The most common type of label you will see in the clinical setting is the unit dosage label,
in which each tablet or capsule is packaged separately. However, the dosage information on
both unit and multiple dose labels is identical.
EXAMPLE 1
Look at the Synthroid®label in Figure 6-2. The first thing to notice is that this drug has
two names. The first, Synthroid, is its trade name, which is identified by the ®registration symbol. Trade names are usually capitalized and printed first on the label. The
name in smaller print, levothyroxine sodium, is the generic or official name of the
drug. Each drug has only one official name but may have several trade names, each
for the exclusive use of the company that 1nanufactures it. It is important to remember,
however, that most labels do contain both names. Drugs may be ordered by either name
depending on hospital policy or prescriber preference. You will frequently need to crosscheck trade and generic names for accurate drug identification.
Next on the label is the dosage strength, 100 mcg or 0.1 mg. The prepared dosage
often represents the average dosage strength; the dosage given to the average
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55
56
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
patient at one time. This label also identifies the manufacturer of this drug, Knoll
Pharmaceuticals.
Notice that 100 TABLETS is printed near the bottom of the label. This is the total
number of tablets in the bottle. Be careful not to confuse the quantity of tablets or capsules with the dosage strength. The dosage strength always has a unit of measure
associated with it; in this case, mcg and mg. Because label designs vary widely, this is an
important point to remember.
EXAMPLE 2
The Percocet® label in Figure 6-3 is an example of a medication that contains not one but
two drugs: 5 mg of the narcotic oxycodone and 325 mg of acetaminophen, an analgesic.
The dosages in multiple drug products are routinely written in the same order as the
drugs listed in the product. Oxycodone and acetaminophen are generic names, and
Percocet is the manufacturer's trade name for this product. Medications that contain
more than one drug are usually ordered by trade name and number of tablets or
capsules to be given rather than by dosage.
The balance of the label information includes the total number of tablets near the
bottom, 100; average dosage considerations; a bar code; and a space where the manufacturer would enter the drug lot number and expiration date. Expiration dates are carefully
monitored by clinical pharmacies, but you must also make checking them a habit.
KEVpoint: Tablets and capsules that contain more than one drug are
usually ordered by trade name and number of tablets or capsules to be
given, rather than by dosage.
£,,do•
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(Oxycoclone and Acetaminophen
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5 mg/325 mg
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EXAMPLE 3
The small unit dosage label in Figure 6-4 bears only one name, phenobarbital, which
is actually the generic name of the drug. Generic labeling is common with drugs that
have been in use for generations. The official (generic) name was so well established that
drug manufacturers did not try to promote their own trade names. Also notice that following the drug name are the initials U.S.P. This is the abbreviation for United States
Phar1nacopeia, one of the two official national listings of drugs. The other is the National
Formulary, NF. You will see U.S.P. and NF on drug labels and must not confuse them with
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,ed fro m Lhe cBook and/or eChapLe1ts).
Edilori.al review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts restrictions require iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
other initials that identify additional drugs or specific action of drugs in a preparation.
Also notice that the label contains the dosage strength in both the metric, 15 mg, and
apothecary, 1/4 gr, measures. Finally, on the right of the label, printed sideways, is Exp
6-6-16, which identifies the last date when the drug should be used.
KEVpaint: You may still see the obsolete apothecary abbreviation for grain
("gr"), on a few drug labels, as in Figures 6-4 and Figure 6-5. The apothecary
system is gradually being eliminated from use in health care. In addition,
not all medication labels have been updated to reflect The Joint Commission
standards of leaving a space between the dosage and unit of measure, for
example "500mg" instead of "500 mg"; or the use of "u" instead of "units:•
These also will continue to be corrected by the manufacturers.
Next, refer to Figure 6-5. Notice that this label also contains the dosage strength
of nitroglycerin in both the 0.3 mg metric and the 1/200 gr (grains) of the obsolete
apothecary system units of measure. As with phenobarbital, the inclusion of apothecary
dosages on this label relates to the age and historic use of this drug. Relabeling is already well
under way by manufacturers to remove apothecary dosages completely from their products.
K.EYpaint: For safety in medication administration, focus on the drug name
and its dosage strength.
c::
Store at Controlled Room Tern perature
20•.2s•c (68'· 77'F) [see u SPJ.
Dispense In original , unopened container.
DOSAGE AND USE
See accompanying prescribing information.
Each tablet contains 0.3 mg nitroglycerin.
in
PHENOBARBITAL
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Warning-To prevent loss of potency. keep ; ;
these tablets In the onginal container or in a : :
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: :
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Manufactured by:
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►►► PROBLEMS 6.1
Refer to the label in Figure 6-5 and answer the questions about this drug.
1. What is the generic name?
2. What is the trade name?
3. What is the dosage strength in metric units?
4. What is the dosage strength in the obsolete
apothecary measure?
5. If nitroglycerin 0.3 mg is ordered, how many
tablets will be required?
6. Read the information above the Nitrostat name.
What kind of tablets are these?
7. How must the drug be administered?
Copyrig hl 201 5 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts, some Lhlnl party conle nl may be s uppressed from Lhe c Book and/or eChapLe1ts).
Edilori.al re view has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righLLo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions req uire iL
57
58
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
8. Who is the manufacturer of this drug?
9. How many tablets will be needed to give a
0.6 mg dosage of nitroglycerin?
Answers 1. nitroglycerin 2. Nitrostat® 3. 0.3 mg 4 . 1/200 gr 5. 1 tab 6. sublingual
7. under the tongue 8. Parke-Davis, a division of Pfizer Pharmaceuticals LLC 9. 2 tab
►►► PROBLEMS 6 .2
Refer to the label in Figure 6-6 and answer the questions about this drug.
1. What is the generic name?
2. What is the trade name?
3. What is the dosage strength?
4. What company manufactured this drug?
5. How many tablets are in this container?
6. If Prinivil 5 mg is ordered, how many tablets will you give?
7. Iflisinopril 10 mg is ordered, how many tablets will you give?
Dist_by.
0 MERCK&CO., INC.
Whitehouse Station, NJ 08889, USA
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USUAL ADULT DOSAGE: See accompanying clrtular.
Store at controlled room t~mperalure, 15-3D°C (59-86°F),
and protect from moisture.
This Is a bulk package and not Intended for dispensing.
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Answers 1. lisinopril 2 . Prinivil® 3. 5 mg 4. Merck & Co., Inc. 5, 100 tablets 6 . 1 tab 7 . 2 tab
Refer to the Sinemet®label in Figure 6-7. Sinemet is another example of a combined
drug tablet. The generic names of the drugs it contains are carbidopa and levodopa.
These are listed on the label in several places: directly under the trade name and with the
amount of each drug in the fme print near the bottom of the label. Also, notice the box to
the right of the trade name, which contains the numbers 25-100. This again is the amount
of carbidopa-25 mg-and levodopa-100 mg. Contrast this label with the Sinemet labels
in Figure 6-8 and Figure 6-9.
In Figure 6-8, the dosage strengths are different. A blue box to the right of the Sinemet
trade name identifies the strengths of carbidopa and levodopa as 10 mg and 100 mg, respectively, which are actually lower dosages. And, finally, Figure 6-9 is a label for Sinemet® CR, a
controlled-release or sustained-release tablet, with yet another dosage strength of 50-200:
carbidopa 50 mg and levodopa 200 mg. Unlike the previous combined drug tablet discussed,
an order for Sinemet must include the dosage strength because it is available in several strengths.
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noL be copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlnl party conte nt may be suppressed from Lhe cBook and/or eChapLe1ts).
Edilori.al review has deemed LhaL any suppressed conlenl does nol materially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righLLo remove addiLlonal contenl al any time if subsequenl rig hts res trictions require iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
KE point: Extra numbers after a drug name may be used to identify the
dosage strengths of more than one drug in a preparation, and extra initials
may be used to identify a special drug action.
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FIGURE 6-9
TABLET/CAPSULE DOSAGE CALCULATION
When the time comes for you to administer medications, you will have to read a Medication Administration Record, abbreviated MAR, to prepare the dosage. This will tell you the
name and amount of drug to be given, but it will not tell you how many tablets or capsules
contain this dosage. This you must calculate yourself. However, remember that most tablets/ capsules are prepared in average dosage strengths, and most orders will involve giving
one-half to three tablets (or one to three capsules, because capsules cannot be broken in
half). Learn to question orders for more than 3 tablets or capsules. Although some
drugs require multiple tablets, most do not. Some clinical pharmacies do carry a limited
quantity of a particular medication as a cost-saving factor, so if a drug came in 25 mg,
50 mg, 100 mg, and 200 mg dosages and that facility's pharmacy only carried 25 mg tablets,
an order for 200 mg would translate into 8 tablets, which would seem unreasonable. In the
100 or 200 mg supply, the order results in 1 or 2 tablets, which is reasonable. Always question
an order of more than 3 tablets, and double-check your calculations.
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.ated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be .supprcs..,;,ed from Lhe c Book and/or eChapLe r(s).
Edilori.al review has deemed LhaL any suppressed conlenl does nol materially affecl Lheove rall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove :iddiLlonal conte nl al any Lime if subsequenl rig hts res trictions req uire iL
59
60
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
KEVpoint: An unusual number of tablets or capsules could be a warning of
an error in prescribing, transcribing, or calculating.
Let's now look at some sample orders and do some actual dosage calculations. Assume
that tablets are scored and can be broken in half.
►►► PROBLEMS 6.3
Refer to the Inderal®LA label in Figure 6-10 to answer these questions.
1. What is the dosage strength?
2. If you h ave an order for 120 mg, give
3. If you h ave an order for 60 mg, give
4. What is the gen eric n am e of this drug?
5. What is the tot al number of cap sules in this p ackage?
i~~,
·i~i ,1~ lnderal® LA
·Il'if3 i3
11
I I 60mg
llt:I
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NOC 2'1090-47~
t~
0-
100
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(propranolol
hydrochloride)
0
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YOUR PAOlECTION
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Answers
1. 60 mg 2. 2 cap 3. 1 cap 4. propranolol hydroch loride 5. 100 capsules
►►► PROBLEMS 6.4
Refer to the Glucotrol®label in Figure 6-11 to answer these questions.
1. What is the dosage strength?
2. If 10 mg is ordered, give
3. If 2.5 mg is ordered, give
4. If 5 mg is ordered, give
5. What is the gen eric n am e of this drug?
6. What is the total number of tablets in this p ackage?
Copyrig hL 20 15 Ce ng agc Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhlnl party conte nt may be s uppressed from LhecBook and/or eChaple t1s).
Edilori.al re view has deemed Lhat :my suppressed content does noL materially :iffecL Lheovc rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righl lo remove additional contenLal any time if su bsequenLrig hts res trictions req uire iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
o, • .,..,
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NOC 0662-4110-73
500Tablets
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glipizide
.c
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CAUTION: Federal law prohibits
dispensing without prescription.
a
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FIGURE 6-11
Answers 1. 5 mg 2. 2 tab 3. ½ tab 4. 1 tab 5. glipizide 6. 500 tablets
It is not uncommon to have a drug ordered in one unit of metric measure-for example,
mg-and discover that it is labeled in another measure-for example, g. It will then be
necessary to convert the metric units to calculate the dosage. Conversions will always
be between touching units of measure: g and mg or mg and mcg. Converting involves
moving the decimal point three places.
EXAMPLE 1
Refer to the Halcion®label in Figure 6-12. A dosage of 250 mcg has been ordered. The label
reads 0.25 mg. Convert the mg to mcg by moving the decimal point three places to the
right, and you can mentally verify that these dosages are identical. Give 1 tablet.
Halcion®
triazolam tablets, USP
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FIGURE 6-12
EXAMPLE 2
Refer to the Xanax®label in Figure 6-13. A dosage of 500 mcg is ordered. The label reads
0.25 mg, so you must give 2 tablets (1 tab= 250 mcg, so 500 mcg requires 2 tab). The
decimal moves three places to the right in this conversion from mg to mcg.
Copyrig hl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be .supprcs..,;,ed fro m Lhe c Book and/or eChapte1ts).
Edilori.al review has deemed LhaLany suppressed content does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righL Lo remove addiLlonal conte nLal any time if subsequenLrig hts res trictions require iL
61
62
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
N
NOC 0009·0029·01
6505- 01 -143·9269
Ij'..ontv
See package Insert for
complete product
Information.
keep container tightly
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resistant container.
Store at controlled room
temperature 20• to 2s• c
(68° to 77° Fl lsee USPI.
Pharmacia & UpJohn
Company
Kalamazoo, Ml 49001, USA
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atprazolam tablets,
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►►► PROBLEMS 6 .5
Locate the appropriate labels for the following dosages, and indicate how many
tablets or capsules are needed to give them. Assume all tablets are scored and can
be broken in half. Labels may be used in more than one problem.
1. verapamil HCl 0.12 g
cap
2. Terbutaline®10 mg
tab
3. Ritalin®HCl 7.5 mg
tab
4. methylphenidate HCl 2500 mcg
tab
~
NOC 0078-0439-05
Ritalin• HCI
11"1
I
methylphenldate HCI USP ~
._.,
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0
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Rx only
100 tablets
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NOC 0527-1311~1
USUAL DOSAGE:
See paol<ago lnse<t lor pmsoiblrg
Di!penseil a ligl1, ~~e,islan1
con1ainer as defiled iltle USPwitl
achickes6ian1 dosure.
Storeal 20'-25'<: (68'-77'F)
!See USPCOnlroled Aoool
Terrperalure). Excursioopermilled
~
Rev.00/05
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lnadil<, ngre<ien!s:
Anhymlus lactooe, ma.gnesium
slearale, nicrocry<1meceUose.
povidone. andpregelaliized star<h.
TERBUT ALINE
SULFATE
TABLETS,USP
15' .:JO'C (59'-116'F)
=
"'
Each lalllel ainiails:
Tell>Jlaline SIAlaie, USP ...... Smg
illonnalm
Marufa<:IJred tlf:
l.3nne.i1 Company, Inc.
U11l·I
~ . PA 19136
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.t90
Verelan®
VERAPAMIL HCI
SUSTAIN£0flELEASE
PillEl FILLED CAPSULES
~r-'"
120MG
EACJ4 CAl'SUI.E CONTA/NS:
120 mg " - ' • ~ H,a,ocll/ollar, USP
USUAi. .\0(.(. r ~ E Set l»CUQO' " - ' Ir,, ~.A
~ inlll'ma'#l Otp,Mo kl 19'1~• m<tl&»l~.r.OUINO nUSP
11wt~l!Olb7,,__~
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~-be-
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Pr""o:cc-,&om~
Ulll~ rev-•
Mn!.~~
S,:tr,an Phatma. Inc
1.1.lw~l toe VI I S.120 I
100 CAPSULES
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Answers 1. 1 cap 2 . 2 tab 3. 1½ tab 4. ½ tab
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplicated, in whole or in part. Due to elec.tronic rights. some Lhird party conle nl may be s uppressed fro m Lhe cBook and/or eChapler(s).
Edilori.al review bas deemed LhaL any suppressed conlenl does nol materially affec l Lheoverall leaming e xpe rience. Cengage Leaming re.serves Lhe righl lo remove addilional conte nl al any Lime if subsequenl rig hls res trictions require iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
►►► PROBLEMS 6.6
Locate the appropriate labels for the following drug orders, and indicate
the number oftablets/ capsules that will be required to administer the dosages ordered. Assume that all tablets are scored and can be broken in half.
Notice that both generic and trade names are used for the orders and that a
label may be used in more than one problem.
1. isosorbide dinitrat e 80 m g
cap
2. sulfasalazine 0.5 g
t ab
3. Azulfidine®1 g
t ab
4. t erbutaline sulfat e 2500 m cg
t ab
5. chlordiazepoxide HCI 50 mg
cap
6. Librium®25 mg
cap
7. Dilatrat e®-SR 80 mg
cap
8. Synthroid®0.2 mg
t ab
9. levothyroxine Na 0.2 mg
t ab
10. t erbutaline sulfat e 3.75 m g
t ab
Liii ,1u·m·@
1
(chlordiaz~oxide HCI)
....,
NOC 0048-1070-03
HSN 6505-01-340-0152
Code3P1073
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0
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(Levo1hyroxlne Sodium
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Azulfidine·
sulfasatazlne tablets, USP
.;
25mg
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Each capsule conllllns
(t)
>
25 mg chlordiazepoxide HCI
0
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100 Capsules
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Sustained Release
In• o,y pllal.
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NOC 0527-1318-01
USUAL DOSAGE:
See package insert for prescribing
infonnation.
Dispense in a tight, light-resistant
container as defined in the USP with
achild-resistant closure.
Store at 20' -25"C (68'·77'F)
[See USP Controlled Room
Temperature}. E,,cursion permitted
15'..JO' C (59' -SG'F)
~~~~y,r
TERBUTALINE
SULFATE
TABLETS,USP
Rev. 03/05
2.5 mg
11 1111
11111
527-
3 1 8-0
5
Rx Only
100 TABLETS
u
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Each tablet contains:
Terl:iutaline, USP ...... 2.5 mg
:,;.
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Inactive Ingredients:
Anhydrous lactose, magnesium
stearate, microaystalline cellulose,
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Manufactured by:
Lannelt Company, Inc.
Philadelphia, PA 19136
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Edilori.al review bas deemed Lhat :my suppressed content does noL materially :iffecl Lheovcrall leaming e xperience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rights res trictions require iL
63
64
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Answers 1. 2 cap 2 . 1 tab 3 . 2 tab 4. 1 tab 5, 2 cap 6. 1 cap 7 . 2 cap 8 , 2 tab
9. 2 tab 10. 1½ tab
ORAL SOLUTION LABELS
In liquid drug preparations, the dosage is contained in a certain mL volume of solution.
Let's review dosages in some solid and liquid drug preparations to illustrate the difference.
EXAMPLE 1
Solid: 250 mg in 1 tablet
Liquid: 250 mg in 5 ml,
EXAMPLE 2
Solid: 100 mg in 1 capsule
Liquid: 100 mg in 10 ml,
EXAMPLE 3
Refer to the Lomotil®label in Figure 6-14. The information it contains will be familiar.
Lomotil is the trade name and diphenoxylate is the generic or official name. The
dosage strength is 2.5 mg per 5 ml,. As with solid drugs, the medication administration
record, MAR, will tell you the dosage of the drug to be administered, but it will not
specify the volume that contains this dosage.
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FIGURE 6-14
►►► PROBLEMS 6.7
Refer to the Lomotil®label in Figure 6-14 to calculate these dosages.
1. The order is for diphenoxylate 2.5 mg. Give
2. The order is for Lomotil 5 mg. Give
Answers 1. 5 ml 2 . 10 ml
N o te: If you did not express your answers as ml, they are incorrect. Numbers have no mean ing unless they are expressed w ith
a un it of measure.
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be .supprcs..,;,ed fro m Lhe c Book and/or eChapter(s).
Edilori.al review has deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
►►►
PROBLEMS 6. 8
Refer to the penicillin V label in Figure 6 -15 to calculate these dosages.
1. The order is for p enicillin V 400,000 units.
2. p enicillin V 125 m g h as b een ordered .
3. p enicillin V 375 m g h as b een ordered .
NOC 0093-4127-73
PENICILLIN V
POTASSIUM
for Oral Solution, USP
ro
250 mg (400,000 U) per 5 ml
>
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WARNING: NOT FOR INJECTION
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361·32·787156240A Rtv. 01
Rev. F4/2012
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FIGURE 6-15
Answers
1. 5 ml 2. 2.5 ml 3. 7.5 ml
Note: Your answers are incorrect unless they include ml as the un it of volume measure.
►►►
PROBLEMS 6. 9
Refer to the solution labels in Figure 6-16 and Figure 6-1 7 to calculate these dosages.
1. oxycodone soln. 10 mg
2. cefaclor susp. 187 mg
3. cefaclor susp. 374 mg
4. oxycodone soln. 30 mg
5. oxycodone soln. 20 m g
Copyrig hL 20 15 Cengage Leaming. All RighL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to electronic rig hts. .some Lhird party content may be .suppres..,;;ed from Lhe e.Book and/or eChapte11s}.
Edilori.al review has deemed LhaL :my suppressed content does noL materially affect Lheoverall learning experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent r ighls restricLions require it.
65
66
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
NOC 0527-142&-36
O')
co
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OXYCODONE
HYDROCHLORIDE
Oral CONCENTRATE Solution
20 mg per ml
(Warning: may be habit fonnlng.)
Each ml contains.
Oxycodone Hydrochlonda USP 20 mg
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See Package lnsen for Complete
Prescribing tnlomiation
Dispense only 1n this bottle and
Only w,1h the cahbrated delivery device provided
Store al controlled room temperature
1S•·30'C (59°-86"F)
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SHAKE WELL BEFORE USE
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FIGURE 6-17
Answers 1. 0.5 ml 2. 5 ml 3. 10 ml 4. 1.5 ml 5. 1 ml
MEASUREMENT OF ORAL SOLUTIONS
Oral solutions are most commonly measured using a disposable calibrated medication
cup. Take a close look at the schematic drawing of the medication cup calibrations in
Figure 6-18. Many disposable medication cups, like this one, still contain the TSP (teaspoon), TBS (tablespoon), and OZ (ounce) calibrations of the household system and the obsolete DR ( for dram) of the apothecary system. Some also contain the increasingly disused
cc (cubic centimeter) calibration, which is identical to a mL {milliliter). Oral solutions are
most safely poured at eye level. Because of the number of units of measure on these cups,
always read calibrations very carefully.
Copyrig hL 20 15 Cengage Leaming. All RighL'i Reserved May noL be copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhlnl party conlenl may be s uppressed fro m LhecBook and/or eChaple t1s).
Edilori.al review has deemed LhaLany suppress ed conlenl does nol materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove additional contenl al any time if subsequenl rig hls res trictions require iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
1 oz
2TBs -
--i--- 30 ML
25 ML
3/402
4DR
1/2
oz
20ML
1TBs--t-- 15 ML
2TSp -
2 DR
1 DR
1/4
oz
1ta OZ
-i------- 10 ML
7.5 ML
1 Tsp - - 1 - - - 5 ML
112 TSP---1--- 2.5 ML
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FIGURE 6-18
Small-volume solution dosages can also be measured using specially calibrated oral
syringes such as those illustrated in Figure 6-19 and Figure 6-20. Oral syringes have safety
features built into their design to prevent their being mistaken for hypodermic syringes.
One of these features is color, as illustrated in Figure 6-19. Hypodermic syringes are not
colored, although their packaging and needle covers are colored to aid in identification.
A second feature is the syringe tip, which is a different size and shape and is often off
center (termed eccentric). Figure 6-20 illustrates an eccentric oral syringe tip. Hypodermic
syringes without a needle can also be used to measure and administer oral dosages.
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FIGURE 6-20
The main concern with correct syringe identification is that oral syringes, which are
not sterile, should not be confused and used for hypodermic medications, which are
sterile. This mistake has been made in spite of the fact that hypodermic needles do not fit
correctly on oral syringes. The precaution, therefore, does need to be stressed.
Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplica ted, in whole or in part. Due to elec.tronic rights. some Lhlrd party conte nt may be s uppress.eel from Lhe cBook and/or eChapLer(s).
Ed llorial review has deemed LhaL any suppressed content does nol materially :iffecl Lheoverall leaming e xpe rience . Ce ng age Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions req uire iL.
67
68
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Oral solutions may also be ordered as drops (gtt), and when this is the case, the dropper
is attached to the bottle stopper. Medicine droppers are often calibrated in mL or by actual
dosage, such as 125 mg, and so forth. (Refer to Chapter 22 for more information on droppers.)
Summary
This concludes the chapter on reading oral medication labels. The important
points to remember from this chapter are:
Most labels contain both generic and trade names.
Dosages are clearly printed on the label, including preparations containing
multiple drugs.
Combined dosage tablets and capsules may be ordered by trade name and number
of tablets/ capsules to be given and may include dosages.
The letters U.S.P. (United States Pharmacopeia) and NF (National Formulary) on
drug labels identify their official generic listings.
Additional letters that follow a drug name are used to identify additional drugs in
the preparation or a special action of the drug.
Most dosages of tablets or capsules consist of ½ to 3 tablets (1-3 capsules, which
cannot be broken in half). An unusual number of tablets or capsules may indicate
an error.
Check expiration dates on labels before use.
For accurate measurement, solutions are poured at eye level when a medicine cup
is used.
Liquid oral medications may be measured and administered using an oral medication syringe or a hypodermic syringe without a needle.
Care must be taken not to use oral syringes for hypodermic medication preparation
because these are not sterile.
Summary Self-Test
Locate the appropriate label for each of the following drug orders, and indicate
the number of tablets, capsules, or ml, that will be required to administer them.
Assume that all tablets are scored and can be broken in half. Labels may be used
more than once in each problem set.
PART I
1. Glucotrol®15 mg
2. dexamethasone 4 mg
3. Dilatrate®-SR 80 mg
4. morphine sulfate 20 mg
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party content may be .supprcs..,;,00 fro m Lhe cBook and/or eChapLer(s).
Edllorial review has deemed LhaLany suppress ed content does noLmaterially affect Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
ORAL MEDICATION LABELS AND DOSAGE CALCULATION
........
ROeRIG4/N·
'1-F ts Hlf,..""'°"'Y.Ji.'f,_ t
NOC 0662- 4110-73
500Tablets
u
Glucotrole
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S1ore at ~lllrollld
~~~~~~'fl Dilatrate~-SR
"'
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(isosorbide dinlJrate)
Sustained Release
Oisptnse In tight
capsules
contalnlnas
dactibld in USP.NF.
.IJ Onty
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CAUTION: Federal law prohibits
dispensing without presc ription.
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ROeRIG 4 N•
NOC 0054817S.25
10 X 10
Tablets
2mg
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glipizide
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KADIAN•
t,lorplllne Su11ite
Exlrncled-flelease capsules
I f
10mg
~only
--
100 Capsules
~ ALJIHAAM-'.
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iI1Htlt!ii~fiJ·
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PART II
5. piroxicam 20 m g
6. cefaclor susp . 250 m g
7. Lortab®5/500 2 t ab
8. Halcion ®250 m cg
9. alprazolam 750 m cg
10. gab ap entin 0.2 g
11. Biaxin®1 g
12. Xan ax®500 m cg
13. clarithromycin 0.5 g
14. triazolam 500 m cg
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplica ted. in whole or in pan . Due to elec.tronic rights. .some Lhird party content may be s uppressed from the e Book and/or eChaple t1s}.
Editorial review has deemed that any s uppressed content does not rn:iterially :iffecl the overall learning e xpe rience. Cengage Leaming reserves the right Lo remove :idditional conte nt al any time if subsequent rig hts restrictions req uire it.
69
70
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Ctot.htew•"f l30'C)
100 Capsules
Dl'll)tllM " l,Ohl t,gnr
~ I tor! ner, (USP)
N
NOC 0069-3230-fj6
..'...,,.. i
,0
,0 •
Feldene
OOSAOE AND USE
Ste ICCOll'fp!ll1YIIIO
(plroxicam) . .
P'IIKTID•~O lflfOffl\11' "'"
On• Cll)SIJlt pe, c.r,
.,<.>
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0
-0
:::,
-0
0
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EKII Q/lilJlt com20 mg l)IIOIIJCll!I
IMPORTANT TIiis cloMJre
I
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20 mg
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not Jl dO·lflliJJnl
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MADE INUSA
il: -~
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Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplica ted. in whole or in pan . Due to elec.tronic rights. .some Lhird party content may be suppressed from the e Book and/or eChapte11s}.
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CHAPTER
In this chapter you will be introduced to a sample Medication Adminis-
tration Record (MAR} that may be used to prepare, administer, and chart
medications. Additional instruction will include the six rights of medica-
tion administration: the basic guidelines for all medication administration; information on the most common sources of medication errors;
and the actions that you must take when errors occur. You'll also be
introduced to new transcription rules for medication dosages and abbreviations that have been addressed by the major watchdog organizations
for medication safety: The Joint Commission and The Institute for Safe
Medication Practices (ISMP}.
MEDICATION ADMINISTRATION RECORDS
The focus of this section is to familiarize you with a sample MAR so that
you will understand the many columns and features it contains. Your instructors will orient you to the actual MA.Rs you will use in your clinical
experiences, and you will quickly discover that there is no one universal
form in use. Each clinical facility using MARs makes its own determination on the particular format that suits its needs. What you will notice,
however, is that all MARs are more similar than different. A MAR is,
simply stated, a paper record of all medications a patient is receiving
and has received.
The most prominent MAR feature is a large column where medications given on a continuing basis are listed. This column will contain a
drug name (or names, if trade and generic listing is appropriate), dosage,
frequency, actual times of administration, and precautions related
to administration, such as checking blood pressure, pulse, or body
weight. Other columns provide the following: an area that the person
who transcribed the dosages initials; the start date of the medication; columns where dosages administered are recorded; an area for the initials of
the nurse who gives the dosage; and an additional area where all staff initials are identified with a full name. A MAR may consist of a single sheet of
paper printed on both sides, or two sheets, to allow separate space for
p.r.n. (pro re nata or "as needed") medications (given on an as needed
basis), for parenteral medications and site identification, and IV medications
and/ or fluids.
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Edilorial review ha.s deemed Lhal :my supprcs.~ed content does nol m.at.eri.ally affecl the overall learning experience. Cengage Leaming reserves the rig hL Lo remove additi
78
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Refer now to the sample MAR in Figure 7-1, and locate the follo,-ving column headings
and entries.
Column 1 Labeled "Start" and "Stop:' The three drugs listed are being given on a continuing basis. They were started on "5-1." None has been discontinued.
Column 2 Labeled "Medication and Dose:· The frrst drug listed is Lanoxin®including its
generic name, digoxin. The dosage, "0.25 mg," and frequency, "daily;· is next. There is a precautionary designation to "Check pulse" (ck pulse).
Column 3 Labeled "Schedule:· Gives the actual times of each medication's administration. For Lanoxin, this is 8 am.
Column 4 This column has two designations: "Route:· which is oral or "PO" for all
three medications. The "Nurse" space, which "GJ" has initialed, identifies the transcriber of
these medication orders.
Column 5 There are three designations here: "Time:· the actual hour the drug is to be
given (i.e., "8 am''); "Site" if the drug is parenteral; and "Initials:· where the nurse who gave
the drug, "EPP;' verified administration. The pulse, "64:' is recorded next to the 8 am dosage.
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SAFE MEDICATION ADMINISTRATION
This particular MAR covers only four days of medications, "5-3" through "5-6:' However, most MARs provide for longer periods of up to a month. At the bottom of this MAR is
an area for identification of staff initials, where "GJ" is clearly identified as "G Jennings" and
"BPP" as "BP Prentiss:·
►►► PROBLEMS 7.1
Refer to the MAR in Figure 7-1 to answer the following questions.
1. List the second and third listed drugs and dosages on this sample record.
2. Who administered the 4 pm dosage for the second drug listed?
3. Drug number 3 is administered twice a day. Identify the hours these dosages
are to be given.
Answers 1. Hydrodiuril 50 mg, ciprofloxacin 250 mg
2. G. Jennings 3 . 6 am and 6 pm
►►► PROBLEMS 7 .2
Use the drug entries on the MAR in Figure 7-1 as a guide to enter the following two
additional drugs and dosages. Use today's date as the start date. Have your instructor
or a fellow student check your entries.
1. Coumadin®(warfarin) 5 mg PO daily 6 pm.
2. Pronestyl®(procainamide) 1000 mg PO every 6 hours: 6 am, noon, 6 pm, and midnight.
3. Identify your initials as the transcriber of these dosages.
4. Sign for the initial 6 pm dosage administration for each drug.
Information needs to be filled in on the MAR.
Computer-controlled records, usually keyed to drug label bar codes, are making a strong
appearance in the health care field. The Veterans Administration System in the United
States is already completely computerized, and this has resulted in increased safety and
lower costs in medication services. It is wise to remember, however, that errors can occur
anywhere, and the newer systems of administration will have identified their own safety
precautions for error-prone areas.
THE SIX RIGHTS OF MEDICATION ADMINISTRATION
The six rights of administration consist of the right drug, the right dosage, the right
route, the right time, the right person, and the right recording of a dosage when it is
administered. These rights will be covered in more detail in your fundamentals text, but it
is appropriate to discuss them briefly here.
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Ed llorial review b:is deemed LhaL any suppressed content does noLmaterially affec t Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
79
80
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Right Drug
When preparing dosages, the drug order and drug label are routinely checked against
each other three times: when you locate the drug, just before you open or pour it,
and immediately before you administer it. There are three specific safety reminders
related to reading labels that need to be revisited. The first is that a drug may be ordered
by trade name but available only in a generic so make sure you have the drug ordered.
The second concern is that many drug names, particularly generic, are very similar
and must be identified carefully. And, frnally, because it is easy to miss the special initials
that follow a drug name-a familiar example is CR, for controlled release-look for and
identify these. When doing the three required order and label cross checks, all these precautions to locate the correct drug apply.
Right Dosage
Dosage is a particular concern in metric dosages containing a decimal. Think back
to your instruction in conversions between the different units of metric measure containing decimals. You know that in conversions in metric dosages, the decimal point will
always move three places. If you are converting from a greater to a lesser unit: g to
mg or mg to mcg, the num her will become larger; if you are converting from a lesser
to a greater unit: mcg to mg or mg tog, the number will become smaller. If you inadvertently convert in the wrong direction, the numbers often don't make sense:
0.25 mg cannot be 250 g; and 2 mg cannot be 0.002 mcg. Remember that medications are
prepared in average dosages and usually consist of one-half to three times the average dose ( tablet or capsule) available. Ask yourself if the conversion makes sense, and
recognize when it doesn't.
Right Route
Oral medications are swallowed. This is not always easy for patients to do, and this is
why many children's medications are prepared as liquids. This means you must watch the
patient actually take oral medications. If you have any doubt that the medications have
been swallowed, check the patient's mouth.
An additional oral route is the sublingual: under the tongue. There has been a considerable increase in the number of sublingual drugs in use, so this route designation is one
to carefully identify. A sublingual drug swallowed will not have the desired effect, if it has
any at all, because the acid of the stomach will destroy it.
Drops are another administration route, and eye, nose, and ear drops are quite common. Eye medications are also prepared as ointments, and, understandably, they are
clearly labeled for their intended ophthalmic use. Locating the ophthalmic designation is mandatory before the use of any preparation on the eyes.
An increasing number of topical drugs is in use. These are ointments or, less commonly, liquids that are applied to the skin. The amount of ointment or liquid to be used is
specific, as is the cleansing of a site for repeated ointment applications, and covering or not
covering the site after application.
Now in very wide use are transdermal patches. The precautions in their use relate
to where the patch must be applied, how long it is to stay on, and examination for local skin
reaction to the adhesive that secures the patch. Unfortunately, many people are sensitive
to transdermal patch adhesives. A rash may appear when a patch is used for the first time,
or even after repeated use. Inflamed skin will not absorb well, and inflammation can cause
acute discomfort.
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Ed llorial review has deemed LhaL any suppres.,;ed content does noL materially :iffecl Lheove rall leaming e xperience. Ce ng age Leaming re.serves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions req uire iL
SAFE MEDICATION ADMINISTRATION
A large number of inhalation medications is in common use. These medications are
usually self-administered, and your responsibility will be to make sure that the patient understands how to use the inhalation device, how many activations each dosage requires, how many
times a day to use the medication, and precautions in use, such as for temporary dizziness.
The creams and suppositories used for the genitorectal systems provide another
method of direct medication application. These are very clearly labeled and recognizable.
Finally, there are the parenterals: medications administered under the skin. The
intravenous is the primary parenteral route, with intramuscular (IM) and subcutaneous coming in second, and intradermal a distant third. Most injectable drugs are sitespecific, and are labeled for either rv, IM, or subcutaneous use. You'll be reading many drug
labels that identify specific parenteral site routes in the balance of this text.
Right Time
The time each drug is to be given is often critical, such as insulin immediately before a
meal or, more correctly, a meal as soon as insulin is injected. Drugs may be ordered at specific hours during the day or only at bedtime. Some drugs must be given before or after specific blood tests. Pain medications are given p.r.n., which means as needed. Pain
medications are extremely time sensitive, and must be given before pain becomes severe
in postoperative situation s, and at least half an hour before a painful procedure, including
postoperative ambulation.
Each clinical facility designates routine administration times; however, twice a day
may mean 9 am and 5 pm or 9 am and 9 pm, depending on the action of the drug being
given. Each MAR identifies two time-related specifics: frequency-for example, "twice
a day"-then specific hours-for example, 9 (am) and 5 (pm) or, in international/military
time, 09 and 17, representing 0900 and 1700.
A final consideration, just illustrated, is standard versus international/military time.
A clinical facility will use either one time or the other, but not both. International/
military time uses a 24-hour clock, starting with 0001 for one minute after midnight, to 2400
for midnight of the same (next date) day. To convert from standard to international/military
time, add 12 hours to each hour beginning with 1 pm standard time. For example, 2 pm plus
12 hours is 1400; 4 pm plus 12 (hours) is 1600. Using international time, if you are unfamiliar
with it, will initially require careful thought Refer to Figure 7-2 for a complete time conversion chart.
Standard
am
International/Mi Iitary
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Standard
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2:00
3:00
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1100
1200
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2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
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1300
1400
1500
1600
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1800
1900
2000
2100
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FIGURE 7-2 Comparison of standard and international/military time.
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Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts restrictions require iL
81
82
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Right Person
Administering medications to the right person should be foolproof, but it isn't. All MARs
identify patients by the room number and bed they occupy. But sometimes patients are
moved, so room and bed number cannot be relied on for identification. The current identification procedure is to ask an individual her or his name and birthdate, then check
the response against the wrist Identa-Band®. Obviously, some people will not be able to
state their name. But if they can, they must be asked.
Of considerable concern is the possibility of having two people with the same surname
on the same floor or even, though more rarely, in the same room. Duplicate names are a
source of errors, so read both surname, first name, and birthdate on each Identa-Band®.
Do this every time you give a medication. No exceptions. Once a drug is administered, there is no way to get it back.
Right Recording
If an administered drug is not charted, it can be given again in error. There is an absolute rule that a drug given must be recorded immediately. It is also necessary to
record and report unusual reactions to a medication, such as nausea or dizziness, or
a patient's refusal to take a medication. In such an occurrence, record and report the
incident immediately.
If you give a parenteral medication other than by Iv, the injection site used is usually recorded, so that a different site can be used next time. Diabetic or other patients
receiving frequent injections may tell you which site they prefer, which they have a perfect
right to do. Or, ask them if they have a preference. In actual practice, sites are chosen by
the condition of the tissues at acceptable sites, because previous injection sites are
generally easy to see and must be avoided.
THE SEVENTH RIGHT: PARTNERING WITH THE PATIENT
Partnering with the patient/recipient is so important a concern that it should be a seventh
right. You are only half of a medication administration twosome. The medication recipient is one of your best assists in preventing errors. Consider the following, not uncommon, verbal reports: "I just had my medication." Or, "My doctor told me he was stopping
this drug:' Or, "The doctor said I needed a bigger dose:· Or, "This pill doesn't look the same
as the one I had before:• Or, "Where is my ... pill?" Or, "This pill made me sick the last time
I took it:' Learn to listen very carefully, and consider the patient correct until proven
otherwise.
You will also be responsible for helping the patient learn what drugs and dosages
he or she is taking, what they are for, what time they must be taken, and how they
must be taken. Most individuals will be discharged with medications, so the sooner theyor, if they are not deemed responsible, their caretaker-can learn what they are taking, the
better. They must also learn about common side effects and, if particularly relevant, what
untoward effects they should watch for. Patients taking medications are essentially under
chemical assistance, or assault, and they or their caretakers must be full partners in their
medication administration.
"---Ypoint: An important safety precaution is recognition of the patient/
recipient as a full partner in medication administration.
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Ed llorial review has deemed LhaL any suppres.,;ed content does noL materially :iffecl Lheoverall leaming e xperience. Ceng age Leaming re.serves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions req uire iL
SAFE MEDICATION ADMINISTRATION
COMMON MEDICATION ERRORS
Prescription drugs are estimated to kill close to 100,000 people a year in the United States,
although not all these deaths are hospital based. Medication errors happen, and they will
continue to happen in all three of the modalities related to drug orders: the prescribing
(done by a licensed practitioner), the transcribing (done by a person who specializes in
this responsibility, frequently the pharmacy staff), or the administering (primarily a nursing responsibility). The vast majority of errors is in the prescribing and transcribing areas,
but those attributable to administering still represent a very large number of incidents.
There has been a concerted international effort in recent years to identify the
source of, and take active steps to reduce, the incidence of medication errors caused by the
use of administration abbreviations. The primary and an ongoing leader in this project is
The Joint Commission, formerly known as the Joint Commission on Accreditation of
Healthcare Organizations.
Most safety recommendations fall into two major categories: abbreviations for
administration and drug names, and metric dosages containing decimals.
Errors in Abbreviations and Drug Names
A number of abbreviations designating the frequency and routes of medication administration have been eliminated; for example, the abbreviations Q.D., QD, q.d., and qd
used for a single daily dose and Q.O.D., QOD, q.o.d., and qod used for a dosage given every
other day. These are no longer used but are now clearly written as ''daily'' or ''every other
day.'' Similarly, q.d. and QD for "every day" have been eliminated and are now designated
"daily"; qhs, formerly used for "nightly" and misread as "every hour:' is now written "nightly";
SC or sub q used for "subcutaneous" has been changed to "subcut" or "subcutaneous"; the
use of "per os" for "by mouth" has been eliminated in favor of "PO," "by mouth;' or "orally:'
An additional abbreviation, q2h or q2hr (or any specific hour) is now clearly written "every
2 hours:' Another deletion is the use of a lowercase "u" or uppercase "U" or "IU" for "units:'
As you have already learned, units is not abbreviated, but is written as "units:' A current
list of acceptable administration abbreviations is available on the inside front cover of this
text, but do keep in mind that there may be future changes in this evolving area of concern.
Common examples of confusing drug name abbreviations are MS for morphine
sulfate and MS0 4 or MgS04 for magnesium sulfate. These drugs are now identified using
their complete names. Figure 7-3, the Official "Do Not Use" List, identifies these changes.
Errors in Writing Metric Dosages
All the correct rules for Wl·iting metric dosages have been covered earlier in this text. But
let's revisit the culprit areas, which are also identified in Figure 7-3. The first error is in
placing a decimal and a zero (0) following a whole number dosage (called a trailing
zero); for example, 4.0 g instead of 4 g. The decimal could easily be missed and 10 times the
ordered dosage, 40 g, administered. The second error is failing to place a zero in front
of a decimal fraction (referred to as lack of a leading zero); for example, .5 mg instead
of 0.5 mg. Once again, the decimal could be missed and 5 mg administered. Unfortunately,
you may still see an occasional commercial drug label that has not yet been standardized
to reflect the new recommended notation rules. But at least on a drug label you will not
have the problem of trying to interpret indecipherable handwriting, which is often the
direct cause of many of the errors just discussed. Commercial drug labels are being redesigned
to reflect these new guidelines.
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83
84
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Additional changes have since been recommended by ISMP, the Institute for Safe
Medication Practices. Those of you re-entering the health care field after a significant
absence may want to review the ISMP lists in Appendix B. These tables are for reference
only and need not be memorized.
Action Steps When Errors Occur
You will almost certainly meet with an error in one way or another during your career. So,
let's look at the routine steps you must take when one occurs.
STEP
1
Errors must be reported as soon as they are discovered.
STEP
2
Necessary remedial measures must be instituted immediately.
STEP
3
The reason for the error must be determined.
STEP
4
An incident/ accident report must be prepared.
STEP
5
Corrective policies/procedures must be instituted, if possible, to prevent the
error from recurring.
Offic ial "Do Not Use" List1
Do Not Use
Potential Problem
Use Instead
U, u (unit)
Mistaken for "O" (zero), the
number "4" (four) or "cc"
Write "unit"
IU (International Unit)
Mistaken for IV (intravenous)
or the number 1O (ten)
Write "International Unit"
Q.D., OD, q.d., qd (daily)
Mistaken for each other
Write "daily"
0.0.D., QOD, q.o.d, qod
(every other day)
Period after the Q mistaken for
"I" and the "O" mistaken for "I"
Write "every other day"
-~
----------------------------------~
Trailing zero (X.O mg)*
Decimal point is missed
Write X mg
~
§
Lack of leading zero (.X mg)
Write O.X mg
1
-0
MS
1
Can mean morphine sulfate or
magnesium sulfate
Confused for one another
Write "morphine sulfate"
Write "magnesium sulfate"
Applies to all orders and all medication-related documentation that is handwritten (including free-text
computer entry) or on pre-printed forms.
*Exception: A "trailing zero" may be used only where required to demonstrate the level of precision of the
value being reported, such as for laboratory results, imaging studies that report size of lesions, or
catheter/tube sizes. It may not be used in medication orders or other medication-related documentation.
-~
I,,;
gN
-a
--,
FIGURE 7-3 Official "Do Not Use" list of medical abbreviations.
The most important step after ensuring the safety of the patient is reporting the
error. If an error isn't reported, no action can be taken. Keep in mind that an error is an
accident, and it is not necessarily a reflection on competency, nor will reporting
an error terminate your career. Distraction and fatigue play a significant role in
medication errors, and when in stressful situations, you must be particularly aware and
vigilant that you do not become the person making an error.
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SAFE MEDICATION ADMINISTRATION
KE point: The major factors in nursing medication administration errors
are distraction and fatigue, and particular vigilance is necessary in these
stressful situations.
In time, and with repeat practice, administering medications will become familiar and
comfortable. The irony is that when it does, you must exercise more caution than ever.
Routine medication administration must never be routine.
Ypoint: Regardless of the source of an error, if you give a wrong drug or
dosage, you are legally responsible for it.
Summary
This completes your introduction to safe medication administration. The important
points to remember from this chapter are:
When identifying a drug, pay particular attention to generic names and any initials
that identify additional drug components or action.
When identifying dosages, take special precautions with metric dosages containing
a decimal.
The route of administration is critical to medication safety and effectiveness.
Parenteral medications are site specific: rv, IM, subcutaneous, and intradermal.
Time of administration is especially important for p.r.n. medications for pain, and
for drugs with a rapid action such as insulin.
Identification of the right person begins with asking the patient his or her name,
followed by checking the Identa-Band®.
Making the patient or caretaker a full partner in medication administration is a
major safety consideration.
Recent changes in abbreviations for drug names and administration are creating
increased safety in the clinical setting.
Dosage errors must be reported as soon as discovered to set in motion the four
additional steps you must take.
Administering medications must never become routine.
Fatigue and/ or clinical distractions are major factors in medication errors.
MARs are the immediate reference for medication administration, and keeping
them up-to-the-minute is of prime importance.
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85
86
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Summary Self-Test
Answer the questions as succinctly as possible.
1. List the six rights of medication administration.
2. What consideration was stressed regarding reading generic names?
3. What might extra initials following a drug na1ne identify?
4. List the two major transcribing considerations for metric dosages containing
a decimal.
5. What use will you make of the fact that medications are prepared in average dosages?
6. Name and discuss the two time-sensitive medications that were identified in this chapter.
7. What t\,vo patient identification steps follow arrival at the room and bed number
indicated on a MAR?
8. What will you do if a patient refuses a medication? _ _ _ _ _ _ _ _ _ _ _ __
9. List the steps you must take when a medication error occurs.
10. List your medication responsibilities in preparing a patient for discharge.
Answers 1. Drug, dosage, route, person , time, and recording 2. Read carefully; they are often similar
3 . Additional medications in a preparation or special action 4 . Use a zero in front of a decimal to draw
attention to it; no decimal or zero following a whole-number dosage
5. An unusual number of oral tablets
or capsules or excessively large ml volumes must be questioned 6 . Pain medications-give before pain becomes severe or half an hour before a painful procedure; insulin-make sure a meal is available shortly after
7 . Ask the patient for his or her name and birthdate; check response against the ldenta-Band®
8 . Ask why, record it, report it 9 . Report the error, take remedial measures as necessary, determine the
cause, complete an incident report, and institute a policy to prevent a repeat 1 O. Review all the discharge
administration
drugs by asking the patient to explain the dosage, frequency, time, and route of administration for each.
Review these again as necessary, including side effects and precautions
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CHAP
A variety of hypodermic syringes is in clinical use. This chapter focuses
most heavily on the frequently used 3 ml syringe. However, larger volume syringes are used on occasion, so it is necessary that you learn the
differences as well as the similarities of all syringes in use.
Regardless of a syringe's volume or capacity-0.5, 1, 3, 5, 10, or
20 ml-all except specialized insulin syringes are calibrated in ml.
Because some syringe manufacturers have not yet replaced the labeling
on their syringes with the official ml volume measurement, you may
still see cc on syringes. Keep in mind, however, that these two measures, ml and cc, are essentially identical. They will be correctly referred
to throughout this text as ml. The various capacity syringes contain
calibrations that differ from each other. Recognizing the difference in
syringe calibrations is the chief safety concern of this chapter.
•
The calibrations on different volume syringes
differ from each other, requiring particular care in dosage
measurement.
STANDARD 3 mL SYRINGE
The most commonly used hypodermic syringe is the 3 mL size illustrated
in Figure 8-1. Notice the calibrations for the metric mL scale, and that longer calibrations identify zero (0) and each½ and full mL measU1·e. These
longer calibrations are numbered: ½, 1, 1½, 2, 2½, and 3.
Next, notice the number of calibrations in each ml,, which is 10,
indicating that, on this syringe, each mL is calibrated in tenths. Tenths
of a mL are written as decimal fractions; for example 1.2 mL, 2.5 mL, or
0.4 mL. Also, notice the arrow on this syringe, which identifies a 0.8 mL
dosage.
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Edilorial review has deemed Lhal :my suppres..~ed content does nol m.at.eri.ally affecl the overall learning experience. Cengage Leaming reserves the rig ht Lo remove additi
88
READING MEDICATION LABELS AND SYRINGE CALIBRATION S
--- 'h
----- 1
-- n
-:®
--- 21
--- 3
LO
0
N
Cl
c::
E
.,
_,
.,
(tJ
Cl
(tJ
Cl
.,c::
u
@
FIGURE 8-1 A 3 ml syringe.
►►► PROBLEMS 8 . 1
Use decimal numbers-for example, 2.2 mL-to identify the measurements indicated
by the arrows on the standard 3 ml, syringes that follow.
--- ,h
------ 1
-- 11
-=@
---- 2\
--
---,h
---1
----- 1h
-- 1
----
--,,
--=@
---- 211.
--
LO
0
N
Cl
c::
::::
.,
_,
.,
(tJ
Cl
--- 1'h
=®
----- 211
-
LO
0
N
Cl
c::
E
.,
_,
.,
3
(tJ
Cl
LO
0
N
Cl
c::
::::
.,
_,
.,
(tJ
Cl
(tJ
(tJ
(tJ
Cl
.,c::
u
c::
.,
u
Cl
u
@
@
@
1.
Cl
2.
.,c::
3.
Answers 1. 0 .2 ml 2. 1.4 ml 3. 1.9 ml
Did you have difficulty with the 0.2 mL calibration in Problem 1? Remember that the
first long calibration on all syringes is zero. It is slightly longer than the 0.1 mL and
subsequent one-tenth calibrations. Be careful not to mistakenly count it as 0.1 mL.
You have just been looking at photos of syringe barrels only. In assembled syringes,
the colored suction tip of the plunger has two widened areas in contact with the barrel
that look like two distinct rings. Calibrations are read from the front, or top, ring. Do
not become confused by the second, or bottom, ring or by the raised middle section of the
suction tip.
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HYPODERMIC SYRINGE MEASUREMENT
►►►
PROBLEMS 8.2
What dosages are measured by the following three assembled syringes?
--
---- ~
--- 1
-2
----
-- 1
--- 1½
,-
,,;
c:,
--- 2½
-
N
Cl
c::
E
3
"'
_,
Q)
3
Q)
Cl
"'
Cl
c::
Q)
-- 2
-- 2½
,,;
c:,
--
N
Cl
c::
E
"'
_,
Q)
"'
Cl
c::
c :,
N
Cl
c::
E
3
Q)
Cl
,,;
Q)
"'
_,
Q)
Q)
Cl
"'
Cl
c::
Q)
u
u
u
@
@
@
2.
1.
3.
Answers 1. 0 .7 ml 2. 1.2 ml 3. 0.3 ml
►►►
PROBLEMS 8 .3
Draw an arrow or shade in the following syringe barrels to indicate the required
dosages. Have your instructor check your accuracy.
--- 1h
----- 1
-- 11
-:®
--- 21
---3
--,h
-
--
-- 1
-- 11
--
,,;
c:,
N
Cl
c::
c::
~
"'
_,
Q)
Q)
Cl
:®
-
-- 21'
---3
,,;
c:,
N
Cl
c::
c::
~
"'
_,
Q)
Q)
-:®
----- 2\
- 311
Cl
-
,,;
c :,
N
Cl
c::
c::
~
"'
_,
Q)
Q)
Cl
"'
Cl
c::
"'
Cl
c::
"'
Cl
c::
u
u
u
@
@
@
Q)
1. 1.3 ml
---- 1h
--- 1
--- 11h
r.:..
Q)
2. 2.4 ml
Q)
3. 0.9 ml
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Edilori.al review has deemed LhaL any s uppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire it.
89
90
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
--r 1J.i
------ 1
-- fl
-=®
---- 2\
-3
---- ½
----- 1
- fl
---:®
----- 2\
-90 3
Lri
0
N
en
,!:
:::
.,"'
_,
.,en
"'
en
.,c::
--
-- 11z
---- 1
- fl
--:@
----- 21A
-
Lri
0
N
en
c::
c::
.,"'
_,
.,en
~
90
"'
en
3
.,c::
Lri
0
N
en
,!:
:::
.,"'
_,
.,en
"'
en
.,c::
u
u
u
9
9
9
4. 2.5 ml
5. 1.7 ml
6. 2.1 ml
Verify your answers with your instructor.
►►►
PROBLEMS 8.4
Identify the dosages measured on the following 3 mL syringes.
---
-- ;
--1
---
-- 2l
-
-"'
-3
-- 1¼
---- 2
- 2i
--3
0
N
~
-
"'
~
0
N
en
.!:
.,"'
_,
.,en
~
"'
en
.,c::
1.
---- I
-
--- 1
--- 1½
-- 2
-
c::
3
----- !
-
en
.!:
c::
.,"'
_,
.,en
~
"'
en
.,c::
-"'
0
N
en
.!:
c::
.,"'
_,
.,en
~
"'
en
.,c::
u
u
u
9
9
9
2.
3.
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplica ted. in whole or in pan. Due to elec.tronic rights. .some Lhird party content may be suppressed from the e Book and/or eChapte11s}.
Edilori.al review has deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire it.
HYPODERMIC SYRINGE MEASUREMENT
---
---- i
---- 1
--- 1½
-
--- 2
--- i
-
------ i
- 1
---
---- 2½
-- 2
- 2½
I-
-- 1
- 1½
--Lri
0
N
CJ)
-- 3
ti..
,E:
E
.,"'
_,
.,
CJ)
"'
c::
CJ)
.,
-
-
..,_
Lri
0
N
Lri
0
N
-- 3
IL
CJ)
c::
c::
~
.,"'
_,
.,
CJ)
"'
c::
CJ)
.,
CJ)
c::
c::
~
.,"'
_,
.,
CJ)
"'
c::
CJ)
.,
u
u
u
9
9
9
4.
6.
5.
Answers 1. 1.5 ml 2 . 2.3 ml 3 . 0.8 ml 4 . 2.6 ml S. 1.9 ml 6. 1.4 ml
SAFETY SYRINGES
A number of safety syringes has been developed in recent years to reduce the danger of
accidental contaminated needle sticks. Several of these syringes are illustrated in the following photos. Take a few minutes to become familiar with them, because you will in all
probability be using them in the clinical setting.
Refer first to the photos in Figure 8-2, which show t\vo BD SafetyGlide™syringes. Each
of these syringes contains a protective needle guard that can be activated by a single finger
to cover and seal the needle after injection.
-;:;::
-;:;::
"'
0.
"'
0.
c::
c::
E
0
u
E
0
u
-0
-0
"'
c::
0
,,,
"'
c::
0
,,,
:;;;
:;;;
0
0
-.,
-.,
-.,
-.,
t::
t::
0
0
c::
c::
<.>
c::
0
<.>
CD
0
CD
0
ii;"
::,
<.>
,,,
-
c::
c::
<.>
c::
0
<.>
CD
0
CD
0
ii;"
::,
<.>
.,
,,,
-
1l
-0
. E:
. E:
~
~
Cl.
0
0
..c::
a..
Cl.
0
0
..c::
a..
FIGURE 8 -2 SafetyGlide™ syringes .
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Edilori.al review has deemed LhaL any s uppressed content does, noL m aterially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
91
92
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
The syringe shown in Figure 8-3, the VanishPoint~, has a needle that automatically
retracts into the barrel after injection.
.,;
. !!l
Cl
0
0
C:
..r::
u
.,!!l
.,
25
~
u
-.,
I!!
cc
15
.,i;;-
t::
:::,
0
u
FIGURE 8-3 VanishPoint®.
A third type of safety needle commonly used is the Magellan Safety Needle by Covidien™, as
shown in Figure 8-4. This design also offers one-handed activation. It can be activated one
of three ways: by thumb, forefinger, or on a flat surface. As with the other safety syringes,
once activated, its safety shield covers the entire needle, providing protection during and
after disposal.
c::
C:
. !!l
. !!l
'>
0
·~
0
0
"'O
-.,
u
i;;-
~
:::,
0
u
"'O
-.,
u
i;;-
~
:::,
0
u
FIGURE 8-4 Magellan Safety Needle.
TUBERCULIN (TB) SYRINGE
When very small dosages are required, they are measured in special tuberculin {TB) 0.5
or 1 ml, syringes calibrated in hundredths. Originally designed for the small dosages
required for tuberculin skin testing, these syringes are also ,videly used in a variety of
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Edilori.al review has deemed LhaL any suppressed content does, noL materially affect Lheoverall leaming experience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
HYPODERMIC SYRINGE MEASUREMENT
sensitivity and allergy tests. Pediatric dosages frequently require measurement in hundredths, as does heparin, an anticoagulant drug.
Refer to the 0.5 mL TB syringe in Figure 8-5, and take a careful look at its metric
calibrated hundredth scale. Notice that slightly longer calibrations identify zero, 0.05, 0.1,
0.15, 0.2, and so on, through the 0.5 mL measure. Shorter calibrations lie between these to
measure the hundredths. Each tenth m.L, .1, .2, .3, .4, and .5, is numbered on this particular
TB syringe. Take a moment to study the dosage measured by the arro,v in Figure 8-5, which
is 0.43 mL.
The closeness and small size of TB syringe calibrations mandate particular care and
an unhurried approach in TB syringe dosage measurement
----
---
-~-2
-----:-.3
---:.4
--;._5
-
-
LO
0
N
Cl
c::
c::
~
a,
"'
_,
•
a,
Cl
"'c::
Cl
a,
u
@
FIGURE 8-5 A tuberculin (TB) syringe.
►►► PROBLEMS 8.5
Identify the measurements on the six TB syringes provided.
------
---
------~.]
--?-.2
•
I---
-=-.4
---:..s
Ml
§..1
----:-.2
----;-_3
----
LO
~-4
---
0
N
Cl
c::
E
I
"'
a,
_,
a,
Cl
"'
Cl
c::
a,
1.
i----•
:-.1
--•
•-----
§-.3
----;._4
----
LO
0
N
Cl
c::
c::
~
-
LO
0
N
Cl
c::
c::
~
:..s
"'
a,
_,
a,
"'
a,
_,
a,
Ml
Cl
"'
Cl
c::
Cl
"'
Cl
c::
a,
u
u
@
@
2.
a,
I
I
u
@
3.
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.aled. in whole or in pan . Due Lo elec.tronic rig hts. some Lhird party conlenl may be s uppressed from Lhe e Book and/or eChapte11s ).
Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheove rall leaming e xpe rience. Ce ngage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire iL
93
94
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
----
------
-----
----
C
:-.1
---~.2
--
-----~-2
---
--=-.1
--;..2
-----
§..3
-----
§..3
---=-.4
-----
:..s
Ml
:-.4
-----~.s
Lri
0
N
en
,!:
:::
.,"'
_,
.,en
ML
"'
en
c::
.,
Lri
0
0
N
N
en
en
,!:
.,"'
_,
.,en
.,"'
_,
.,en
.sc::
~
:._5
ML
"'
en
c::
.,
:::
"'
en
.,c::
u
u
u
9
9
9
5.
4.
6.
Answers 1. 0.24 ml 2. 0.46 ml 3. 0. 15 ml 4 . 0.06 ml
►►►
Lri
s. 0.27 ml 6. 0.41 ml
PROBLEMS 8.6
Draw an arrow on the barrel to identify the dosages indicated on these TB syringes.
Have your instructor check your answers.
--------
---:-.2
----
2.2
-
-~3
--·
--:- .4
---=-.s
Ml
§..2
---
:- .3
Lri
0
N
en
c::
E
.,"'
_,
.,en
"'
en
c::
.,
u
---: .4
--=-.sML
9
1. 0.28 ml
-...
2. 0.32 ml
-
Lri
0
N
en
c::
c::
~
.,"'
_,
.,en
"'
en
c::
----
:- .4
---=-.5
Ml
Lri
0
N
en
c::
E
.,"'
_,
.,en
"'
u
en
c::
.,
u
9
9
.,
3. 0.45 ml
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or dupHc.a led. in whole or in pan. Due to elec.tronic rights. .some Lhird party content may be s uppressed from the e Book and/or eChapte11s}.
Edilorial review has deemed LhaL any s uppressed content does noL rn:iterially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions req uire it.
HYPODERMIC SYRINGE MEASUREMENT
=-.2
---E-.3
---1:-- .4
----
----
,:
------
Lri
0
----
N
Cl
,!:
E
.,"'
_,
.,
Lri
"'
Cl
.,c::
I:.
0
N
Cl
--
c::
c::
~
.,"'
_,
.,
=-.5ML
Cl
---:.3
----
Cl
Lri
0
N
Cl
,!:
E
.,"'
_,
.,
Cl
"'
Cl
"'
Cl
.,c::
.,c::
u
u
u
9
9
9
4. 0.12 ml
5. 0.27 ml
6. 0.35 ml
Verify your answers with your instructor.
5 AND 10 mL SYRINGES
When volumes larger than 3 mL are required, a 5 or 10 mL syringe is typically used. Refer
to Figure 8-6, and examine the calibrations between the numbered m.Ls to determine how
these syringes are calibrated.
----- 1
- 2
-- 3
--1
------
--2
-3
4
-
Lri
0
N
Cl
.E
c::
.,"'
_,
.,
~
4
5
6
-- 9
-~11
,
D
Cl
0
N
Cl
.E
c::
.,"'
_,
.,
~
Cl
"'
Cl
c::
"'
Cl
c::
.,
.,
u
u
9
9
A
A
-
Lri
B
FIGURE 8-6 A 5 ml (A) and a 1O ml (B) syringe.
As you may have discovered, the calibrations divide each mL of these syringes into five so
that each shorter calibration actually measures 0.2 ml,. The 5 mL syringe on the left
measures 4.6 m.L, and the 10 mL syringe on the right measures 7.4 m.L. These syringes are
most often used to measure whole rather than fractional dosages, but in your practice readings, we will include a full range of measurements.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.aled. in whole or in part. Due to elcc.tronic rig hts. some Lhinl party content may be s uppressed from Lhe e Book and/or eChapte11s ).
Edilori.al review has deemed LhaL any suppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire iL
95
96
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
►►►
PROBLEMS 8.7
What dosages are measured on the following syringes?
1
---- 1
--- 2
--- 3
-
--- 1
--- 2
- 3
-- 4
-
- 7
---- 89
-- 1
- 6
--- 7
--- 8
--- 9
-
2
-
,,;
0
N
Cl
5
1&01
c::
E
"'
_,
4
,,;
0
N
Cl
c::
E
Q)
Cl
Q)
Q)
Cl
0
N
Cl
c::
c::
~
"'
_,
Q)
Q)
Cl
"'
Cl
c::
"'
Cl
c::
"'
Cl
c::
u
u
u
(Q)
(Q)
(Q)
Q)
Q)
1.
2.
-- 1
--- 2
--- 34
--- 5
--- 6
-- 7
-- 8
-
3
4
1901
5
Q)
3.
1
,,;
0
N
,,;
0
N
Cl
Cl
c::
c::
"'
_,
"'
_,
c::
c::
~
~
Q)
Q)
Q)
Q)
Cl
Cl
"'
Cl
c::
"'
Cl
c::
u
u
(Q)
(Q)
Q)
4.
:~01 11
"'
_,
:[B·DI
Q)
,,;
Q)
5.
Answers 1. 3 .4 ml 2. 5 ml 3. 4 .6 ml 4. 1.8 ml 5, 9 .4 ml
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplic.a led. in whole or in part. Due to electronic rig hts. some Lhinl party conte nt may be s uppressed from the c Book and/or eChapte1ts}.
Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require iL
HYPODERMIC SYRINGE MEASUREMENT
►►►
PROBLEMS 8. 8
Measure the dosages indicated on the syringes provided. Have an instructor check
your accuracy.
,
-
--- 1
----- 2
- 3
---- 4
--- 5
BJ
-"'
0
N
Cl
.!:
c::
.,"'
-'
.,
~
---- 23
-- 4
--- 5
---- •7
--- •I
-
Bl
Cl
"'
Cl
4
5
•
•
7
-"'
0
I
N
Cl
-
"'
0
N
Cl
.!:
.£
~
.,"'
-'
.,
.,"'
-'
.,
Cl
Cl
c::
c::
~
"'
Cl
.,c::
.,c::
u
u
u
@
@
@
1. 1.4 ml
2. 3.2 ml
,
3. 6.8 ml
--- 1
-- 2
-- 3
--- 23
-- 4
-- 5
-1
---- I•
3
"'
Cl
.,c::
~·
--
--- ,
- 2
LO
0
N
Cl
c::
--- 4
--
BISI
::::
.,"'
-.,'
LO
0
---- ,
-- 2
-- 3
-- 4
-- 5
---- •7
-•
I
N
Cl
c::
c::
~
.,"'
.,
-'
Cl
Cl
"'
Cl
c::
Cl
.,
0
c::
c::
~
.,"'
.,
Cl
LO
N
Cl
-'
"'c::
-
"'
Cl
c::
.,
.,
u
u
u
@
@
@
4. 9.4 ml
5. 3 ml
6. 5.6 ml
Verity your answers with your instructor.
Copyrig hL 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplica ted, in whole or in part. Due to electronic rights. some Lhird party conte nt may be s uppressed from Lhe e Book and/or eChapte 1ts}.
Editorial review has deemed LhaL any s uppres sed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions req uire iL
97
98
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
20 mL AND LARGER SYRINGES
Examine the 20 mL syringe in Figure 8-7, and determine how it is calibrated.
--5
---- •
-- 15
---
.,;
... •
0
N
Cl
c::
c::
~
"'
-'
QJ
QJ
Cl
"'
Cl
c::
QJ
u
(9)
FIGURE 8-7 A 20 ml syringe.
As you can see, this syringe is calibrated in I ml, increments, with longer calibrations
identifying the 0, 5, 10, 15, and 20 mL volumes. Syringes with a capacity larger than 20 mL
are also calibrated in full mL measures. These syringes are used only for measurement of
very large volumes.
►►► PROBLEMS 8 .9
What dosages are measured on these syringes?
.....
,
_.,I
I
I
I
I
I
I
4!
•
.
_.1
I
I
5
I
I
.....I
I
..I
5
.
-ii
10
I
I
-ii
10
15
Ir-I'I
15
I
I
..; I
I
I
t
I
~_..lI
I
-t'I
I
.,;
I
.,1I
0
N
Cl
c::
E
ro
QJ
-'
~ta-01
QJ
Z-i(i;g]
Cl
"'c::
Cl
QJ
5
10
.t-i'I
-
-
c::
c::
.,;
.,;
0
0
N
Cl
2(t
N
Cl
a
E
"'
-'
QJ
z~{ao)
QJ
Cl
"'
Cl
c::
QJ
E
ro
QJ
-'
QJ
Cl
"'c::
Cl
QJ
u
u
u
(9)
(9)
(9)
1.
2.
3.
Answers 1. 7 ml 2. 12 ml 3. 16 ml
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or dupHc.aled. in whole or in pan. Due to elec.tronic rights. .some Lhird party content may be s uppressed fro m the e Book and/or eChapte11s}.
Edilori.al review has deemed LhaL any s uppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require it.
HYPODERMIC SYRINGE MEASUREMENT
►►► PROBLEMS 8.10
Shade in or draw arrows on the three syringe barrels provided to identify the volumes
listed. Have your answers checked by your instructor.
---
-- 5
--•
- 15
--Ill
•
--- 5
--
--- 5
--
-- 15
--
-- 15
--- a
-
-
-•
LO
0
N
c::n
.!:
c::
~
"'
_,
"'
"'
c::n
"'
c::n
c::
u"'
--
... •
@)
1. 1 1 ml
-•
LO
0
N
c::n
.!:
c::
~
"'
_,
"'
"'
c::n
"'
c::n
c::
u"'
...
@)
2. 18 ml
LO
0
N
c::n
.£
c::
~
"'
_,
"'
"'
c::n
"'
c::n
c::
u"'
@)
3. 9ml
Verify your answers with your instructor.
Summary
This concludes your introduction to syringe calibrations. The important points to remember from this chapter are:
3 mL syringes are calibrated in tenths.
TB syringes are calibrated in hundredths.
5 and 10 mL syringes are calibrated in fifths (two-tenths).
Syringes larger than 10 mL are calibrated in full mL measures.
The first long calibration on all syringes indicates zero.
All syringe calibrations must be read from the top, or front, ring of the plunger's
suction tip.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.a led. in whole or in pan. Due to elec.tronic rig hts. some Lhird party content may be s uppressed from Lhe e Book and/or eChapte11s}.
Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require iL
99
100
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Summary Self-Test
Identify the dosages measured on the following syringes.
rf-
---
-- fi
-- 2
- 2½
---3
-.;_
.,__
--- ½
--- 1
---
---- ½
--- 1
-- 1½
----- 2
f-
;-
-"'
0
N
Cl
0
N
Cl
.!:
.!:
.,"'
-'
.,
.,"'
-'
.,
Cl
Cl
~
"'
Cl
"'
Cl
.!:
c::
.,"'
-'
.,
~
Cl
"'
Cl
.,c::
u
@
@
@
3.
..-
-----
----
-----
)
--
-.,
:-.1
----;-.2
---
f.1
---
-
----
=-.3
---
-
-
0
~
.,"'
-'
.,
Cl
"'
Cl
.,c::
ML
u
=-.s
Ml
.,"'
-'
.,
0
c::
c::
~
0
"'
Cl
Cl
"'
Cl
u
u
@
@
t
I
-i'
••
I
4
5
-1'I
I
I
-uI
I
I
I
I
.,;
.,;
0
N
Cl
.:::
c::
.,"'
-'
E
.,"'
-'
.,
.,c::
0
N
Cl
c::
6.
-
0
N
Cl
.,c::
- 3
.,;
.,;
ML
Cl
--- 1
--- 2
6
-
;-_4
--~.5
N
Cl
5.
------- 21
- 3
-- 54
--
-
-~.4
.,;
I
@
4.
----§..3
---
---
c::
c::
:..s
-;-.2
--
-
N
Cl
---
•
I----
.,;
§..4
-
N
Cl
.!:
.!:
.,
.,"'
-'
.,
.,"'
Cl
Cl
c::
~
c::
~
"'
Cl
c::
~
.,
-'
Cl
"'
Cl
c::
.,
7.
0
N
Cl
u
,...
•
-"'
u
2.
-'ID?J
·D 11
IL 3
.,c::
1.
8
9
--
c::
~
c::
.,c::
----
--- 21
-"'
"'
Cl
c::
.,
.,
u
u
u
@
@
@
8.
9.
Copyrig hL 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplica ted, in whole or in pan. Due to electronic rig hts. some Lhird party content may be s uppressed from Lhe e Book and/or eChapte 1ts}.
Editorial review has deemed LhaL any suppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt at any time if subsequent rig hts restrictions require iL
HYPODERMIC SYRINGE MEASUREMENT
Draw arrows or shade the barrels on the following syringes/ cartridges to measure the
indicated dosages. Have your answers checked by your instructor.
--
--§..2
-----:.3
---,..
:- .4
--
..
=-.5
.,;
0
N
Cl
.'.:
E
"'
-'
QJ
QJ
Cl
"'
Cl
c::
QJ
u
@)
10. 0.42 ml
..--
:
-
---
----:- .2
--:- .3
---:-.4
--=-.s
-:- .2
---: .3
---; .4
---=-.5
..
-
.,;
0
N
Cl
.E
C:
~
"'
QJ
-'
QJ
Cl
"'
Cl
C:
QJ
u
@)
11 . 0.31 ml
--- •
... •
-
-
I!')
I!')
0
N
0
N
Cl
Cl
.E
.E
~
~
c::
C:
"'
"'
QJ
0
N
Cl
.E
C:
~
"'
QJ
-'
QJ
Cl
"'
Cl
C:
QJ
u
Ml
@)
-- 1
--- 2
--- 3
-- 4
-- 5
---- •7
-- I
--•
-
I!')
0
N
Cl
IDl
.E
c::
~
"'
QJ
-'
QJ
-'
-'
QJ
QJ
QJ
Cl
Cl
Cl
"'
Cl
c::
"'
u
u
u
@)
@)
@)
QJ
13. 13 ml
14. 1.2 ml
--: ''2
-'="1
--=®
-: 2l
-=--3
-=-1
-=-1½
-,=@
-=-2l
----
=-"
.,;
0
N
Cl
c::
c::
~
"'
Cl
c::
Cl
C:
QJ
"'
QJ
15. 7.6 ml
-
-
Cl
C:
C:
Cl
.,;
.,;
0
N
0
N
c::
E
~
"'
QJ
"'
QJ
-'
QJ
-'
-'
QJ
QJ
QJ
Cl
Cl
Cl
"'
Cl
c::
"'
Cl
C:
u
u
u
@)
@)
@)
QJ
16. 1.7 ml
.,;
12. 0.44 ml
-- 5
---
-- 15
---
t:
"'
Cl
c::
QJ
QJ
17. 2.2 ml
18. 0 .9 ml
Answers 1. 0 .5 ml 2. 2.5 ml 3. 1.6 ml 4. 0 .18 ml
9. 17 ml 10-18. Verify yo ur answers with yo ur instructor.
S. 0 .25 ml 6. 0 .08 ml 7. 6 .4 ml
8. 4 .8 ml
Copyrig hL 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplica ted, in whole or in part. Due to electronic rights. some Lhird party content may be s uppressed fro m Lhe e Book and/or eChapte11s).
Editorial review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt at any time if subsequent rig hts restrictions require iL
101
Parenteral medications are administered by injection, with intravenous
(IV), intramuscular (IM), and subcutaneous (subcut) being the most
frequently used routes. The labels of oral and parenteral solutions are
very similar, but the size of the average parenteral dosage label is much
smaller. Intramuscular solutions are manufactured so that the average
adult dosage will be contained in a volume of between 0.5 ml and
3 ml, with subcutaneous injections being smaller, and seldom exceeding
1 ml. Excessively larger or smaller volumes would need to be questioned
and calculations rechecked.
Volumes larger than 3 mL are difficult
for a single IM injection site to absorb, and the 0.5 to
3 mL volume can be used as a guideline for accuracy of
calculations in IM and subcutaneous dosages.
Intravenous medication administration is usually a two-step
procedure. The dosage is prepared first, then may be further diluted
in IV fluids before administration. In this chapter, we will be concerned
only with the first step of IV drug preparation, which is accurate mea-
surement of the prescribed dosage.
Parenteral medications are packaged in a variety of single-use glass
ampules, single- and multiple-use rubber-stoppered vials, and premeasured syringes and cartridges. See Figure 9-1.
READING METRIC/SI SOLUTION LABELS
Let's begin by looking at parenteral solution labels on which the dosages
are expressed in metric units of measure.
y noLbe copied, scanned, or d uplica ted, in whole o r in part. Due Lo electronic rig bi.o;, some Lhird party conLe nLmay be suppressed rmm Lhe e Book and/or eChapLe t~s).
m.at.eri.ally affecL the overall learning e xpe rience. Cengage Leaming reserves the rig hL Lo remove additional c.o nlenl al any time if subscq uenL rig hLS restricLions require it.
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
•
~ •1 I
... 11 i
...
...I
__.,
.,f ... ~~;p
-
\
=-.:.-~ . . -·
Cl
.!:
c::
~
!ti
w
_,
w
Cl
!ti
Cl
c::
w
u
@
FIGURE 9-1 Ampules, vials, and a prefilled cartridge.
EXAMPLE 1
Refer to the Vistaril" label in Figure 9-2. The immediate difference you will notice between
this and oral solution labels is the size. Ampules and vials are small and their labels are
small, which requires that they be read with particular care. The information, however,
is similar to oral labels. Vistaril is the trade name of the drug; hydroxyzine hydrochloride
is the generic name. The dosage strength is 50 mg per rnL (in the red rectangular area).
The total vial contents are 10 rnL {in black, center). Keep in mind that average intramuscular and subcutaneous dosages usually consist of one-half to double the average dosage
strength, which for this IM Vistaril is 50 mg per mL.
For 50 mg, you would give 1 rnL
For 25 mg, you would give 0.5 rnL
For 100 mg, you would give 2 mL
For 75 mg, you would give 1.5 rnL
These average dosages are within the usual 0.5 to 3 mL IM volume.
FOR INTRAMUSCULAR USE ONLY.
USUAi. AOULT DOSE: ln\taffluSQllally. 2S •
100 mo sue. ,er:,nl ""Y ◄ to &hours,
une1clecl
Sec accom•no prncnblnolntofflQl1on.
10 ml
Vistaril®
(hydroxyzine hydrochloride)
-0
w
u
:::,
-0
0
~
C.
£.tell ml oon!Jlni 5G 110 of hyd,Ol()'lllll
ll'fdroehlorile. 09'. belll)'I ilcahol and
lntrimus&uJ,r So/ullon
sodium nydro~e to td1ull to ol)llm~m pH-
To mo dlscotmtion, p,wcl 1,om prolonQlcl t,.posu,1 10 l,ot,I
,...
Ra only
50 mg/ml
0
w
a:
u
c::
Roerig
o,.,_ ol rlul IM,'"·HY 10011
FIGURE 9-2
Copyrighl 20 15 Ce ngage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplic.ated, in whole or in part. Due to e lec.tronic rig hts. some Lhlrd party conte nt may be suppressed from Lhe cBook and/or eChapte1t s).
Edilori.al review has deemed LhaL any suppressed conLenLd oes noLmaterially affecLLheoverall leaming experience. Cengage Lea.ming reserves Lhe righl lo remove addiLlonal contenLal any Lime if subsequenL rig hts res trictions require iL
103
104
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
EXAMPLE 2
The Robinul" (glycopyrrolate) medication in Figure 9-3 has a dosage strength of 0.2 mg/ mL.
For a 0.2 mg dosage, you would give 1 mL
For a 0.1 mg dosage, you would give 0.5 mL
For a 200 mcg dosage, you would give 1 mL
For a 100 mcg dosage, you would give 0.5 mL
For a 0.4 mg dosage, you would give 2 mL
For a 400 mcg dosage, you would give 2 mL
~ ter lor 1n1ettlon USt> 11,J&tnJVI !!!!
Alcohol. NF(p,eseMl!ve) O9'
;;;;;;
oH ad1usted When necessary, 'tilth hydroC11'1!rlc acid ~01 sodium hyd1oade
!!!!! • •
(GlyCOIJ'iTToJate Injection, USP) ll, ont, tlalal 0ua,,:
NDC009n-1ss 63
Robinul Injectable
=
~i
0.2 mg/ml !NOT FOR ii# IN NIWBORJq! See ui::ump,nyino @sellplM li.lerilure 5 1;
FOR INTRAMUSCULAR
11ft INTRAvtNOUS AOMINISTRATIDN
20 ml Multiple Dose Vial
□
_
O
>
=:it 3 .!
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►►► PROBLEMS 9 . 1
Refer to the antibiotic solution label in Figure 9-4 to answer the following questions.
1. What is the dosage strength of this solution?
2. How many mL are required for a dosage of 3 mg?
3. How many mL for a 6 mg dosage?
4. How many mL for a 9 mg dosage?
5. How many mL for a 12 mg dosage?
NOC 0000-0000-00
=
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Injectable Suspension, USP
For intremuscular and regional use.
Not ror intravenous use.
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betamethasone sodium phosphate
and betamethasone acetate
6 mg per ml
1
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Answers 1. 6 mg/ml 2. 0.5 ml 3. l ml 4. 1.5 ml 5. 2 ml
►►► PROBLEMS 9.2
Refer to the Ativan label in Figure 9-5 to answer the following questions.
1. What is the total volume of this vial?
2. What is the dosage strength?
Copyrig hL 20 15 Cengage Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhinl party content may be s uppressed fro m LhecBook and/or eChaple t1s).
Edilori.al review has deemed Lhat :my suppressed content does noL materially :iffecl Lheovcrall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
3. If 8 mg were ordered, how many mL would this be?
4. If 6 mg were ordered, how many mL would this be?
5. How many mL would you need to prepare a 20 mg dosage?
I?, only For IVuse, additional
NDC00000-000--00
I
40 mg/10 ml (4 mg/ml)
FOR IMUSE
FOR IV ROUTE, SEE DIRECTIONS
10 ml Multiple Dose Vial
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Manufactured by Buts Healtbctre Cornticn
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FIGURE 9-5
Answers 1. 10 ml 2. 40 mg/10 ml or 4 mg/ml 3. 20 ml 4. 15 ml S. 5 ml
PERCENT(%) AND RATIO SOLUTION LABELS
Drugs labeled as percentage solutions often express the dosage strength in metric measures in addition to percentage strength. The lidocaine label in Figure 9-6, a 2% solution, is an example.
But directly underneath this is a "20 mg/mL" designation. Lidocaine HCl is most often
ordered in mg, but it is also used as a local anesthetic, and when it is, a physician may ask
you to prepare a volume dosage specifying % strength.
►►► PROBLEMS 9 . 3
Refer to the lidocaine label in Figure 9-6 to answer the following questions.
1. How many mL are needed for a 10 mg dosage?
2. How manymL for a 20 mg dosage?
3. If you are asked to prepare 5 mL of a 2% solution,
how many mL would you draw up?
4. If you are asked to prepare 15 mg?
NOC 10019-019·57
(20 mg/ml)
~ only
Each ml contains l1doca1ne hydrochlonde 20 mg, soc:hum chloride 6 mg
and methylparaben I mo 1n Water tor
lnjechon pH 5 O 7.0; sodium hy•
drox,de and/or hydrochloric acid used.
ti needed. tor pH ad1ustmenl
Usual Dosage: See package insen for
complete prescribing lntormauon.
FOR INFILTRATION ANONERVE BLOCK
Store at controlled room temperature
NOT FOR SPINAL OR EPIDURAL ANESTHESIA 15 '·30"C(59 ·86 F),
50 ml Multiple Dose Vial
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Answers
1. 0.5 ml 2 . 1 ml 3. 2 ml 4 . 1.5 ml
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105
106
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
►►► PROBLEMS 9.4
Refer to the lidocaine label in Figure 9-7 to answer the following questions.
1. What is the percentage strength of this lidocaine solution?
2. How many mL does the vial contain?
3. If you are asked to prepare 20 mL of a 1% lidocaine solution,
how many mL will you draw up in the syringe?
4. What is the metric dosage strength of this solution?
5. If you are asked to prepare 25 mg from this vial,
what volume will you draw up?
NOC 10019-017-57
f.lch ml contarns llllocame hydrochloride 10 mo, sodn,m thlondt 7 mo
and mettrylparaben 1 mo ,n Wile, lor
lnJeclion pH 5.0-7.0; $Odium hydroxide and/or hydroch!Qric acid used.
rl needed, lor pH ad1ustment.
Usu1I Dong,; Set p:idQoe !nun for
S?t only
complett prescribing inlomwion.
SIOfe 11 conttolled room lemperature
FOR INFILTRATION ANO NERVE BLOCK
NOT FOR SPINAL OR EPIDURAL ANESTHESIA 15 -SO C(59 ·86 F).
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Refer to the calcium gluconate label in Figure 9-8 to answer the following questions.
6. What is the percentage strength of this solution?
7. How many mL does this preparation contain?
8. What is the per mL mEq dosage strength of this solution?
NOC 00000-0000-00
CALCIUM GLUCONATE
INJECTION, USP
10%
4.65 mEq/10 ml calcium
(D.465 mEq/ml)
10 ml
SINGLE DOSE VIAL
FOR SLOW I.V. USE
I_Rx onlyI
Each 1 ml contains: calcium gluconate
(monohydrate) 98 mg, calcium
saccharate (tetrahydrate) 4.6 mg,
water for Injection q.s. pH adjusted With
sodium hydroxide and/or hydrochloric
acid.
0
0
Contains no more than 12.5 mg per liter
of aluminum.
WARNING: Solution must be clear when
Injected. If unused solution shows
crystallization, discard.
storeat controlled room temperature
15• -30°c (59°-86°F) (See u SP).
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Answers 1. 1% 2. 50 ml 3. 20 ml 4. 10 mg/m l 5. 2.5 ml 6. 10% 7. 10 ml 8. 0.465 mEq/ml
Parenteral medications expressed in ratio strengths are not common, and when they are
ordered, it will be by number of ml,. Ratio labels 1nay also contain dosages in metric
weights.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan . Due to elec.tronic rig hts. some Lhlnl party conte nt may be .supprcs..,;,ed fro m Lhe c Book and/or eChapter(s).
Edilori.al review bas deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require iL
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
►►► PROBLEMS 9.5
Refer to the epinephrine label in Figure 9-9 to answer the following questions.
1. What is the ratio strength of this solution?
2. What volume is this contained in?
3. What is the metric dosage strength of this solution?
NDC 00000-0000-00
EPINEPHRINE
CONTAINS NO SULFITE$
OR PRESERVATIVES.
FOR IV, IM, OR SC USE
1 ml AMPULE
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Answers 1. 1 : 1000 2. 1 ml 3. 1 mg/ ml
SOLUTIONS MEASURED IN INTERNATIONAL UNITS
A number of drugs are measured in International Units. The following labels will introduce you to several examples.
►►► PROBLEMS 9 .6
Refer to the heparin label in Figure 9-10 to answer the following questions.
1. What is the total volume of this vial?
2. What is the dosage strength?
3. If a volume of 1.5 mL is prepared, how many units
will this be?
4. Ho,v many mL will you need to prepare a dosage of
5500 units?
5. If 0.25 mL of this medication is prepared, ,vhat dosage
will this be?
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Copyrig hL 20 15 Cengage Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan . Due to elec.tronic rig hts. some Lhlrd party conte nt may be .suppressed fro m Lhe cBook and/or eChapte1ts).
Edilori.al review bas deemed Lhal any suppressed content does noL materially affect Lheoverall leaming e xperience. Cengage Leaming reserves Lhe righl lo remove additional conLe nL al any time if subsequenLrig hts res trK:tions require iL
107
108
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Refer to the penicillin G procaine label in Figure 9-11 to answer the following
questions.
6. What is the dosage strength of this medication?
7. If 600,000 units are ordered, how many mL
would this require?
Penicillin G Procaine
Injectable Suspension
1,200,000 UNITS per 2 ml
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FIGURE 9-11
Answers 1. 10 ml 2. 1000 units/ml 3. 1500 units 4. 5.5 ml S. 250 units 6. 1,200,000 units/2 ml
7. 1 ml
SOLUTIONS MEASURED AS MILLIEQUIVALENTS (mEq)
The next four labels will introduce you to milliequivalent {m.Eq) dosages. Refer to the calcium gluconate label in Figure 9-12 and notice that in addition to its 10% strength, this vial
has a dosage of 0.465 m.Eq/ mL. If a dosage of 0.465 m.Eq were ordered, you would draw up
1 mL in the syringe.
NOC 00000-0000-00
CALCIUM GLUCONATE
INJECTION, USP
10%
4.65 mEq/1 Oml calcium
(0.465 mEq/ml)
10 ml
SINGLE DOSE VIAL
FOR SLOW I.V. USE r:---,-,
!Rx onlyl
Each 1 ml contains: calcium gluconate
(monohydrate) 98 mg, calcium
saccharate (tetrahydrate) 4.6 mg,
water for Injection q.s. pH adjusted With
sodium hydroxide and/or hydrochloric
acid.
0
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0
of aluminum.
0
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►►► PROBLEMS 9 .7
Refer to the potassium chloride label in Figure 9-13 to answer the following questions.
1. What are the total dosage and volume of this vial?
2. What is the dosage in m.Eq per mL?
3. If you were asked to prepare 15 m.Eq for addition to an rv,
what volume would you draw up?
Copyrig hL 20 15 Cengage Leaming. All RighL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhinl party content may be s uppressed from LhecBook and/or eChapte11s).
Edilori.al review has deemed Lhat any suppressed content does noLmaterially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional contenLal any time if subsequent rig hts restrictions require iL
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
NDC 0000-0000-00
POTASSIUM CHLORIDE
For JnjecrionConcentrare. USP
Concentrated Must be
Diluted Before Use
130 mEq I (2 mEq/ml.)
15 ml
Single Dose Vial
!Rxonlyl
Preservative Fre-e
MUST BE DILUTED PRIOR
TOW ADMINISTRATION
Sterile, nonpyrogenic
Each ml contains potassium
ch lo ride 2 mEq (149 mg) \\Oater
for inject ion q.s. HO and/or KOH
may have been added for pH
adjustmenL
4,000 mOsmoVL (calc.J
Contains no more than 100
mcg/l of aluminum.
Store at 21r10 25°C
(68" to 1rFJ.
Lot:
Exp. Date:
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Refer to the potassium acetate label in Figure 9-14 to answer the following dosage
questions.
4. What is the strength of this solution in mEq per 1nL?
5. If you were asked to prepare 40 rnEq for addition to an
IV solution, what volume would you draw up in the syringe?
6. What volume would you need for a dosage of 20 rnEq?
NOC 00000-0000--00
POTASSIUM ACETATE
INJECTI ON, USP
40 mEq/20 ml
(2 mEq/mL)
20ml
SING LE DOSE VIAL
FOR IV USE AFTER DILUTION
JRx onlyl
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Each ml contains: potassium
acetate (anhydrous) 196 mg
(2 mEq), water for injection q.s.
pH adjusted with acetic acid.
4 mOsmol/ml
Contains no more than
25 mg per liter of aluminum.
WARNING: Solution must
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Refer to the sodium bicarbonate label in Figure 9-15. Notice that this solution lists the
drug strength in mEq, percentage, and g. Read the label very carefully to answer the
following questions.
7. What is the dosage strength expressed in rnEq/ mL?
8. What is the total volume of the vial, and how many
mEq does this volmne contain?
9. What is the strength per mL expressed as g?
10. If you were asked to prepare 10 mL of an 8.4% sodium
bicarbonate solution, what volume would you draw
up in a syringe?
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,ed fro m Lhe cBook and/or eChapLer(s).
Edilori.al review has deemed LhaL any suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts restrictions require iL
109
110
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
NOC 0000-0000-00
SODIUM BICARBONATE
INJECTION, USP
2 mOsmol/ml
8.4%
4.2 grams
(50 mEq)/50 ml
50ml
SINGLE-DOSEVIAL
FOR SLOW IV USE
Each 50 ml of medication contains 4.2 grams
(50 mEq) of Sodium Bicarbonate,
Water for injection q.s.
!Rx only!
WARNING: DISCARDANY UNUSED PORTION.
USE ONLY IF SOLUTION ISCLEARAND
CONTAINS NO PRECIPITATE.
Store at 20' to 25'C (68' to 77'F);
brief excursions allowed at 15' to 30'C
(59' to 86' F):
(See USPcontrolled Room Temperature.)
See package insert for directions for use.
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Answers 1. 30 mEq; 15 ml 2. 2 mEq/ ml 3. 7.5 ml 4. 2 mEq/ ml 5. 20 ml 6 . 10 ml 7 . l mEq/ml
8. 50 ml; 50 mEq 9. 0.084 g/ml 10. 10 ml
Summary
This concludes the introduction to parenteral solution labels. The important points to
remember from this chapter are:
The most commonly used parenteral administration routes are rv, IM, and
subcutaneous.
The labels of most parenteral solutions are quite small and must be read with particular care.
The average IM dosage will be contained in a volume of between 0.5 mL and 3 mL.
These 0.5 to 3 mL volumes can be used as a guideline to accuracy of calculations.
The average subcutaneous dosage volume is between 0.5 and I mL.
IV medication preparation is usually a two-step procedure: measurement of the
dosage, then dilution according to manufacturer's recommendations or a physician's or prescriber's order.
Parenteral drugs may be measured in metric, ratio, percentage, unit, or mEq
dosages.
If dosages are ordered by percentage or ratio strength, they are usually specified in
mL to be administered.
Most IM dosages are prepared using a 3 mL syringe.
Most subcutaneous dosages are prepared using a 3 mL or tuberculin syringe.
Summary Self-Test
Read the parenteral drug labels provided to measure the following dosages. Then,
indicate on the syringe provided exactly how much solution you will draw up to
obtain these dosages. Have your answers checked by your instructor to be sure you
have measured the dosages correctly.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,ed fro m Lhe cBook and/or eChapLer(s).
Edilori.al review bas deemed LhaL any suppressed conlenl does nol materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLlonal conle nl al any time if subsequenl rig hls restrictions require iL
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
ml, Needed
Dosage Ordered
1. terbutaline sulfate 500 mcg
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SULfffl.81■1USP
NOC 55390·101·10
Sterile Vial
1111/mL
Protect from light
Manufactured tor.
Bedford Laboratonesm
Bedtord, OH 44146
RIGID
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FOR IC INJECTION ONLY.
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2. furosemide 10 mg
NDC 0000-0000-00
FUROSEMIDE
INJECTI ON, USP
20 mg/2 ml
(10 mg/ml)
WARNING: Use only if solution is
clear and colorless.
Protect from light.
Store at control! ed room temperature
between 1s•-so•c (59°-86°F).
SINGLE DOSEVIAL
FOR IV OR IM USE
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Edilori.al review has deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hls restricLi ons req uire it.
111
112
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
mLNeeded
Dosage Ordered
3. heparin 2500 units
sample ~i-1
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USP units
5,000 per ml
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Edilori.al re view has deemed LhaL any suppressed content does noL materially affect Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions req uire it.
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
Dosage Ordered
mLNeeded
5. atropine 0.2 mg
10 mL
1 mg
0.1 mgl mL ·
ATROPINE SULFATE
INJECTION, USP
FOR I V Ull I SEE INSERT
SINGLE DOSE I NO PRES~RVATIVE ADDED
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113
114
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PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
mLNeeded
Dosage Ordered
10. cyanocobalamin 1 mg
NOC 00000-0000-00
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May contain a preservative.
Contains no more than
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WARNING: Protect from light.
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FOR IM OR SC USE ONLY
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115
116
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
mLNeeded
Dosage Ordered
12. epinephrine 2 mg
NDC 00000-0000-00
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PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
mLNeeded
Dosage Ordered
14. calcium glucon at e 0.93 mEq
ND C 00000-0000-00
CALCIUM GLUCONATE
INJECTION, USP
10%
4.65 mEq/10 ml calcium
(0.465 mEq/ml )
10 ml
SINGLE DOSE VIAL
FOR SLOW I. V. USE
I_Rx onlyI
Each 1 ml contains: calcium gluconate
(monohytlrate) 98 mg, calcium
saccharate (tetrahydrate) 4.6 mg,
water for Injection q.s. pH adjusted with
sodium hydroxide and/or hydrochloric
acid.
Contains no more tl1an 12.5 mg per liter
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WARN ING : Solution must be clear when
Injected. If unused solution shows
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117
118
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
mLNeeded
Dosage Ordered
16. h eparin 500 units
NOC 0000-0000-00
HEPARIN SODIUM
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1,000 units/ml
Derived from porcine
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PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
Dosage Ordered
mLNeeded
18. epinephrine 0.5 mg
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119
120
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
mLNeeded
Dosage Ordered
20. Ativan 6 mg
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dilution Is required; see
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PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
mLNeeded
Dosage Ordered
22. sodium chloride 40 mEq
NOC 0000-0000-00
P-,vative free
Ead, ml contains: sodium chloride 234 mg;
water for injection q.s. pH may have been
adjuste<I with hydrochloric acid.
SODIUM CHLORIDE
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CONCENTRATED
8008 mOsmol/L 4,000 mEq /L
Directions for pharmacy bulk package: Swab
stopper with an antiseptic solution. Withdraw
PHARMACY BULK PACKAGENot for direct infusion
contents of the vial using a sterile dispensing
set. If prompt fluid transfer is not possible, a
23.4% 4 mEq / ml
maximum time of 4 hours from the time of
initial entry is allowed to complete the
transferring operations. Discard the container
FOR IV USE ONLY
AFTER DILUTION
no later than 4 hours after initial closure,
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121
122
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Dosage Ordered
mLNeeded
24. meperidine 50 mg
IIOC 10019-154..U
Meperidine 'ii':~
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SU!CUTAIIEOUS OR SLOW
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W'Jh XflJC IOCkodlUlll KIIIII
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CUNDAMYCIN Usual
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[ 150mg/ml]
(9 Qqmg par 60 ml)
PHARMACY BUL• PAWGE
NOT FDR DIRECT IIIFUSIOH
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Eaelt ml COl\talns C f ~ pbaspllalt l!!Uivalllftl to cJlnlliamlocln 150 mg: alsc dlsocllum
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ad~ with sadlum byd!uxide aiidlllr Jiydrochforil: acid.
THIS PHAIIIIIACY IUU PACICAGE II rmNDBl FDR PREPARING lWIY SUIGLE DOSES II
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PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
mLNeeded
Dosage Ordered
26. morphine sulfate 15 mg
NOC 10019-179-44
€I
15mg/ml
FOR sc. IM OR 11 I
$1.0WIVUSE
1 ml
COSETTE Vial
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28. cisplatin 20 mg
CISplatln doses greater than 100 mg/m 2
once every 3 to 4 weeks are rarely used.
See package Insert.
CISplatin
Injection
50 mg/50 ml
FOR IV USE ONLY
1 mg/ml Aqueous
NOC 55390-11 2-50
50 ml MULTIPLE DO SEVIAL
USUAL DOSAGE: See package insert.
Each ml contains 1 mg cisplatin and 9 mg
sodium chloride in water for injection. HCI
and/or sodium hydroxide added to adjust
pH to 3.5 to 4.5.
Store at 15° to 25°C (59° to 77°F).
Protect lrom llghl. DO NOT REFRIGERATE.
STERILE SOLUTIONS FOR INTRAVENOUS USE.
Rx ONLY
M,mufactured for:
Manufactured by:
Bedford LaboratoriesTM
Ben Venue Labs, Inc.
10 110
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123
124
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
mLNeeded
Dosage Ordered
29. sodium chloride 20 mEq
NOC 0000-0000-00
SODIUM CHLORIDE
INJECTION, USP
CONCENTRATED
8008 mOsmol/L 4,000 mEq/L
Directions for pharmacy bulk package: Swab
stopper with an antiseptic solution.Withdraw
contents of the vial using a sterile dispensing
set. If prompt fluid transfer is not possible, a
PHARMACY BULK PACKAGENot for direct infusion
23.4% 4 mEq/mL
maximum time of 4 hours from the time of
initial entry is allo ~ to complete the
transferring operations. Discard the container
no later than 4 hours after initial closure.
FOR IV USE ONLY
AFTER DILUTION
100 ml
Presemi.tive fr.e
Each ml contains: sodium chloride 234 mg;
water for injection q.s. pH may have been
adjusted with hydrochloric acid.
Use only if solution is clear and seal intact.
Store at controlled room temperature 15° to
30'C (59' to 86•F). Do not freeze.
IRx only!
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Editorial review has deemed LhaLany s uppressed contenl does noLrn:iterially :iffecLLheoverall leaming e xpe rience. Ceng:ige Leaming reserves Lhe right Lo remove :iddiLional conLe nl al any time if subsequenLrig hLs restrictions require it.
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
mLNeeded
Dosage Ordered
31. furosemide 30 mg
Each ml contains l urosemide 10 mg,
water for inj ections q.s., sodium chloride,
hydrochlonic acid to adjust pH
between 8.0 and 9.3.
WARNING: Use only if solution is clear and
Colorless. Protect from light.
Discard unused portion.
Store at controlled room temperature
between 15°-30°C (59°-86°F).
NOC 0000-0000-00
FUROSEMIDE
INJECTION , USP
40 mg/4 ml
(10 mg/ml)
4ml
SINGLE DOSE VIAL
FOR IV OR IM USE
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1002
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125
126
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
mLNeeded
Dosage Ordered
33. m eperidine 50 mg
NOC 10019 1~3!1
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Edilori.al review has deemed LhaLany s uppressed conlcnl does nol rn:iterially :iffecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove :iddiLional conle nl al any time if subsequenl rig hls rcstricLions require it.
PARENTERAL MEDICATION LABELS AND DOSAGE CALCULATION
mLNeeded
Dosage Ordered
36. fentanyl 0.05 mg
NOC 1001g..0J8·67
•
100 mcg/2 ml
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50 mcg/ ml (0.05 mg/ml)
0
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0
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rentanyl base In Waler lor Injection. pH 4.0-7.5: sO<llum h~ciroxlde
andlo( hydrochloric acid added, 11nuded, for pH adJu,tmenL COHTAINS
110 PRESERVATIVE.
Usual Oos1;1: See pacl:age ~rt lor complete J)(estribfnO lnlorm,llon.
PROTECT FROM LIGHT: IC11p cove:ed In ~rtoa until Ume ol are.
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NOC 00000--0000- 00
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INJECTION, USP
1000 mcg/ml
May contain a preservative.
Contains no more than
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WARNING: Protect from light.
Store between 20°-25°C (68°-77°F).
FOR IM OR SC USE ONLY
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127
128
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Dosage Ordered
mLNeeded
39. ketorolac tromethamine 15 mg
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Answers
1. 0.5 ml
2. 1 ml
3. 0.5 ml
4. 2 ml
5. 2 ml
6. 1 ml
7. 0.5 ml
8. 5 ml
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10. 1 ml
11. 0.5ml
12. 2 ml
13. 2.5 ml
14. 2 ml
15. 2 ml
16. 0.5 ml
17. 1.5 ml
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18. 0.5ml
19. 2 ml
20. 1.5 ml
21. 5 ml
22. 10 ml
23. 2 ml
24. 0.5 ml
25. 2 ml
26. 1 ml
27. 3 ml
28. 20 ml
29. 5 ml
30. 2 ml
31. 3 ml
32. 1.5 ml
33. 2 ml
34. 0.5 ml
35. 2 ml
36. 1 ml
37. 1.5 ml
38. 1 ml
39. 0.5 ml
40. 1 ml
Copyrig hL20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplicated, in whole or in pan . Due to electronic rights. .some Lhird party content may be s uppressed from Lhe e Book and/or eChapte11s).
Editorial review has deemed LhaLany s uppressed content does not materially affec t Lheoverall leaming experience. Cengage Leaming reserves Lhe righLLo remove add(Lional conLenl al any time if subsequenLrighLs restricLions require it.
CH~PTER
Many drugs are shipped in powdered form because they retain their
potency only a short time in solution. Reconstitution of these drugs is
often the responsibility of clinical pharmacies, but you will need to know
how to read and follow reconstitution directions and how to label drugs
with an expiration date and time once they have been reconstituted. The
drug label, or instructional package insert, will give specific directions for
reconstitution of the drug. Reading these requires care, and this chapter
will take you step by step through the entire process.
RECONSTITUTION OF A SINGLE-STRENGTH
SOLUTION
Let's start with the simplest type of reconstitution instructions, for a
single strength solution. Examine the label for the Solu-Medrol®500 mg
vial in Figure 10-1.
,.
~ only
-......
see pactage inseft for coml)lete ptoduct
Information Store at controlled room
temperature 20" to is•c C68" to 77'Fl ISee
0,
USPI Prolect from ltght ~Onslltute With
"'
B
ml Baaeriost.iuc \Yater for Injection wllh
'°g Benzvt
AICOhol wnen reconstttuteCI as
d:ltected each a ml contains:
• Methyli,rednrsotone sodium S\Jcdnate
eQuivalent to 500 mg methvt1>redniso10ne
162 5 mg per mu. Store solution at
controlled room temperature 20- to 2s•c
C68• to 77•F► lsee USPI and uw w,thin 48
houn after miJang. Lyoc)h1Uzed In concalner
Protect f rom light .
Reconstituted:
CD
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Diluent Conc;iins aenzyl Alcohol
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FIGURE 10-1
.,..,..;~ Reconstitution directions on vial labels may
be small and difficult to read, and extreme care in reading
them is essential.
The first step in reconstitution is to locate the directions. They are on the
left side of this label.
CopyrigbL 20 15 Ce ng age Learning. AU Rig hL'i Reserve d May noLbe c opied. scanned, or d uplicated, in whole o r in part. Due to e lcc.tronic rig hts. some Lhird party c o
Edilorial re vie w has deemed Lhal :my s uppres..~ed content d oes nol m.at.eri.ally affecL the overall learning expe rience. Cengage Leaming reserves the rig ht Lo remove additi
130
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Locate the Reconstitute with 8 ml, Bacteriostatic Water for injection with Benzyl
Alcohol instructions. Water, or any other solution specified for reconstitution, is called the
diluent. The type of diluent specified will be different for different drugs. The volume
of diluent will also vary. Therefore, reading the label carefully to identify both the type
and the volume of diluent to be u sed is mandatory.
Once the type of diluent is identified, the next step is to use a sterile syringe and
aseptic technique to draw up the 8 mL volume required. Inject it slowly into the vial
above the medication level, because air bubbles can distort drug dosages. If the
diluent volume is large, as in this case, be aware that the syringe plunger will be forced
out to expel air to reequalize the internal vial pressure as you inject. Very large volumes of diluent will have to be injected in divided amounts to keep the internal vial pressure equalized. When all the diluent has been injected, the vial is rotated and upended until
all the medication has been dissolved. Do not shake unless directed to do so, because this
also can add air bubbles to some medications and distort dosages.
After reconstitution locate the information that relates to the length of time the
reconstituted solution may be stored, and how it must be stored. Look again at the
Solu-Medrol directions and locate this information. You will find that this solution can
be stored at room temperature and that it must be used within 48 hours of reconstitution.
The next step is to print your initials on the label as the person who reconstituted the drug, in case any questions subsequently arise concerning the preparation.
Next, add the expiration date and time to the label. Let's assume you reconstituted this
Solu-Medrol solution at 2 pm on January 3 . What expiration (EXP) date and time will you
print on the label? The reconstituted drug last s only 48 hours at room temperature, so you
would print Exp. Jan. 5, 2 pm, which is 48 hours (2 days) from the time you reconstituted it.
KEV paint: The person who reconstitutes a drug is responsible for labeling
it with the date and time of expiration, and with his or her initials.
Next, identify the total dosage strength of this vial, which is 500 mg. Near the top of the
label, you can locate the individual dosage strength: 4-125 mg doses. Because you have
injected 8 mL of diluent, this will be approximately 2 ml, for each 125 mg dose, but if you
read the small print on the label, you will see that the individual dosage is clearly identified
as 62.5 mg per ml,.
Reconstituted volumes do not always exactly equal the amount of diluent
added; in fact, most do not. This is because the medication itself has a volume, and it usually makes the total volwne somewhat larger than the amount of diluent injected. Our next
examples of a single-strength reconstitution will illustrate this increased volume concept
If a 62.5 1ng dosage is ordered, you will need 1 mL.
If a 125 mg dosage is needed, you will need 2 mL (125 mg= 62.5 mg X 2).
If a 250 mg dosage is needed, you will need 4 mL; and if 500 mg is ordered, the total
is 8 mL.
KEY paint: Reconstituted volumes may exceed the volume of the diluent
added, because the drug itself has a volume.
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhird party conle nl may be .suppress.eel fro m Lhe c Book and/or eChaple t1s).
Edllorial review has deemed LhaL any suppres.,;ed content does noL materially :iffecl Lheoverall leaming e xperience. Cengage Leaming re.serves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions require iL
RECONSTITUTION OF POWDERED DRUGS
►►► PROBLEMS 10.1
Other drugs shipped in powdered form are antibiotics. Read the label in Figure 10-2 to
answer the following questions about reconstituting this drug. All the information you
need is printed sideways on the right of the label.
I. How should this drug be stored before reconstitution?
2. How is this drug administered?
3. How long will this solution retain its potency at room
temperature after reconstitution?
4. How long if refrigerated?
5. If you reconstitute this drug at 10:10 am on October 3
and it is refrigerated, what expiration time will you
print on the label?
6. What else will you print on the label?
7. What is the total dosage of this reconstituted IV solution?
NDC 0049•0013•83
Unasyn®
(amplcillln sodlum/sulbactam sodium)
Sterile
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Answers 1. at or below 86°F (30°C) 2. IM or IV 3. 2-8 hours 4. 24-72 hours 5, Exp. Oct. 4 l 0: l O am
to Oct. 6 l 0: l O am (your answer must include "Exp." to be correct) 6. your initials 7. 1.5 g
►►► PROBLEMS 10 .2
Refer to the penicillin V potassium oral suspension label in Figure 10-3 to answer the
following questions.
I. How much diluent is needed to reconstitute this
large-volume oral suspension preparation?
2. What kind of diluent will you use?
3. The label is specific about how to add this diluent.
What does it tell you?
4. This is an oral suspension. Does the diluent need
to be sterile?
5. What is the mg dosage strength of the prepared
solution?
Copyrighl 20 15 Ce ngage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.ated, in whole or in part. Due to elec.tronic rig hts. some Lhlnl party conte nt may be .supprcs..,;,ed from Lhe c Book and/or eChapte r(s ).
Edilori.al re view bas deemed LhaLany suppressed conLenLdoes noLmaterially affec LLhe ove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righl lo remove addiLlonal conte nLal any time if subsequenLrig hts res trictions req uire iL
131
132
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
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PENICILLIN V
POTASSIUM
for Oral Solution, USP
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FIGURE 10-3
6. Determine the expiration date if you reconstitute
this drug on March 15 at 4:40 pm.
7. How must the reconstituted solution be stored?
8. If the dosage ordered is 125 mg, how many mL are needed?
9. For a 500 mg dosage, how many mL are needed?
10. How many units of medication will there be in a 5 mL dose?
11. What should you do to this medication before administering it?
12. What must the person who reconstitutes the medication
print on the label?
Answers 1. 75 ml 2. water 3. Slowly add water, partially fi ll bottle, and shake vigorously. Add remaining
water and shake. 4. No, this is an oral medication. 5. 250 mg/5 ml 6. Exp. March 29 4:40 pm
7. in a refrigerator 8. 2.5 ml 9. 10 ml 10. 400,000 units 11. shake well 12. his or her initia ls
►►► PROBLEMS 10 .3
Refer to the ceftriaxone label in Figure 10-4 to answer the following questions.
1. What is the total dosage of this vial?
2. How much diluent is used for IM reconstitution?
3. What kind of diluent is specified for IM reconstitution?
Storage Prior to Reconstitution:
Rx only Each vial oontains: ceflriallllnesodium
pONder equivalent tn 500 mg ceftriaxone. Store powder at 20° to 25°C
■,
Forl.M.Administration : Reconstitutewith (680to 77•F) [See USP Controlled
l ml 1%UdocaineHyllrochloride
Room Temperature].
lni,ction {USP) or sterile Water for lni,ction Protect from light
Or In1· ectio n,
(USP). Each I mlof solution contains
Storage After Reconstitution:
approllim ately350 mg equivalent of
See Package Insert
cettriaxone. . . .
Mid for: Teva Parenteral
For I.V.Admnislrat1on: See Package Insert Medi:ines, Irvine, CA 92618 ~ - - - - - - - - - ~1 ~~~ See P~
Insert
;~
For I.M. or I.V. Use
lss. 3/2010
,Single Use Vial
39C1405450310
~NOC 0703-0325-01
Ceftr
f
aXO ne
usp
500 mg
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Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due Lo elec.tronic rig hts, some Lhinl party conte nt may be s uppressed from LhecBook and/or eChapte11s).
Edilori.al re view has deemed LhaLany suppressed content does noLmaterially affec t Lheove rall leaming e xpe rience. Ce ngage Lea.ming reserves Lhe right Lo remove additional conte nLal any time if subsequenLrig hts res trictions req uire iL
RECONSTITUTION OF POWDERED DRUGS
4. What dosage will l mL of IM reconstituted solution contain?
5. Where does it tell you to look for information on the
kind of diluent to use for IV reconstitution?
6. Where will you find storage and expiration details?
7. What will you print on the label in addition to the expiration date?
Answers 1. 500 mg 2. 1 ml 3. 1% lidocaine hydrochloride injection or sterile water for injection 4. 350 mg
S. package insert 6. package insert 7. your initials
►►► PROBLEMS 10.4
Refer to the clindamycin label provided in Figure I 0-5 to answer the following questions.
1. What is the total dosage in this vial?
2. Where will you locate reconstitution instructions?
3. How long may the reconstituted solution be used?
4. How much clindamycin will a 6 mL IV volume contain?
5. How many mL will be needed for a 1500 mg IV dosage?
6. What is the mL strength of the reconstituted solution?
7. How is this drug administered?
CLINDAMYCIN
INJECTION USP
(9 Grams par 60 ml)
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adjus!Bd wfth sodium hydroxide and/or h~rochloflc add.
THIS PHARMACY BULJ< PACKAGE IS UITTNDm FOR PREPARING MANY SINGLE DOSES IN
APHARMACY ADMIXTURE PROGRAM. FURTHER DILUTION IS REOUIRm. SEE INSERT FOR
FURTHER INFORMATION.
DO NOT DISPENSE AS AUNIT
60 ml PHARMACY BULJ< PACKAGE
RJONLY
W1mln9: Dilute before IV use. Swab vial closure with an antlseotlc soluflon. Dispense allQuotJ
from tho vial via a suitable dispensing device Into ln1usion fluids under a laminar flow hood
edetate 0.5 mo: benzyt alcohol 9.45 mg ai!ded as preseMtlve. When necessary, pH was
PHARMACY BUI K PAC~AGE
NOT FOR DIRECT INFUSION
FOR IHTRAVEMOUS USE ONLY
Usual DosaQa: See pad<aoe Insert.
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using aseptic technique. DISCARD VIAL WITlilN4 HOURS AFTER INITIAL ENTRY
Slore at20-10 25-C (68° to nOf): see USP cont~led room temperature. Do not refrigerate.
Each ml contains clll'ldamyctn phosphate equivalem to ctlnda.mvcln 150 mg: also dlsodlum
[ 150 mg/ml]
--
60 ml Pharmacy Bl.Ilk Vial
NOC 55390-109--01
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Answers 1. 9 grams 2. on the package insert directions 3 . 4 hours 4 . 900 mg/6 ml S. 10 ml
6. 150 mg/ml 7. IV
►►► PROBLEMS 10.5
Refer to the cytarabine label in Figure 10-6 to answer the following questions.
1. What is the total dosage strength of this vial?
2. How much diluent is required for reconstitution?
Copyrig hL 20 15 Ceng agc Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhinl party conte nt may be s uppressed fro m LhecBook and/or eChaple t1s).
Edilori.al review has deemed Lhat :my suppressed content does noL materially :iffecl Lheovcrall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
133
134
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
NOC 55390-133-01
LYOPHILIZEO
See package insert for complete prescribing information.
Each vial contains cytarabine 1 g and, if necessary, hydrochloric acid and/or
sodium hydroxide for pH adjustment.
When reconstituted with 10 ml Bacteriostatic Water for Injection USP with
benzyl alcohol, each ml contains 100 mg cytarabine. Oo not use a diluent
FOR INTRAVENOUS, SUBCUTANEOUS, containing benzyl alcohol !or intrathecal and high dose investigational use.
OR INTRATHECAL USE
Store both powder and reconstituted solution at 25 C(J7 F); excursions
permitted to 15 to 30 C(59 to 86 F)[see USP Controlled Room Temperature].
Use reconstituted solution within 48 hours. Discard solution if a slight haze
develops.
Manufactured for:
Manufactured lly:
Bedford Laboratories™
Ben Venue Laboratories, Inc.
Rx ONLY
Bedford, OH 44146
Bedford, OH 44146
CYB-VC05
CYTARABINE
FOR INJECTION USP
1 gram
FIGURE 10-6
3. What will be the dosage strength per mL of
the reconstituted solution?
4. What type of diluent is to be used?
5. Ho,v long can the reconstituted solution be retained?
6. How is this medication administered?
Answers 1. 1 g 2. 1 0 ml 3. 1 00 mg per ml 4. bacteriostatic water S. 48 hours 6. intravenously,
subcutaneously, or intrathecally
►►► PROBLEMS 10.6
Refer to the cytarabine label in Figure 10-7 to answer the following questions.
1. What is the total dosage strength of this vial?
2. How much diluent is required for reconstitution?
3. What will be the dosage per mL of the reconstituted
solution?
4. What is the expiration time of the reconstituted solution?
5. What diluent must be used for subcutaneous injection?
CYTARABINE
NOC 55390-132-10
LYOPHILIZEO
See package insert lor complete prescribing information.
FOR INJECTION USP Each vial contains 500 mgand, if necessary, hydrochloric
• - - - - - - - acid and/or sodium hydroxide for pH adjustment.
When reconstituted with 10 ml Bacteriostatic Water for
FOR INTRAVENOUS,
Injection USP with benzyl alcohol, each ml contains 50 mg
SUBCUTANEOUS,OR cy1arabine. Do not use a dlluent containing benzyl alcohol
tor intrathecal and high dose investlgatlonal use.
INTRATHECAL USE
Store both powder and reconstituted solution at 20° to 25°C
(68° to 77°F). [See USP Controlled Room Temperature.J
Use reconstituted solution within 48 hours. Discard
solution if a slight haze develops.
Manufactured for:
Bedford Laboratories™
Rx ONLY
Bedford, OH 44146
CYB-VB06
[500 mg]
-
--3
-·-
FIGURE 10-7
Answers 1. 500 mg 2. 10 ml 3. 50 mg per ml 4. 48 hours 5. bacteriostatic water for injection USP with
benzyl alcohol
RECONSTITUTION FROM PACKAGE INSERT DIRECTIONS
The package insert directions provided represent just a small portion of the information
that drug package inserts contain. Additional information includes specific use of the drug
for diagnosed conditions, such as bacterial meningitis, infections of the gastrointestinal or
Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhinl party content may be s uppressed fro m LhecBook and/or eChaple t1s).
Edilori.al review bas deemed Lhat :my suppressed content does noL materially :iffecL Lheovcrall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions require iL
RECONSTITUTION OF POWDERED DRUGS
genitourinary tracts, and so forth; dosage recommendations if the vial label does not contain them; and untoward or adverse reactions, to name just a sample of the topics covered.
►►► PROBLEMS 10 .7
Refer to the selected package insert information in Figure 10-8 to answer the following
questions.
1. Identify the types of diluent that may be used for reconstitution
under the section labeled For Intramuscular Use.
2. Look next at the four-column table for reconstitution, and
notice that information is provided for the four different
strengths of vials available: 250 mg, 500 mg, 1 g, and 2 g.
What volume of diluent is specified for a 250 mg vial?
3. How much diluent is required for a 500 mg vial?
4. How much diluent is required for a 1 g vial?
5. How much diluent is required for a 2 g vial?
6. The mL dosage strength of all four reconstituted
solutions is the same. What is it?
7. Refer to the information under For Direct Intravenous Use.
How much diluent must be added to the 250 mg or 500 mg vials?
8. What stipulation is made for direct IV administration of the
250 mg and 500 mg reconstituted solution?
9. What is the caution pertaining to rapid IV administration?
NOC 0000-0000-00
AMPIC/ll/N
Use ampicillin for injection to treat and/or prevent
infections that are known to be caused by bacteria.
FOR INJECTION, USP
DIRECTIONS:
Use only freshly prepared solut ions. Use
intramuscular and intravenous injections
within one hour of preparation .
For Intramuscular Use
Dissolve contents of a vial with the amount of
sterile water for injection or bacteriostatic water for
injection as outlined in the foll owing table.
Amount of Approximate
Vial
Available
Diluent to Be
Amount
Added (ml) Volume (ml)
250 mg
0.9
1
500 mg
1.7
2
1g
3.4
4
6.8
8
29
Approximate
Concentration
(in mg/ml)
250
250
250
250
Ampicillin tor injecti on 1 g and 2 g vials are
in tended for in travenous use; however,
in tramuscular administration is permissible when
250 mg or 500 mg vials are unavailable. In these
instances, dissolve in 3.4 or 6.8 ml sterile water
for injection or bacteriostatic water for injection,
respectivel y. The resu lting solution will provide a
concentration of 250 mg per ml.
For Direct Intravenous Use
Add 5 ml sterile water for injection or
bacteriostatic water tor injection to the 250 and
500 mg vials. Administer slowly over 3 to 5
minutes. Ampicillin for injection 1 g or 2 g, may
also be given by direct intravenous administration.
Dissolve in 7.4 or 14.8 ml sterile water for
injection or bacteriostatic water for injection ,
respectively.
Administer slowly over at least 10 to 15 minutes.
r.:rl Cengage learning
~ few Edu:::aliond P\Jrposes OnJy
CAUTION: More rapid administration may result in
convul sive seizures.
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Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlnl party conlenl may be suppressed fro m Lhe cBook and/or eChapLe 1ts).
Edilori.al review has deemed LhaLany suppressed conlenl does nol materially affecl Lheoverall leaming e xperience. Cengage Leaming reserves Lhe righLLo remove addiLlonal contenl al any time if subsequenl rig hts restrictions require iL
135
136
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Answers 1. steri le water for injection or bacteriostatic water for injection 2. 0.9 ml 3. 1.7 ml 4. 3.4 ml
5. 6.8 ml 6. 250 mg per 1 ml 7. 5 ml 8. Inject slowly over 3 to 5 minutes. 9. Rapid administration may
result in seizures.
In this section, you were concentrating specifically on locating vial label and package
insert directions for reconstitution of a single-strength solution. And you quickly discovered that there is no standard way that this information is presented. But the information
is all there somewhere; you must persist until you locate it.
The next section will introduce you to labels and package inserts that contain directions for preparation of multiple-strength solutions.
RECONSTITUTION OF MULTIPLE-STRENGTH SOLUTIONS
Some powdered drugs offer a choice of dosage strengths. When this is the case, you must
choose the strength most appropriate for the dosage ordered. For example, refer to the penicillin label in Figure 10-9. The dosage strengths that can be obtained are listed on the right.
SEE ACCOMPAHVlNG
PRESCRIBING INFORMATION.
RECOMMEHDED STORAGE IN
DRY FORM.
Store below WF (30-C).
Buffered with sodium citrate
and citric acid to opUmum pH.
AFTER RECONSTITUTION,
SOLUTION SHOULD BE
REFRIGERATED.
DISCARD UNUSED
SOLUTION AFTER 7 DAYS.
IRx only I
NOC 0049-0530-28
Buffered
Pfizerpen 8
(penicillin Gpotassium)
For Injection
TWENTY
MILLION UNITS
2
USUAL DOSAGE
6 to 40 mllllon units dally by
Intravenous Infusion only.
.....
ml dllutlll
75ml
33 ml
11.5 ml.
Appra.
■lllts per ml
ll10lilllo•
2so,000 wni.
soo.ooo wm1.
1,000,000 wml
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FIGURE 10-9
Notice that three dosage strengths are listed: 250,000 units, 500,000 units, and
1,000,000 units/mL. If the dosage ordered is 500,000 units, the most appropriate strength to
mix would be 500,000 units/mL. Read across fro1n this strength, and determine l1ow much
diluent must be added to obtain it. The answer is 33 mL. If the dosage ordered is 1,000,000
units, what would be the most appropriate strength to prepare, and how much diluent
would this require? The answers are 1,000,000 units/mL and 11.5 mL.
KE point: A multiple-strength solution requires that you add one
additional piece of information to the label after reconstitution: the
dosage strength just mixed.
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts, some Lhlrd party conLe nLmay be s uppressed from Lhe c Book and/or eChapLe 1ts).
Edilori.al re view has deemed LhaLany suppressed conlenl does noLmaterially affec l Lhe ove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righLLo remove addiLlonal conte nLal any time if subsequenLrig hts res trictions req uire iL
RECONSTITUTION OF POWDERED DRUGS
►►► PROBLEMS 10.8
Refer to the Pfizerpen"label in Figure 10-9 to answer these additional questions.
1. If you add 75 mL of diluent to prepare a solution of penici11in,
what dosage strength will you print on the label?
2. Does this prepared solution require refrigeration?
3. If you reconstitute it on June 1 at 2 pm, what expiration
time and date will you print on the label?
4. What is the total dosage strength of this vial?
5. What else do you print on the label besides the dosage
strength just reconstituted?
6. Where will you locate information on the diluent to be used?
Answers 1. 250,000 units per ml 2. yes 3. Exp. June 8 2 pm 4. 20 million units 5. your initials
6. package insert
The next problems consist of two simulated vial labels with solution strengths of 500 mg
and 1 g and a package insert that gives the directions for their reconstitution.
►►► PROBLEMS 10.9
Refer to the Antibiotic for Intravenous Use labels and insert in Figure 10-10, Figure 10-11,
and Figure 10-12. Use both the insert and label information to answer the following
questions.
1. How much diluent must be used to reconstitute a 500 mg vial?
2. Ho,v much diluent will be needed for a 1 g vial?
3. What kind of diluent is specified?
4. What is the reconstituted dosage per mL of both of these solutions?
5. Ho,v long can the solution be used if stored in a refrigerator?
6. If the drug is reconstituted on May 4 at 1350, what
expiration date and time will you print on the label?
7. What else must you print on the label?
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Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rig hts. some Lhinl party conlenl may be s uppressed from LhecBook and/or eChaple t1s.).
Edilori.al re view bas deemed LhaLany suppressed conlenl does nol materially affecl Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righL Lo remove additional conle nl al any time if subsequenl rig hls res trictions req uire iL
137
138
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
NOC 0000-0000-00
ANTIBIOTIC
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PREPARATION AND SUBILITY
IRxonly l
FOR INTRAVENOUS USE
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At the time of use, reconstitute by adding either 10 mL of
Sterile Water for Injection to the SOO-n1g vial or 20 mL of
Sterile Water for Injection to the 1-g vial of dry, sterile
powder. Vials reconstituted in this mam1er will give a
solution of SO n1g/n1L. FURTHER DILUTION IS REQAftUIRED.
. . t he V1"als n1ay be stored .m a ref ngerator
.
er reconstitution,
for 14 days without significant loss of potency. Reconstituted
solutions containing 500 mg must be diluted with at least
100 nlL of diluent. Reconstituted solutions containing 1 g
n1ust be diluted with at least 200 mL of diluent, The desired
dose, diluted in this mam1er, should be administered by
intermittent intravenous infusion over a period of at least
60 minutes.
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FIGURE 10-12
Answers 1. 10 ml 2. 20 ml 3. sterile water for injection 4. 50 mg per ml 5, 14 days
6. Exp. May 18 1350 7. your initia ls
Summary
This concludes the chapter on the reconstitution of powdered drugs. The important
points to remember from this chapter are:
If the medication label does not contain reconstitution directions, these may be
located on the medication package insert.
The type and amount of diluent to be used for reconstitution must be exactly as
specified in the reconstitution instructions.
If directions are given for both IM and IV reconstitution, be careful to read the
correct set for the solution you are preparing.
The person who reconstitutes a drug must initial the vial and print the expiration
time and date on the label, unless all the drug is used immediately.
If a solution is prepared using multiple-strength medication directions, the
strength reconstituted must also be printed on the label.
Summary Self-Test
Refer to the ceftriaxone label in Figure 10-13 to answer the following questions about
reconstitution.
1. What is the total dosage of this vial?
2. What volume of diluent must be used for I.M. reconstitution?
3. What will be the dosage strength of 1 mL of reconstituted I.M. solution?_ _ _ _ __
NOC 0703-033~01
R
u,., Eachvialooltains,ceftri:ooneso(ltm
Storage Prior to Recon~mrtion:
pa,ider equiva~nl loI gram ooftriaKone. Store p<r•der at 20• to 21•c
XQ
ForLM.Mmlltstraijon,Reoonstitutev,ith (63"1o77"f)ISeeUSP
2.1 mll'Y. ~ine ~'d~c~ori<I!
Control~d Roof!' TemperatuieJ.
for Injection, USP lfieclion(IJ~orSten~\VaterlHl~mn
liglll
(Us>).Eachl mlofsollJ!ijnoonlans
ReconttiMioncSee
-=
approximat!ly350 mg equiva~ntof
Pacl<age ln5e1I
;■
ceftna:t1re.
hWb:fMP.rmlB'alM'JJmes !S:
_ _ ,,.,___ _ _ For LV.Adllinistnilon :See Package Insert 1111~C192QI
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Usua D-e: SeePa:kage lnsert
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F IM IV U
Singleu~ Vial
lss. 9'2009
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FIGURE 10-13
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be s uppressed fro m Lhe c Book and/or eChapte1ts).
Edilori.al review has deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require iL
RECONSTITUTION OF POWDERED DRUGS
Refer to the levothyroxine sodium label in Figure 10-14 to answer the following questions.
4. What is the dosage strength of this vial in mcg? In mg?
5. What volume of diluent must you add to prepare the solution for use?
6. What kind of diluent must be used?
7. How long will this reconstituted solution retain its potency?
8. What is the per mL strength of the reconstituted solution?
9. Where will you find average dosage instructions?
LEVOTHYROXINE
SODIUM FOR IIIJECTIOI
FOR 1M OR IV USE ONLY
LYOPHILIZED
RIONLY
NOC 55390-880-10
Ul■ II Dolage: See iisert for canpleill nb,,ralloo.
Vial contaJns 200 mcg lewtt,yroxlne sodl001,
10 mo mannttol, 0.7 mg lr1baslc sodium
phosphate, and sodium hydroxide for pH
ldjuslment
Use lmmedlatety after reconstitution with 5 rnL
of 0.9'1. sodium Chlor1de ln}ectioo, USP only.
Reconstltuted concentration ls 40 mco/mL
Preservative free. Discard arr, unused"portion.
Store at controlled room lemperature,
1s• 10 ao-c (59- to &M=).
Manwlctured for.
Bedford Laboratol'les•
Bedford, OH 44146
I.JR-vat
FIGURE 10-14
Refer to the cytarabine label in Figure 10- 15 to answer the following questions.
10. How much diluent is used to reconstitute this solution?
11. What type of diluent?
12. What is the total vial dosage?
13. At what temperature should this medication be stored?
14. What dosage will each 1 mL contain?
15. What is the expiration time of the reconstituted solution?
16. If the solution is reconstituted on Feb 14 at 0840,
what expiration date must be printed on the label?
NOC 55390-133-01
LYDPHILIZED
See package insert for complete prescribing information.
Each vial contains cytarabine 1 g and, if necessary, hydrochloric acid and/or
sodium hydroxide for pH adjustment
• - - - - - - - - When reconstituted with 10 ml Bacteriostatic Water for Injection USP with
benzyl alcohol, each ml contains 100 mg cytarabine. Do not use a diluent
FDR INTRAVENOUS,1 SUBCUTANEOUS, containing benzyl alcohol for intrathecal and high dose investigational use.
DR INTRATnECAL USE
Store both powder and reconstituted solution at 25°C(77°F); excursions
permitted to 15° to 30°C(59° to 86°F) [see USP Controlled Room Temperature].
Use reconstituted solution within 48 hours. Discard solution if a slight haze
develops.
Manufactured for:
Manufactured by:
Bedford Laboratories™
Ben Venue Laboratories, Inc.
Rx ONLY
Bedford, OH 44146
Bedford, OH 44146
CYB-VCD5
CYTARABINE
FOR INJECTION USP
1 gram
FIGURE 10-15
Refer to the Vfend"I.V. label in Figure 10-16 to answer the following questions.
17. How much diluent is required to reconstitute this Vfend I.V. solution?
18. What diluent is specified for use?
19. What is the strength of each 1 mL of the reconstituted solution?
20. What is the total dosage of this vial?
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts, some Lhlrd party conle nl may be s uppressed from Lhe c Book and/or eChapLe1ts).
Edilori.al re view has deemed LhaL any suppressed conlenl does noLmaterially affecl Lhe ove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righLLo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions req uire iL
139
140
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
!Rx
NOC 0049-3190-28
-- Vfendi. I. V.
ii
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tor injection
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200 mg *
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Refer to the Vantine Oral Suspension label in Figure 10-17 to answer the following
questions.
21. How much diluent will be required to reconstitute
this medication?
22. What type of diluent is listed for reconstitution?
23. How is this diluent to be added?
24. What is the reconstituted dosage strength?
25. How long will the reconstituted Vantin solution retain its potency?
~ontv
see oaclca9e Insert for dosage and complete
product Information.
warning: Not for lfllectlon
store unconst!tuted product at controlled
room temperature irr to 2s•c 1684' to 77°A
!see USPl. Store constituted susPenSion In a
refrigerator 2" to a-c 136° to 46•FJ
NOC 0009-3615-03
so ml fWhen mlxedl
Vantin~
Shake well before US1ng Keep container
tightly closed. The mixture may be used for
cefpodoxime proxetil
14 davs. Discard unused portion after 14 days,
for oral suspension
Directions for mixing: Shake bottle to IOOSe1i
granuleS. Add approxlmatety 1/2 the total
amount d distilled wate< required for
constitution (total water = 29 mu. Shalce
\'lgor<Mlv to wet the granules. Add
remaining water and snake vigo(oosly.
perSmL
Each s ml cl suspenslon contains
cefl)Odoxime proxedl equivalent to 100 mg
EQutvatent to 100 mg per 5 ml
cefl)Odoxime.
c:efpoc!oxime when constituted
100 mg
u.s Patent Nos. 4,486.425: 4.409.215
licensed from 5ankv0 Ccmpanv. Ltd • Japan
Miln\JfacnJred by
Pharmacia & IJDJOhn s A •Nv . Puurs • Belglurn
for
Pharmacia & Uojohrl Company
ICalamazoo. Ml 49001, USA
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FIGURE 10-17
Refer to the cytarabine label in Figure 10-18 to answer the following questions.
26. What is the total strength of this medication?
27. What diluent must be used for reconstitution?
28. Howmuch?
29. What is the dosage per reconstituted mL?
30. How long does the reconstituted cytarabine solution retain
its potency at room temperature?
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be .supprcs..,;,ed fro m Lhe c Book and/or eChapte1ts).
Edilori.al review has deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions require iL
RECONSTITUTION OF POWDERED DRUGS
·---"""-........
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FIGURE 10-18
Refer to the acyclovir label in Figure 10-19 to answer the following questions for
reconstitution.
31. What type of diluent is recommended for reconstitution?
32. How much diluent must be added?
33. What is the total dosage strength of this vial?
34. How soon must this solution be used?
NDC55390-S12-10
Usual Dosage- See package in sert
FOR INJECTION USP
Preparation of Solution: Inject 10 ml SterileWater
_ _ _ _ _ _ _ _ _ for Injection into vial. Shake vial until a clear solution
1
is achieved and usewithin 12 hours. DO NOT USE
BACTERIOSTATICWATER FOR INJECTION
FOR IV INFUSION ONLY
CONTAINING BENZVL ALCOHOL OR PARABENS.
Equivalent to
Dilute to 7 mg/ml or lower prior to infu sion.
See package insert for additional reconst~ution and
-;dilution instructions.
Store between 15° to 25' C(59' to 77"F).
acyclovir
Manufactured by:
Manufactured for:
Rx ONLY
Ben VenueLabs, Inc. Bedford Laboratories"'
\ - - - - - - - - - - Bedford, OH 44146 Bedford, OH 44146 ACYV04
ACYCLOVIR
-=•· -~
·_.,_
---- --
FIGURE 10-19
Refer to the cytarabine label in Figure 10-20 and answer the following questions.
35. What is the total dosage strength of this vial?
36. What volume of diluent must be added?
37. What kind of diluent must be used?
38. What is the reconstituted dosage strength per mL?
39. How long will this medication retain its potency?
NOC 55390-134-01
LYOPHILIZED
See package insert for complete prescribing information.
Each vial contains cytarabine 2 g and, if necessary, hydrochloric acid
and/or sodium hydroxide for pH adjustment.
When reconstituted with 20 ml Bacteriostatic Water for Injection USP
with benzyl alcohol, each ml contains 100 mg cytarabine. Do not use
FORINTRAVENOUS, SUBCUTANEOUS, a diluent containing benzyl alcohol for intrathecal and high dose
OR INTRATHECAL USE
investigational use.
Store both powder and reconstituted solution at 25°C (77°f); excursions
permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room
Temperature]. Use reconstituted solution within 48 hours. Discard
solution if a slight haze develops.
CYTARABINE
FOR INJECTION USP
2 gram Rx ONLY
Manufactured for: Bedford Laboratories™
Bedford, OH 44146
CYB-VOD5
FIGURE 10-20
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due to elec.tronic rig hts. some Lhlnl party conle nl may be s uppressed from Lhe c Book and/or eChapte1ts).
Edilori.al review has deemed LhaL any suppressed content does noL materially affec t Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions require iL
141
142
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Refer to the Pfizerpen "label in Figure 10-21 to answer the following questions.
40. What is the total dosage strength of this vial?
41. How much diluent must be added to prepare a
100,000 units/mL strength?
42. How much diluent must be added to prepare a
500,000 units/mL strength?
43. How much diluent must be added to prepare a
50,000 units/mL strength?
44. This label has no information on the type of diluent to use.
Where will you find this?
45. How must this solution be stored?
46. If reconstituted at 1:10 am on December 18, what must
you print on the label?
47. What else must you print on the label?
48. Why should you print?
NOC 0049-0510-83
Blltfered
Pfiz
en®
penicilli
For lnjectio
ONE MILLI
CAUTION· Fede
d ,spens,ng with
UNITS
prohibits
escr,plion.
R08RIG 49
Adrvlslonof Pf1Zcr lnc~N.Y•. N.Y.10017
FIGURE 10-21
Refer to the Zithromax"label in Figure 10-22 to answer the following questions.
49. What is the generic name for Zithromax?
50. What is the dosage strength of this vial?
51. What diluent is specified for reconstitution?
52. How much diluent is required?
53. What is the reconstituted dosage strength?
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d 1sp ens,no w1tlloul PICSCIIPhOll
FIGURE 10-22
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .suppressed from Lhe c Book and/or eChapLe1ts).
Edilori.al review has deemed LhaL any suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
RECONSTITUTION OF POWDERED DRUGS
Answers
1. 1 g
2. 2.lml
3. 350 mg/ml
4. 200 mcg; 0.2 mg
s. 5 ml
6. 0.9% sodium
chloride
7. must be used
immediately
8, 40 mcg/ml
9. package insert
10. 10 ml
11. bacteriostatic water
for injection USP
with benzyl alcohol
12. 1 gram
13. 25°C (77° F)
14. 100 mg/ml
15, 48 hours
16. Exp. Feb . 16 0840
17. 19ml
18. water for injection
19. 10 mg/ml
20. 200 mg
21. 29 ml
22. disti lled water
23. Shake the bottle
27. bacteriostatic water
for injection USP
with benzyl alcohol
28. 10 ml
29. 50 mg/ml
30. 48 hours
31. sterile water for
injection
41. 10ml
42. 1.8 ml
43. 20 ml
44. package insert
45. refrigerate
46. Exp. Dec. 25
1: 10 am
47. your initials
to loosen granu les,
add half ( 15 ml)
of the disti lled
32. 10ml
33. 500 mg
34. within 12 hours
48. Space consider-
water, and shake
vigorously to
dissolve granu les;
35. 2 g
36. 20 ml
37. bacteriostatic
49. azithromyci n
SO. 500 mg
51. sterile water for
add balance of
water and shake
vigorously.
24. 100 mg/5 ml
25. 14 days
26. 500 mg
water for injection
USP with benzyl
alcohol
ations; handwriting
is difficu lt to read.
injection
52. 4.8 ml
53. 100 mg/ml
38. 100 mg/ml
39. 48 hours
40. one million units
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or dupHc.a led. in whole or in pan . Due Lo elec.tronic rig hts. .some Lhird party conlenl may be s uppressed from Lhe c Book and/or eChaptc11s}.
Edilori.al review has deemed LhaL any s uppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire it.
143
CHAPTER
Diabetes is one of the fastest-growing health problems in both the
United States and Canada. Since the advent of DNA technology in the
1980s, the number of insulin products has almost quadrupled in an effort
to keep pace with treatment needs.
This chapter will introduce you to the current insulin preparations
available; provide real insulin vial labels to familiarize you with the different insulins; describe the physical appearance of insulins; instruct you in
the use of specialized insulin syringes; and provide a step-by-step procedure for the combination of two different insulins in a single syringe, a
skill you may use on an ongoing basis throughout your career.
We will briefly introduce you to insulin action times and injection
techniques, which will be covered in detail in your pharmacology text.
TYPES OF INSULIN
Prior to the 1980s, all insulin was produced from animal sources. Today,
all are products of DNA. The two earliest DNA insulins, R (Regular)
and N (NPH)*, are made from recombinant DNA (cut and spliced DNA
fragments). Both of these insulins incorporate the ''lin'' of the word insulin in their trade names: Humuline R and Humuline N manufactured
by the Eli Lilly Co., and Novoline Rand Novoline N from Novo Nordisk.
Regular insulin is a clear solution, and it is fast acting, while N is
cloudy, classified as intermediate acting, and has a slower start but
longer action. Regular and N insulin are often combined in a single
syringe to reduce the number of injections an individual must have. They
may be combined at first to determine an individual's R and NPH insulin
requirements, then ordered in commercially combined insulin preparations, such as 70/30 and 50/50 mixes, to provide both a fast and more
prolonged action.
Another type of DNA preparation is the analogs, which are chemically altered DNA. Depending on their structure, the analogs offer an
extremely rapid action, or a longer and more balanced control of blood
-r< NOTE:
The N intermediate action insulin takes its "N" designation from NPH,
the first intermediate action insulin developed in the mid 1930s. The NPH initials
represent neutral protamine Hagedorn, the chemical structure and name of the
developer ofNPH, Hans Hagedorn.
y noL be copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the overall learning expe.rie.oce. Cengage Leaming reserves the rig hL Lo remove addiLional conle nl al any ti.me if subscq uenl rig hls restricLions require it.
MEASURING INSULIN DOSAGES
glucose levels. Once again, some of the trade names of these products reflect their origin: the
''log'' of analog is incorporated in two of the frequently used trade-named insulins: Humalog®
and Novologe. Among the analogs whose trade names do not identify their analog structure
are Apidra" (glulisine), Lantis" (glargine), and Levemire (detemir).
KEYpoint: The -lin ending of regular and N insulin trade names can be
used as an additional safeguard in distinguishing them from several of the
analogs, which incorporate -log at the end of their trade names.
Unfortunately, most insulin vials, solutions, and labels look very much alike, and it is
here where the first precaution in insulin preparation must be stressed .
INSULIN VIAL AND INSULIN INJECTION PEN LABEL
IDENTIFICATION
Like other medications, insulin preparations have both trade and generic names. Eli Lilly
and Novo Nordisk are the major insulin m anufacturers; however, there are now other manufacturers producing and marketing insulin. In the insulin label identification problems
that follow, you will be asked to identify insulin manufacturers, as well as insulin types
and dosages. Some of the labels included are from insulin pen preparations: prefilled,
self-injection syringes that contain multiple doses of insulin (Figure 11-1). To see an
excellent demonstration of insulin pen use, go to http:/ /www.levemir-us.com. All insulin is
prepared in units per mL doses.
It would be hard to watch television today and not see advertisements for prefilled
insulin injection pens, which are also called simply insulin pens. Many prefilled pens
contain two insulins, one rapid acting and the other intermediate or long acting, which
are combined to establish maintenance doses for each individual patient. All have
a mechanism to set the dosage to be inj ected and each contains multiple doses that require multiple injections. Most contain a single needle, which is reused several times by
the individual until a new insulin pen dosage is ordered. Pen insulins do not require
refrigeration.
Pens are beginning to be used in the clinical setting, either for initial patient instruction in use, or ongoing therapy. The same label identity checks that are required for other
meds are critical prior to administration. Ongoing supervision is essential to determine if
a patient, who is being instructed in self-injection, is correctly administering the ordered
dosage independently.
As with all medication s, errors in insulin pen use have begun to creep in, and the pens
are now a source of concern for in-hospital use. Under no circumstances are insulin
pens to be used for anyone other than the patient they are ordered for.
KEV paint: Pens are prescribed for exclusive use with a single patient.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO fro m Lhe cBook and/or eChaplet1s).
Edilorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
145
146
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
'
•
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A. Humalog KwikPen 100 units/ml
ILantus' SoloStar•
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100
s►f &-.,t•
bDNU'
----==-
B. lantus SoloStar 100 units/ml
FIGURE 11-1 Prefilled insulin pens.
Insulin pens are ordered for exclusive use for a single patient. This applies even if the
pen needles are removable, which in most cases they are not.
►►► PROBLEMSll.l
1. What does the 70 on the label in Figure 11-2 represent?
2. What does the 30 identify?
3. What company manufactured this insulin?
4. What is the dosage strength of this insulin?
•
e:
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C
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X
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_
,10 ml
100 units per ml .e~
s ~
-=
Humulin®7%o -_ o' -:- en ._.=>
NOC 0002-8715-01
Hl-710
_
_
~
~
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-
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~
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.sophane =
r - - e "' :::, ~
70C¾o human .1nsu1·1n 1
iiiiiiiii "? 8 := >-"'
suspension, 30% human Insulin ~ :il g _, ;
injection ~DNA origin)
A _ g il ~ ~ ~
-100
<D>
t; ~ ~ g_
U
- - - - - - ~ - -~: .2),a:ic:
~-C'0
t
-=
g_
....
~!S!
M E 'S
'g
==
C'0
_c,: :;;
_
FIGURE 11-2
5. What is the generic name of the insulin preparation in Figure 11-3?
6. What is the dosage strength?
7. What volume of insulin does this pen contain?
Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated , in whole or in pan. Due to electronic rig hts. .some Lhird party conte nt may be .suppres..,;;ed from Lhec.Book and/or eChapte11s}.
Edilori.al review has d ee med LhaLany suppressed contenLdoes noLmaterially affecLLheoverall learning e xpe rience. Ce ngage Leaming reserves Lhe righLLo remove additional conLe nLa l any time if subsequenLrig hLs restrictions req uire it.
MEASURING INSULIN DOSAGES
0
WX 1122AMX
IIll II I1111111111111111
(01)10300028799014
ro
"'
Cl
0
Eli Lilly and Company
Indianapolis, IN 46285, USA
ro
E
:::,
:c
<:_R;,,,, NOC 0002-8799-01
~
3ml
HP-8799
100 units per ml
..c::
:t=
~
al
Humalog®
KwikPen™
::3
_,
.,~
"'
~
"'
..c::
-
. S1'
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:,:.
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0
u
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ro
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Cont.
No.
:-=
-'
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-
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Cl U
·~
-0
Exp.
Ei:
c::
o ro
+
u
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@ ~
FIGURE 11-3
8. What is the generic name of the insulin in Figure 11-4?
9. What exactly does the 50/50 identify?
.........•.
-~
, rt,•••
0
WX1132AMX
·--.
r•~
111111111111 11111111111
(01)10300028798017
Eli Lilly and Company
Indianapolis, IN 46285, USA
~a,,,
~
NOC 0002-8798-01
3 ml
HP-8798
100 units per ml
Humalog®Mix 50/50
KwikPen™
50% insulin lispro protamine
suspension
50% insulin lispro injection
(rDNA origin)
Rx only
U-100
prefilled insulin delivery device
Cont
No.
Exp.
+
ro
@
Cl
0
~
:c
:::,
c::
0
. vi
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a.
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ro
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0
-0
c::
ro
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:-=
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ro
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FIGURE 11-4
CopyrighL20 15 Cengage Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated , in whole or in pan. Due Lo electronic rig hts. .some Lhird party conlenl may be suppres..,;;ed fro m Lhec.Book and/or eChapte11s}.
Edilori.al review has deemed LhaL :my s uppressed content does noL materially affect Lheovcrall learning e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequenL r ighls restricLions require it.
147
148
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
10. What is the gen eric n am e of the insulin in Figure 11-5?
MJC 0002-7510-01
•
VL-7510
100 units per mL -
10ml
=
e:
0
._ _ >-
;:,lj
E
0'
:::,
-
t'1
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-
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:.::; .,i: ·-
0
-
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~
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:::,
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E= :C E
insulin lispro injection, - N' ~c::"" 1;;,
- O o>ii
USP (rDNA origin)
0 ., ai
_
0 iCL E
'S E
"'
Rx only
U-100
.8 8
ii
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Ill
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FIGURE 11-5
11. What is the gen eric n am e of the insulin in Figure 11-6?
12. What is the trade n am e of this insulin?
13. What is the dosage strength of this prep aration?
FIGURE 11-6
14. What is the trade n am e of the insulin in Figure 11-7?
15. What is the gen eric nam e?
16. Who m anufactures this insulin?
NDC0088-2500-33
Apidra®
insulin glulisine {rDNA origin) injection
100 units/ml (U-100)
~
"C
"O
Cll
:;.a
r-
0
,-+
2::
Rx ONLY
FOR SUBCUTANEOUS USE ONLY
STORE REFRIGERATED - DO NOT FREEZE
USE WITHIN 28 DAYS AFTER OPENING
10 ml Via l
sanofi-aventis U.S. LLC, Bridgewater, NJ 08807
Origin Germany © 2007
Cll
Cll
"'
="'
~
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<(
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. in
-~
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11111111
C.
=
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FIGURE 11-7
17. What does the Ron the lab el in Figure 11-8 identify?
18. Iden tify the precaution for using this p articular insulin.
19. What is the total volume of this vial?
20. What is the dosage strength of this insulin?
,.
HOC 0002-8501-01 ,-
0
20 ml
U-500 Hl-500
(Concentrated)
--_, ,
-_ , _,
=
o
Humulin"'R
!!!! O
REGULAR
insulin human injection. USP/rDNA origin)
- g
500 units per ml
IMPORTANT:
SEE INSl'RUCTIONS FOR USE.
_ .,"'
=
=
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--2
FIGURE 11-8
Copyrig hL 20 15 Ce ng age Leam ing. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due Lo elec.tronic rig his. some Lhinl party conte nLmay be s uppressed from LhecBook and/or eChapLe t1s).
Edilori.al review has deemed LhaL:my suppressed content does noLmaterially affec LLheove rall leaming e xpe rience. Ce ngage Leam ing reserves Lhe right Lo remove additional contenLal any time if su bsequenLrig hts res trictions req uire iL
MEASURING INSULIN DOSAGES
21. What is the generic name of the insulin in the combination
preparation in Figure 11-9?
(t)
•
J C',
I\IDC0002-7511-01
VL-7511
10mL
100 units per mL
"'"'
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0 18
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0
?; 0,
§, Cl
2.
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.
,0
'
,,-
..t=
f l:-"
:3
X
•
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r--
75% insulin lispro protamine
suspension, 25%insulin lispro
injection (rDNA origin)
'
C\J
0
0
0
U-100
Rx only
-~
.«
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FIGURE 11-9
22. What is the trade name of the insulin label in Figure 11-10?
23. What is its generic name?
24. What is its dosage strength?
25. Who manufactures this insulin?
J
\
-
NOC 0088-2220·33
insulin g/orgint.
&' 100 units/ml 10:I
-
QJ
i::
QJ
"'
"'
..c::
QJ
~
FORSUBCUTA=
:,, 00 NOT MIX
.lJ
'1
J'I
-0
STORE REFRIGERATf1l'
One 10ml Vial
sanofkventis U.S. U(
Orii iiif111
.;::
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o.;:
0
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FIGURE 11-10
Answers 1. 70% isophane suspension 2. 30% human insu lin 3. Li lly USA 4. 100 units/ml
5. insu lin lispro injection (rDNA origin) 6. 100 units/ml 7. 3 ml 8. lispro
9. 50% insulin lispro protamine suspension; 50% insu lin lispro injection 10. lispro 11. glulisine
12. Apidra® 13. 100 units/ml 14. Apidra® 15. glulisine 16. sanofi-aventis 17. regu lar insu lin
18. high potency; not for ordinary use 19. 20 ml 20. 500 units/ml 21. lispro 22. lantus®
23. glargine 24. 100 units/ml 25. sanofi-aventis
KEVpoint: Diligence in the identification of insulin preparations is critical,
because many vials, solutions, and labels are strikingly similar.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplica ted. in whole or in part. Due to elcc.tronic rig hts. some Lhird party content may be s uppressed from Lhe e Book and/or eChapte1ts).
Editorial review has deemed that any s uppressed content does, not materially affect the overall learning e xpe rience. Cengage Leaming reserves, the right Lo remove additional content a l any time if subsequent rig hts restrictions require it.
149
150
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
INSULIN SYRINGES
Think b ack for a moment to the insulin labels you have just read, and you will recall that all,
except one high-potency vial, have a dosage strength of 100 units per ml,. You may have
also noticed that these vials are additionally labeled U-100, which similarly identifies the
100 units per mL strength.
Insulin is administered using special insulin syringes calibrated in units. In diameter, these are quite like the smaller TB syringes, but the calibrations are totally different.
Insulin syringes are used only for insulin administration, and they are available in the
100 unit, 50 unit, and 30 unit sizes in Figure 11-11. The smaller 30 and 50 unit syringe
calibrations are larger, and they provide an added degree of safety in measurement of small
dosages.
Because of their small diameter, insulin syringe calibrations and numbering wrap
around the small syringe barrel. Refer to the insulin syringes in Figure 11-11 again, and
notice the calibrations there. For accurate measurement, you will learn to rotate insulin
syringes side to side to locate the calibration you need and to draw up the insulin
dosage ordered. To make your instruction in measuring insulin dosages easier, sample
flattened out versions of calibrated syringes are provided. You will be using these flattened
out syringes for your initial instruction in preparing insulin dosages.
,n
-
,n
0
N
-
,n
0
N
0
N
Cl
Cl
Cl
E
E
c::
c::
c::
E
.,"'
_,
.,
.,"'
_,
.,
.,"'
_,
.,
Cl
Cl
Cl
"'
Cl
"'
Cl
.,c::
.,c::
u
9
A. 30 units/ml
-
u
"'
Cl
.,c::
u
_ _ _ _ _ _ _ _ _ __. 9
----------- 9
B. 50 units/ml
C. 100 units/ml
FIGURE 11-11
The calibrations for the 50 unit dosage syringes are used in the frrst problems that
follow. Notice that the first long calibration, as on all other syringes, identifies zero
and that each subsequent calibration measures 1 unit. Each 5 unit calibration is
numbered: 5, 10, 15, 20, and so forth.
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.ated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 fro m Lhe cBook and/or eChapLer(s).
Edllorial review has deemed LhaLany suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any Lime if subsequenL rig hts restrictions require iL
MEASURING INSULIN DOSAGES
►►► PROBLEMSll.2
Refer to the syringe calibrations for the 50 unit calibrated syringes provided to identify
the dosages indicated by the shaded areas and arrows.
:=-5
:=-5
:=-5
:=-10
:=-10
=-15
:=-15
=-20
=-20
:=-25
=-25
. =-25
=-30
=-30
=-30
.. =-10
.
=-15
--
=-35
=-40
-
-
:=-45
1;2 =- 50
UNITS
ml
:=-20
--
--
=-35
LO
0
N
0
N
=-40
C,
c::
c::
~
"'
Ql
_,
u
=-45
1;2 =-so
@
ml
Ql
C,
"'
c::
C,
Ql
c::
c::
~
Answers
C,
c::
-
"'
Ql
_,
E
"'
Ql
_,
u
=-45
1;2 =-so
u
@
ml
@
Ql
C,
"'
c::
C,
Ql
UNITS
LO
0
N
=-40
-
C,
2.
1.
=-35
LO
Ql
C,
"'
c::
C,
Ql
UNITS
3.
1. 11 units 2. 15 units 3. 22 units
►►► PROBLEMSll .3
Use the 50 unit calibrations provided to shade in the following dosages.
=-5
=-5
=-5
-10
-10
-10
:=-15
--
:=-15
=-15
:=-20
:=-20
=-25
=-25
--=-20
=-30
=-30
=-35
:=-40
-
:=-45
1;2 =- 50
ml
--
0
N
:=-40
-
C,
c::
-
E
"'
_,
Ql
Ql
C,
"'
c::
C,
Ql
u
UNITS @
1. 33 units
=-35
LO
:=-45
1;2 =- 50
ml
=-25
=-30
--
=-35
LO
0
N
:=-40
C,
c::
E
"'
Ql
_,
=-45
Ql
C,
c::
c::
~
"'
Ql
_,
Ql
C,
C,
"'
c::
"'
c::
C,
Ql
1;2
UNITS @
ml
2. 38 units
-
LO
0
N
u
=-so
C,
Ql
u
UNITS @
3. 18 units
Answers Have your instructor check your accuracy.
There are two 100 unit insulin syringes in common use. Refer to the first of tl1ese syringe
calibrations in Problems 11.4. First, notice the 100 unit capacity and that, in contrast to
the smaller dose syringes, only each 10 unit increment is numbered: 10, 20, 30, and
so forth. Next, notice the number of calibrations in each 10 unit increment, which is 5,
Copyrig hL 20 15 Cengage Leaming. All RighL'i Reserved May noL be copied, scann ed, or duplic.ated, in whole or in pan. Due to electronic rig hts. some Lhird party content may be s uppressed fro m Lhe e.Book and/or eChapte11s}.
Edilorial review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming expe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require iL
151
152
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
indicating that this syringe is calibrated in 2 unit increments. Odd-numbered units
cannot be measured accurately using this syringe.
►►► PROBLEMS 11 .4
Identify the dosages indicated by the shading and arrows on the 100 unit syringes
provided.
..
:=-10
:=-10
:=-10
:=-10
:=-20
:=-20
:=-20
:=-20
:=-30
~40
:=-30
:=-30
:=-30
:=-40
:=-40
:=-40
:=-50
~60
:=-50
:=-50
:=-60
:=-60
.
~so
~60
--
--
=- 70
=- 70
Lri
-
c:,
~80
c:,
N
N
=:-80
C)
C:
C:
C:
C:
--
--
C)
C)
1
UNITS
ml
1.
_,
"'
"'
m
C:
C:
u"'
1
ml
UNITS
9
_,
"'
"'
m
C:
C:
E
m
_,
"'
"'
m
C)
u"'
9
C)
~100
1
UNITS
ml
C:
u"'
C)
~100
1
UNITS
ml
9
3.
2.
C)
C)
C)
~100
C:
m
C)
c :,
N
:=-80
C)
=:-90
-
Lri
.. ~go
c:,
N
~
m
:=-90
"'
m
~100
-
~
_,
"'
=- 70
Lri
=:-80
C)
~
m
=:-90
.. =- 70
Lri
C:
u"'
9
4.
1. 32 units 2. 52 units 3. 7 4 units 4. 84 units
Answers
►►► PROBLEMS 11 .5
Shade in the syringe calibrations provided to measure the dosages indicated.
=:-10
=:-10
=:-10
=:-10
=:-20
=:-20
=:-20
=:-20
--
--
--
--
-30
-30
-30
-30
:=-40
:=-40
:=-40
:=-40
~so
~so
~so
~so
~60
~60
~60
~60
~10
-
Lri
c:,
~80
N
~go
C:
C)
c::
~
m
_,
"'
--
"'
m
C)
~100
UNITS
C)
C:
1 u"'
ml 9
1. 66 units
~10
-
Lri
c:,
~80
N
~go
C:
--
C)
c::
~
m
_,
"'
"'
m
C)
~100
UNITS
C)
C:
1 u"'
ml 9
2. 84 units
~10
-
Lri
c:,
~80
N
~go
C:
--
C)
c::
~
m
_,
"'
"'
m
C)
~100
UNITS
3. 28 units
C)
C:
1 u"'
ml 9
~10
~80
~go
--
-
Lri
c :,
N
C)
c::
C:
~
m
_,
"'
"'
m
C)
~100
UNITS
C)
C:
1 u"'
ml 9
4. 44 units
Answers Have your instructor check your accuracy.
Copyrig hL 20 15 Ceng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplic.ated, in whole or in pan. Due to electronic rig hts. some Lhird party conte nt may be s uppressed fro m Lhe e.Book and/or c.Chapte11s}.
Edilorial review has deemed LhaL any suppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional conte nt al any time if subsequent rights restrictions require iL
MEASURING INSULIN DOSAGES
The second type of 100 unit syringe calibration is illustrated
in Figure 11-12. Notice that this syringe has a double scale: the
odd numbers are on the left, and the even are on the right.
Each 5 unit increment is numbered, but on opposite sides of the
syringe. This syringe does have a calibration for each 1 unit increment, but in order to count every calibration to measure a dosage,
the syringe would have to be rotated back and forth. This could
cause confusion. There is a safer way to read the calibrations. To
measure uneven numbered dosages-for example, 7, 13, and
27-use the uneven (left) scale only; for even-numbered dosages-such as 6, 10, and 56-use the even (right) scale only.
Count each calibration (on one side only) as 2 units, because
that is what it is measuring.
5
15
25
35
45
55
10
20
30
40
50
60
70
80
.,"'
90 .,
"'
.,
100 u
65
75
85
95
Lri
0
N
Cl
,£
c::
~
-'
Cl
Cl
c::
1ml
UNITS (9)
A FIGURE 11-12
EXAMPLE 1
To prepare an 89 unit dosage, start at 85 units on the uneven left scale, count the first
calibration beyond this as 87 units and the next as 89 units (each calibration on the
same side measures 2 units).
EXAMPLE 2
To measure a 26 unit dosage, use the even-numbered right side calibrations. Start at
20 units, move up one calibration to 22 units, another to 24 units, and one more to
26 units (each calibration is 2 units).
►►► PROBLEMS 11.6
Identify the dosages measured on the 100 unit syringe calibrations provided.
5
15
25
35
45
55
1111 65
75
85
5
15
25
35
1111
45
55
65
75
85
10
20
30
40
50
60
70
80
.,"'
90 .,
"'
.,
100
Lri
0
N
Cl
c::
c::
~
-'
95
1.
Answers
..
Lri
0
N
Cl
c::
c::
~
-'
95
Cl
Cl
c::
1ml
10
20
30
40
50
60
70
80
.,"'
90 .,
"'
.,
100
u
1 ml
UNITS (9)
2.
Cl
Cl
c::
u
5
15
25
35
45
55
65
75
85
95
1ml
UNITS (9)
10
20
30
40
50
60
70
80
.,"'
90 .,
"'
.,
100
Lri
0
N
Cl
c::
c::
~
-'
Cl
Cl
c::
u
UNITS (9)
3.
1. 66 units 2. 41 units 3. 79 units
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party content may be .supprcs..,;,00 fro m Lhe cBook and/or eChapLer(s).
Edllorial review has deemed LhaLany suppressed content does noLmaterially affect Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
153
154
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
►►► PROBLEMSll.7
Shade in the syringe calibrations provided to identify the following dosages.
5
15
25
35
45
55
65
75
85
95
10
20
30
40
50
60
70 '-"
80 .~
90
100
0
N
C)
c::
ro
~
Q)
-'
Q)
C)
(tJ
C)
c::
5
15
25
35
45
55
65
75
85
95
Q)
1ml
u
UNITS @
1. 55 units
10
20
30
40
50
60
70 '-"
80 .s
90
100
0
N
C)
c::
~
(tJ
Q)
-'
Q)
C)
(tJ
C)
c::
5
15
25
35
45
55
65
75
85
95
Q)
1ml
'-"
0
N
C)
c::
~
(tJ
Q)
-'
Q)
C)
(tJ
C)
c::
Q)
u
1ml
UNITS @
2. 94 units
10
20
30
40
50
60
70
80 .s
90
100
u
UNITS @
3. 69 units
Answers Have your instructor check your accuracy.
COMBINING INSULIN DOSAGES
Insulin-dependent individuals may have one or even several subcutaneous injections of insulin per day. In order to reduce the number of injections as much as possible, it is common
to combine two insulins in a single syringe: a short-acting Regular with an intermediateacting NPH insulin.
KE paint: When two insulins are combined in the same syringe, the
clear Regular (shortest-acting) insulin is drawn up first.
Both insulins will be withdrawn from sealed 10 mL vials. This requires that an amount
of air equal to the insulin to be withdrawn be injected into each vial as a preliminary step,
to keep the pressure inside the vials equalized after the insulin is withdrawn. An additional step concerns preparation of the insulin itself. Regular clear insulin does not need
to be mixed, but N (NPH) is cloudy and precipitates out. It must be gently rotated to
mix immediately before withdrawal.
The smallest volume insulin syringe available is used to measure the dosages you
need, because their larger calibrations provide additional ease and safety in reading.
Examples of the actual step-by-step combination procedure follow.
EXAMPLE 1
The order is for a dosage of 10 units of Regular and 48 units ofNPH.
STEP
1
Locate the correct Rand NPH insulin and use an alcohol wipe to cleanse
both vial tops.
STEP
2
The combined dosage, 10 units of Regular and 48 units ofNPH, is 58 units.
This requires the use of a 100 unit syringe.
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 fro m Lhe cBook and/or eChapLer(s).
Edllorial review b:is deemed LhaLany suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
MEASURING INSULIN DOSAGES
STEP
3
Draw up 48 units of replacement air for the NPH in the syringe, and insert
the needle tip into the NPH vial. Keep the needle tip above the insulin level
so as to not inject air into the insulin and possibly distort the dosage. Inject
the air and remove the needle.
STEP
4
Draw up 10 units of replacement air for the Regular insulin vial. Insert the
needle into the vial, again above the insulin level, and inject the air. Draw up
the 10 units of Regular insulin.
STEP
5
Pick up and gently rotate the NPH vial until the insulin is mixed. Insert the
needle back into the vial and draw up the 48 units of NPH.
STEP
6
Administer the insulin dosage at once so that the NPH has no chance to
precipitate out. Chart the administration.
EXAMPLE 2
A dosage of 16 units Regular and 22 units ofNPH has been ordered.
STEP
1
Locate the correct Regular and NPH insulin and use an alcohol wipe to
cleanse both vial tops.
STEP
2
The combined dosage, 16 units of Regular and 22 units ofNPH, totals
38 units. For this administration, you can use a 50 unit volume syringe.
STEP
3
Draw up 22 units of replacement air for the NPH in the syringe. Insert the
needle tip into the NPH vial. Keep the needle tip above the insulin level so as
to not inject air into the insulin and possibly distort the dosage. Inject the air
and remove the needle.
STEP
4
Draw up 16 units of replacement air for the Regular insulin vial. Insert the
needle into the vial, again above the insulin level, and inject the air. Draw up
the 16 units of Regular insulin.
STEP
5
Pick up and gently rotate the NPH vial until the insulin is mixed. Insert the
needle and draw up the 22 units of NPH.
STEP
6
Administer the insulin at once so that the NPH has no chance to precipitate
out. Chart the administration.
INSULIN ACTION TIMES
As equally important as insulin type and dosage is the timing of insulin administration,
based on onset of action, peak and duration, and relationship to dietary intake.
Insulin is classified by action as rapid, short, intermediate, or long acting. The
rapid-acting insulins aspart, glulisine, and lispro, whose onset of action varies from 10 to
30 minutes, must be followed immediately by a meal. Failure to immediately ingest food
would result in a rapidly lowered blood glucose level and insulin reaction from hypoglycemia. Also note that these rapid-acting insulins have a peak and duration of from 0.5 to 5
hours. Their action is relatively short.
Next, compare the short-acting, regular insulins whicl1 have an onset of 30 minutes,
a peak of 1-5 hours, and a duration of 8 hours. These also require that the individual eat
shortly after administration.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party content may be .supprcs..,;,00 fro m Lhe cBook and/or eChaplet1s).
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155
156
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
KE paint: Rapid- and short-acting insulin must be followed immediately
by a meal.
The intermediate-acting insulins are moving into the longer action range, with an
onset of 1-4 hours, a peak of 4-12 hours, and duration of 14-26 hours. And, finally, the
long-acting detemir and glargine insulins have an onset of 1-2 hours but a sustained
minimal peak of up to 24 hours. Their administration is not related to dietary intake. Insulin
detemir may be administered once or twice a day, while glargine is administered at night.
KE paint: Long-acting insulins are not administered in relation to immediate food ingestion.
The number of diabetic products will continue to increase because of the rapidly rising incidence of Type 2 diabetes. An inhalation insulin, Exubera'\ is now available, and two
additional new drugs are now in increasing use: Byettae and Symline. Both of the latter act to
change the body's response to food, either by promoting insulin secretion, delaying gastric
emptying, and/ or altering glucose metabolism.
INSULIN INJECTION SITES AND TECHNIQUES
Insulin is injected subcutaneously. As with other parenteral medications, the injection
sites must be rotated, keeping at least an inch away from each previously used site.
The abdomen has the most rapid absorption, followed by the upper arm. The outer thigh, a
full hand's breadth above the knee and below the hip, may be used, but absorption is somewhat slower at this site. Your responsibility is, and will continue to be, to give the correct insulin and dosage at the correct time, taking special care to ensure that a meal immediately
follows rapid- and short-acting insulin injection.
►►► PROBLEMSll.8
For each of the following combined Regular and NPH insulin dosages, indicate the
total volume of the combined dosage and the smallest capacity syringe you can use to
prepare it; 30, 50, and 100 unit capacity syringes are available.
Total Volume
Syringe Size
1. 28 units Regular, 64 units NPH
2. 16 units NPH, 6 units Regular
3. 33 units Regular, 41 units NPH
4. 21 units Regular, 52 units NPH
5. 13 units Regular, 27 units NPH
Answers 1. 92 units; 100 unit 2 . 22 units; 30 unit 3. 74 units; 100 unit 4 . 73 units; l 00 unit
5. 40 units; 50 unit
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlnl party conlenl may be supprcssOO from Lhe cBook and/or eChaplet1s).
Edilorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions req uire iL
MEASURING INSULIN DOSAGES
Summary
This concludes the chapter on insulin dosages. The important points to remember
from this chapter are:
Insulin labels must be read with extreme care because they look very similar.
Insulin is measured using specially calibrated insulin syringes.
Insulin syringes are available in 100, 50, and 30 unit capacities.
The smaller 30 or 50 unit capacity syringes provide a greater degree of safety
because of their larger calibrations.
Each calibration on 30 and 50 unit volume syringes measures 1 unit.
Calibrations on 100 unit capacity insulin syringes may measure 1 or 2 unit
increments, depending on their design.
The "lin" in the trade names of Regular and N (NPH) insulin identifies their
recombinant DNA origin.
The "log" in several of the analog insulins identifies their chemically altered
DNA structure.
Regular (R) and N (NPH) insulin can be mixed in a single syringe.
Regular insulin is drawn up first in combination Rand N dosages.
N insulins are cloudy because they contain insoluble particles.
Because N insulins precipitate out, they must be gently and thoroughly mixed
before withdrawal, and injected immediately after preparation.
Insulin is administered subcutaneously.
The abdomen and upper arm provide the most rapid subcutaneous absorption sites.
Insulin injection sites are routinely rotated.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 fro m Lhe cBook and/or eChapLer(s).
Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
157
158
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Summary Self-Test
Use the syringe calibrations provided to measure the following dosages. For
combined insulin dosages, use arrows to indicate the exact calibration to be
used for each insulin ordered. Have your instructor check your answers.
5
15
25
35
45
55
65
75
85
95
1 ml
10
=-5
=-10
20
:=--10
=-20
30
--=-15
=-30
40
:=--20
:=--40
50
=-25
=-so
60
=-30
70
15
25
35
45
55
65
75
85
95
1 ml
:=--35
Lri
0
80
=-40
C)
.!:
c::
~
UNITS
c::
_,
"'
"'
"'
c::
u"'
1;2
'9
ml
C)
=-45
_,
"'
=- 50
c::
UNITS
"'
=-100
'9
UNITS
=-20
30
=-15
40
:=--20
--=-30
-40
50
:=--25
=-50
60
=-30
--
-
--
0
N
c::
c::
·-
~
:=--45
"'
"'
c::
u"'
1;2
'9
ml
C)
C)
UNITS
4. 14 units Regular
58 units NPH
Lri
N
C)
c::
c::
(t)
_,
"'
=- 50
UNITS
1 u"'
ml '9
=-60
=-70
_,
"'
"'
C)
(t)
C)
c::
u"'
'9
5. 12 units NPH
Lri
0
=-80
~
ro
c::
-0
=-40
C)
"'
3. 48 units NPH
=-10
=-35
_,
"'
C)
(t)
C)
u"'
2. 17 units Regular
12 units NPH
Lri
(t)
C)
(t)
C)
20
100
c::
c::
=-go
=-10
90
C)
~
:=--5
80
N
=-80
C)
.!:
10
70
Lri
0
N
(t)
C)
100
=-70
Lri
~
(t)
90
-=-60
-0
N
1. 37 units Regular
5
--
N
C)
c::
c::
~
=-go
--
(t)
_,
"'
"'
C)
(t)
C)
=-100
UNITS
c::
u"'
1
ml '9
6. 18 units Regular
8 units NPH
Copyrig hL 20 15 Cengage Leaming. All RighL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in pan. Due to electronic rig hts. .some Lhird party content may be suppres..,;;ed fro m Lhec.Book and/or eChapte11s}.
Edilori.al review has deemed LhaL :my suppressed content does noL materially affec t Lheovcrall learning expe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rights restrictions require it.
MEASURING INSULIN DOSAGES
5
15
25
35
45
55
65
75
85
95
1 ml
-10
20
-5
-~10
30
=-15
-30
40
~20
-~25
~40
-=-so
~30
-=-35
~60
-~70
10
50
60
70
,ri
15
25
35
45
55
65
75
85
95
1 ml
80
en
c::
E
90
.,"'
_,
.,en
100
.,c::
"'
en
UNITS
u
@)
15
25
35
45
55
65
75
85
95
1 ml
,ri
=-40
-=-45
en
c::
c::
~
.,"'
_,
.,en
"'
en
.,<=
1;2 =-so
UNITS
ml
u
@)
8. 8 units Regular
20 units NPH
0
.,"'
_,
=-100
.,c::
UNITS
20
~10
-~15
~20
-~30
--=-20
=-25
=-40
50
60
70
,ri
80
90
en
c::
c::
~
.,"'
_,
.,en
"'
en
.,<=
100
u
UNITS
@)
=-30
-=-35
,ri
0
N
=-40
en
c::
c::
~
.,"'
_,
=-45
.,en
"'
en
.,c::
1;2 =-so
UNITS
ml
u
@)
11 . 22 units Regular
UNITS
~20
~40
50
=-25
=-50
60
-30
-=-35
=-50
en
c::
E
90
.,"'
_,
.,en
100
.,c::
u
UNITS
@)
"'
en
13. 24 units Regular
27 units NPH
1;2 =-so
UNITS
ml
0
N
en
c::
c::
~
.,en
"'
en
1
ml
u
@)
~10
-=-20
~30
,ri
0
=-40
-=-45
,ri
12. 14 units Regular
44 units NPH
40
80
@)
=-100
30
0
u
.,c::
20
N
1
ml
=-go
-10
-~15
-
"'en
.,"'
_,
~s
,ri
.,en
=-60
-=-70
-=-so
10
70
c::
c::
~
=-so
0
N
en
9. 24 units Regular
~10
40
N
=-so
-=-go
~s
30
-
,ri
0
N
10
10. 57 units NPH
5
--
0
N
7. 23 units Regular
14 units NPH
5
~20
N
en
<=
c::
~
.,"'
_,
.,en
"'
en
.,c::
u
@)
14. 33 units Regular
10 units NPH
=-70
-=-so
-
=-go
.,"'
_,
.,en
=-100
.,c::
,ri
0
N
en
c::
E
UNITS
"'
en
1
ml
u
@)
15. 56 units Regular
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159
160
READING MEDICATION LABELS AND SYRINGE CALIBRATIONS
Identify the dosages measured on the following syringes.
5
15
25
35
45
55
65
1111
75
85
95
1 ml
10
:=-5
:=-10
20
:=-10
=:-20
30
:=-15
:=-30
40
:=-20
:=-40
50
:=-25
60
:=-30
70
0
80
90
:=-35
,Ij
N
Cl
c::
c::
~
m
_,
"'
.
"'
Cl
m
Cl
100
UNITS
c::
u"'
(§)
1;2
--
.
:=-50
=-50
--
=-70
,Ij
,Ij
0
:=-40
=-45
=-so
ml
UNITS
0
N
Cl
:=-80
_,
"'
:=-90
c::
c::
~
m
"'
Cl
m
Cl
c::
=-100
u"'
(§)
UNITS
N
Cl
c::
c::
~
m
_,
"'
"'
Cl
m
Cl
c::
1
ml
16. - - - - - -
17. - - - - - - -
18. - - - - - - -
5
10
:=-5
:=-10
20
:=-10
=-20
30
:=-15
:=-30
40
:=-20
:=-40
50
=-25
:=-50
15
25
35
45
55
65
1111
75
85
95
1ml
.
70
0
80
90
N
Cl
_,
"'
UNITS
15
25
35
45
1111
55
65
75
85
95
1ml
. --
=:-60
=- 70
U"J
0
N
Cl
_,
"'
u"'
u"'
=-100
(§)
ml
(§)
UNITS
"'
Cl
m
c::
UNITS
Cl
c::
.
:=-10
-10
:=-20
30
:=-15
:=-30
40
=-20
:=-40
50
=-25
:=-50
60
=-30
:=-60
20
70
0
80
=-40
c::
--
E
m
90
_,
"'
Cl
100
UNITS
22. _ _ _ __
u"'
(§)
1;2
ml
N
Cl
c::
E
-45
"'
Cl
m
c::
,Ij
0
N
Cl
=-so
UNITS
23. _ _ _ __
_,
"'
"'
Cl
m
Cl
c::
1
ml
u"'
(§)
--
--
=-35
,Ij
c::
c::
~
m
21. - - - - - - -
=:-5
10
0
N
Cl
=:-90
"'
Cl
m
20. - - - - - - -
U"J
:=-80
c::
c::
~
m
=:-45
1;2 =-so
19. - - - - - -
5
=:-35
=:-40
c::
c::
~
m
Cl
100
--
:=-30
--
U"J
(§)
--
--
60
u"'
.
:=-70
,Ij
0
N
Cl
:=-80
c::
E
m
_,
"'
"'
Cl
m
Cl
c::
u"'
(§)
m
_,
"'
=:-90
=-100
UNITS
"'
Cl
m
Cl
c::
1
ml
u"'
(§)
24. _ _ _ __
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MEASURING INSULIN DOSAGES
5
15
25
35
45
55
65
75
..
85
95
1 ml
10
:=-5
:=-10
20
:=-10
:=-20
=-15
:=-30
40
=-20
=-40
50
-25
:=-50
60
=:-30
.
30
70
--
=:-35
,Ij
80
90
15
25
35
45
55
65
.
75
85
95
1ml
-
UNITS
=:-40
c::
c::
~
m
_,
"'
u"'
(§)
ml
Cl
c::
=-100
u"'
UNITS
(§)
26. _ _ _ __
UNITS
:=-10
20
:=-10
=-20
30
:=-15
:=-30
40
:=-20
--
:=-40
50
=-25
:=-50
60
:=-30
=:-60
0
80
90
.
N
Cl
c::
c::
~
m
_,
"'
"'
Cl
m
Cl
100
UNITS
c::
112
u"'
(§)
ml
28.
Answers
1-15. See instructor
16. 67 units
17. 43 units
18. 54 units
c::
1
ml
u"'
(§)
--
--
U"J
..
0
N
Cl
:=-40
c::
c::
~
m
_,
"'
=:-45
Cl
c::
=-so
UNITS
=- 70
U"J
0
N
Cl
:=-80
c::
c::
~
m
_,
"'
=:-90
"'
Cl
m
u"'
=-100
(§)
UNITS
29.
19. 73 units
20. 32 units
21. 60 units
22. 52 units
23. 8 units
Cl
--
:=-35
-
"'
Cl
m
27.
:=-5
U"J
_,
"'
=:-90
"'
Cl
m
12 =-so
c::
c::
~
m
--
_,
"'
1
c::
N
Cl
=:-80
c::
c::
~
m
=:-45
"'
Cl
m
0
N
Cl
10
70
,Ij
0
Cl
100
:=-60
:=-70
,Ij
0
N
Cl
25. _ _ _ __
5
..
"'
Cl
m
Cl
c::
1
ml
u"'
(§)
30.
24. 76 units
25. 92 units
26. 14 units
27. 58 units
28. 85 units
29. 43 units
30. 82 units
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161
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I
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTHR
A ratio consists of two different numbers or quantities that have a sig-
nificant relationship to each other. Earlier in the text, you learned how
to read the dosage on drug labels. Each of these dosages was expressed
as a ratio: a certain weight (strength) of drug in a tablet (tab), capsule
(cap), or a certain volume of solution, most commonly ml; for example,
so mg per ml, 100 mcg per tab, 1000 units per ml.
RATIOS
There are two ways to express (write) a ratio. The numbers can be written
as a common fraction, or separated by a colon.
Separated by a colon
As a common fraction
50 mg
or
50mg: 1 mL
or
100 mcg : 1 tab
or
1000 units: 1 mL
1 mL
100 mcg
ltab
1000 units
1 mL
•
A ratio consists of two numbers that have a
significant relationship to each other. It can be expressed
as a common fraction or with the numbers separated
by a colon.
y noL be copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig bi.o;, some Lhird party conLenLmay be suppressed rmm Lhe eBook and/or eChapLet~s).
m.at.eri.ally affecL the overall learning experience. Cengage Leaming reserves the righL Lo remove additional c.onlenl al any time if subscquenLrighLS restricLions require it.
RATIO AND PROPORTION
►►► PROBLEMS 12.1
Express dosages using the ratio format you prefer.
1. An injectable solution that contains 100 mg
in each 1.5 mL
2. An injectable solution that contains 250 mg
in each 0.7 mL
3. A tablet that contains 0.4 1ng of drug
4. Two tablets that contain 450 mg of drug
Answers
100 mg
250 mg
4
1. - - ~ ; 100 mg: 1.5 ml 2. - - ~ ; 250 mg: 0.7 ml; 3. 0. mg ; 0.4 mg: 1 tab
1.5 ml
4.
0.7 ml
1 tab
450 mg
2 ta
b ; 450 mg : 2 tab
Note: If you did not include the units of measure, your answers are incorrect.
To complete the chapter, choose the ratio format you prefer. If you choose the
common fraction for1nat, continue on this page. If you prefer ratios using
the colon format, turn now to page 171 to "Ratio and Proportion Expressed
Using Colons:·
RATIO AND PROPORTION EXPRESSED USING
COMMON FRACTIONS
Whereas a ratio is an expression of a significant relationship between two nmnbers, a
proportion is used to show the relationship between two ratios. In a proportion, the
ratios are separated by an equal ( =) sign.
50
100
1
2
KEYpoint: A true proportion contains two ratios that are equal.
The previous example is a true proportion. This is a simple comparison, and by using drug
strength examples, we can verify that the ratios are equal and that the proportion is true.
EXAMPLE 1
50mg
100mg
1 tab
2 tab
If 1 tablet contains 50 mg, 2 tablets will contain 100 mg.
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165
166
DO SA GE CA LCU LATI ONS
EXAMPLE 2
50mg
100 mg
1 ml,
2mL
If 1 mL contains 50 mg, 2 mL will contain 100 mg.
You can also prove mathematically that these ratios are equal and that tl1e proportion is
true. Look again at Example 1.
50mg _ lOOmg
1 tab
2 tab
KEYpoint: In a true proportion, the cross-multiplied products will be
identical.
To prove that a proportion is true, cross multiply. The products (answers) you obtain will
be identical.
EXAMPLE 1
50mg _ lOOmg
1 tab
2 tab
50 K.-._/1 100
1 r ':,, 2
Drop the measurement units
50 X 2 = 100 X 1
Cross multiply
100 = 100
The products of cross multiplying in this proportion, 100, are the same. We have now
proved mathematically what we previously proved mentally: The ratios are equal and the
proportion is true.
EXAMPLE 2
500mg
250mg
2m.L
lm.L
250 X 2 = 500 X 1
Drop the measurement units, then
cross multiply
500 = 500
The products of cross multiplying, 500, are identical. This is a true proportion; the
ratios are equal.
EXAMPLE 3
10 units
20 units
lm.L
2m.L
10 X 2 = 20 X 1
20 = 20
This is a true proportion. The products of cross multiplying, 20, are equal.
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RATIO AND PROPORTION
►►► PROBLEMS 12.2
Determine mathematically if these proportions are true.
1.
2.
34 mg _ 51mg
2mL
3 mL
15 mg _ 45 mg
4 mL
12 mL
46mg _ 23 mg
3.
1.3 mL 0.65 mL
4.
150 units
130 units
2.3 mL
l .9 mL
40 mg _ 80 mg
5.
1.1 mL
2.2 mL
Answers 1. true (2 X 51 = 102 and 34 X 3 = 102) 2. true (4 X 45 = 180 and 15 X 12 = 180)
3. true (46 X 0.65 = 29.9 and 23 X 1.3 = 29.9) 4. not true (150 X 1.9 = 285 and 130 X 2.3 = 299)
5, true (40 X 2.2 = 88 and 1.1 X 80 = 88)
DOSAGE CALCULATION USING RATIO AND PROPORTION
EXPRESSED AS COMMON FRACTIONS
Ratio and proportion are important in dosage calculations because they can be u sed wl1en
only one ratio is known, or complete, and the second is incomplete. Look carefully at
the following examples for mL parenteral dosages, which is where calculations are most
often required.
EXAMPLE 1
A solution strength of 8 mg per ml, will be u sed to prepare a
dosage of IO mg.
The known ratio is provided by the solution strength available, 8 mg per mL. The
incomplete ratio is the dosage to be given, 10 mg, and Xis used to represent the mL
which will contain 10 mg.
8 mg
10 mg
1 mL
XmL
complete ratio
drug strength
incomplete ratio
dosage to give
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167
168
DO SA GE CA LCU LATI ONS
KE paint: The ratios in a proportion are written in the same sequence
of measurement units.
In the previous example, they are:
mg _ m g
mL
mL
Both numerators are mg; both denominators are ml,.
Next, let's look at the math steps u sed to determine the value of the unknown, X mL.
The math will be familiar because it was covered earlier in the refresher math section.
8mg _ 10mg
lmL
Set up the proportion to include the measurement
units; make sure they are in the same sequence
XmL
8mg
10mg
1 mL
XmL
Drop the measurement units as you cross multiply
BX = 10
Keep X on the left of the equation
Divide 1Oby the number in front of X; reduce by the
highest common denominator (2)
5
Divide the final fraction to obtain a decimal fraction
4
= 1.25 ml,
The X in the original proportion was mL, so the
answer is 1.25 mL
The ordered dosage of 10 mg is contained in 1.25 ml,.
It is routine to check your math twice in dosage calculations. However, it is also necessary
to assess each answer to determine if it is logical, and here is where the review of the
relative value of numbers is put to use. Consider the answer just obtained in Example 1.
8 mg
10 mg
1 mL
XmL
X = 1.25 ml,
If I ml, contains 8 mg, you will need a larger volume than 1 mL to obtain 10 mg. The
answer obtained, 1.25 ml,, is larger; therefore, it is logical. This routine check does not
guarantee that your math is correct, but it does indicate that you did not 1nix up the units
of measure when you set up the proportion and cross multiplied.
KEYpaint: Assess each answer obtained to determine ifit is logical.
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RATIO AND PROPORTION
EXAMPLE 2
The strength available is 25 mg in 1.5 ml,. A dosage of 20 mg has
been ordered.
25 mg _ 20mg
1.5 mL
Make sure the units are in the same sequence
XmL
25 X = 1.5 X 20
Cross multiply; keep X on the left
,306
Reduce by 5, then divide the final fraction
X =--
J:Ss
= 1.2 ml,
Include the measurement unit in your answer
The dosage ordered, 20 mg, is smaller than the strength available, 25 mg in 1.5 mL. So, the
answer should be smaller than 1.5 mL, and it is. The answer is logical.
EXAMPLE 3
A dosage of 200 mg must be prepared from a solution strength of
80 mg per ml,.
80 mg _ 200 mg
lmL
XmL
BOX = 200
,.2005
- - = 2.5ml,
fe02
The unknown, X, was mL, so the answer must be mL. The dosage ordered, 200 mg, is
larger than the 80 mg per mL strength being used, so it 1nust be contained in more than
1 mL. The answer, 2.5 mL, is larger. Therefore, it is logical.
As soon as you are comfortable with the math for ratio and proportion, you can combine several steps and work even 1nore efficiently. You may already have been doing this,
but here are a few examples to demonstrate the shortcuts.
EXAMPLE 4
A 300 mg in 1.2 ml, solution will be used to prepare a dosage
ofl20mg.
300 mg _ 120 mg
1.2 mL
X mL
1.2 X 120
X = ---
300
1.2 X )20
0
d
..,x,v 5
2
=
2.4
5
= 0.48 = 0.5 ml,
Set up the proportion, with
the known ratio written first
Cross multiply, and immediately divide by the number
in front of X
Reduce (by 60); do final division; round to nearest tenth
A dosage of 120 mg will require fewer mL than the 300 mg per 1.2 mL strength
available. The smaller 0.5 mL answer is logical.
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169
170
DO SA GE CA LCU LATI ONS
EXAMPLE 5
Prepare a 2 mg dosage using a 1.5 mg in 0.5 ml, solution.
1.5mg _ 2mg
0.5 mL
XmL
1
X =
,,()5 X 2
,L
= 0.66 = 0.7 ml,
y.;_, 3
The 0.7 mL answer is a larger volume than the 1.5 mg in 0.5 mL dosage strength
available; therefore, it is logical for this 2 mg dosage.
EXAMPLE 6
A 120 mg dosage is ordered. The solution available is labeled
80 mg per ml,.
80mg _ 120mg
lmL
XmL
)203
X = - - = 1.5 ml,
fl{) 2
The 120 mg dosage ordered will require a volume larger than the 80 mg per mL
available dosage strength. The answer, 1.5 mL, is larger; therefore, it is logical.
►►► PROBLEMS 12 .3
Calculate these dosages. Express answers to the nearest tenth. Assess answers to
determine if they are logical.
1. A dosage of 24 mg has been ordered. The solution strength
available is 12.5 mg in 1.5 mL.
2. A 40 mg in 2.5 mL solution will be used to prepare
a 30 mg dosage.
3. Prepare 0.3 mg from a solution strength of
0.6 mg in 0.8 mL.
4. A 36 mg per 2 mL strength solution is u sed to prepare 24 mg.
5. A dosage of 52 mg is to be prepared from a 78 mg in
0.9 mL solution.
6. A dosage of 150 1ng has been ordered. The solution strength
is 100 mg per mL.
7. A strength of 3 mL containing 750 mcg is available
to prepare 600 mcg.
8. If the strength available is 1.5 g per 1nL, how many
mL will a 4 g dosage require?
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RATIO AND PROPORTION
9. Prepare a 0.25 mg dosage from a 0.5 mg per 1 mL
strength solution.
10. Prepare a 3 g dosage from a 4 gin 2.7 mL strength solution.
Answers 1. 2.9 ml 2. 1. 9 ml 3. 0.4 ml 4. 1.3 ml 5. 0.6 ml 6. 1.5 ml 7. 2.4 ml 8. 2.7 ml
9 . 0.5 ml 10. 2 ml
Note: If you did not include the units of measure, your answers are incorrect.
Turn now to page 176, "Calculations When Dosages Are in Different Units of Measure;' to
complete the chapter.
RATIO AND PROPORTION EXPRESSED USING COLONS
Whereas a ratio is an expression of a significant relationship between two numbers, a proportion is used to show the relationship between two ratios. In a proportion, the ratios
are separated by an equal ( =) sign.
50: 1 = 100: 2
KEYpaint: A true proportion contains two ratios that are equal.
The previous example is a true proportion.
50: 1 = 100: 2
By using our previous drug strength examples, we can mentally verify that these ratios are
equal and that the proportion is true.
EXAMPLE 1
50 1ng : 1 tab = 100 1ng : 2 tab
If 1 tablet contains 50 mg, 2 tablets will contain 100 mg.
EXAMPLE 2
50 mg : 1 ml, = 100 mg: 2 ml,
If 1 mL contains 50 mg, 2 mL will contain 100 mg.
You can also prove mathematically that these ratios are equal and that the proportion is
true. Look again at Example 1.
50 mg : 1 tab = 100 mg: 2 tab
The numbers on the ends of the proportion {50, 2) are called the extremes, whereas
those in the middle (1, 100) are called the means.
KE paint: It is critical in all math involving proportions that the means
and extremes not be mixed up or an incorrect answer will be obtained.
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Ed llorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions req uire iL
171
172
DO SA GE CA LCU LATI ONS
Here is a memory cue that you can use to prevent confusion. Notice that the means are
in the middle of a proportion. Both of these words begin with an "m" (means, middle).
The extremes are on the ends of the proportion. Both of these words begin with an "e"
( extremes, ends). Use these cues to prevent mix-ups.
KEV point: In a true proportion, the product of the means equals
the product of the extremes.
If you multiply the means, then the extremes-their products (answers)-will be equal.
EXAMPLE 1
50 mg : 1 tab = 100 mg: 2 tab
(extremes,
50: 1 = 100: 2
(means)
50 X 2 = 100 X 1
100 = 100
The product of the means, 100, equals the product of the extremes, 100. We have now
proved mathematically what ,ve previously proved mentally: The ratios are equal and the
proportion is true.
EXAMPLE 2
500 mg : 2 mL = 250 mg : 1 mL
500 : 2 = 250 : 1
'-.__.../
500 X 1 = 2 X 250
500 = 500
The product of the means, 500, equals the product of the extremes, 500. This is a true
proportion; the ratios are equal.
EXAMPLE 3
10 units: 1 mL = 20 units: 2 mL
10 X 2 = 20 X 1
20 = 20
This is a true proportion.
►►► PROBLEMS 12.4
Determine mathematically if these proportions are true.
1. 34 mg : 2 mL = 51 mg : 3 mL
2. 15 mg : 4 mL = 45 mg : 12 mL
3. 46 mg : 1.3 mL = 23 mg : 0.65 mL
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Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheove rall leaming e xpe rience. Ce ngage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire iL
RATIO AND PROPORTION
4. 150 units : 2.3 mL = 130 units : 1.9 mL
5. 40 mg : 1.1 mL = 80 mg : 2.2 mL
1. true (2 X 51 = l 02 and 34 X 3 = l 02) 2. true (4 X 45 = l 80 and 15 X 12 = l 80)
3. true (46 X 0.65 = 29.9 and 1.3 X 23 = 29.9) 4. not true (150 X 1.9 = 285 and 2.3 X 130 = 299)
s. true (40 X 2.2 = 88 and 1.1 X 80 = 88)
Answers
DOSAGE CALCULATION USING RATIO
AND PROPORTION EXPRESSED WITH COLONS
Ratio and proportion are important in dosage calculations because they can be used when
only one ratio is known, or complete, and the second is incomplete. Look carefully at
the following examples for mL parenteral dosages, which is where calculations are most
often required.
EXAMPLE 1
A solution strength of 8 mg per ml, will be used to prepare a
dosage of 10 mg.
The known ratio is provided by the solution strength available, 8 mg per mL. The
incomplete ratio is the dosage to be given, 10 mg, and Xis used to represent the mL
which will contain 10 mg.
8 mg: 1 mL
complete ratio
drug strength
lOmg:XmL
incomplete ratio
dosage to give
KEV point: The ratios in a proportion are written in the same sequence of
measurement units.
In the previous example, they are: mg: mL =mg: mL
Next, let's look at the math steps used to determine the value of the unknown, X mL. The
math will be familiar because it was covered earlier in the refresher math section.
8 mg : 1 mL = 10 mg: X mL
Check the sequence of measurement units: mg :
rnL = mg: mL
8: 1 = 10 :X
Drop the measurement units
BX= 10
Multiply the extremes, then the means, keeping X on
the left of the equation
10
X = -
Divide 10 by the number in front of X
8
- )05
:i4
= 1.25 ml,
Reduce the numbers by their highest common
denominator, 2. Divide the final fraction. Divide 5 by 4.
The X in the original proportion was mL, so the
answer is 1.25 mL
The ordered dosage of 10 mg is contained in 1.25 ml,.
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Edilorial review has deemed LhaL any suppressed content does noLmaterially affec t Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
173
174
DO SA GE CA LCU LATI ONS
It is routine to check your math twice in dosage calculations. However, it is also necessary
to assess each answer to determine if it seems logical, and here is where the previous
review of the relative value of numbers is put to use. Consider the answer just obtained in
Example 1.
8 mg : 1 mL = 10 mg: X mL
X = 1.25 ml,
If 1 ml, contains 8 mg, you will need a larger volume than 1 ml, to obtain 10 mg. The
answer obtained, 1.25 ml,, is larger; therefore, it is logical. This routine check does not
guarantee that your math is correct, but it does indicate that you h ave not mixed up the
means and extremes in your calculations.
KEYpaint: Assess each answer obtained to determine ifit is logical.
EXAMPLE 2
The dosage strength available is 25 mg in 1.5 ml,. A dosage of
20 mg has been ordered.
251ng : 1.5 mL = 20 mg :Xm.L
Make sure the units are written
in the same sequence:
mg : mL = mg: mL
25 : 1.5 = 20 : X
Drop the measurement units
25X = 1.5 X 20
Multiply the extremes, then the
means, keeping X on the left
30
Divide by the number in front of X
25
= 1.2
Reduce the common denominator
by 5, then divide the final
fraction, 6 by 5
X= l.2mL
The dosage ordered, 20 mg, is a smaller amount of drug than the strength available,
25 mg in 1.5 m.L. So, the answer should be smaller than 1.5 m.L, and 1.2 mL is smaller.
This answer is logical.
EXAMPLE 3
A dosage of 200 mg must be prepared from a solution strength of
80 mg per ml,.
80 mg : 1 mL = 200 mg : X mL
BOX= 200
5
= - = 2.5 ml,
2
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Edllorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
RATIO AND PROPORTION
The unknown, X, was m.L, so the answer must be mL. The dosage ordered, 200 mg, is
larger than the 80 mg per mL strength u sed, so it must be contained in more than 1 m.L.
The answer, 2.5 m.L, is larger. Therefore, it is logical.
As soon as you are comfortable with the math for ratio and proportion, you can combine several steps and work even more efficiently. You may have already been doing this,
but here are a few examples to demonstrate the shortcuts.
EXAMPLE 4
A 300 mg in 1.2 ml, solution will be u sed to prepare a dosage
ofl20mg.
300 mg : 1.2 mL = 120 mg :Xm.L
Multiply the means, and
immediately divide by
the number in front of X
1.2 X 120
X =----
300
1.2 X )20
2
,,3005
2.4
= -
= 0.48 X 0.5 ml,
5
Set up the proportion,
with the known ratios
written first
Reduce by the common
denominator, 60.
Do final division: 2.4 by
5. Round to the nearest
tenth.
The required dosage, 120 mg, is smaller than the 300 mg per 1.2 mL available strength.
The refore, the smaller 0.5 mL ans,-ver is logical.
EXAMPLE 5
Prepare a 2 mg dosage using a 1.5 mg in 0.5 ml, s olution.
1.5 mg : 0.5 mL = 2 mg :Xm.L
1
X =
J}.5 X 2
.Lf'
1
= 0.66 = 0.7 ml,
y.~ 3
The dosage ordered, 2 mg, is larger than the 1.5 mg in 0.5 mL dosage available.
The 0.7 mL answer is logical.
EXAMPLE 6
A 120 mg dosage is ordered. The solution available is labeled
80 mg per ml,.
80 mg: 1 mL = 120 mg :X m.L
= 1.5 ml,
The 1.5 mL answer is logical because the 120 mg ordered is larger than the 80 mg per mL
dosage strength available.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO from Lhe cBook and/or eChaplet1s).
Edllorial review has deemed LhaLany suppressed conlenl does noL materially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions require iL
175
176
DO SA GE CA LCU LATI ONS
►►► PROBLEMS 12.5
Calculate these dosages. Express answers to the nearest tenth. Assess answers to
determine if they are logical.
1. A dosage of 24 mg has been ordered. The s olution strength available
is 12.5 mg in 1.5 mL.
2. A 40 mg in 2.5 mL s olution will be used to prepare a
30 mg dosage.
3. Prepare 0.3 mg from a solution strength of 0.6 mg in 0.8 mL.
4. A 36 mg per 2 mL strength solution is used to prepare 24 mg.
5. A dosage of 52 mg is to be prepared from a 78 mg in
0.9 mL s olution.
6. A dosage of 150 mg has been ordered. The s olution strength
is 100 mg per mL.
7. A strength of 3 mL containing 750 mcg is available
to prepare 600 mcg.
8. If the strength available is 1.5 g per mL, how many mL
will a 4 g dosage require?
9. Prepare a 0.25 mg dosage from a 0.5 mg per 1 mL strength
s olution.
10. Prepare a 3 g dosage from a 4 gin 2.7 mL strength s olution.
Answers 1. 2.9 ml 2. 1.9 ml 3. 0.4 ml 4. 1.3 ml
10. 2 ml
s. 0.6 ml 6 . 1.5 ml 7. 2.4 ml 8 , 2.7 ml 9 . 0.5 ml
Note: If you did not include the un its of measure, your answers are incorrect.
CALCULATIONS WHEN DOSAGES
ARE IN DIFFERENT UNITS OF MEASURE
Consider the following dosage calculations. Refer to the ratio and proportion for1nat you
chose earlier.
EXAMPLE 1
The order is to give 0.15 g of medication. The dosage strength
available is 200 mg per ml,.
This problem cannot be s olved as it is now written because the dosages are in different
units of measure: g and mg. You learned that it may be safer to convert from larger to
smaller units of measure to eliminate/ avoid decimal points. Convert the g to mg.
Separated by a colon
As a common fraction
200 mg _ 0.15 g
lmL
XmL
or
200 mg : 1 mL = 0.15 g: X mL
or
200 mg : 1 mL = 150 mg :XmL
200 mg _ 150mg
lmL
XmL
200X= 1 X 150
200X= 1 X 150
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Edllorial review b:is deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
RATIO AND PROPORTION
15 0
15 0
X = - = 0.75
200
X = - = 0.75
200
= 0.8 ml,
= 0.8 ml,
150 mg is a smaller dosage than 200 mg, so it must be contained in a s1naller volmne than
1 m.L. The answer, 0.8 mL, is logical.
EXAMPLE 2
You have a dosage strength of 200 mcg per ml,. The order is to give
0.5 mg.
200 m cg _ 0.5mg
Xm.L
lm.L
200 m cg _ 500 mcg
Xm.L
lm.L
or
200 mcg : 1 mL = 0.5 mg: Xm.L
or
200 mcg : 1 mL = 500 mcg: X1nL
200X= 500
200X= 500
X= 2.5 ml,
X= 2.5 ml,
500 mcg is a larger quantity than 200 mcg, so it must be contained in a larger quantity
than 1 mL. The answer, 2.5 m.L, is logical.
Ratio and proportion is also u sed to solve calculations for unit and mEq dosages.
EXAMPLE 3
The order is to give 1200 units. The available dosage strength is
1000 units per 1.5 ml,.
1000 units
1200 units
1.5 mL
Xm.L
or lOOOunits : 15 mL = 1200 units :Xm.L
lOOOX = 1.5 X 1200
lOOOX = 1.5 X 1200
1.5 X 1200
X = ---1000
1.5 X 1200
X = ---1000
= 1.8 ml,
= 1.8 mL
1200 units is a larger dosage than 1000 units, s o the answer in mL should be larger than
1.5 m.L, which it is.
EXAMPLE 4
A drug has a dosage strength of 2 mEq per ml,. You are to give
10 mEq.
2mEq _ lOmEq
lm.L
Xm.L
or
2 mEq: 1 mL = 10 mEq: Xm.L
2X= 10
2X= 10
X= 5 ml,
X = 5 ml,
10 mEq is considerably larger than 2 mEq, s o the answer should als o be significantly
larger, and it is.
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Edllorial review has deemed LhaLany suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
177
178
DO SA GE CA LCU LATI ONS
►►► PROBLEMS 12.6
Solve these dosage problems. Express answers to the nearest tenth.
1. The drug label reads 1000 mcg in 2 mL. The order is 0.4 mg.
2. The ordered dosage is 275 mg. The available drug
is labeled 0.5 g per 2 mL.
3. A dosage strength of 0.2 mg in 1.5 mL is available. Give 0.15 mg.
4. The strength available is 1 g in 3.6 mL. Prepare a 600 mg dosage.
5. A 10,000 units dosage has been ordered. The dosage strength
available is 8000 units in 1 mL.
6. The dosage available is 20 mEq per 20 mL. You are
to prepare 15 mEq.
7. The order is for 200,000 units. The strength available is
150,000 units per 2 mL.
Answers 1. 0.8 ml 2. 1.1 ml 3. 1.1 ml 4. 2.2 ml 5. 1.3 ml 6. 15 ml 7. 2.7 ml
Summary
This concludes the introductory chapter on ratio and proportion and its uses in
dosage calculations. The important points to remember from this chapter are:
A ratio is composed of two numbers that have a significant relationship to each
other.
In medication dosages, ratios are used to express the amount of drug contained in
a tablet or capsule, or in a certain volume of solution.
A proportion consists of two ratios with a significant relationship to each other.
If one number in a proportion is missing, it can be determined mathematically by
solving an equation to determine the value of X.
The available dosage strength provides the complete or known ratio for
calculations.
The dosage to be given provides the incomplete or unknown ratio.
Ratios in a proportion are set up in the same sequence of measurement units; for
example, mg, mL and mg, mL.
If the measurement units in a calculation are different-for example, mg and
g-one of these must be converted before the problem can be solved.
It may be safer to convert from larger to smaller metric units of measure to
eliminate decimal points.
The math of calculations is double checked, and the answer is assessed to
determine if Xis appropriately larger or smaller than the dosage strength available.
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplka ted, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 from Lhe cBook and/or eChapLer(s).
Ed llorial review b:is deemed LhaL any suppressed conlenl does noLmaterially affecl Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenLrig hts res trictions req uire iL
179
RATIO AND PROPORTION
Summary Self-Test
Calculate these dosages using ratio and proportion. Express mL answers to the nearest
tenth (or hundredth where indicated) using the medication labels provided. Measure
the dosages you calculate on the syringes provided. Have your answers checked by
your instructor to be sure you have calculated and measured the dosages correctly.
Dosage Ordered
mLNeeded
1. t erbutaline sulfate 800 mcg
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Edilori.al review has deemed Lhal any suppressed content does noL materially affecL Lheoverall leaming e xperience. Cengage Leaming reserves Lhe right Lo remove additional content al any Lime if subsequent rig hts restrictions require iL
180
DO SA GE CA LCU LATI ONS
mLNeeded
Dosage Ordered
4. fentanyl citrate 0.15 mg
---
IIDC 1ll019-o33·7l
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Edilori.al re view has deemed LhaL any suppressed content does noL materially :iffecl Lheoverall leaming experience. Cengage Leaming re.serves Lhe right Lo remove additional content al any Lime if subsequent rig hts res trictions require iL
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181
RATIO AND PROPORTION
mLNeeded
Dosage Ordered
8. midazolam HCI 4 mg
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MIDAZOLAM
NOC 55390-126-05
5 ml vial
USUAL DOSAGE: See package Insert.
Store at controlled room temperature
15° to 300C (59° to 86°F).
DISCARD UNUSED PORTION.
/!i ~ 1 1
UV Mfg by: Ben Venue Labs, Inc.
"Mlda201Nn 15 motmL (as the hydrochloride) Bedford, OH 44146
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DO SA GE CA LCU LATI ONS
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mLNeeded
Dosage Ordered
16. Dilantin®0.1 g
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l'altcedale Pharm-uticals. Inc.
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184
DO SA GE CA LCU LATI ONS
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a maximum time of 4 hours from the time of initial entry is
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23.4% 4 mEq/mL
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26. lorazepam 6 mg
NOC 60977-11 3-71
F?c only
Ativan (lorazepam) Q
Injection
0
40 mg/10 ml (4 mg/ml)
FOR IM USE
FOR IV ROUTE, SEE DIRECTIONS
10 ml Multiple Dose Vial
Baxter
Manufactured by Baxter Heaftllcare Corporation
Deerfield, IL 60015 USA
462-1 60--01
For IV use, additional
dilution Is required; see
accompanying Information. Usual Dosage: See accompanylng Information.
PROTECT FROM LIGHT Do not use HsoluUon Is
discolored or contains
a precipitate.
STORE IN A REFRIGERATOR
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Copyrig hl 20 15 Ce ngage Leaming. All RighL'i Reserved. May nol be copied, scanned, or duplicated, in whole or in part. Due to e lec.tronic rights, some Lhird party conle nl may be suppressed fro m Lhe cBook and/or eChaple-r{s).
Edilori.al re view bas deemed LhaLany suppressed conlenl does nol materially affecl lheoverall leaming experience. Cengage Leaming re.serves lhe righl lo remove addilional contenl al any Lime if subsequenl rig hls res trictions require iL
186
DO SA GE CA LCU LATI ONS
mLNeeded
Dosage Ordered
27. Dilantin®0.15 g
-
N 0071-4-47~45
Dosage-See
package irniert.
l} only
.·-- J
m111-1ML.e
C
,:,
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-'§
O :, C
uc-
J
-- -i
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l\ochill10t, i111 '8307
for
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28. doxorubicin HCI 16 mg for an IV additive
--·
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29. meperidine HCI 30 mg
111 1111
LOI
exp_
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NOC 10019-155-88
..c:
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ln11" lot COlllpitll PIIICllbi11Q
inlarmllon. Do net ' " predpilal•tl.
11 eallllo lid rn• i-pa11r, 11•-1t•c (59'-U'fll••
To OP40 lml)YII, l(l'IOrt ealor Ina: IM'Uk II eoMINC110I\.
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30. methotrexate 40 mg
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Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplicated, in whole or in part. Due to elec.tronic rig hts. some Lhird party conte nt may be s uppressed fro m Lhe cBook and/or eChaple-r{s).
Edilori.al review has deemed LhaL any suppressed content does nol materially :iffecl Lheoverall leaming e xpe rience . Ceng age Leaming re.serves Lhe right Lo remove additional conte nt al any Lime if subsequent rig hts res trictions require iL.
187
RATIO AND PROPORTION
mLNeeded
Dosage Ordered
31. midazolam HCI 3 mg
MIDAZOLAM
NDC 55390-126-05
5 ml vial
USUAL DOSAGE: See package Insert.
Store at controUed room temperature
15° to 30"C (59° to 8S°F).
*
DISCARD UNUSED PORTION.
Mfg by: Ben Venue labs, Inc.
•MJdazolam 5 mg/ml (as the hydrochloride) Bedford, OH 44146
FOR IM OR IV USE ONLY
Mfg for. Bedford Laboratories™
Bedford, OH 44146
Contains Benzyl Alcohol Rx ONLY
KC-MDZ-VB02
HCI INJECTION
.,;
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32. ondansetron 3 mg
55390-121•10
ONDANSETRON 1/0C
i mL Sll)QII Dou Yl&I
HUfCTlOI UIP
lbONLY
MIO 1or:
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33. dexamethasone 5 mg
Ill
NDC DOODO·OOO·OO
16501
DEXAMETHASDNE
SODIUM PHOSPHATE
INJECTION, USP
e uiva1ent to
a,
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-'
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Oexamethasone Phosphote
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mt
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34. hydroxyzine HCl 40 mg
IOI llmlll~ Ull OILY
1'&UltAMf OOll ~ n •
IOO~tUL--•tot-. a
~et!:ilCt,I z;se,ra;__,..
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CloSC111"'19 Wll!IOIII Pll'Str,ot,aa
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Copyrig hl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplicated, in whole or in part. Due to elec.tronic rig hts. some Lhird party conte nt may be s uppressed fro m Lhe c Book and/or eChaptcr(s).
Edilori.al review has deemed LhaL any suppressed content does nol materially :iffecl Lheoverall leaming e xpe rience . Cengage Leaming re.serves Lhe right Lo remove additional content al any Lime if subsequent rig hts res trictions require iL.
188
DO SAGE CA LCU LATI ONS
mLNeeded
Dosage Ordered
35. ketorolac tromethamine 20 mg
KnOROLAC
TROMETHAMINE
INJECTION USP
Cl
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c::
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9
36. nalbuphine HCl 30 mg
NOC 63481-509-05
NUBAI~
(Nalbuphine HCI) l~oulr
20 mg/ml injection
10 ml Mul!!21e Dose Vial
<.>
c::
-"'fj
T-
-~
Each ml come.ms· 20 me n!!lbuplune
HCI, 0.9.t'llo socf,um cilra e hydro"5,
1.26% oitnc acid anhydrous. and
o 2% of a 9:1m,xru,e of me111yt and
propylparaben, as preseMithles pH is
cd~eo. 11 neo=,v, to 3.6 to 3. 7
wl1h hydfochloric acid
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FOR IM, SC OR IV USE
Cl
c::
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-
Usual Dosage, See package inser1
for aompiete preecnlling lllfonnation.
S10ra at 2S-C (77' F) ; excursions
pemutted to 1s~-oo•c (59'-86'FJ.
0
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PROTECT FROM EXCESSIVE LIGHT.
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..r:::
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Chadds Ford, Pl'. 19317
"'O
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38. cyanocobalamin 750 mcg
NOC 00000-0000-00
LL
a
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a
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a
a
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CYANOCOBALAMI N I::::
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Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplicated. in whole or in pan. Due Lo e lec.tronic rig hts. some Lhird party conlenl may be s uppressed fro m the eBook and/or eChaple t1s}.
Edilori.al review has deemed LhaL any s uppressed conlenl does nol materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLional conle nl al any time if subsequenl rig hls restricLions require it.
in
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189
RATIO AND PROPORTION
Dosage Ordered
mLNeeded
39. aminophylline 0.4 g for an IV additive
a 20 mL Single•dose
NOC 0074-7386-01
Ampul
&ch ml ,on11l111 111lnophyUln1
lulcula1ed 1s the dthydretel 25 mg
p
1>.
(equ,val1111 to ISJ 1119/IIIL a4 1nhyd1ous
nJ.,
..Y only lhaophyl1I11~Marcomaln 1ntxce~of
500 mg (25 mg/ml) e1
hy!enedi1min~ for pH 1dj11Stmen1.
pH LB ll& 10 !1.0), Dlsc11d unused
ProtKt from Ugltl.
poniM Sl!!tlt, nonpyrogenlc. flll IV
DO NOT USE IF CRYSTALS HAVEuse. Usual dOK: Set insert
~
AMINOPHYLLINE
• US
II
SEPARATED FROM SOLUTION
.t!J"On LJ!BCJRA
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40. Dilantin®125 mg
~
package Insert.
)J. onty
Manufactured
,..,._
.
_8
N 0071-4'75-45
8
STERI-VIAUD
by:
~
Rccll_,, Ml4IS30'7
Dilantine
(Phonytoln Sodium
...
r«
PMICE-QIMS
OW olW.,,,.,-umben Co
Molril Plab. NJ 07950 USA
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41. ketorolac 25 mg
KETOROLAC
TROMETHAMlNE
INJECTION USP
~ C'\I ~ C")
_____,._,:--!-'111l1111l1111l1111 11111111,Jril~ ~.
0
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42. Vistaril• 50 mg
.............
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,GIIT--.ulUIIOlll.t
U:IUM. AOUII OOSL W-r uflb.-.. :1 •
it7$"Q
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Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplica ted. in whole or in part. Due to electronic righl'i. some Lhinl party conlenl may be .suppressed fro m the eBook and/or eChapte r(s}.
Edilori.al review has deemed Lhal any s uppressed contcnl does, noLm aterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe righLLo remove additional conte nt al any time if subsequent rig hls restrictions require iL
190
DO SA GE CA LCU LATI ONS
mLNeeded
Dosage Ordered
43. Ativan 10 mg
NDC 60977-113-71
~ only For IV use, addiUonal
dilution Is required; see
accompanying
information.
(lorazepam)
Usual Dosage: See accom~
panylng Information.
= ::;
PROTECT FROM LIGKT ·
;;;;;; ;:.
(4 mg/ml)
Do not use tt solullon Is
1/;
~
FORIM USE
discolored or contains
- 8
2:
- ,._ '-' c:i.
FOR IVROUTE, SEE DIRECTIONS a preclpttale.
STORE IN AREFRIGERATOR
§. .9 ,ll
10 ml Multiple Dose Vial
Bax ter
D
Ativan
=
t:,
Injection
40 mg/10 ml
..........
;:#!:
=
11 11 111
Monufactured by Baxter lloalthcare CorporaUan
Deertield, IL 60015 USA
462-160-01
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44. Robinule 180 mcg
NDC lillm· ISS-81
Roblnul
Injectable
(Glycopynolate
lnjectfon, USP)
•
•
•
•
I
!
0.2 mg/111.L 1a1y •
FOR IMOR IVUSE
----c.,.
•
1 ml $11,ale Dose V1o1t
Mt•"""-'••l"I
l)ffft ,14 1.1,1111~~~
◄62-17&-00
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rt11 ~ U R aa,.
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1. 0. 8 ml
2 . 1.5 ml
3. 1.4 ml
4. 3 ml
s. 0 .9 ml
6. 1.5 ml
7. 0 .38 ml
8. 0 .8 ml
9. 1.2 ml
10. 0 .8 ml
11. 8 ml
12. 2 ml
13. l .5ml
14. 0.45 ml
1 s. 1 .6 ml
16. 2 ml
17. 2 .3 ml
18. 1 .8 ml
19. 2.4 ml
20. 15 ml
21. 1 .5 ml
22. 0 .8 ml
23. 1.6 ml
24. 1.7 ml
25. 1.3 ml
26. 1.5 ml
27. 3 ml
28. 8 ml
29. 1.2 ml
30. 1.6 ml
31 . 0 .6 ml
32. 1.5 ml
33. 1.3 ml
34. 1.6 ml
35. 1.3 ml
36. 1.5 ml
37. 1.5 ml
38. 0. 8 ml
39. 16 ml
40. 2 .5 ml
41. l .7ml
42. 2 ml
43. 2 .5 ml
44. 0 .9 ml
45. 1.4 ml
46. 0 .7 ml
47. 0 .3 ml
48. 10 ml
49. 1.8 ml
so. 1.4 ml
51. 0 .8 ml
52. 1.5 ml
53. 1.5 ml
54. 1.5 ml
55. 0.8 ml
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplica ted. in whole or in pan . Due Lo elec.tronic righl'i. .some Lhird party conlenl may be .suppressed fro m the e Book and/or eChaple t1s}.
Edilori.al review has deemed LhaLany s uppressed conlenl does nol rn:iterially :iffecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove :iddiLional conle nl al any time if subsequenl rig hls restricLions require it.
H
You may already be familiar with dimensional analysis (DA) under its
official name: units conversion, which is used in chemistry, physics, and
other scientific calculations. DA was first introduced for dosage calculations in the 1950s using the name dimensional analysis, but it has had
several other names along the way: the label factor and factor label
methods being two.
DA is actually ratio and proportion made simple. Its great virtue is
that it reduces multiple-step calculations to a single equation. However, to understand the simplicity of DA, it is necessary to look at clinical
ratios from a different perspective.
CLINICAL RATIOS
Clinical ratios provide the components for all the calculations you have
already learned and will be learning in the remainder of this text. Some
examples of ratios you are already familiar with from previous chapters
include the following:
oral dosages: 1 tab = 250 mg; 5 mL = 125 mg
IM and subcutaneous dosages: 2 g = 1.5 mL;
1 mL = 10 units; 10 mL = 20 m.Eq
metric conversions: 1000 mcg = 1 mg; 1 g = 1000 mg
In addition, you will be using the following ratios, althougl1 it isn't necessary for you to memorize them at this time.
IV flow rates: 80 gtt per min; 100 mL per hr
IV set calibrations: 10 gtt per mL; 15 gtt per mL; 60 gtt per mL
time conversions: 60 min = 1 hr; 1 hr = 60 min
In DA, ratios are written as common fractions.
1 tab
125 mg
2g
250 mg
5 mL
1.5 mL
10 units
20 m.Eq
1000 mcg
1 mL
10 mL
1 mg
y noLbe copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecLthe overall learning experience. Cengage Leaming reserves the rig hL Lo remove addiLional conlenl al any time if subscquenL righls restricLions require it.
DIMENSIONAL ANALYSIS/ UNITS CONVERSION
THE BASIC DA EQUATION
The first step in setting up a DA equation is to write the unit of measure being calculated.
One commonly calculated measure is mL, so let's begin by using a mL calculation to illustrate the steps involved. Notice that color is used in the first DA examples to help you learn
the sequence of ratio entry.
EXAMPLE 1
The available dosage strength is 750 mg in 2.5 ml,. How many mL
will be needed to prepare a 600 mg dosage?
Write the mL unit of measure being calculated, followed by an equal sign.
mL =
There are two important reasons for identifying the unit of measure being calculated
first: It eliminates any confusion over exactly which measure is being calculated, and it
dictates how the first or "starting" clinical ratio is entered in the equation.
KEVpoint: In a DA equation, the unit of measure being calculated is written
first, followed by an equal sign.
Next, go back to the problem to identify the complete clinical ratio that contains ml,.
This is provided by the dosage strength available, which is 7 50 mg in 2.5 ml,. Enter
this as a common fraction so that the 2.5 ml, numerator matches the ml, unit of measure being calculated; 750 mg becomes the denominator.
mL = 2.5 mL
750 mg
KEVpoint. In a DA equation, the unit of measure being calculated is matched
in the numerator of the first clinical ratio entered.
All additional ratios are entered so that each denominator is matched in its successive
numerator. The denominator in the first ratio is mg, so the next numerator must
be mg. Go back to the problem to discover that this is provided by the 600 mg dosage to
be given. Enter this now as the next numerator to complete this single-step equation.
2.5 mL
600 mg
mL = - - - X - - 750 mg
KEYpoint: The unit of measure in each denominator of a DA equation is
matched in the successive numerator entered.
All the pertinent clinical ratios have now been entered in this one-step DA equation. The
next step is to cancel the alternate denominator/numerator measurement units
(but not their quantities) to be sure they match. This ensures that the clinical ratios
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO from Lhe cBook and/or eChaplet1s).
Ed llorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions req uire iL
195
196
DO SA GE CA LCU LATI ONS
were entered correctly. Mter cancellation, only the unit of measure being calculated
may remain in the equation. The denominator/ numerator mg/ mg units cancel, leaving
only the mL unit being calculated remaining in the equation.
2.5 mL
600 m,t{
mL = - - - X __7_ 5_
750 ;ng
KEYpoint. Only the unit of measure being calculated may remain in the
equation after the denominator / numerator units of measure are cancelled.
Only the mL being calculated remains in the equation. The math can now be done.
2.5 mL
600 m,t{
mL = - - - X _ _Y'1_f?_
750 ~
,600 ~
4
_ 2.5 mL
mL - JBOs~
X
Divide by 150
ml,
To obtain a dosage of 600 mg from an available dosage strength of 750 mg in 2.5 ml,,
you would give 2 ml,.
DA works exactly the same way for every calculation regardless of the number of ratios
entered As you can see, there are no complicated rules to memorize. In these simple steps,
you have already learned how to use DA for all clinical calculations.
EXAMPLE 2
A dosage of 50,000 units is ordered to be added to an IV solution.
The strength available is 10,000 units in 1.5 ml,. Calculate how
many ml, will contain this dosage.
Write the mL being calculated to the left of the equation followed by an equal sign.
mL =
Locate the complete ratio containing mL, the 10,000 units in 1.5 mL dosage strength
available. Enter this now, with 1.5 ml, as the numerator to match the ml, being
calculated; 10,000 units becomes the denominator.
1.5 mL
m.L = - - - 10,000 units
The units denominator must be matched in the next numerator. This is provided by the
50,000 units ordered. Enter this now to complete this one-step equation.
1.5 mL
50,000 units
mL = - - - - x - - - 10, 000 units
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan . Due to elec.tronic rig hts. some Lhlrd party conle nl may be s upprcssOO fro m Lhe c Book and/or eChaple t1s).
Edllorial review has deemed LhaLany suppressed content does noLmaterially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
DIMENSIONAL ANALYSIS/ UNITS CONVERSION
Cancel the alternate denominator/ numerator units/units entries to double-check for
correct ratio entry. Only the mL being calculated remains in the equation. Do the math.
mL =
1.5 mL
X 50, 000 )mits
10,000 )mits
mL =
X _§0,0001 Jm1fs
15 mL
J_OO;OOD 2 Jm1fs
15
m.L = - = 7.5 ml,
Eliminate the decimal
point in 1.5, then reduce
the numbers as much as
possible; divide the final
fraction.
2
It will require a 7.5 ml, volume of the 10,000 units in 1.5 ml, solution to prepare
the 50,000 units ordered for this IV additive.
EXAMPLE 3
Tablet calculations are not common but would be done the same
way using DA.
Scored (breakable) tablets with a strength of 0.5 mg are available to prepare a dosage of
1.25 mg. How many tablets must you give?
Enter the tab being calculated to the left of the equation followed by an equal sign.
tab =
The tab unit being calculated is matched by the tab strength available, 0.5 mg in I tab.
Enter this as the first ratio, with 1 tab as the numerator; 0.5 mg becomes the denominator.
tab = 1 tab
0.5 mg
The mg denominator must be matched in the next numerator. This is provided by the 1.25 mg
ordered. Enter this to complete the equation.
1 tab
1.25 mg
tab = - - - X - - 0.5 mg
Cancel the alternate denominator/ numerator mg units of measure to check that you
have entered the ratios correctly. Only the tab being calculated remains in the equation.
Do the math.
I tab
1.25 .,..-.I{
tab = - - - X ----'~0.5
_;ng
_ I tab
tab - ,50
;ng X
)25 ;ng
5
Eliminate the decimal points.
Reduce the numbers.
2
5
tab = - = 2.5 tab
2
To obtain the 1.25 mg dosage ordered, 2¼ tab must be given.
Let's stop for a moment now and take a look at what happens if the ratios are incorrectly
entered in a DA equation. We'll assume that the units of measure have not been
entered with their quantities and that the entries have been mixed up. The correct
equation will be shown alongside for comparison.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO fro m Lhe cBook and/or eChaplet1s).
Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
197
198
DO SA GE CA LCU LATI ONS
EXAMPLE 4
A drug label reads 100 mg per 2 mL. The medication order is for
130 mg. How many ml, must you prepare?
Correct
Incorrect
130 mg
100 130
mL = - - - X - - - = 2.6 ml, mL = X= 6500 ml,
100 mg
2
2 mL
In the incorrect equation, the starting ratio is upside down, and because the units of
measure were not entered with their quantities, there is no way to catch this. The safety
step of cancellation to check ratio entry cannot be done. But notice something else: The
answer, 6500 mL, is impossible. If the entries in a DA equation are mixed up, the numbers
are often so outrageous that you will know instantly that you have made a mistake. But
mistakes are not always this obvious, so stick to the step-by-step calculation rules.
There is a reason for every one of them. Let's look at a few more examples.
EXAMPLE 5
How many ml, ,vill you draw up to prepare a 1.2 g dosage if the
solution available is labeled 2 gin 3 ml,?
Write the mL unit being calculated to the left of the equation followed by an equal sign.
Enter the starting ratio, 2 g in 3 mL, with 3 mL as the numerator to 1natch the mL
being calculated; 2 g becomes the denominator.
mL = 3 mL
2g
Match the g denominator in the next numerator with the 1.2 g ordered to complete the
equation.
mL = 3 mL X 1.2 g
2g
Cancel the alternate denominator/ numerator g units of measure to double-check that the
entries are correct. Only the mL being calculated remains.
3 mL
1.2 ,I
mL = - - X ----'--"2
I,
Do the math, expressing fractional answers to the nearest tenth.
3 mL
1.2
The 1.2 g dosage ordered is contained in 1.8 ml, of the 2 gin 3 ml, solution
available.
EXAMPLE 6
Medication with a strength of O. 75 mg per ml, is available to prepare a dosage of 2 mg. Calculate the mL this will require.
Write the mL being calculated to the left of the equation followed by an equal sign.
mL =
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DIMENSIONAL ANALYSIS/ UNITS CONVERSION
The mL being calculated is provided for the frrst ratio by the 0.75 mg per mL dosage
strength available. Enter 1 mL as the numerator and 0.75 mg as the denominator.
mL =
1 mL
0.75 mg
The mg denominator must now be matched. This is provided by the 2 mg dosage ordered.
Enter this now to complete this one-step equation.
1 mL
2 mg
mL = - - - X - 0.75 mg
Cancel the alternate denominator/ numerator mg units of measure to check for correct
ratio entry, then do the math.
1 mL
2 7n-w{
5
mL = - - - X - - = 2.67 = 2.7 ml,
0.75 ~
It will require 2. 7 ml, of the O.7 5 mg in I ml, dosage available to administer the
2 mg ordered.
►►► PROBLEMS 13 . 1
Calculate these dosages using DA. Express mL answers to the nearest tenth.
1. A dosage of 0.3 g has been ordered. The strength available
is 0.4 gin 1.5 mL.
2. A dosage strength of 0.8 mg in 2 mL is to be used to prepare
a 0.5 mg dosage.
3. Prepare a 1.8 mg dosage from a solution labeled 2 mg in 3 mL.
4. The order is for 1500 mg. You have available a 1200 mg
per mL solution.
5. A dosage strength of 0.2 1ng in 1.5 mL is available. Give 0.15 1ng.
6. The strength available is 1000 mg in 3.6 mL. Prepare
a 600 1ng dosage.
7. A 10,000 units dosage has been ordered. The strength available
is 8000 units in 1 mL.
8. An IV additive has a dosage strength of 20 mEq per 20 mL.
A dosage of 15 mEq has been ordered.
9. A 200,000 units dosage must be prepared from a 150,000 units
in 2 mL strength.
10. An IV additive order is for 400 mg. The solution available has a
strength of 500 mg in 20 mL.
Answers 1. 1.1 ml 2. 1.3ml 3. 2.7ml 4. 1.3ml
9 . 2.7 ml 10. 16 ml
5, 1.1 ml
6 . 2.2ml 7. 1.3ml 8. 15ml
You now know the basics of using DA in calculations. But how do you know if the answer
you obtain is correct? The answer to this question is provided by the key points already
covered.
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199
200
DO SA GE CA LCU LATI ONS
► If the unit being calculated is correctly identified to the left of the equation
If the starting ratio is entered so that its numerator matches the unit of measure being
calculated
If the unit of measure in each denominator is matched in each successively entered
numerator
If the only unit of measure remaining after cancellation is the sa1ne as the unit of measure
being calculated
► If the quantities have been correctly entered
► If the math has been double-checked and is correct
Then the Answer Will Be Correct.
A tall order? Not really. You are doing a clinical dosage calculation. All you must do is carefully follow each step, and the answer will be correct.
In addition, don't divorce your previous learning and reasoning from the calculation process. You already know that most IM dosages are contained in a 0.5-3 mL
volume, that IV additives may be contained in larger volumes, and that large numbers
of tab/ cap are unusual in dosages. If you get an unreasonable answer to a calculation,
you must question it. In time, you will know the average dosages of all the drugs you give
and another safety component will be added to your repertoire, but for now, concentrate on
the simple mechanics of calculation you have just been taught. Don't shortcut these steps,
and you'll do just fine.
EQUATIONS REQUIRING METRIC CONVERSIONS
The major advantage of DA is that it allows multiple ratios to be entered in a single equation. This is especially useful when a drug is ordered in one unit of measure- for example,
mg-but is labeled in another-for example, g or mcg.
There are two ways to handle a conversion. Sometimes, it will be easier to do the conversion before setting up the equation. In other instances, you may elect to incorporate the
conversion into an equation. For practice purposes, let's look at how conversion ratios-for
example, 1 g = 1000 mg or 1 mg= 1000 mcg-are entered in a DA equation.
EXAMPLE 1
The IM dosage ordered is 275 mg. The drug available is labeled 0.5 g
per 2 ml,. How many ml, must you give?
Enter the mL to be calculated to the left of the equation. Locate the ratio containing
mL, the 0.5 g per 2 1nL dosage strength, and enter it, with 2 mL as the numerator; 0.5 g
becomes the denominator.
mL = 2 mL
0.5 g
When you refer back to the problem, you will not find a g measure to match the starting
ratio g denominator. The dosage to be given is in mg. So, a conversion ratio between
g and mg is needed: 1 g = 1000 mg. Enter this now, with I gas the numerator to
match the g of the previous denominator; 1000 mg becomes the new denominator.
1g
mL = - - X - - 0.5 g
1000 mg
2 mL
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DIMENSIONAL ANALYSIS/ UNITS CONVERSION
The final entry, the 275 mg dosage to be given, will automatically fall into its correct
position as it is entered as the final numerator to match the mg of the previous
denominator. The equation is now complete.
mL = _2 _mL
_ X _ l_g_
X _27_5_ m
_g
0.5 g
1000 mg
Cancel the alternate denominator/ numerator g/g and mg/ mg units of measure to doublecheck the ratio entry. Only the mL being calculated remains. Do the math.
i
mL = 2 mL X
1
X 275 )Jli = I.I ml,
0.5 /
1000 ~
To give a dosage of275 mg, you must prepare I.I ml, of the 0.5 gin 2 ml, strength
solution.
EXAMPLE 2
The drug label reads 800 mcg in 1.5 ml,. The IM order is for 0.6 mg.
Enter the mL to be calculated followed by an equal sign to the left of the equation.
Locate the ratio containing mL, 800 mcg in 1.5 mL. Enter 1.5 mL as the numerator to
match the mL being calculated; 800 mcg becomes the denominator.
1.5 mL
mL = - - 800 m cg
There is no mcg measure in the problem, wltich is your clue to the necessity for a
conversion ratio. Enter the 1000 mcg = 1 mg conversion ratio, with 1000 mcg as the
numerator to match the mcg of the previous denominator; 1 mg becomes the denominator.
mL = 1.5 mL X 1000 mcg
800 m cg
1 mg
The mg denominator is now matched by the 0.6 mg dosage to be given, and completes the
equation.
mL = 1.5 mL X 1000 mcg X 0.6 mg
800 m cg
1 mg
Cancel the alternate denominator/ numerator mcg/ mcg and mg/ mg units of measure to
check for correct ratio entry. Only the mL being calculated should remain in the equation.
Do the math.
1.5 mL
1000 """'"'g
0.6 m6
mL = - - - X _ _y-n-,_~_ X _ _,Yif,_ = 1.12 = I.I ml,
800 jJlCg
l prg
To give a dosage of 0.6 mg from the available 1.5 ml, per 800 mcg strength, you must
prepare I.I mL.
EXAMPLE 3
Prepare a 0.5 mg dosage from an available strength of200 mcg per ml,.
Enter the mL being calculated to the left of the equation followed by an equal sign. Enter
the 1 mL in 200 mcg dosage as the starting ratio, with 1 mL as the numerator to match
the mL being calculated; 200 mcg becomes the denominator.
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201
202
DO SA GE CA LCU LATI ONS
1 mL
mL = - - 200 mcg
A mcg to 1ng conversion ratio is needed. Enter 1000 mcg as the nmnerator to 1natch the
mcg in the previous denominator; 1 mg becomes the new denominator.
mL =
1 mL X 1000 mcg
200 mcg
1 mg
The mg denominator is now matched by the 0.5 mg dosage ordered to complete the
equation.
mL =
1 mL X 1000 mcg X 0.5 mg
200 mcg
1 mg
Cancel the alternate mcg/mcg and mg/ mg units of measure to double-check for correct
ratio entry. Only the mL unit being calculated remains in the equation. Do the math.
_
mL -
1 mL
.,....,✓,: X
200 ~g
1000 ;neg'
~
lyig
0.5 ~ _
X
- 2.5 ml,
A 0.5 mg dosage requires a 2.5 mL volume of the 200 mcg per mL strength solution
available.
EXAMPLE 4
The medication has a strength of 0.5 gin 1.5 ml,. Prepare 7 50 mg.
Enter the mL to be calculated to the left of the equation followed
by an equal sign. Enter the starting ratio, the 1.5 mL in 0.5 g dosage
available, with 1.5 mL as the numerator, to match the mL being
calculated; 0.5 g becomes the denominator.
mL = 1.5 mL
0.5 g
There is no g dosage in the problem, which signals the need for a conversion ratio. Enter
the 1 g = 1000 mg conversion ratio, with 1 g as the numerator, to match the g denominator of the starting ratio; 1000 mg becomes the new denominator.
mL = 1.5 mL X
1g
0.5 g
1000 mg
Enter the dosage ordered, 750 mg, as the final numerator to match the mg in the previous
denominator. The equation is complete.
1.5 mL
1g
750 mg
mL = - - - X - - - X - - 0.5 g
1000 mg
Cancel the alternate g/ g and mg/ mg units of measure to check the accuracy of ratio enh·y,
then complete the math.
1.5 mL
1 rl
750 m,t{
5
mL = - - - X ------'-" - X _ _>"
_ = 2.25 = 2.3 ml,
0.5
1000 ptg
j
A 750 mg dosage requires 2.3 mL of the 0.5 gin 1.5 ml, medication.
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DIMENSIONAL ANALYSIS/ UNITS CONVERSION
►►► PROBLEMS 13.2
Calculate these dosages using DA. Express mL answers to the nearest tenth.
1. Prepare 0.1 g of an IM 1nedication from a strength of
200 mg per rnL.
2. A drug label reads 0.1 gin 2 rnL. Prepare a 130 mg dosage.
3. An oral solution has a strength of 500 mg in 5 rnL. Prepare
a 0.6 g dosage.
4. Prepare a 0.75 g dosage from a 250 mg per mL strength solution.
5. Prepare 500 mg for IM injection from an available strength of
1 g per 3 rnL.
6. A dosage of 85 mg is ordered, and the drug available is labeled
0.1 gin 1.5 rnL.
7. The strength available is 500 mcg in 1.5 rnL. Prepare
a 0.75 mg dosage.
8. A dosage of 1500 mg has been ordered. The solution available
is 0.5 g per rnL.
9. The dosage strength available is 200 mcg per rnL. A 0.5 mg dosage
has been ordered.
10. The dosage ordered is 0.2 g. Tablets available are labeled 80 mg.
Answers 1. 0.5 ml 2. 2.6 ml 3 . 6 ml 4. 3 ml 5. 1.5 ml 6. 1.3 ml 7. 2.3 ml 8. 3 ml
9 . 2.5 ml 10. 2½ tab
Summary
This ends your introduction to clinical calculations using dimensional analysis. The
important points to remember from this chapter are:
The unit of measure being calculated is written first to the left of the equation,
followed by an equal sign.
All ratios entered must include the quantity and the unit of measure.
The numerator in the starting ratio must be in the same measurement unit as the
unit of measure being calculated.
The unit of measure in each denominator must be matched in the numerator of
each successive ratio entered.
Metric system conversions can be made by incorporating a conversion ratio
directly into the DA equation.
The unit of measure in each alternate denominator and numerator must cancel,
leaving only the unit of measure being calculated remaining in the equation.
The numerator of the starting ratio is never cancelled.
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203
204
DO SA GE CA LCU LATI ONS
Summary Self-Test
Calculate these dosages using DA. Express mL answers to the nearest tenth (or hundredth where indicated) using the medication labels provided. Measure the dosages you
calculate on the syringes provided. Have your answers checked by your instructor to be
sure you have calculated and measured the dosages correctly.
Dosage Ordered
mLNeeded
1. terbutaline sulfate 800 mcg
TERBUTALINE
SULFATE IIJECTIGN USP
FOR SC INJfCTION ONLY.
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DIMENSIONAL ANALYSIS/ UNITS CONVERSION
mL Needed
Dosag e Ordered
4. fentanyl citrate 0.15 mg
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Dosage Ordered
8. midazolam HCI 4 m g
MIDAZOLAM
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USUAL DOSAGE: See package Insert.
NCI INJECTION
Store at controlled room temperature
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Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplicated , in whole or in part. Due to elec.tronic rig hts. some Lhird party conte nt may be .supprcs..,;,ed from Lhe cBook and/or eChapter(s).
Edilori.al review has deemed LhaL any suppressed content does nol materially :iffecl Lheoverall leaming e xpe rience . Ceng age Leaming re.serves Lhe right Lo remove additional conte nt al any Lime if subsequent rig hts res trictions req uire iL.
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207
DIMENSIONAL ANALYSIS/ UNITS CONVERSION
mLNeeded
Dosage Ordered
12. calcium gluconate 0.93 mEq for an IV additive
NOC 00000-0000-00
CALCIUM GLUCONATE
,,.;
INJECTION, USP 10%
0
4.65 mEq/ 10 ml Calcium IRx only I
(0.465 m Eq/ml)
N
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13. morphine sulfate 1.5 mg
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10 mg/10 ml (1 mg/ml) ll o-nly
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INA PSINI£®
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PHARMACEUTICALS
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Edilori.al review has deemed LhaLany suppressed contcnl does nol materially affecl lheoverall leaming experience. Cengage Leaming re.serves lhe righl lo remove addilional contenLal any Lime if subsequent rig hts restrictions require iL
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208
DO SAGE CA LCU LATI ONS
mLNeeded
Dosage Ordered
16. Dilantin®0.1 g
package insert.
l}:. only
M•nufectu-red by:
hrtced411• Pharm-.itlcals. lne.
Rocnes,e,, Ml '8307
F«:
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o.v of wam..r•Lamben Co
Moula ~ Ins, NJ 01950 USA
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N 0071•4475•45
STcRl•VIAL4P
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17. medroxyprogesterone 0.9 g
S<e-LIQe.-tlorcoml>lttt
oroou« lo('()tm•tfcn
NOC 0009·0626·02
10 ml Vial
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10. 5 "19: sodium ...-a~
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Oepo-Provera•
oontrollt<l roo'n toma,orature 20'
10 ?S"C 16!" to )'T'fl 11M usPI
tacn mi coni.lM •
procn.,,tttoile •c:etata:. 400 mg
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Ul~1100 MICl\lOln •9001 USA
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18. Ativan 7 mg
~
NOC 60977-11 3-71
~ only
Ativan (lorazepam) {)
Injection
~
40 mg/1 0 ml (4 mg/ml )
FOR IM USE
FOR IV ROUTE, SEE DIRECTIONS
10 ml Multiple Dose Vial
Bax ter
Manu1actured by Suter Healthcare C<lparation
Deerfield, IL 60015 USA
462· 160-01
For IV use. add ltional
dilution Is required; see
accompanying Information.
usual Dosage: Seeaccompanylng information.
PROTECT FROM LIGHTDo nol use tt sohrtlon Is
discolored or contains
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STD RE IN A REFRIGERATOR
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Edilori.al review has deemed LhaL any s uppressed content does noL rn:iterially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions require it.
DIMENSIONAL ANALYSIS/UNITS CONVERSION
209
mLNeeded
Dosage Ordered
19. Vistarile 120 mg
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fO• ll<Til~SClllAA UU OIIIU
llfUALMJUll DOU; NI• rl!l!MU t l\l
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20. sodium chloride 60 mEq for an IV additive
NOC 0000-0000-00
SODIUM CHLORIDE
INJECTION, USP
Pr....-vativefrH
CONCENTRATED
Each ml contains: sodium chloride 234 mg;waterfor inje<tion
q.~ pH may have been adjusted with hydrochloric acid.
8008 m0smol/L4,000 mEq/L
Directions forpham,acy bulk package: Swab stopperwith
an antiseptic solution. Withdraw contents of the vial using a
sterile dispensing set. If prompt Huid transfer is not possible,
a maximum time of 4 hours from the time of initial entry is
allowed to complete the transferring operations, Discard the
container no later than 4 hours after initial dorure.
PHARMACY BULK PACKAGENot for direct infusion
23.4% 4 mEq/mL
FOR IV USE ONLY
AFTER DILUTION
100 ml
Multiple Dose Vial
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21. atropine sulfate 150 mcg
10 mL
1 mg
0.1 mgl mL
ATROPINE SULFATE
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22. meperidine 75 mg
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Editorial review has deemed LhaL any suppressed content does nol materially affect lheoverall leaming e xpe rience. Cengage Leaming re.serves lhe right Lo remove addiliona..l conte nL al any Lime if subsequenL rig hts restrictions require iL
210
DO SA GE CA LCU LATI ONS
mLNeeded
Dosage Ordered
23. fentanyl citrate 80 mcg
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betamethasone sodium phosphate
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25. morphine sulfate 20 mg
-= ~I1l
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~ FOR D'IOUML
! Ba 1rtr11·
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26. lorazepam 6 mg
I?, only For IVuse, additional
dilution Is required; see
accompanying Information. (lorazepam)
Usual Dosage: See accompanying Information.
;;;;;;; i:i
PROTECT FROM LIGHT = ;:::
(4 mg/ml)
Do not use HsoluUon Is
ijj ~
FOR IM USE
discolored or contains
- §
o
a
precip
itate
.
;::,-,
ci.
FOR IV ROUTE, SEE DIRECTIONS
STORE IN A REFRIGERATOR
e. .9 Jl
10 ml Multiple Dose Vial
NOC 60977-11 3-71
Ativan
Injection
40 mg/10 ml
Baxter
Q
t',
Manufactured by Baxter Health en Corporaflon
Deerfield, IL 60015 USA
462-1 60--01
= . .,
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Copyrig hl 20 15 Ccngage Leaming. All RighL'i Reserved. May nol be copied, scanned, or duplicated, in whole or in pan. Due to elec.tronic rights. some Lhird party conte nt may be suppressed fro m Lhe c Book and/or eChaptcr(s).
Editorial review bas deemed Lhat any suppressed content does nol materially affect lheoverall leaming experience. Cengage Leaming re.serves lhe right Lo remove addilional content al any Lime if subsequent rig hts res trictions require iL
a,
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211
DIMENSIONAL ANALYSIS/ UNITS CONVERSION
mLNeeded
Dosage Ordered
27. Dilantin®0.15 g
>o
N 0071 ·447!>-45
Do-.ge-See
peckogo insen.
~ only
STtfil•VIAl.$
... I
. -- !
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A-ltr,Ml'8J07
for
Oiv o(W.,_.........,, Ca
Monjs Pion, IIJ 0'1990 USA
0
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28. doxorubicin HCI 16 mg for an IV additive
:n
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30. methotrexate 40 mg
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Methotrexate
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Edilori.al review bas deemed LhaL any suppressed content does nol materially :iffecl Lheoverall leaming e xpe rience . Ceng age Leaming re.serves Lhe right Lo remove additional conte nt al any Li me if subsequent rig hts res trictions require iL.
212
DO SA GE CA LCU LATI ONS
mLNeeded
Dosage Ordered
31. midazolam HCI 3 mg
MIDAZOLAM
NDC 55390-126-05
5 ml vial
USUAL DOSAGE: See package insert
Store at oontrolled room temperature
15° to 30°C (59° to 86°f) .
DISCARD UNUSED PORTION.
Mfg by: Ben Venue Labs, Inc.
•Mida:zolam 5 mo/ml (as tha hydrochloride) Bedford, OH 44146
Mfg for: Bedford Laboratories™
FORIM ORIV USE ONLY
Bedford, OH 44146
Contains Benzyl Alcohol RI ONLY
KC-MDZ-VB02
HCI INJECTION
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32. ondansetron 3 mg
55390-121•10
ONDANSnRON HOC
t ml. SIIIQII DOM VIII
IIUfCnOII USP
RI DN~Y
4 llg/2 n.
MIO lo!:
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33. dexamethasone 5 mg
Ill
NOC00000-000-00
16501
DEXAMETHASONE
SODIUM PHOSPHATE
INJECTION, USP
equivalent to
I■
4 mg/ml
Dexam1Hhasone PhOsphale
For IMor (V U.se, See Insert
For Other Routes
1 ml
Sterle, N ~nic
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(l!ydtoxyzmt hydrochloride}
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Edilori.al re view has deemed LhaL any suppressed content d oes nol materially :iffecl Lheoverall leaming e xpe rience . Cengage Leaming re.se rves Lhe right Lo remove additional conte nt al any Lime if subsequent rig hts res trictions require iL.
213
DIMENSIONAL ANALYSIS/UNITS CONVERSION
mLNeeded
Dosage Ordered
35. ketorolac tromethamine 20 mg
-..
KETOROLAC
I ..:
TROMETHAMINE
IHJfCTION USP
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9
36. nalbuphine HCl 30 mg
NDC 63481-509-05
NUBAIN®
(Nalbuphine HCI) I~ onlr
20 m9{'.ml injection
10 ml MulYele Dose Vial
u
C:
E11ch mt. cont& •no: 20 mo f161buphine
HCI, 0,94'!1, sodiUm citrate hyd10Ui,
1.26% ottric acid amycrous. and
o 2% of a 9 ·1 m1X1ute of me1hyl and
propylparaben, as preseivatlves pH is
adJ1$1ed. ij neocssa,y, to 3.6 lO 3. 7
wnh hydl'ochlorlc acid
FOR IM, SC OR IV use
Usual Dosage, See ~ckage lnset1
for gompfe1e prescnc g lllfo<mation.
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38. cyanocobalamin 750 mcg
NOC 00000-0000-00
0
0
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0
0
0
0
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CVANOCOBALAMIN
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1000mcg/ml
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Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May nol be copied, scanned, or duplicated. in whole or in pan. Due Lo elec.tronic rig hts. some Lhird party conlenl may be s uppressed fro m the e Book and/or eChaple t1s}.
Edilori.al review has deemed LhaL any s uppressed conlcnl does nol materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLional conle nl al any time if subsequenl rig hls restricLions require it.
214
DO SA GE CA LCU LATI ONS
Dosage Ordered
mLNeeded
39. aminophylline 0.4 g for an IV additive
NDC 0074-m&-01
Eich ml t01111lns 1minophytl1n11
lcalcult11d u lht dihydnla) 25 mo
'D,
lequivll1n1 to 111.7 mg/mlol 1nl1ydro111
._~ only 1hlolllrtllnt}, May ccw111ln an nc■ss al
AMINOPHYLLINE
• USP
IRJ.,
500 mg (25 mg/mL) e1byfened11miftt IOI p_H 1d',us1JTient.
pit 8..8 (8.6 to 9.ol. Discard unused
Protect fro11 llgk
panlall Sttrlll. nanwagenic. fill I.V
DO HOT USE IF CRYSTALS KAVE use. U$u1I dost: Stt inaett
SEPARATlD ~ROM SOlUIION
58-39A7-2/R 12-12/ 02
4SBOTT 1..t80ll• Oli
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40. Dilantin' 125 mg
Douge-See
J)tck.ege Insert.
~ onty
Manu!Ktut9dt,y:
,_bdll1Pberal11ntldc1II.II&.
~.MICIJ07
ra:
MRICH>ilMS
Div ofW.,....._.mben Co
Morris Pia'"-, Kl 07950 USA
N 0071 •«75-45
SltRl-VW..
Dilantine
CPheny,oln Sodium
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readyA,,bclt1
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250mgln5ml.
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41. ketorolac 25 mg
KOOROLAC
TROMETHAMlME
INJECTION USP
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42. Vistaril' 50 mg
Vistaril
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,.,,,,,.m,111
2$...,...
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(9)
Copyrig hl 20 15 Cengage Leaming. All RighL'i Reserved. May nol be copied, scanned, or duplicated. in whole or in pan. Due to elec.tronic rights. .some Lhird party content may be .suppressed from the eBook and/or eChaple t1s}.
Editorial review has deemed that any suppressed content does not materially affect Lheoverall leaming experience. Cengage Lea.ming reserves Lhe right Lo remove additional conte nt al any time if subsequent rights restrictions require it.
215
DIMENSIONAL ANALYSIS/UNITS CONVERSION
mLNeeded
Dosage Ordered
43. Ativan 10 mg
NDC60977-113-71
(?,only For IV use, addltional
dilution Is required; see
accompanying
Information.
(lorazepam)
usual Dosage: See accompanying Information.
= ::;
PROTECT FROM LIGHT(4 mg/ml)
Oonotuseffsofutfonis
2
FOR IM USE
discolored or contains
3
- _ '-' ~
FOR IV ROUTE, SEE DIRECTIONS a precfpttate.
STOREfNAREFRfGERATOR
S
10 ml Multi pie Dose Vial
D
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Ativan
Injection
40 mg/10 ml
= "'
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Deerf•ld, IL 60015 USA
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44. Robinul" 180 mcg
NOC 6"77· 15$-81
•
•
Roblnul •
Injectable •
I
(Glycapynolate
Injection. USP)
---.----~---~=- -,,.:,;;:
~
;:!:
0.2 mg/lllL ~ 11111 •
FOR IM OR IVUSE
----c.,.
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45. hydroxyzine HCl 70 mg
,...,.. _...,,,,.,_
,._
......,_...... ""'°"""'
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........_..""_
--<-•~
Hll--11110-.f,
_ _ , __ ...~ f f -
101111.
S.1et 1mu,,-. • ..,... fc:WlllrM
Vistaril
(hydrol)'ZIM h)'drodllondt)
trllw IS •Ot,,_..,,...,. ,.,.
olllOMl<St""' SMtlloll
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46. penicillin 400,000 units
Penicillin G Procaine
Injectable Suspension
1,200,000 UNITS per 2 ml
FOR DEEP IM INJECTION ONLY
WARNING: NOT FOR INTRAVENOUS USE
Mtg. by: Kirig Pharmaceu1icals. Inc.. Bristol, TN
3000964
Lot:
Ill III 111 11111111 111111
100\00000000000000
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Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplicated, in whole or in part. Due to elec.tronic rights. some Lhird party conte nt m ay be s uppressed fro m Lhe c Book and/or eChaplc-r{s).
Edilori.al review bas deemed LhaL any suppressed content does nol materially :iffecl Lheoverall leaming e xpe rience . Cengage Leaming re.serves Lhe right Lo remove additional conte nt al any Li me if subsequent rig hts restrictions require iL.
216
DO SAGE CA LCU LATI ONS
mLNeeded
Dosage Ordered
47. heparin sodium 1500 units (calculate to the nearest hundredth)
<(.
-
Cl) " '
::::,
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0
Sample label.
Please see
package insert
-
<D
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5, 000 per ml
USP units
0
0
0'
0
0I
0
0
0
0
0
for compJtte
prescribing
information.
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48. potassimn chloride 20 mEq for an IV additive
NOC 0000-0000-00
Preservative Free
POTASSIUM CHLORIDE
MUST BE OlllJfED Pm OR
For Injection Concentrate, USP
lO N AOMINISTAATION
.,;
Concentrated Must Be
Dilu ted Before Use
Sterlie, nonpyrogenic
Each ml contains, potass.ium
ch1oride 2 mEq (149mg) wate,
bf injection q.s.HOancVorKOH
may haw been added for pH
adjusunem.
130 mEq l (2mEq/ml)
0
N
Cl
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Single Dose Vial
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,:JW Cengage Learning
Cl
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Contains no more th.In 100rncg,'l
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Ston! at 2<1' to 25~
~ • to 7TF).
15ml
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49. Inapsinee 4.5 mg
rmc llo,&411CMX%
l a t . - -le
INAPSINI~®
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(DtilPDlDOl.) INJECTION
5 mg/2 mL (2.5 mg/mL)
I
TAYLOR
Al)PADL
IL ft~S .,,
-
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50. epinephrine 1.4 mg
NDC 00000-0000-00
0
0
I
0
0
0
0
I
0
0
0
0
0
EPINEPHRINE
.,;
INJECTION, USP
0
N
Cl
1:1000 (1 mg/ml)
.E
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CONTAINS NO SULFITE$
OR PRESERVATIVES.
FOR IV, IM, OR SC USE
1 ml AMPULE
IRx only I
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liilil For Educofiond Puposes Only
(9)
Copyrighl 20 15 Ccngage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplicated, in whole or in part. Due to elec.tronic rights. some Lhird party conte nt may be s uppressed from Lhe c Book and/or eChaplc-r{s).
Edilori.al review has deemed LhaL any suppressed content does noL materially :iffecl Lheoverall leaming expe rience. Cengage Leaming re.serves Lhe right Lo remove additional content al any Lime if subsequent rig hts restrictions require iL
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217
DIMENSIONAL ANALYSIS/UNITS CONVERSION
mLNeeded
Dosage Ordered
51. Nubain$ 15 mg
NOC 63481 -509-05
NUBAIN®
(Nalbuphine HCI) Rx ool,·
-
<.>
20 mg/mL injection
c::
10 mL Multiple Dose Vial
"'
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"'
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Eech ml. cont11>~ 20 mg Mlbupt,ine
HCI, 0.94% sodium citratEt hydrow,
1.26'll. cnnc acid anhydrous, and
o 2% of a 9 · t mbltllre of methyl and
propylparaben, as prese,vatlves pH la
c::,
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ad,iSled. ij neocssa,y. 10 3,6 10 3 ,7
with hydtochlork: lloid
0
-0
FOR IM, SC OR IV USI:
E
Usual Dosage, See paclcajje insen
for comp1e1e preecnbrig mtotmatlon.
$1ore a12s•c ~7•~; l!l<cur:s1cns
pemulled to I -00 C (59"-SS•F).
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Chadds Ford, PA 19317
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52. furosemide 15 mg
NOC 00000-0000-00
0
FUROSEMIDE
~
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Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leamlng e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire iL
218
DO SA GE CALCU LATI ONS
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6. 1.5 ml
7. 0.38 ml
8. 0.8 ml
9 . 1.2 ml
10. 0.8 ml
11. 8 ml
12. 2 ml
13. 1 .5 ml
14. 0.45 ml
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28. 8 ml
29. 1.2 ml
30. 1.6 ml
31 . 0.6 ml
32. 1.5 ml
33. 1.3 ml
34. 1.6 ml
35. 1.3 ml
36. 1.5 ml
37. 1.5 ml
38. 0.8 ml
39. 16 ml
40. 2.5 ml
41 . 1.7 ml
42. 2 ml
43. 2.5 ml
44. 0.9 ml
45. 1.4 ml
46. 0.7 ml
47. 0.3 ml
48. 10 ml
49. 1.8 ml
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51. 0.8 ml
52. 1.5 ml
53. 1.5 ml
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CHAPT R
The formula method may be used for one-step dosage calculations. It is
really just a variation of ratio and proportion and in other texts has occasionally been presented using different initials. If you are familiar with
different initials from those used in this chapter, by all means continue
to use them. The important thing is the answer, not the initials used to
obtain it.
BASIC FORMULA
The initials most commonly used in the formula method are as follows:
D
-X Q=X
H
Here's what these initials mean.
D = desired
The dosage ordered, in mg, g, etc.
H= have
The dosage strength available, in mg, g, etc.
Q = quantity
The mL volume the dosage strength
available is contained in
X = the unknown
The mL volume the desired dosage will be
contained in
It is necessary to memorize this formula. Printing it several tunes will
help you to remember it
The same three precautions that governed previous calculations
also apply to the use of the formula: (1) routinely double-check all math;
(2) assess each answer to determine if it is logical; and (3) seek help if you
have any doubt of your accuracy. Now let's look at some examples of how
the formula is used so you can begin to be comfortable with it.
The unknown, X, will always be expressed in
the same units of measure as Q, the mL volume the dosage
available is contained in.
.,, ;.,,+-
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Edilorial review has deemed thal any suppressed contenl does nol m.at.erially affecl the overall learning expe.rie.oce. Cengage Leaming reserves the righL Lo remove addiLi
220
DO SA GE CA LCU LATI ONS
A dosage of 80 mg is ordered. The dosage strength available is 100 mg
in 2 ml,. Calculat e the mL n ecessary t o administ er this dosage.
The desired dosage (D) is 80 m g. You have (H) 100 m g in (Q) 2 mL available. Rem ember
that X will always b e expressed in the sam e units of m easure as Q, which is mL in this
problem . Always set up the formula with the units of measure included.
EXAMPLE 1
(D ) 80mg
.
- - - X (Q) 2mL = XmL
(H ) lOOmg
-
80
100
X 2 = X = 1.6 ml,
To give a dosage of 80 mg, you must administer 1.6 ml,.
After you h ave double-ch ecked your m ath, look at your answer to see if it is logical.
The dosage strength available is 100 m g in 2 mL. To prepare 80 mg, which is a smaller
dosage, you will need a smaller volume. Your an swer, 1.6 mL, is sm aller; therefore,
it is logical.
EXAMPLE 2
The dosage ordered is 0.4 mg. The strength available is 0.25 mg
in 1.2 ml,.
The desired dosage (D ) is 0.4 m g. You h ave (J-1) 0.25 m g in ( Q) 1.2 mL.
0.4mg
- - - X l .2mL = XmL
0.25 mg
0.4
- - X 1.2 = X = 1.92 = 1.9 ml,
0.25
To give a dosage of 0.4 mg, you must administer 1.9 ml,.
The 0.4 m g ordered is a larger dosage than the 0.25 m g strength available, and the volume
that contains it must b e larger, which 1.9 mL is.
EXAMPLE 3
A dosage of 750 mcg h as b een order ed. The strength available is
1000 mcg per ml,.
750mcg X lmL = XmL
lOOOmcg
750
1000
X 1 = X = 0.75 = 0.8 ml,
To give a dosage of 750 mcg, you must administer 0 .8 ml,.
The an swer should b e a smaller quantity than 1 mL, and 0.8 mL is.
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Ed llorial review has deemed LhaLany suppressed content does noLmaterially affec t Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
FORMULA METHOD
►►► PROBLEMS 14.1
Calculate the dosages. Express answers to the nearest tenth.
1. A dosage of 0.8 g has been ordered. Tl1e strength available
is 1 g in 2.5 mL.
2. You have available a dosage strength of 250 1ng in 1.5 mL.
The order is for 200 mg.
3. The strength available is 1 g in 5 mL. The order is for 0.2 g.
4. A dosage of 300 mcg has been ordered. The strength available
is 500 mcg in 1.2 mL.
Answers 1. 2 ml 2. 1.2 ml 3 . 1 ml 4 . 0.7 ml
USE WITH METRIC CONVERSIONS
Consider the following problem:
A dosage of 200 mcg is ordered. The strength available is 0.3 mg in 1.5 mL.
This problem cannot be solved as it is now written because the drug strengths, D and
H, are in different units of measure. One of them must be changed before the problem can
be solved.
KE paint: The drug strengths, D and H, must be expressed in the same
units of measure.
EXAMPLE 1
■
A dosage of 200 mcg is ordered. The strength available is 0.3 mg
in 1.5 mL.
Convert mg to mcg to eliminate the decimal point.
0.3 mg = 300 mcg
■
Use the formula for the calculation.
200mcg
- - - X l .5 mL = XmL
300mcg
200
X 1.5 mL = I ml,
300
To give 200 mcg, you must administer 1 ml,.
Your ans,.ver must be a smaller quantity than 1.5 mL, ,.vhich 1 mL is, because the
dosage ordered is smaller than the strength available. Therefore, it is logical.
EXAMPLE 2
■
A dosage of O. 7 g has been ordered. Available is a strength of
1000 mg in 1.5 ml,.
Convert g to mg to eliminate the decimal point.
0.7 g = 700 mg
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221
222
DO SAGE CA LCU LATI ONS
■
Use the formula for the calculation.
7
00 mg X 1.5 mL = X mL
1000mg
700
- - X 1.5 mL = 1.05 mL = I.I ml,
1000
To give 0.7 g, you must administer I.I ml,.
The answer should be less than 1.5 m.L, which 1.1 mL is, because the 700 mg ordered is
less than the 1000 mg strength available.
►►► PROBLEMS 14.2
Calculate the dosages. Express answers to the nearest tenth.
1. The dosage ordered is 780 mcg. The strength available
is 1 mg per mL.
2. The available dosage strength is 0.1 g per m.L. The dosage
ordered is 250 mg.
3. Prepare a dosage of 0.6 mg from an available strength of
1000 mcg per 2 m.L.
4. A dosage of 0.4 g has been ordered. The strength available is
500 mg per 1.3 m.L.
Answers
1. 0.8 ml 2. 2.5 ml 3 . 1.2 ml 4 . 1 ml
USE WITH UNITS AND mEq CALCULATIONS
Dosages expressed in units or mEq are handled in exactly the same way as metric measures.
EXAMPLE 1
A dosage of 7500 units is ordered. The available strength is
I 0,000 units per ml,.
7500units
10,000 units
X lm.L = Xm.L
7500
10,000
X 1 = 0.75 = 0.8 ml,
To give 7500 units, administer 0 .8 ml,.
The dosage ordered, 7500 units, is less than the strength available, 10,000 units, and must
be contained in a smaller volume of solution than 1 m.L, which 0.8 mL is.
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FORMULA METHOD
EXAMPLE 2
A dosage strength of 40 mEq in 5 ml, is available. You are to prepare 30 mEq.
30mEq
- - - X 5m.L = Xm.L
40 rnEq
30
- X 5 = 3.75 = 3.8 ml,
40
A volume of 3.8 ml, is necessary to prepare a 30 mEq dosage.
The dosage ordered, 30 mEq, is less than the 40 mEq dosage strength available. It must be
contained in a smaller volume than 5 m.L, and the answer, 3.8 mL, indicates that it is.
►►► PROBLEMS 14.3
Calculate the dosages. Express answers to the nearest tenth.
1. A dosage strength of 1000 units per 1.5 mL is available.
Prepare a 1250 units dosage.
2. A dosage of 45 units has been ordered. The strength available
is 80 units per m.L.
3. The IV solution available has a strength of 200 mEq per 20 m.L.
You are to prepare a 50 mEq dosage.
4. The strength available is 80 mEq per 5 m.L. Prepare 30 mEq.
Answers 1. 1.9 ml 2. 0.6 ml 3. 5 ml 4. 1.9 ml
Summary
This concludes the chapter on using the formula method to solve dosage calculations.
The important points to remember from this chapter are:
The formula method can be used to solve problems expressed in metric, unit, and
mEq dosages.
When the formula method is used, D and H, the dosage strengths, must be
expressed in the same units of measure.
The answer obtained, X, will always be in the same unit of measure as Q, the
quantity.
The math for all calculations is routinely double-checked.
A logical assessment of the answer you obtain is a routine step in calculations.
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223
224
DO SA GE CA LCU LATI ONS
Summary Self-Test
Calculate the dosages. Express answers as decimal fractions to the nearest tenth.
1. A 50 mg dosage has been ordered. The strength available
is 60 mg in 1.5 rnL.
2. Prepare a 300 mcg dosage. The dosage available is 0.4 mg per rnL.
3. Prepare 0.45 g. The strength available is 300 mg per rnL.
4. The medication is labeled 5 mg per mL. An 8 mg dosage
has been ordered.
5. Prepare a 70 mg dosage from a solution labeled 250 mg in 5 rnL.
6. The drug is labeled 25 mg per rnL; 30 mg has been ordered.
7. The label reads 50 mg per mL. Prepare a 60 mg dosage.
8. The order is for 12 mg. The vial is labeled 5 mg per mL.
9. A dosage of 7 mg has been ordered. The vial label reads
10 mg per mL.
10. The dosage strength is 10 mg in 1 mL; 8 mg has been ordered.
11. Prepare a 0.3 g dosage fro1n a medication labeled 900 mg per 6 mL.
12. Prepare a 300 mg IV dosage from a vial labeled 0.5 g in 20 rnL.
13. The vial is labeled 0.5 g per 2 mL. A dosage of 750 mg
has been ordered.
14. Prepare a dosage of 0.2 mg from an available dosage of
250 mcg in 5 rnL.
15. The order is for 130 mg and the single-use ampule is
labeled 0.1 g per 2 mL.
16. Draw up a 12 mg dosage from a vial labeled 15 mg in 5 mL.
17. The ampule is labeled 20 mg in 2 rnL. Prepare 14 mg.
18. The medication is labeled 1.2 g per 30 rnL. Draw up an
800 mg dosage for IV administration.
19. Prepare an 80 mg dosage of a medication labeled 100 mg in 2 rnL.
20. The solution strength is 0.4 mg per mL. A dosage of
300 mcg has been ordered.
21. Prepare a 600 mg dosage from an available dosage strength
of 0.4 g per rnL.
22. Draw up a 60 mEq dosage for addition to an IV from a solution
labeled 40 mEq per 20 rnL.
23. The label reads 400 mcg per rnL; 0.6 mg has been ordered.
24. Prepare a 60 mg dosage from a 75 mg per rnL strength.
25. Prepare a 0.1 g dosage from a vial labeled 40 mg per mL.
26. The drug is labeled 50 mg in 10 mL. The order is for 8 mg.
27. Measure a 0.8 mg dosage from an available strength of
1000 mcg per rnL.
28. Prepare 40 mg from a vial labeled 25 mg per mL.
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FORMULA METHOD
29. A dosage of 10 mg has been ordered. You have available a strength
of 4000 mcg per mL.
30. Prepare 200 mg for IV use of a medication labeled 0.25 g per 25 mL.
31. The dosage strength available is 15 mg in 1 mL; 10 mg has
been ordered.
32. Prepare a 4 mg dosage from a strength available of 5 mg per mL.
33. A dosage of 75 units has been ordered from an available strength
of 90 units in 1.5 mL.
34. You are to prepare 100 mEq for addition to an IV solution.
The solution available is labeled 80 mEq per 20 mL.
35. Prepare a dosage of 180 mg from a 0.15 gin 1 mL solution.
36. Prepare a 7 50-unit dosage from an available strength of
1000 units per mL.
37. Prepare a 20 mEq dosage of an IV additive from a vial labeled
40 mEq per 20 mL.
38. 400,000 units have been ordered and you have available
300,000 units in 1 mL.
39. A dosage of 0.2 mg per 2 mL is available. Prepare a 250 mcg dosage.
40. A dosage of 35 mEq has been ordered for addition to an
IV solution. The solution is labeled 50 mEq per 50 mL.
Answers
1. l.3ml
2. 0.8 ml
3. 1.5 ml
4. 1.6 ml
5. 1.4 ml
6. 1.2 ml
7. 1.2 ml
8. 2.4 ml
9. 0.7 ml
10. 0.8 ml
11. 2 ml
12. 12 ml
13. 3 ml
14. 4 ml
15. 2.6 ml
16. 4 ml
17 . 1.4 ml
18. 20 ml
19. 1.6 ml
20. 0.8 ml
21. 1.5 ml
22. 30 ml
23. 1.5 ml
24. 0.8 ml
25. 2.5 ml
26. 1.6 ml
27. 0.8 ml
28. 1.6 ml
29. 2.5 ml
30. 20 ml
31. 0.7 ml
32. 0.8 ml
33. 1 .3 ml
34. 25 ml
35. 1.2 ml
36. 0.8 ml
37. 10 ml
38. 1.3 ml
39. 2.5 ml
40. 35 ml
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225
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Edilorial review has deemed LhaLany .suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLional conle nl al any time if subsequenLrighls restric:Lions require iL
I
CHAPTER
15
CHAPTER 16
CHAPTER
Body weight is a major factor in calculating drug dosages for both adults
and children. It is the most important determiner of dosages for infants
and neonates, whose ability to metabolize drugs is not fully developed.
The dosage that will produce optimum therapeutic results for any particular individual, either child or adult, depends not only on dosage but
on individual variables, including drug sensitivities and tolerance, age,
weight, sex, and metabolic, pathologic, or psychologic conditions.
The prescriber will order the drug and dosage. However, it is a nursing
responsibility to check each dosage to be sure the order is correct. Each
drug label or drug package insert provides specific dosage details, but
more complete information is readily available in drug formularies, the
Physicians' Desk Reference (PDRJ, and other medical references. The
hospital pharmacist is the ultimate resource for information.
Individualized dosages may be calculated in terms of mcg or mg
per kg or lb per day. The total daily dosage may be administered in
divided (more than one) dosages; for example, every 6 hours or every
8 hours.
Because body weight is critical in calculating infant and neonatal
dosages, measurement is usually done using a weight scale calibrated
in kg. Adult weights may be recorded in either kg or lb; occasionally,
conversions between these two measures are necessary.
CONVERTING lb TO kg
If body weight is recorded in lb, but the drug literature list s dosage
per kg, a conversion from lb to kg will be necessary. There are 2.2 lb in 1 kg.
This means that kg body weights are smaller than lb weights, so the
conversion from lb to kg is made by dividing bodyweight by 2.2. For
ease of calculation, fractional lb may be converted to the nearest quarter
y noL be copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the overall learning expe.rie.oce. Cengage Leaming reserves the rig hL Lo remove addiLional conle nl al any ti.me if subscquenl rig hls restricLions require it.
ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
and written as decimal fractions instead of oz:¼ lb (4 oz) as 0.25, ½ lb (8 oz) as 0.5, and¾ lb
(12 oz) as 0.75. If this kind of accuracy is critical, the prescribing orders should so indicate.
EXAMPLE 1
A child weighs 41 lb 12 oz. Convert to kg.
41 lb 12 oz = 41.75 -:- 2.2 = 18.97 = 19 kg
The kg weight should be a smaller number than 41.75 because you are dividing,
and 19 kg is smaller.
EXAMPLE 2
Convert the weight of a 144½ lb adult to kg.
144½ lb = 144.5 -:- 2.2 = 65.68 = 65. 7 kg
EXAMPLE 3
Convert the weight of a 27¼ lb child to kg.
27¼ lb = 27.25-:- 2.2 = 12.38 = 12.4 kg
►►► PROBLEMS 15.1
Convert these body weights. Round to the nearest tenth kg.
1. 58¾ lb
kg
6. 134½ lb=
kg
2. 63½ lb
kg
7. 112¾ lb=
kg
3. 163¼ lb=
kg
8. 73¼ lb
--
kg
--
kg
9. 121½ lb=
kg
5. 100¼ lb=
kg
10. 92¾ lb
4. 39¾ lb
Answers 1. 26.7 kg 2. 28.9 kg 3 . 7 4.2 kg 4. 18.1 kg
9. 55.2 kg 10. 42.2 kg
--
kg
s. 45.6 kg 6 . 61.1 kg 7. 51.3 kg a. 33.3 kg
CONVERTING kg TO lb
There are 2.2 lb in 1 kg. To convert from kg to lb, multiply by 2.2. Because you are multiplying, the answer in lb will be larger than the kg being converted. Express weight to the
nearest tenth lb.
EXAMPLE 1
A child weighs 23.3 kg. Convert to lb.
23.3 kg= 23.3 X 2.2 = 51.26 = 51.3 lb
The answer must be larger because you are multiplying, and it is larger.
EXAMPLE 2
Convert an adult weight of 73.4 kg to lb.
73.4 kg= 73.4 X 2.2 = 161.48 = 161.5 lb
EXAMPLE 3
Convert the weight of a 14.2 kg child to lb.
14.2 kg = 14.2 X 2.2 = 31.24 = 31.2 lb
Copyrig hl 201 5 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplka ted, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 from Lhe cBook and/or eChapLer(s).
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229
230
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
►►► PROBLEMS 15 .2
Convert kg to lb. Round to the nearest tenth lb.
1. 21.3 kg=
lb
6. 43.7 kg=
lb
2. 99.2 kg=
lb
7. 63.8 kg=
lb
3. 28.7 kg=
lb
8. 57.1 kg=
lb
4. 71.4 kg=
lb
9. 84.2 kg=
lb
5. 30.8 kg=
lb
10. 34.9 kg=
lb
1. 46.9 lb 2. 218.2 lb 3. 63.1 lb 4. 157. 1 lb
s. 125.6 lb 9. 185.2 lb 10. 76.8 lb
Answers
s. 67.8 lb 6. 96. 1 lb 7. 140.4 lb
CALCULATING DOSAGES FROM DRUG LABEL
INFORMATION
Information you will need to calculate dosages from body weight will be on the actual drug
label or on the drug package insert
Calculating the dosage is a two-step procedure. First, the total daily dosage is
calculated. Then it is divided by the number of doses per day to obtain the actual dose
administered at one time.
Let's start by looking at some oral antibiotic labels that contain the mg/kg/ day dosage
guidelines.
EXAMPLE 1
Refer to the information written sideways on the right of the sample
antibiotic label in Figure 15-1 for children's dosages. Notice that the
dosage is 20 mg/kg/day (or 40 mg/kg/day in otitis media). This
dosage is to be given in divided doses every 8 hours-or a total of 3
doses (24 hr+ 8 hr= 3 doses).
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Once you have located the dosage information, you can 1nove al1ead and calculate the
dosage. Let's assume you are checking the dosage ordered for an 18.2 kg child. Start by
calculating the recommended daily dosage range.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due to elec.tronic rig hts. some Lhlnl party conle nl may be .supprcs..,;,ed from Lhe c Book and/or eChapte r(s ).
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
Lower daily dosage = 20 mg/kg
20 mg X 18.2 kg (weight of child)= 364 mg/day
Upper daily dosage = 40 mg/kg
40 mg X 18.2 kg = 728 mg/ day
The recommended range for this 18.2 kg child is 364-728 mg/day.
The drug is to be given in three divided doses.
Lower dosage 364 mg + 3 = 121 mg per dose
Upper dosage 728 mg + 3 = 243 mg per dose
The per dose dosage range is 121-243 mg per dose every 8 hours.
Now that you have the dosage range for this child, you are able to assess the accuracy of
physician orders. Let's look at some orders and see how you can use the dosage range you
just calculated.
I. lithe order is to give 125 mg every 8 hours, is this within the recommended
dosage range?
Yes, 125 mg is within the average range of 121-243 mg per dose.
2. li the order is to give 37 5 mg every 8 hours, is this within the recommended
dosage range?
No, this is an overdosage. The maximum recommended dosage is 243 mg per dose.
The 375 mg dose should not be given; the prescriber must be called and the order
questioned.
3. lithe order is for 75 mg every 8 hours, is this an accurate dosage?
The recommended lower limit for an 18.2 kg child is 121 mg. Although 75 mg might be
safe, it will probably be ineffective. Notify the prescriber that the dosage appears to
be too low.
4. lithe order is for 250 mg every 8 hours, is this accurate?
Because 243 mg per dose is the recommended upper limit, 250 mg is essentially within
normal range. The drug strength is 125 mg per 5 mL, and a 250 mg dosage is 10 mL. The
prescriber has probably ordered this dosage based on the available dosage strength and
for ease of preparation.
5. lithe dosage ordered is 125 mg every 4 hours, is this an accurate dosage?
In this order, the frequency of administration does not match the recommended
dosage of every 8 hours. The total daily dosage of750 mg (125 mg X 6 doses= 750 mg)
is slightly, but not significantly, higher than the 728 mg maximum. There may be areason the prescriber ordered the dosage every 4 hours, but call to verify it.
EVpoint. To determil1e the safety of an ordered dosage, use body
weight to calculate the dosage range ordered, and compare this with the
recommended dosage range in mg/ kg/ day (or mg/ lb/ day). Assessment must
also include the frequency of dosage ordered.
The difference between 4 and 6 mg is much more critical than the difference bet\,veen
243 and 250 mg because the drug potency is obviously greater.
Additional factors that must be considered are age, weight, and medical condition.
Although these factors cannot be dealt with at length, keep in mind that the younger, the
older, or the more compromised by illness an individual is, the more critical a
discrepancy is likely to be.
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231
232
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
KE paint: Discrepancies in dosages are much more significant if the
number of mg or mcg ordered is small.
►►► PROBLEMS 15.3
Refer to the Biaxin° Granules label in Figure 15-2 to answer the questions
for a 20 lb child.
1. What is the child's body weight in kg to the nearest tenth?
2. What is the recommended dosage in mg per day for this child?
3. How many mg will this be per dose?
4. The order is to give 62.5 mg twice a day. Is this dosage reasonable?
5. How many mL would you need to administer this dosage?
6. How much water must you add as diluent to prepare this
oral suspension?
Stort granulu II IS° Ill 30'C l39° Ill
86'f'I.
CONS111UTING INmUCTlOHS:
VOWME OF WATER: 55 ml
MclSllrt 1ho ltqUJfld YOftl!MI ol
w1111 uslno a 111adu1tld qtindt1,
Add ball tile volume of water III lhe
tioa11 and lh1ke vi9oro~ly. Add
Iha rtm1Jnd11 or wmr u, dll bo1lll
tod &l!au.
Con11lns 2.5 g c:larh!iromycln,
Wlltn riited l l dirK!ed, flCh
teupoonllA 15 mU CAlffllins:
Cl•rimrOfflY"'"-. - -12!51119
In o1nilt puntb•~avorall, aqueou,
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100 m L (when mixed}
BIAXIN®
GRANULES
clarlthromycin for
oral suspension
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Answers
1. 9. 1 kg 2. 136.5 mg/day 3. 68.3 mg/dose 4. yes 5. 2.5 ml 6. 55 ml
CALCULATING DOSAGES FROM DRUG LITERATURE
The labels you have just been reading were from oral syrups and suspensions, but the same
calculation steps are necessary for dosages to be administered by the Nor IM route. Parenteral
labels are much smaller in size and usually do not include dosage recommendations. To
obtain these, you will have to refer to the drug package inserts, the PDR, or similar
references. These references will contain extensive details about each drug's chemistry,
actions, adverse reactions, recommended administration, and so on, so it will be necessary
for you to search for and select the information you need under the heading Dosage and
Administration. In the following exercises, the searching has been done for you, and only
those excerpts necessary for your calculations are shown.
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,ed from Lhe cBook and/or eChapLer(s).
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
►►► PROBLEMS15.4
Refer to the cefazolin package insert in Figure 15-3 to locate the information for
pediatric dosages.
1. What is the dosage range in mg/kg/ day for mild-to-moderate
infections?
2. What is the dosage range for mild-to-moderate
infections in mg/ lb/ day?
3. The total dosage will be divided into ho,v many doses per day?
4. In severe infections, what is the maximum daily dosage
recommended in mg/kg? In mg/ lb?
NOC 0000-0000-00
CEFAZOLIN SODIUM
IRx only I
For injection USP
To reduce the development of drug-resistant bacteria and maintain
the effectiveness of product for injection, cefazolin for injection
should be used only to treat or prevent infections that are proven
or suspected to be caused by bacteria.
Pediatric Dosage
For mild to moderately severe infections: Total daily dosage of
25 to SO mg/kg (approximately 10 to 20 mg/lb) of body weight given
in 3 or 4 equal doses. For severe infections: Total daily dosage may be
increased to 100 mg/kg (45 mg/lb) of body weight. Safety for use in
premature infants and in neonates has not been established.
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Answers
1. 25-50 mg 2. 10-20 mg 3 . 3-4 doses per day 4. 100 mg/kg; 45 mg/lb
►►► PROBLEMS 15.5
Use the information you just obtained from Figure 15-3 to do the calculations for a
child who weighs 35 lb and has a moderately severe infection.
1. What is the lower daily dosage range?
2. What is the upper daily dosage range?
3. If the medication is given in 4 divided dosages, what will the
per dosage range be?
4. If a dosage of 125 mg is ordered every 6 hours, will you
need to question it?
Answers 1. 350 mg/day 2 . 700 mg/day 3. 87.5-175 mg per dose 4 . no; within normal range
Copyrig hL 20 15 Ce ngagc Leaming. All RighL'i Reserved May noL be c opied, scanned, or duplicated, in whole or in pan. Due to e lec.tronic rig hts. some Lhlnl party c ontent may be s uppressed from Lhe cBook and/or e Chaple t1s).
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233
234
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
►►► PROBLEMS15.6
Refer to the dosage information in Figure 15-4 to answer the following questions
about adult IV dosages.
1. What is the recommended daily dosage range for
serious infections?
2. In how many divided doses should this daily dosage be given?
3. What is the maximum daily dosage?
4. Calculate the daily dosage range in g for a 176 lb adult.
5. If this dosage is to be given every 6 hours, what will this
individual's dosage range be?
6. If a dosage of 2 g is ordered, what initial assessment would
you make about it?
7. If a dosage of 10 g is ordered every 6 hours, what assessment
would you make?
DOSAGE AND ADMJNISTRATION
MEZUN@ (sterile mezJocillin sodium) may be administered
intravenously or intramU8CUlarly. For serious infectiona. the
intravenous route of administration should be used Intra•
ml19Cular d0fle8 should not exceed 2g per injection.
The recommended aduJt dOIISIV for serious infectiona i8 200300 mg/kg per day given in 4 to 6 divided doees The USJ&al
doee is 3g given every 4 hours (18g/day) or 4g given every 6
hours (16g/day). For life-threatening infections, up to 350
mg/ kg per day may be administered, but the total daily~
age should ordinarily not exceed 2'tg.
[See table below.)
For patients with life-threatening infection.a. 4g may be administered every•· hours (24g/day).
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Answers 1. 200-300 mg/kg 2. 4-6 doses; every 6 or 4 hours 3. 24 g 4. 16-24 g 5, 4-6 g
6. The dosage is too low. 7. The dosage is too high.
►►► PROBLEMS15.7
Refer to the dosage recommendations for the antineoplastic agent in Figure 15-5 to
answer the following questions for treatment of testicular tumors in a patient
weighing 240 lb.
1. What is the recommended daily dosage range in mcg/kg?
2. How often is this dosage to be given and for how long?
3. What is the daily dosage range in mcg for this
patient? In mg? (Calculate kg weight to the
nearest tenth.)
4. If a dosage of 3 mg IV is ordered every morning, does this need
to be questioned?
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts, some Lhlnl party conle nl may be s uppressed from Lhe c Book and/or eChapLe1ts).
Edilori.al review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Lea.ming reserves Lhe righLLo remove addiLlonal conte nLal any time if subsequenLrig hts res trictions require iL
ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
MITHRACIN®
(pllcamyctn)
FOR INTRAVENOUS USE
DOSAGE
The daily dose of Mithracin is based on the patient's body
weight. If a patient has abnormal fluid retention such as
edema. hydrothorax or ascites, the patient's ideal weight
rather than actual body weight should be Wied to calculate
the doee.
Trutment of Tntieul1r Tumors: In the treatment of patients with testicular tumon the recommended daily doee of
Mithracin (plicamycinl is 25 to 30 mcg (0.026-0.030 mg) per
kilogram of body weight. Therapy should be continued for a
period or 8 to 10 days unless significant side effect.a or toxicity
occur during therapy. A course of therapy consisting of more
than 10 daily doses is not recommended. Individual daily
doees should not exceed 30 mcg (0.030 mg) pel' kilogram of
body weight.
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Answers 1. 25-30 mcg/kg 2. Once a day; 8-10 days 3. 2728-3273 mcg/day; 2.7-3.3 mg/day
4. no; within normal range
►►► PROBLEMS 15.8
Refer to the ceftriaxone literature in Figure 15-6 to answer the following questions
on pediatric dosages.
1. What is the maximum daily dose of ceftriaxone for a child with a skin
structure infection?
2. What is the dosage range for skin structure infections?
3. What is the initial dosage for meningitis?
4. What will the initial dosage be for a child weighing 12.6 kg who
has meningitis? In mg? Ing?
5. What is the t\vice-daily dosage in mg for this child to
follow the initial dose?
6. What will the initial meningitis dosage be for a child
weighing 19½ lb?
7. How many days must ceftriaxone therapy be continued for
meningitis after the initial dose?
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts, some Lhlnl party conle nl may be s uppressed fro m Lhe c Book and/or eChapLer(s).
Edilori.al review bas deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLlonal conte nLal any time if subsequenLrig hts res trictions require iL
235
236
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
DOSAGE AND ADMINISTRATION
Ceftriaxone for injection may be administered intravenously or intramuscularly. However, the intent of this Pharmacy Bulk
Package is for the preparation of solutions for intravenous infusion only. Ceftriaxone for injection should be administered
intravenously by infusion over a period of 30 minutes.
Do not use diluents containing calcium, such as Ringer's solution or Hartmann's solution, to reconstitute ceftriaxone
for injection. Particulate formation can result. Ceftriaxone and calcium-containing solutions, including continuous
calcium-containing infusions such as parenteral nutrition, should not be mixed or co-administered to any patient
irrespective of age, even via different infusion lines at different sites (see CONTRAINDICATIONS and WARNINGS).
NEONATES
Hyperbilirubinemic neonates, especially prematures, should not be treated with ceftriaxone (see CONTRAINDICATIONS).
PEDIATRIC PATIENTS
For the treatment of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a
day (or in equally divided doses twice a day). The total daily dose should not exceed 2 grams.
For the treatment of serious miscellaneous infections other than meningitis, the recommended total daily dose is 50 to
75 mg/kg, given in divided doses every 12 hours. The total daily dose should not exceed 2 grams.
In the treatment of meningitis, it is recommended that the initial therapeutic dose be 100 mg/kg (not to exceed 4 grams).
Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) is recommended. The daily dose may be
administered once a day (or in equally divided doses every 12 hours). The usual duration of therapy is 7 to 14 days.
ADULTS
The usual adult daily dose is 1 to 2 grams given once a day (or in equally divided doses twice a day) depending on the type
and severity of infection. The total daily dose should not exceed 4 grams.
If Chlamydia trachomatis is a suspected pathogen, appropriate antichlamydial coverage should be added, because
ceftriaxone sodium has no activity against this organism.
For preoperative use (surgical prophylaxis), a single dose ol l gram administered intravenously 1/2 to 2 hours before surgery
is recommended.
Generally, ceftriaxone for injection therapy should be continued for at least 2 days after the signs and symptoms of infection
have disappeared. The usual duration of therapy is 4 to 14 days; in com plicated infections, longer therapy may be required.
When trea ting infections caused by Streptococcus pyogenes, therapy should be continued for al least 10 days.
No dosage adjustment is necessary for patients wilh impairment of renal or hepatic function; however, blood levels should
be monitored in patien ts wi lh severe renal impairment (e.g. dialysis patients) and in patients with both renal and hepatic
dysfunctions.
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FIGURE 15-6
1. 2 g 2. 50-75 mg/kg once a day or equally divided dosages twice a day 3. 100 mg/kg not to exceed
4 g 4. 1260 mg ; 1.26 g 5. 630 mg 6. 887 mg (890 mg if rounded) 7. 7-14 days
Answers
Summary
This concludes the chapter on calculation and assessment of dosages based on body
weight. The important points to remember from this chapter are:
Dosages are frequently ordered on the basis of weight, especially for children.
Dosages may be recommended based on mcg or mg per kg or lb per day, usually
administered in divided doses.
Body weight may need to be converted from kg to lb or lb to kg to correlate with
dosage recommendations.
To convert lb to kg, divide by 2.2; to convert kg to lb, multiply by 2.2.
Calculating dosage is a two-step procedure: first, calculate the total daily dosage for
the weight; then, divide this by the number of doses to be administered.
To check the accuracy of a prescriber's order, calculate the correct dosage and
compare it with the dosage ordered.
Dosage discrepancies are much more critical if the dosage range is low-for
example, 2-5 mg, as opposed to high, for example 250-500 mg.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be .suppressed from Lhe c Book and/or eChapte1ts).
Edilori.al review has deemed LhaL any suppressed content does not materially affect the overall learning e xpe rience. Cengage Lea.ming reserves the right Lo remove additional conte nL al any time if subsequent rig hts res trictions req uire it.
ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
Factors that make discrepancies particularly serious are age, low body weight, and
severity of medical condition.
If the drug label does not contain all the necessary information for safe
administration, additional information should be obtained from drug package
inserts, the PDR, drug formularies, or the hospital pharmacist.
Summary Self-Test
Read the dosage labels and literature provided to answer the questions.
1. A 43 lb child has an order for oral cefaclor. What is the daily dosage
for this child?
2. What is the per dose dosage?
3. Is an order for 250 mg of cefaclor every 8 hours correct for this child?
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4. A 140 lb adult has an order for IV methylprednisolone. Calculate this
patient's per dose dosage.
5. How often is this dosage to be given?
6. Children's dosages are smaller. What is the lowest mg/ kg dosage
recommended?
7. Calculate the lowest daily dosage for a child weighing 43 lb.
8. When given intravenously, what period of time is specified for
the Solu-Medrol$ administration?
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due to elec.tronic rig hts. some Lhlrd party conte nt may be .supprcs..,;,ed from Lhe c Book and/or eChapter(s).
Edilori.al review has deemed LhaL any suppressed content does noL materially affec t Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions require iL
237
238
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
SOLU-MEDROL®
brand of methylprednisolone sodium succinate steri'8
powder
(methylpredniaolon• IOdlum auccinate for
injection, USP)
For Intravenous or lntramuacul1r
Administration
DOSAGE AND AD
.. ~TJON
When high doae therapy is desired. the recommended dose of
SOLU-MEDROL St.erile Powder (methylprednisolone ~
dium succinate) is 30 mg/ kg administered intravenously
over at least 30 minutes. This dose may be repeated every 4
to 6 hours for 48 hours.
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than 0.5 mg per kg every 24 hours.
9. Refer to the penicillin V potassium oral solution label and identify
the dosage strength in mg.
10. What is the dosage strength in units?
11. This medication is shipped in powdered form. How much diluent
is needed for reconstitution?
12. What kind of diluent?
13. What dosage in mg/kg is specified for infants?
14. If an infant weighs 6.2 kg, what will the dosage range be?
15. What will the dosage range be for a 16 lb infant?
16. A 7.9 kg infant has an order for 125 mg every 8 hours. Calculate the
per dose dosage based on this infant's body weight. Is the penicillin
dosage ordered correct?
NOC 0000-0000-00
PENICILLIN V POTASSIUM
125 ma {200,000 units)
For Oral Sohltion US.P.
per 5 ml when mixed as directed;
200 ml after mixing
Do Not Use If Caked
IRx o nly !
Contains penicillin V potassium
equivalent to 5 grams penicillin Vin a dry
mixture.
Each 5 ml teaspoon of prepared solution
yields penicillin V potassium equivalent to
125 mg (200,000 units) penicillin V.
DIRECTIONS FOR PREPARATION
Use 117 ml of water to prepare 200 ml
oral solution. Loosen powder then add
water and shake vigorously.
Usual dosage: Adults and children -1 to
2 teaspoons, given three or four times per
day. Infants -15 to 56 mg/kg body weight
daily, given in three to six divided doses.
See insert for detailed information.
Store at room temperature in dry form.
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
17. Cefaclor oral suspension has been ordered for a child weighing
100 lb. Calculate the daily dose.
18. What will the per dose dosage be?
19. Would a 5 mL dosage every 8 hours be reasonable for this child?
20. How is this oral cefaclor suspension to be reconstituted?
21. What precautions did you learn about pouring and administering
suspensions such as cefaclor?
RANBAXY
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22. Refer to the acyclovir sodium injection insert to locate the adult
and adolescent dosage in mg/kg.
23. What will the dosage be per dose for an adult with mucosal
herpes simplex weighing 61.4 kg?
24. What would the dosage be for an adolescent with herpes
simplex encephalitis weighing 180 lb?
25. What mg/kg dosage is recommended for an infant with
herpes simplex encephalitis?
26. Read the literature to locate the time period recommended for
intravenous infusion.
27. There are bold print precautions regarding parenteral
administration on this insert. What are they?
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239
240
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
ACYCLOVIR SODIUM
INJECTION
DOSAGE IN SEVERE INITIAL CLINICAL EPISODES OF HERPES GENITALIS:
Adults and Adolescents 12 years of age and older : S mg/kg infused at a
constant rate over 1 hour, every 8 hours for S days.
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DOSAGE IN HERPES SIMPLEX ENCEPHALITIS:
DOSAGE ANO ADMINISTRATION:
CAUTION - AVOID RAPID OR BOLUS INTRA VENOUS INJECTION.
(see WARNINGS and PRECAUTIONS).
AVOID INTRAMUSCULAR OR SUBCUTANEOUS INJECTION
(see WARNINGS).
Initiate therapy as early as possible following onset of signs
and symptoms of herpes infections.
Do not exceed a dose equivalent to 20 mg/kg every 8 hours for
any patient.
DOSAGE IN HERPES SIMPLEX INFECTION:
MUCOSAL AND CUTANEOUS HERPES SIMPLEX (HSV-1 and HSV-2)
INFECTIONS IN IMMUNOCOMPROMISED PATIENTS:
Adults and Adolescents 12 years of age and older: S mg/kg
infused at a constant rate over 1 hour, every 8 hours for 7 days.
Children under 12 years of age: 10 mg/kg infused at a constant
rate over 1 hour, every 8 hours for 7 days.
Adults and Adolescents 12 years of age and older : 10 mg/kg infused at a
constant rate over 1 hour, every 8 hours for 10 days.
Children 3 months to 12 years of age: 20 mg/kg infused at a constant rate
over 1 hour, every 8 hours for 10 days.
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9
Further dilute the calculated dose in an appropriate intravenous solution at a
volume selected for administration during each 1 hour infusion. Infusion
concentrations of approximately 7 mg/ml or lower are recommended.
Clinical studies reveal that the average 70 kg adult received between 60 and
1SO ml of fluid per dose. Higher concentrations (e.g., 10 mg/ml) may produce
phlebitis or inflammation at the injection site upon inadvertent extravasation. Standard, commercially available electrolyte and glucose solutions are
suitable for intravenous administration; biologic or colloidal fluids (e.g., blood
products, protein solutions, etc.) are not recomm ended.
Once diluted, each dose should be used within 24 hours.
Visually inspect for particulate matter and discoloration prior to
administration, whenever solution and container permit.
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28. A 198 lb adult is to be treated with IV ticarcillin disodium for
bacterial septicemia. What is the daily dosage range in mg
for this patient?
29. If the drug is administered every 4 hours, what will the per dose
being?
30. Do you need to question a per dose dosage of 4 g of ticarcillin
every 4 hours for this patient?
TICARCILLIN DISODIUM
FOR INTRAMUSCULAR OR INTRAVENOUS ADMINISTRATION
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DOSAGE AND ADMINISTRATION
In serious urinary tract and systemic infections, intravenous therapy in the higher doses should be used. Intramuscular injections
should not exceed 2 grams per injection.
0
Adults:
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Bacterial septicemia
200 to 300 mg/kg/day by I.V. infusion in divided doses every four or six hours.
Respiratory tract infection
Usual dose is 3 grams every four hours (18 grams/day) or 4 grams every six hours
Skin and soft-tissue infection
(16 grams/day) depending on weight and the severity of the infection.
Intra-abdominal infection
Infections of the female pelvis and genital tract
Urinary tract infections
Complicated:
Uncomplicated:
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Give 1SO to 200 mg/kg/day by I.V. infusion every four to six hours in divided doses.
Recommended dosage for average (70 kg) adult: 3 grams four times daily.
Give 1 gram I.M. or direct I.V. every six hours.
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Edilori.al review has deemed LhaL any suppressed conLenLdoes noLmaterially affecLLheoverall leaming e xpe rience. Cengage Lea.ming reserves Lhe righl lo remove addiLlonal conte nL al any time if subsequenL rig hts restrictions require iL
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY WEIGHT
31. Refer to the VFEND&package insert information to locate the IV
maintenance dosage in mg/ kg every 12 hours (written with the
abbreviation ql2h, now slated for deletion) for invasive aspergillosis.
32. What would the daily IV dosage be for an individual
weighing 92.7 kg?
33. What would the daily oral dosage be for this same
92.7 kg individual?
34. What will a single IV maintenance dosage be for the same
92.7 kg individual?
35. Locate the VFEND information on the maximum rate of
administration for intravenous administration.
36. There is a bold type and capitalized warning for IV administration
of VFEND on this insert. What is it?
VFEND® I.V.
(voriconazole) for Injection
VFEND® Tablets
(voriconazole)
VFEND® (voriconazole) for Oral Suspension
DESCRIPTION
VFEND® (voriconazole), a triazole antifungal agent, is available as a lyophilized powder f or
solution f or intravenous infusion, fi lm-coated tablets f or oral administration, and as a powder f or
oral suspension.
DOSAGE AND ADMINISTRATION
Administration
VFEND Tablets or Oral Suspension should be taken at least one hour before, or one hour
f ollowing, a meal.
VFEND 1.V. for Injection requires reconstitution to 10 mg/ml and subsequent dilution to 5 mg/ml
or less prior to administration as an infusion, at a maximum rate of 3 mg/kg per hour over 1-2
hours (see Intravenous Administration).
NOT FOR IV BOLUS INJECTION
Recommended Dosing Regimen
Infection
Invasive Aspergillosis
Loading dose
IV
6 mg/kg q 12h f or the first 24 hours
Scedosporiosis and Fusariosis
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6 mg/kg q 12h for the f irst 24 hours 3- 4 mg/kg q 12hb 200 mg q 12h
Esophageal Candidiasis
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37. Refer to the fluconazole injection insert to locate the first day
dosage for a child with esophageal candidiasis.
38. What is the dosage recommendation for subsequent days?
39. How long must treatment for this condition be continued?
40. What will the first dose be for a child weighing 18.2 kg?
41. What will the subsequent dosage be for this same 18.2 kg child?
42. How often will this dosage be administered?
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan . Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be s uppressed from Lhe c Book and/or eChapLe1ts).
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241
242
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
43. What is the maximum mg/ kg dosage recommended if the child
has a particularly severe infection?
44. What would the first dose of fluconazole be for a child
weighing 72 lb?
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Fluconazole, the first of a new subclass of synthetic triazole anti fungal agents, is available as a sterile solution for intravenous use in glass vials.
Adults
3 mg/kg
6 mg/kg
12'mg/kg
100 mg
200 mg
400 mg
1. 390 mg
2. 130 mg/dose
3. no, too high
4. 1908 mg/dose
5. every 4-6 hours
for 48 hours
6. 0.5 mg/kg every
24 hours
7. 9.8 mg/day
8. at least 30 minutes
9. 125 mg/5 ml
10. 200,000 units/
5 ml
11. 117ml
12. water
13. 15-56 mg/kg
14. 93-347 mg
15. 11 0-409 mg/
dai ly
16. 40-147 mg/dose;
the 125 ordered is
correct
17. 910 mg/day
18. 303 mg/dose
19. yes
20. Add 53 ml water
22. 5 mg/kg
23. 307 mg
24. 818 mg
25. 20 mg/kg
26. 1 hour
27. No rapid or bolus
injection; no intra-
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•some older children may have clearances similar to that of adults. Absolute doses exceeding 600 mg/day are not recommended. Experience
with fluconazole in neonates is limited to pharmacokinetic studies in premature newborns. (See CLINICAL PHARMACOLOGY.) Based on the
prolonged half-life seen in premature newborns (gestational age 26 to 29 weeks), these children, in the first two weeks of life, should receive
the same dosage (mg/kg) as in older children, but administered every 72 hours. After the first two weeks, these children should be dosed once
dally. No information regarding fluconazole pharmacokinetics in full-term newborns is available.
Oropharyngeal candidiasis: The recommended dosage of fluconazole for oropharyngeal candidiasis in children is 6 mg/kg on the first day,
followed by 3 mg/kg once daily. Treatment should be administered for at least 2 weeks to decrease the likelihood of relapse.
Esopha.gea/ candidiasis:Forthe treatment of esophageal candidiasis, the recommended dosage offluconazole in children is 6 mg/kg on the first day,
followed by 3 mg/kg once daily. Doses up to 12 mg/kg/day may be used based on medical judgment of the patient's response to therapy. Patients
with esophageal candidiasis should be treated for a minimum of three weeks and for at least 2 weeks following the resolution of symptoms.
Systemic Candida infections: For the treatment of candidemia and disseminated Candida infections, daily doses of 6 to 12 mg/kg/day have
been used in an open, noncomparative study of a small number of children.
Cryptococca/ meningitis: For the treatment of acute cryptococcal meningitis, the recommended dosage is 12 mg/kg on the first day, followed by 6
mg/kg once daily. A dosage of 12 mg/kg once daily may be used, based on medical judgment of the patient's response to therapy. The
recommended duration of treatment for initial therapy of cryptococcal meningitis is 10 to 12 weeks after the cerebrospinal fluid becomes culture
negative. For suppression of relapse of cryptococcal meningitis in children with AIDS, the recomm ended dose of fluconazole is 6 mg/kg once daily.
Answers
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Dosage and Administration in Children:
The following dose equivalency scheme should generally provide equivalent exposure in pediatric and adult patients:
Pediatric Patients
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35. 3 mg/kg per hour
over 1-2 hours
36. not for IV bolus
injection
37. 6 mg/kg
38. 3 mg/kg
39. minimum of three
in two portions.
muscu lar or subcutaneous injection
28. 18,000-27,000 mg
Shake well after
each addition unti l
mixed.
dai ly
29. 3-4.5 g/dose
30. no
symptoms
40. 109 mg
41. 55 mg
21. Shake well to mix
31. 4 mg/kg
32. 7 42 mg daily
33. 400 mg daily
34. 371 mg/dose
42. once daily
43. 12 mg/kg/day
44. 196 mg
completely before
pouring; administer
immediately to prevent settling out.
weeks and at least
two weeks followi ng resolution of
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .suppressed from Lhe cBook and/or eChapLe1ts).
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C A TER
Body surface area (BSA or SA) is a major factor in calculating dosages for
a number of drugs, because many of the body's physiologic processes
are more closely related to body surface than they are to weight. Body
surface is used extensively to calculate dosages of antineoplastic agents
for cancer chemotherapy, and for patients with severe burns. However,
increasing numbers of other drugs are also calculated using BSA. The
nursing responsibility for checking dosages based on BSA varies
widely in clinical facilities; therefore, this chapter covers all three
essentials: calculation of BSA, calculation of dosages based on BSA,
and assessment of physician orders based on BSA.
Body surface is calculated in square meters (m 2) using the patient's
weight and height and a calculator that has square root (v) capabilities. Two formulas are used by physicians and pharmacists: one using kg
and cm measurements, and another using lb (pound) and in (inch) measurements. We'll look at these separately.
CALCULATING BSA FROM kg AND cm
The safe st way to calculate BSA is by using a time-tested formula with
kilogram and centimeter measurements.
BSA=
wt(kg) X ht(cm)
3600
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244
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
EXAMPLE 1
Calculate the BSA of a man who weighs 104 kg and whose height
is 191 cm. Express BSA to the nearest hundredth.
104 (kg) X 191 (cm )
3600
= ✓5.517
= 2.348 = 2.35 m 2
Calculators vary in the way a square root must be obtained. Here is how the BSA
was calculated in this example and throughout the chapter:
104. X 191. 7 3600. = 5.5 17, thenimmediatelyenter ✓
Practice with your own calculator to determine how to calculate a s quare root. Be careful
to insert periods after all whole numbers or you may obtain a wrong answer from
preset decimal placement.
The m 2 BSA is rounded to hundredths. Answers may vary slightly depending on
how your calculator is set Consider answers within 2-3 hundredths correct. Fractional
weights and heights are also used in calculations. Refer to Examples 2 and 3.
EXAMPLE 2
Calculate the BSA of an adolescent who weighs 59.1 kg and is
157 .5 cm in height. Express BSA to the nearest hundredth.
59.1 (kg) X 157.5 (cm)
3600
= ✓2.585
= 1.607 = 1.61 m 2
EXAMPLE 3
A child is 96.2 cm tall and weighs 15. 17 kg. What is his BSA in m 2 to
the nearest hundredth?
15.17 (kg) X 96.2 (cm )
3600
= .Jo.4053
= 0.636 = 0.63 m 2
►►► PROBLEMS 16.1
Calculate the BSA in m 2 • Express answers to the nearest hundredth.
1. An adult weighing 59 kg whose height is 160 cm.
2. A child weighing 35.9 kg whose height is 63.5 cm.
3. A child weighing 7.7 kg whose height is 40 cm.
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY SURFACE AREA
4. An adult weighing 92 kg whose height is 178 cm.
5. A child weighing 46 kg whose height is 102 cm.
Answers 1. 1.62 m2 2. 0.8 m2 3. 0.29 m 2 4. 2.13 m2 5 . 1.1 4 m2
CALCULATING BSA FROM lb AND in
The formula for calculating BSA from lb and in measurements is equally easy to use.
The only difference is the denominator, which is 3131.
BSA =
EXAMPLE 1
wt (lb) X ht (in)
3131
Calculate BSA to the nearest hundredth for a child who is 24 in tall
and weighs 34 lb.
34(lb) X 24(in)
3131
= ✓0.260
= 0.510 = 0.51 m 2
EXAMPLE 2
Calculate BSA to the nearest hundredth for an adult who is 61.3 in
tall and weighs 142.7 lb.
142.7(lb) X 61.3(in)
3131
= ✓2.793
= 1.671 = 1.67 m 2
EXAMPLE 3
A child weigl1s 105 lh and is 51 in tall. Calculate BSA to the nearest
hundredth.
105 (lb) X 51 (in)
3131
= ✓1.710
= 1.307 = 1.31 m 2
►►► PROBLEMS 16.2
Determine the BSA. Express answers to the nearest hundredth.
1. A child weighing 92 lb who measures 35 in.
2. An adult who weighs 17 5 lb and who is 67 in tall.
3. An adult who is 70 in tall and weighs 194 lb.
Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplica ted, in whole or in pan. Due to electronic rig hts. .some Lhird party conte nt may be suppres..,;;ed from Lhec.Book and/or eChapte11s}.
Edilori.al review has deemed LhaL :my suppressed content does noL materially affect the overall learning e xpe rience. Cengage Leaming reserves the right Lo remove additional conte nt al any time if subsequent rig hts restrictions req uire it.
245
246
DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
4. A child ,vho weighs 72.4 lb and is 40.5 in tall.
5. A child who measures 26 in and weighs 36 lb.
Answers 1. 1.01 m2 2 . 1.94 m2 3. 2.08 m 2 4. 0.97 m2 5. 0.55 m2
DOSAGE CALCULATION BASED ON BSA
Once you know the BSA in m 2, dosage calculation is straight multiplication.
EXAMPLE 1
Dosage recommended is 5 mg per m 2 . The child has a BSA of 1.1 m 2 .
l.l(m2) X 5 mg= 5.5 mg
EXAMPLE 2
The recommended child's dosage is 25-50 mg/ m 2 • The child l1as a BSA
of0.76 m 2 .
Lower dosage
0.76(m2) X 25 mg= 19 mg
Upper dosage
0.76(m2 ) X 50 mg= 38 mg
The dosage range is 19-38 mg.
►►► PROBLEMS 16 .3
Determine the dosage for the following drugs. Express answers to the nearest
whole number.
1. The recommended child's dosage is 5-10 mg/m2 •
The BSA is 0.43 m 2 •
2. A child with a BSA of 0.81 m 2 is to receive a drug with a
recommended dosage of 40 mg/ m 2 •
3. Calculate the recommended dosage of 20 mg/ m 2 for a
child with a BSA of 0.51 m 2•
4. An adult is to receive a drug with a recommended
dosage of 20-40 units/m 2 • The BSA is 1.93 m 2 •
5. The adult recommended dosage is 3-5 mg/m2•
Calculate dosage for 2.08 m 2•
Answers
1. 2-4 mg 2. 32 mg 3. 10 mg 4. 39-77 units 5. 6-10 mg
ASSESSING ORDERS BASED ON BSA
In situations where you will have to check a dosage against m 2 recommendations, you will
be referring to drug package inserts, medication protocols, or the Physicians' Desk Reference
(PDR) to determine what the dosage should be.
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Ed llorial review has deemed LhaL any suppressed content does noLmaterially affec t Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions req uire iL
ADULT AND PEDIATRIC DOSAGES BASED ON BODY SURFACE AREA
EXAMPLE 1
Refer to the vinblastine information insert in Figure 16-1 and calculate
the first dose for an adult whose BSA is 1.66 m 2 . Calculations are to
the nearest whole number.
Recommended first dose = 3.7 mg/ m 2
1.66(m2) X 3.7 mg = 6.14 = 6 mg
EXAMPLE 2
A child with a BSA of 0.96 m 2 is to receive her fourth dose ofvinblastine.
Recommended fourth dose = 6.25 mg/ m 2
0.96(m2) X 6.25 mg= 6 mg
cEtus onc□ L□GY
STERILE VINBLASTINE SULFATE, USP
DOSAGE AND ADMINISTRATION
Caution: It Is extremely Important that the needle be properly
posit ioned In the vein before this product is injected.
If leakage into surrounding t issue should occur during
Intravenous admin istration of vinblastine sulfate, it may cause
considerable irritation. The injection should be discontinued
Immediately, and any remaining portion of the dose should then be
Introduced Into another vein. Local injection of hyaluronldaae and
the app lication of moderate heat to the area of leakage help
disperse the drug and are thought to minimize discomfort and the
posslbltlty of cellulltls.
There are variations in the depth of the leukopenic response which
follows therapy with vinblastine sulfate . F or this reason . it is
recommended that the drug be given no more frequently than once
every 7 days. It is wise to initiate therapy for adults by administering a
single intravenous dose of 3 .7 mg/M2 of body surface area (bsa) ; the
initial dose for children should be 2.5 mg/M2. Thereafter, white-blood-cell
counts should be made to determine the patient 's sensitivity to
vinblastine sulfate. A reduction of 50% in the dose of vinblastine is
recommended for patients having a direct serum bilirubln value above
3 mg/100 ml. Since metabolism and excretion are primarily hepatic. no
modification is recommended for patients with impaired renal function.
A simplified and conservative incremental approach to dosage at
weekly Intervals may be outlined as follows
Adults
Children
First dose ....... ..............
3 .7 mg/M2 bsa
2.5 mg/M2 bsa
Second dose .. .... .. .. ...... . 5.5 mg/M2 bsa
3.75 mg/M2 bsa
Th ird dose ..................... 7.4 mg/M2 bsa
5
mg/M2 bsa
Fourth dose.................... 9.25 mg/M2 bsa
6.25 mg/M2 bsa
Fifth dose ...................... 11 .1 mg/M2 bsa
7 .5 mg/M2 bsa
The above-mentioned increases may be used until a maximum dose
(not exceeding 18.5 mg/ M2 bsa for adults and 12.5 mg/M 2 bsa fo r
children) is reached. The dose should not be increased after that dose
which reduces the white-cell count 10 approximately 3000 cells/mm3. In
some adults, 3.7 mg/M2 bsa may produce this leukopenia: other adults
may require more than 11 . 1mg/M 2 bsa: and. very rarely, as much as
18.5 mg/M2 bsa may be necessary. For most adult patients, however.
the weekly dosage will prove to be 5 .5 to 7.4 mg/M2 bsa.
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DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
►►► PROBLEMS 16.4
Calculate the following dosages of vinblastine to the nearest whole number from the
information available in Figure 16-1.
1. Calculate the dosage for an adult's third dose.
The patient's BSA is 1.91 m 2 •
2. Calculate the child's first dosage for a patient with
a BSA of 1.2 m 2 •
3. Calculate the adult's fifth dosage. The BSA is 1.53 m 2 •
4. Calculate the child's second dosage for a BSA of 1.01 m 2•
5. Calculate the adult's second dose for a BSA of 2.12 m 2•
Answers 1. 14 mg 2. 3 mg 3. 17 mg 4. 4 mg 5. 12 mg
►►► PROBLEMS 16.5
•
Refer to Figure 16-2 for BiCNU to locate the following information. Express all dosages
to the nearest whole number.
1. What is the dosage per m 2 if the drug is to be given
in a single dose?
2. If the patient has a BSA of 1.91 m 2, what will the
daily dosage range be?
3. If the order for this patient is a single dosage of 325 mg,
is there any need to question it?
4. If the dosage ordered is 450 mg, is there any need to question it?
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DOSAGE AND ADMINISTRATION
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treated patients is 150 to 200 mg/m 2 intravenously every 6 weeks. ¾
This may be given as a single dose or divided into daily injections J
such as 75 to 100 mg/m2 on 2 successive days. When BiCNU is ~
used in combination with other myelosuppressive drugs or in pa- :~
tients in whom bone marrovv reserve is depleted, the doses should ~
be adjusted accordingly.
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FIGURE 16-2
Answers 1. 150-200 mg/m2 2. 287-382 mg 3. no 4. yes, too high
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY SURFACE AREA
►►►
PROBLEMS 16.6
Refer to the package insert for the antineoplastic medication bleomycin in Figure 16-3
to answer the following questions.
1. Locate the dosage information on Hodgkin's disease
and identify the dosage per m 2•
2. This insert also identifies the dosage per kg.
What is this dosage?
3. Calculate the unit dosage based on m 2 for an
adult with a BSA of 1.73 m 2 •
4. Ho,v often is the dosage recommended?
LABORA TORIES
BLEOMYCIN FOR INJECTION USP
BLE-P03
Rx ONLY
To reduce the development of drug-resistant bacteria and maintain the effectiveness of bleomycin and other antibacterial drugs, bleomycin should be used
only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
WARNING
It is recommended that bleomycin be administered underthe supervision of a qualified physician experienced in the use of cancer chemotherapeutic
agents. Appropriate management of therapy and complications is possible only when adequate diagnostic and treatment facilities are readily available.
Pulmonary fibrosis is the most severe toxicity associated with bleomycin. The most frequent presentation is pneumonitis occasionally progressing to
pulmonary fibrosis. Its occurrence is higher in elderly patients and in those receiving greater than 400 units total dose, but pulmonary toxicity has
been observed in young patients and those treated with low doses.
A severe idiosyncratic reaction consisting of hypotension, mental confusion, fever, chills, and wheezing has been reported in approximately 1% of lymphoma patients treated with bleomycin.
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Because of the possibility of an anaphylactold reaction , lymphoma patients should be treated with 2 units or less for the first two doses. If no acute
reaction occurs, then the regular dosage schedule may be followed.
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The following dose schedule is recommended:
Squamous cell carcinoma, non-Hodgkin's lymphoma, testicular carcinoma-0.25 to 0.50 units/kg (10 to 20 units/m 2) given intravenously, intramuscularly, or subcutaneously weekly or twice weekly.
Hodgkin's Oisease-0.25 to 0.50 units/kg (10 to 20 unitstm2) given intravenously, intramuscularly, or subcutaneously weekly or twice weekly. After a
50% response, a maintenance dose of 1 unit daily or 5 units weekly intravenously or intramuscularly should be given.
Pulmonary toxicity of bleomycin appears to be dose related with a striking increase when the total dose is over 400 units. Total doses over 400 units
should be given with great caution.
Note: When bleomycin for injection is used in combination with other antineoplastic agents, pulmonary toxicities may occur at lower doses.
Improvement of Hodgkin's Disease and testicular tumors isprompt and noted within 2 weeks. If no improvement is seen by this time, improvement is unlikely
Squamous cell cancers respond more slowly, sometimes requiring as long as 3weeks before any improvement is noted.
Malignant Pleural Effusio~60 units administered as a single dose bolus intrapleural injection (see Administration: lntrapleural).
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Answers
1. l 0-20 units/m 2 2. 0.25-0.5 units/kg 3. 17-35 units 4. weekly or twice weekly
►►►
PROBLEMS 16.7
Refer to the mitomycin package insert information in Figure 16-4 to answer the
following questions.
1. This preparation is a combination of two different drugs.
It is shipped in powdered form. How much diluent must
be added to prepare a mitomycin 40 mg and mannitol 80 mg
dosage strength?
2. What kind of diluent is specified?
3. What dosage is required in m 2?
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249
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DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
4. What mitomycin dosage will be required for an
individual with a BSA of 1.73?
5. Ho,,v will this be administ ered?
MITOMYCIN FOR INJECTION, USP
Rx ONLY.
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Mitomycin should be given intravenously only, using care to avoid extravasation of the
compound. If extravasation occurs, cellulitis, ulceration, and slough may result.
Each vial contains either mitomycin 5 mg and mannitol 10 mg, or mitomycin 20 mg and
mannitol 40 mg, or mitomycin 40 mg and mannitol 80 mg. To administer, add Sterile Water for
Injection, 10 ml 40 ml, or 80 ml, respectively. Shake to dissolve. If product does not dissolve
immediately, allow to stand at room temperature until solution is obtained.
After full hematological recovery (see guide to dosage adjustment) from any previous chemotherapy, the following dosage schedule may be used at 6- to 8-week intervals:
20 mg/m2 intravenously as a single dose via a functioning intravenous catheter.
Because of cumulative myelosuppression, patients should be fully reevaluated after each
course of mitomycin, and the dose reduced if the patient has experienced any toxicities. Doses
greater than 20 mg/m2 have not been shown to be more effective and are more toxic than lower
doses.
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Answers 1. 80 ml 2. steri le water for injection 3. mitomycin 20 mg/m2 4. 35 mg
5. intravenously as a sing le dose via a functioning intravenous catheter
Summary
This concludes the chapter on dosage calculation based on BSA. The important points
to remember from this chapter are:
The BSA in m 2 is calculated from a patient's weight and height.
BSA is more important than weight alone in calculating some drug dosages
b ecause many physiologic processes are more closely related to surface area
than they are to weight.
BSA is calculated in square m et ers (m2) using a formula.
Two formulas for calculation of BSA are available:
Using kg and cm:
wt (kg) X ht (cm)
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Using lb and in:
wt (lb) X ht (in)
3131
After the BSA has been obtained, it can be used to calculate specific drug dosages
and assess accuracy of physician orders.
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ADULT AND PEDIATRIC DOSAGES BASED ON BODY SURFACE AREA
Summary Self-Test
Use the formula method to calculate the following BSAs. Express m 2 to the nearest
hundredth.
1. The weight is 58 lb and the h eight is 36 in.
2. An adult weighing 74 kg and measuring 160 cm.
3. A child who is 14.2 kg and m easures 64 cm.
4. An adult weighing 69 kg whose height is 170 cm.
5. An adolescent who is 55 in and 103 lb.
6. A child who is 112 cm and weighs 25.3 kg.
7. An adult who weighs 55 kg and measures 157.5 cm.
8. An adult who weighs 65.4 kg and is 132 cm in height.
9. A child whose height is 58 in and whose weight is 26.5 lb.
10. A child whose height is 60 cm and weight is 13.6 kg.
Read the drug insert information provided in Figure 16-5 to answer the following
questions. Calculate dosages to the nearest whole number.
11. Read the information on children's dosage to calculate the daily
dosage for a 6-year-old child whose BSA is 0.78 m 2 •
12. If a dosage of 4 mg is ordered for this 6-year-old child,
would you question it?
13. What would the daily dosage be for a 4-year-old child
whose BSA is 0.29 m 2 ?
14. What would the daily dosage be for a 5-year-old child
with a BSA of 0.51 m 2 ?
Antibiotic
DOSAGE AND ADMINISTRATION
DOSAGE SHOULD BE INDIVI DUALIZED ACCORDING TO
THE NEEDS AND THE RESPONSE OF THE PATIENT.
Each tablet contains 4 mg of antibiotic.
Pediatric Patients
Age 2 to 6 years
The total daily dosage for pediatric patients may be calculated on the basis of body weight or body area using approximately 0.25 mg/kg/day or 8 mg per square meter of body
surface (8 mg/m 2).
The usual dose is 2 mg C/2 tablet) two or three times a day,
adjusted as necessary to the size and response of the patient.
The dose is not to exceed 12 mg a day.
Age 7 to 14 years
The usual dose is 4 mg (1 tablet) two or three times a day,
adjusted as necessary to the size and response of the patient.
The dose is not to exceed 16 mg a day.
Adults
The total daily dose for adults should not exceed 0.5 mg/kg/
day.
The therapeutic range is 4 to 20 mg a day, with the majority
of patients requiring 12 to 16 mg a day. An occasional patient
may require as much as 32 mg a day for adequate relief. It is
suggested that dosage be initiated with 4 mg (1 tablet) three
times a day and adjusted according to the size and response of
the patient.
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251
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DOSAGE CALCULATION FROM BODY WEIGHT AND BODY SURFACE AREA
Refer to Figure 16-6 to answer the following questions.
15. A patient is to be treated with the drug carboplatin for ovarian
carcinoma. Her BSA is 1.61 m 2 • What will her dosage be?
16. Another patient with ovarian cancer, who weighs 130 lb and
measures 62 in, is to receive carboplatin. What is her BSA?
17. What dosage of carboplatin will she require?
18. Carboplatin is given in conjunction with cyclophosphamide.
What is the recommended m 2 dosage for this drug?
19. Calculate the BSA of a third patient who is receiving therapy
for ovarian cancer. She weighs 53.2 kg and measures 150.3 cm.
20. What will the companion dosage of cyclophosphamide be
for this patient?
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Manufactured by:
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Manufactured for:
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Keep it for future reference.
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This information will help you learn more about CARBOplatin for Injection. It cannot, however, cover all the possible warnings or side effects relating to
CARBOplatin, and it does not list all of the benefits and risks of CARBOplatin. Your doctor should always be your first choice for detailed information
about your medical condition and your treatment. Be sure to ask your doctor about any questions you may have.
DOSAGE ANO ADMINISTRATION
NOTE: Aluminum reacts with carboplatin causing precipitate formation and loss of potency, therefore, needles or intravenous sets containing
aluminum parts that may come in contact with the drug must not be used for the preparation or administration of carboplatin.
Single Agent Therapy
Carboplatin for injection, as a single agent, has been shown to be effective in patients with recurrent ovarian carcinoma at a dosage of 360 mg/m 2
IV on day 1 every 4 weeks (alternatively see Formula Dosing). In general, however, single intermittent courses of carboplatin should not be
repeated until the neutrophll count is at least 2000 and the platelet count is at least 100,000.
Combination Therapy with Cyclophosphamide
In the chemotherapy of advanced ovarian cancer, an effective combination for previously untreated patients consists of:
Carboplatin injection-300 mg/m2 IV on day 1 every four weeks for six cycles (alternatively see Formula Dosing).
Cyclophosphamide-600 mg/m 2 IV on day 1 every four weeks for six cycles. For directions regarding the use and administration of cyclophosphamide please refer to its package insert. (See CLINICAL STUDIES.)
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FIGURE 16-6
Answers
1. 0.82 m 2
2. l. 81 m2
3. 0.50 m2
4. 1.81 m2
5, 1.35 m2
6 . 0.89 m2
7 . 1.55 m2
8. 1.55 m2
9 . 0.70 m2
1 O. 0.48 m2
11. 6 mg per day
12 . yes; too low
13. 2 mg per day
14. 4 mg
15. 580 mg
16. 1.6 m2
17. 576 mg
18, 600 mg/m2
19. 1.49 m2
2 0. 894 mg
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I
CHAPTER 17
CHAPTER 20
CHAPTER 18
CHAPTER 21
CHAPTER 19
CalcCJlatir.19
Comr.letior.1
-
CIHAPTER
The calculations associated with IV therapy will be easier to understand
if you have some general understanding of IV therapy. Intravenous fluid
and medication administration is one of the most challenging of all
nursing responsibilities. There are currently estimated to be over 200
different manufactured IV fluids, and at least as many additives are used
with IV fluids, including medications, electrolytes, and nutrients. In addition, there are hundreds of different types of IV administration sets
and components, and dozens of different models of electronic infusion
devices (El Os) to infuse and monitor IV fluids. This would appear to make
the entire subject of IV therapy overwhelming, but it is not. This chapter
presents the essentials in understandable segments and provides you
with an excellent base of instruction upon which to build. Let's begin by
looking at a basic sterile IV setup, which is referred to as a primary line.
'" ;... The choice of IV fluids and additives is a
physician responsibility. The preparation of IVs containing
additives is a pharmacist's, or specially designated and
trained IV nurse practitioner's, responsibility. The staff
nurse responsibility in almost all clinical settings will be to
double-check for the correct solution, and set and regulate
IV flow rates of the solutions ordered. Use of IV pumps is a
hospital in-service education responsibility.
PRIMARY LINE
Refer to Figure 17-1, which shows a typical primary IV line connecting an
IV fluid bag or bottle to the needle or cannula in a vein. The IV tubing is
connected to the W solution bag (using sterile technique), and the bag
is hung on an IV stand .
•
Close all roller clamps on the IV tubing before
connecting it to the solution bag. This step prevents air
bubbles from entering the tubing.
The drip chamber, Figure 17-lA, is then squeezed to half-fill it with
fluid. This level is very important because W flow rates are set and
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INTRODUCTION TO IV THERAPY
monitored by counting the drops falling in this chamber. If the chamber is too full,
the drops cannot be counted. On the other hand, if the outlet at the bottom of the chamber
is not completely covered, air can enter the tubing during infusions and, subsequently, the
vein and circulatory system. So, the half-full fluid level is extremely important.
KEVpoint: The correct fluid level for IV drip chambers is half-full to allow
drops to be counted and prevent air from entering the tubing.
A. Drip Chamber
D. Injection Port
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Next, notice Figure 17-lB, the roller clamp. This is adjusted while the drops falling in the
drip chamber are counted to set the flow rate. It provides an extremely accurate control
of rate. A second type of clamp, Figure 17-1 C, called a slide clamp, is present on all IV tubings. The slide clamp can be used to temporarily stop an IV without disturbing the
rate set on the roller clamp.
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255
256
INTRAVENOUS CALCULATIONS
Next, notice Figure 17-1D, the injection port. Rubber ports are located in several
locations on the tubing, typically near the cannula end, drip chamber, and middle of the
line, and also on most IV solution bags. Ports allow injection of medication directly
into the line or bag or the attachment to the primary line of secondary IV lines
containing compatible IV fluids or medications.
Intravenous fluids run by gravity flow. This necessitates that the IV solution bag
be hung above the patient's heart level to exert sufficient pressure to infuse. Three feet
above heart level is considered an average height.
KEYpoint: The higher an IV bag is hung, the greater the pressure and the
faster the IV will infuse.
This pressure differential also means that if the flow rate is adjusted while the patient is
lying in bed, it will slow down if he or she sits or stands, and, in fact, it changes slightly with
each turn from side to side. For this reason, monitoring IV flow rate is ongoing, officially
done every hour, but routinely checked after each major position change.
There are two additional terms relating to primary lines that you must know. If an arm
or hand (or, less commonly, leg) vein is used for an infusion, it is referred to as a peripheral
line. This is to distinguish it from a central line, which uses a special catheter whose tip
is located centrally in a deep chest vein. Central lines may access the chest vein directly
through the chest wall, via a neck vein, or through a peripheral vein in the ar1n or leg.
SECONDARY LINE
Secondary lines attach to the primary line at an injection port. They are used primarily to
infuse medications, frequently on an intermittent basis; for example, every 6-8 hours.
They may also be used to infuse other compatible IV fluids. Secondary lines are commonly
referred to as IV piggybacks. They are abbreviated IVPB. Refer to Figure 17-2, which
illustrates a primary and secondary line setup.
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INTRODUCTION TO IV THERAPY
The IVPB is connected to a port located below the drip chamber on the primary line.
Notice that the IVPB bag is hanging higher than the primary. This gives it greater pressure and causes it to infuse first. Each IVPB set includes a plastic or metal extender, in
Figure 17-2 A, which is used to lower the primary solution bag to obtain this pressure differential. The flow rate for the IVPB is set by a separate roller clamp located on the secondary
line. When the IVPB bag has emptied, the primary line will automatically resume its flow.
Secondary medication bags are usually much smaller than primary bags. Fifty, 100, 150, 200,
and 250 mL bags are frequently u sed.
Another type of secondary medication setup is provided by the Abbott Laboratories
ADD-Vantage System®(Figure 17-3). In this system, a specially designed IV fluid bag that
contains a medication vial port is used. The medication vial containing the ordered
drug and dosage is inserted into the port, and the drug ( frequently in powdered form) is
mixed using IV fluid as the diluent, as illustrated in Figure 17-4. The vial contents are then
displaced back into the solution bag and thoroughly mixed in the total solution before infusion. The vial remains in the solution bag port throughout the infusion, making it possible
to cross-check the vial label for drug and dosage at any time.
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If a drug is not available in either a prepackaged or ADD-Vantage format, it is often prepared
and labeled by the hospital pharmacy. And, finally, an IV medication may be prepared,
added to the appropriate IV fluid, thoroughly mixed, labeled and initialed, and administered
by the nurse who initiates the infusion.
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257
258
INTRAVENOUS CALCULATIONS
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B, The medication vial port on the IV bag is opened. C, The vial top is inserted into the IV bag port and
twisted to lock tightly in place. D, The vial stopper is removed "inside"the IV bag, and the medication and
solution are thoroughly mixed before infusion.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.a ted, in whole or in part. Due to elec.tronic rights. some Lhlrd party conte nt may be .supprcs..,;,00 from Lhe c Book and/or eChapLer(s).
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INTRODUCTION TO IV THERAPY
259
VOLUME-CONTROLLED BURETTES
For greater accuracy in the measurement of smallvolume IV medications and fluids, a calibrated
burette chamber such as the one shown in Figure 17-5
may be used. The total capacity of burettes varies from
100 to 150 rnL, calibrated in 1 mL increments. Many
burettes are calibrated to deliver very small drops
{microdrops), which also contributes to their accuracy.
Burettes are most often referred to by their trade names;
for example, Buretrols,t' Solusets,t' or Volutrolse. Burette
chambers are most often connected to a secondary
solution bag and used as a secondary line, but they can
also be primary lines. When medication is ordered, it is
injected into the burette through its injection port. The
exact amount of IV fluid is then added as a diluent. After
thorough mixing, the flow rate is set using a separate
clamp on the burette line. Burettes are used extensively
in pediatric and intensive care units, where medication
dosages and fluid volumes are critical.
INDWELLING INFUSION PORTS/
INTERMITTENT LOCKS
When a continuous IV is not necessary, but intermittent IV medication administration is, an infusion port
adapter {Figure 17-6) can be attached to an indwelling
cannula in a vein. Infusion ports are frequently referred
to as hep locks or saline locks ( or ports). This terminology evolved because the ports must be irrigated
with 1-2 mL of sterile saline every 6-8 holll·s, or with a
heparin lock flush solution (100 units/rnL) to prevent
clotting and blockage. To infuse medication, the port
top is cleansed and the medication line is attached.
When the infusion is complete, the line is disconnected
until the next dosage is due. Ports are also used for direct
injection of medication using a syringe, which is
called an IV push or bolus.
Heparin anticoagulant therapy will be discussed
in detail in a later chapter, where you will learn that
heparin is most commonly diluted in large volume
intravenous solutions for administration. The heparin
vial dosage strengths available for IV dilution
range from 1000 to 50,000 units/ml,. Stop now,
and think about the enormous difference in dosage
strengths between heparin flush solutions and
intravenous admixture dosages: 10 to 100 units/ml,
for a flush; 1000 to 50,000 units/ml, for IV admixes.
These large differences in dosage strength demonstrate why extreme caution is necessary in heparin flush dosage preparation.
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260
INTRAVENOUS CALCULATIONS
HEPARIN FLUSH DOSAGE ALERT
Heparin flush solutions used to maintain patent (open) indwelling infusion ports
come in two dosage strengths: 10 units/ml, and 100 units/ml,. Refer to the
Heparin Lock Flush vial label in Figure 17-7 and identify its 10 units/mL strength.
In early 2008, errors in heparin flush dosages became national news when
actor Dennis Quaid publicized the near-death of his newborn twins by not one,
but two successive errors in flush dosages, which caused the newborns to almost
hemorrhage to death.
Thanks to Mr. Quaid, this error was taken all the way to a Congressional
hearing to publicize the danger. Similar heparin vial size and label colors were cited
as contributing to the errors. But the fact remains that these errors in dosage
were caused by failure to correctly identify label dosage strengths, not vial
size or label color.
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►►► PROBLEMS 17.1
Answer the questions about IV administration sets as briefly as possible.
1. What is the correct fluid level for an IV drip chamber?
2. Which clamp is used to regulate IV flow rate?
3. When might a slide clamp be used?
4. What is a peripheral line?
5. What is a central line?
6. What is the common abbreviation for an intravenous piggyback?
7. Is the IVPB a primary or secondary line?
8. What must the height of a primary solution bag be when a
secondary bag is infusing?
9. When is a saline lock used?
10. What are the two strengths of heparin flush solutions available?
Answers 1. middle of chamber 2. roller clamp 3. stop the IV temporarily without disturbing the rate set on
the roller clamp 4. arm or leg vein 5. IV catheter inserted into a deep chest vein 6. IVPB 7 . secondary
8. lower than secondary bag 9 . for intermittent infusions when a continuous IV is not necessary
10. 10 units/ml and 100 units/ml
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlnl party conle nl may be s uppressed from Lhe c Book and/or eChapLe 1ts).
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INTRODUCTION TO IV THERAPY
VOLUMETRIC PUMPS
Refer now to Figure 17-8 of the Alaris" SE Dual pump. Notice that the IV tubing with the
AccuSlide" flow regulator has been inserted into the channels on the right and left. The
center pumping mechanism maintains the desired flow rates.
All volumetric pumps look similar, and may physically resemble the Alaris SE pump,
but the functions of different models vary widely. Some models continue to pump fluids even if an IV infiltrates, whereas others have a built-in pressure sensor that will sound
an alarm if a resultant increased infusion resistance pressure occurs. Some models sound
an alarm when the solution has completely infused; other models do not.
Because of the wide variation in pump models and their functions, caution is mandatory when they are used. It is estimated that a significant number of IV medication errors
results from errors in pump programming.
K.EYpaint: Hospital or clinical in-service education is required for the use
of all infusion devices.
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Infusion devices are also widely used for IV medication administration, and their precautions in use apply less to the difficulty of the skill than in becoming familiar with the particular infusion model being used. A single hospital or clinic could realistically have a dozen
different models in use, and it is an ongoing nursing responsibility to learn how to use each
particular model.
KEVpoint. Double-checking of programming is ma11datory in the use
of infusion devices.
Because errors in infusion device programming are factors in IV medication errors, it is
mandatory that all programming be double-checked. A new generation of sophisticated
infusion safety systems has built-in libraries of usual drug dosages, offers customizable
drug libraries for facility-specific needs, and is capable of alerting users to programming
errors outside hospital-defined parameters. The Sigma Spectrum from Baxter shown in
Figure 17-9 is one exainple. Another dose-specific pump is the Alaris Syste1n with Guardrails"
Suite MX of safety software shown in Figure 17-10, a lightweight, modular platform that
integrates infusion, patient monitoring, and clinical best-practice guidelines. As you can
clearly see from the photograph, this is an infusion device that requires in-service instruction and certification to use.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO from Lhe cBook and/or eChaple t1s).
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261
262
INTRAVENOUS CALCULATIONS
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Auto-ID module and Alaris EtC02 and Sp02 monitoring modules.
SYRINGE PUMPS
Syringe pumps, as their name implies, are devices that use a syringe to administer medications or fluids {Figure 17-11 ). Syringe pumps are particularly valuable when drugs that
cannot be mixed with other solutions or medications must be administered at a
controlled rate over a short period of time; for example, 5, 10, or 20 minutes. The drug
is measured in the syringe, which is inserted into the device, and the medication is infused
at the rate set.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.aled. in whole or in part. Due to elcc.tronic rig hts. some Lhird party content may be s uppressed from Lhe e Book and/or eChapte11s ).
Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire iL
INTRODUCTION TO IV THERAPY
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PATIENT-CONTROLLED ANALGESIA (PCA) DEVICES
PCA devices allow a patient to self-administer medication to control pain. A prefilled sy1inge or medication bag containing pain medication is inserted into the device (Figure 17-12 ),
and the dosage and frequency of administration ordered are set. The patient presses
the control button as medication is needed, and the medication is administered and
recorded by the PCA
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263
264
INTRAVENOUS CALCULATIONS
The device also keeps a record of the number of times a patient attempts to use it
and thus provides a record of the effectiveness of the dosage prescribed. If a patient's pain
is not being relieved, new orders must be obtained and the PCA reset to administer the new
dosage.
KEYpaint: All electronic devices must be monitored frequently to be sure
they are functioning properly.
Is the IV infusing at the rate that was set? Is the patient who activates a PCA getting
relief of pain? Ifnot, is it possible the PCA itself is malfunctioning? Electronic devices have
been in use for many years and are relatively trouble-free, but if the desired goal is not being
obtained, in the absence of other obvious reasons, the possibility of malfunction must
always be considered.
►►► PROBLEMS 17 .2
Answer the questions about infusion devices as briefly as possible.
1. What is the function of a volumetric pump?
2. List two major precautions in the use of volumetric pumps.
3. When might a syringe pump be used?
4. What is a PCA?
Answers 1. to administer IVs at a controlled rate 2. accurate programming; rate and site monitoring
3 . to infuse small volumes of drugs that are not compatible with other drugs and/or fluids
4 . patient-controlled analgesia device
INTRODUCTION TO IV FLUIDS
Intravenous fluids are prepared in plastic solution bags or glass bottles in volmnes ranging
from 50 mL (bags only) to 1000 mL. The 500 and 1000 mL sizes are the most commonly
used. The bags and bottles are labeled with the complete name of the fluid they contain,
and the fine print under the solution name identifies the exact amount of each component
of the fluid. Orders and charting, however, are done using abbreviations.
KEYpaint: In IV fluid abbreviations, D identifies dextrose; W identifies
water; S ide11tifies saline; NS identifies normal saline; and numbers ide11tify
percentage (%) strengths.
Solutions may be abbreviated in different ways; for example, D5W, 5%D/W, D5%W, or other
combinations. But the initials and percentage have the identical meaning regardless
of the way they are abbreviated. Normal saline solutions are frequently written with
the 0.9, or % sign included; for example, D5 0.9NS, or D5 0.9%S. Solutions with different
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplka ted, in whole or in part. Due to elec.tronic rig hts. some Lhlnl party conte nt may be .supprcs..,;,00 from Lhe c Book and/or eChapLe r(s).
Ed llorial re view has deemed LhaL any suppressed content does noL materially affec t Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions req uire iL
INTRODUCTION TO IV THERAPY
percentages of saline are also available: 0.45%, often written as ½ (0.45% is half of 0.9%),
and 0.225%, sometimes written as ¼ (¼ of 0.9) are examples. Some typical orders might be
abbreviated D5 ½S or D5 ¼NS.
Another commonly used solution is Ringer's lactate, a balanced electrolyte solution,
which is also called Lactated Ringer's Solution. As you would now expect, this solution
is abbreviated RL, LR, or RLS. Electrolytes may also be added to the basic fluids (DW
and DS) just discussed. One electrolyte so commonly added that it must be mentioned is
potassium chloride, which is abbreviated KCl. It is measured in milliequivalents (mEq).
►►► PROBLEMS 17.3
List the components and percentage strengths of the IV solutions.
1. DlONS
2. D5NS
3. D2.5 ½S
4. D5 ¼S
5. D20W
6. D5NS 20 mEq KCl
7. D5RL
Answers 1. 10% dextrose in 0.9% saline 2 . 5% dextrose in normal (0.9%) saline 3. 2.5% dextrose in
0.45% saline 4. 5% dextrose in 0 .225% saline S. 20% dextrose in water 6. 5 % dextrose in 0.9% saline
with 20 mEq potassium chloride
7. 5% dextrose in Ringer's lactate solution
PERCENTAGES IN IV FLUIDS
You will recall that percent means grams of drug per 100 ml, of fluid. This means
that a 5% dextrose solution will have 5 g of dextrose in each 100 mL. A 500 mL bag of a 5%
solution ,vill contain 5 g x 5, or 25 g of dextrose, whereas 500 mL of a 10% solution contains
10 g x 5, or 50 g of dextrose. The fine print on N labels always lists the name and amount
of all ingredients.
The Ringer's lactate solution in Figure 17-13 illustrates this very well. Take a minute to
read the components of this solution.
The point being made here is that percentages make IV fluids significantly
different from each other. As with drugs, reading labels and making sure the Ns are
administered as ordered is critically important.
Copyrig hl 201 5 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplka ted, in whole or in part. Due Lo elec.tronic rig hts. some Lhlnl party conle nl may be .supprcs..,;,00 from Lhe cBook and/or eChaple t1s).
Ed llorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions req uire iL
265
266
INTRAVENOUS CALCULATIONS
NOC 007.d-7929-09
2) 1000 ml
LACTATED RINGER'S and
5°/o DEXTROSE
-1
--2
Injection, USP
EACH 100 ml CONfAJNS DEXTROSE. HYDROUS
.S g; SOOIOM LACTATE. ANHYD 310 mg,
SODIUM CHLORIDE 600 mg. POTASSIUM CHLORIDE JO 1119, CALCIUM CHLORIDE,
OIHYORATE 20 mg IN WATER FOR INJECTION pH ADJUSTED WITH HO
ElECTROLYrES PEIi 1000 ml !NOT INCWOING
pH ADJUSTMENTI SODIUM 130 IIIEQ.
: POTASSIUM 4 m&i; CAWUM 3 mfq. CHLORIDE
: 109 mEq. LACTATt 28 ..Eq
525 mO.mollllTEll lCALCI pH 4 9 14 O to 65)
• CAUTION DO NOT ADMINISTER CALCIUM
; CONTAINING SOLUTIONS CONCURRENTLY
~ WITM STORED BLOOD NOT FOR USE IN M
TREATMENT Of LACTIC ACIDOSIS
:: ADDITIVES MAY BE INCOMPATIBLE. CONSULT
WITH PHARMACIST. IF AVAILABLE WHEN
INTIIOOUCING AOOITIVES, USE ASEPTIC
TtCHNIOUE. MIX THOROUGHLY AND 00 NOT
STORE. SINGLE,DOSE CONTAINER FOR I Y
USE USUAl DOSAGE SEE INSERT Sltllll.E.
NONPYROGENIC USE ONLY IF SOLUTION IS
CLEAR ANO CONTAINER IS UNDAMAGED
MUST NOT BE USED IN SERIES CONNECTIONS.
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PARENTERAL NUTRITION
One of the options available for providing nutrition when a patient is unable to eat is to
administer a nutrient solution via a central vein. This is referred to as parenteral nutrition. The solutions infused are generally of a high caloric content and contain varying
percentages of glucose, amino acids, and/ or fat emulsions. A number of abbreviations/
descriptions are used for parenteral nutrients. Some of the more common are total parenteral nutrition (TPN), partial parenteral nutrition (PPN), and hyper-alimentation
(nutrition in excess of maintenance needs). There is a noticeable difference in fluids
that contain lipids ( fat, intralipids) in that they are opaque-white in appearance, similar
to nonfat milk These fluids are normally infused slowly, but not usually over a period
of more than 24 hours because they can spoil and support bacterial growth. All
precautions applicable to IVs in general apply equally to parenteral nutrients, with more
care necessary for the IV site to prevent infection. Flow rate and infusion time calculations
covered in subsequent chapters are also applicable for parenteral nutrition solutions.
Summary
This concludes your introduction to IV therapy. The important points to remember
from this chapter are:
Sterile technique is used to set up all IV solutions, tubings, and devices.
The correct fluid level for an IV drip chamber is half full.
Injection ports on an IV line are used to connect secondary lines and to infuse
medications.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be s uppressed from Lhe c Book and/or eChapLe1ts).
Edilori.al review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
INTRODUCTION TO IV THERAPY
A peripheral line refers to an IV infusing in a hand, arm, or leg vein.
A central line refers to an IV infusing into a deep chest vein.
IVs flow by gravity pressure, and the higher the solution bag, the faster the IV will
infuse.
The average height for an IV solution bag above the patient's heart level is 3 feet.
Secondary solution bags must hang higher than the primary bag to infuse first.
Volume-controlled burettes are used for very exact measurements of IV
medications and fluids.
Intermittent infusion locks or ports are used to infuse IV medications or fluids on
an intermittent basis when a continuous IV is not necessary.
Infusion locks or ports may be irrigated with sterile saline, or heparin flush
solutions not to exceed 10-100 units/ m.L.
Volumetric pumps are electronic devices that force fluids into a vein under
pressure and control infusion rates.
Syringe pumps are used to infuse medications that cannot be mixed with other
fluids or medications.
Patient-controlled analgesia (PCA) devices allow a patient to self-administer pain
medication.
In IV fluid abbreviations, D identifies dextrose, W identifies water, S identifies
saline, NS identifies normal saline, RL or LR identify Ringer's lactate solution,
and numbers identify percentage (%) strengths.
Summary Self-Test
You are to assist with some IV procedures. Answer the situational questions
concerning these procedures.
1. A patient is admitted and an IV of 1000 mL D5RL is started.
These initials identify what type of solution?
This is referred to as what type of IV line?
2. All roller cla1nps on the IV tubing are closed before
connection to the solution bag. Why?
3. The IV is started in the back of the patient's left l1and.
This makes it what type of line?
4. You are asked to check the fluid level in the drip chamber, and
you observe that it is correct, which is ...
5. You are then asked to adjust the flow rate. You will use what
type of clamp to do this?
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267
268
INTRAVENOUS CALCULATIONS
6. It is decided to use an electronic infusion control device to
administer this N. The device used is a ...
7. An IV antibiotic is ordered for the patient. This is sent from the
pharmacy already prepared in a small-volume IV solution bag.
The setup used to infuse this medication is referred to as an IV ...
8. How is this abbreviated?
9. In order for the antibiotic to infuse first, how must it be hung in
relation to the original solution bag?
10. Some days later, the patient's IV is to be discontinued, but he
is to continue to receive IV antibiotics. What is the site used for
this intermittent administration called?
11. The patient had a PCA in use for one day. What do these
initials mean?
What does this device control?
Answer these as briefly as possible.
12. A small-volume IV medication is to be diluted in 20 rnL and infused.
This can be most accurately measured using a _ _ _ _ _ _.
13. These devices are calibrated in - - - - - - increments.
14. When an IV medication is injected directly into the vein
via a port, it is called an IV_ _ _ _ _ _ or _ _ _ _ _ _.
15. What heparin dosage strengths are used for IV port flush? _ _ _ _ __
16. Ports may be irrigated with _ _ _ _ _ _ mL of _ _ _ _ __
to prevent blockage every _ _ _ _ _ _ hours.
17. In IV fluid abbreviations, D5NS identifies what IV fluid? - - - - - Answers
1. 5% dextrose in
Ringer's lactate;
.
primary
2. to prevent air from
entering the tubing
3. peripheral
4. half full
5. roller
6. volumetric pump
7. piggyback
8. IYPB
9. higher
10. intermittent infusion
port; so Ii ne or
11. patient-controlled
15. 10 units/ ml or
analgesia; administration of pain
medication
100 units/ml
16. 1-2 ; norma l
12. calibrated burette
13. 1 ml
saline; 6-8
17. 5% dextrose in
normal saline
14. push or bolus
heparin lock
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Ed llorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions req uire iL
C A TE
This chapter presents a number of ways to calculate IV flow rates: ratio
and proportion, dimensional analysis, and the formula and division factor method.
Intravenous fluids are ordered on the basis of ml/hr to be administered; for example, 125 ml/hr. With the widespread use of electronic
infusion devices that can be set to deliver a ml/hr rate, simply setting
the rate ordered on the device and making sure it is working properly is
all that is required for many infusions.
The most common flow rate calculation is necessary when an
infusion device is not being used. It involves converting a ml/hr
order to the gtt/min rate necessary to infuse it; for example,
1000 ml to infuse at 125 ml/hr or 3000 ml/24 hr.
IV TUBING CALIBRATION
The size of IV drops is regulated by the type of IV set being used, which
is calibrated in number of gtt/ml,. Unfortunately, not all set s (or their
drop size) are the same. Each clinical facility uses at least two sizes of
infusion sets: a standard macrodrip set calibrated at 10, 15, or
20 gtt/ml, that is used for routine adult IV administrations, and a
microdrip set calibrated at 60 gtt/ml, which is used when more exact
measurements are needed; for example, to infuse medications or in critical
care and pediatric infusions. Figure 18-1 gives a graphic representation of
the various drop/ gtt sizes.
KEYpoint: IV administration sets are calibrated in gtt/ ml,.
The gtt/ml, calibration of each IV infusion set is clearly printed on
each package, and the first step in calculating flow rates is to identify the
gtt/ mL calibration of the set to be used for an infusion.
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Edilorial review has deemed Lhal :my suppres..~ed content does nol m.at.eri.ally affecL the overall learning experience. Cengage Leaming reserves the rig ht Lo remove additi
270
INTRAVENOUS CALCULATIONS
10 gtt/ml
15 gtt/ml
20 gtt/m l
60 gtt/m l
0
N
C)
c::
c::
~
"'
QJ
-'
QJ
C)
Macrodrip Chambers
Microdrip Chambers
"'
Cl
c::
QJ
u
@
FIGURE 18-1 Comparative IV drop sizes.
►►►
PROBLEMS 1 8. 1
Identify the calibration in gtt/ mL for each IV infusion set.
1. Figure 18-2
2. Figure 18-3
II I I
I I
a Primary I.V. Set, Vented, 70 Inch
... l lll
>-
"' .
QJ
-
YEIIIOSET • MICIIOOIIP •
"'
QJ
~.c::
:::,
o _0
u>- "'
~
~ 0
-
..c
C. " '
=
~-'
C)
0
O
-o..c
..c
cE <(
FIGURE 18-2
a VENO SET , Piggyback
No. 4967
>"'
I I
Primary I.V. Set, Vented, 80 Inch 15
(((.AIIOff lAIOIATOIIESi NOITH CHfCAGO. ILID08f. USA
tm>&•t f..
.
QJ
"'
O
0
t:
.IB
:::,
~
u lo
>- ~
..c:: 0
C. ..c
"'
"'
c,
z::
0
0
~-'
-0 ..c
..c
cE <(
FIGURE 18-3
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IV FLOW RATE CALCULATION
3. Figure 18-4 _ _ _ __
QJ
-.
~
~
..r=
--.::,
2C5419s
(tJ
QJ
Baxter-Travenol
Vented Basic Set
10 drops/ml
QJ
:c >~
~
QJ
QJ
"'
-0
, Cl
-
'I< ~
(tJ
"'
co -"'
~
>--
"' -<(
QJ
't=
.
:::, c::
0
0
u ·,;::;
"'
QJ !::
0
Cl Cl.
(tJ
~
Eu
o
_
FIGURE 18-4
Answers 1. 60 gtt/ml 2. 15 gtt/ml 3. 10 gtt/ml
USING RATIO AND PROPORTION TO CALCULATE
gtt/min FLOW RATES
The flow rate in gtt/min is calculated from the gtt/ml, calibration of the IV set being
used, either 10, 15, 20, or 60 gtt/ mL, and the ml,/hr ordered.
An IV is ordered to infuse at a rate of 125 ml,/hr using a set
EXAMPLE 1
calibrated at 10 gtt/ ml,. Calculate the gtt/ min flow rate.
You are calculating gtt/min. Start by converting ml,/hr to ml,/min. This is done by
dividing the 125 ml,/hr rate by 60 min.
■
Convert the 125 ml,/hr ordered to ml,/ min.
125 mL + 60 min = 2 ml,/min
■
Calculate the gtt/min rate for 2 ml,/min. Enter the 10 gtt/ml, set calibration
as the first ratio in the proportion. The X gtt in 2 ml, is entered next.
10 gtt
X gtt
--=--=20gtt
lmL
2mL
or
10 gtt : 1 mL = X gtt : 2 mL
X= 20gtt
To infuse an IV at 125 ml,/hr using a set calibrated at 10 gtt/ml,, set the drip
rate at 20 gtt/min.
An IV of 150 ml, is to infuse in 1 hr using a set calibrated at 15 gtt/ ml,.
EXAMPLE 2
Calculate the gtt/min flow rate.
■
Convert the 150 ml,/hr to ml,/min.
150 mL + 60 min= 2.5 ml,/min
■
Calculate the gtt/min rate for 2.5 ml,/min.
15 gtt
X gtt
lmL
2.5mL
= 37.5
38 gtt
or
15 gtt: 1 mL = X gtt : 2.5 mL
X= 37.5 = 38gtt
To infuse 150 ml,/hr using a set calibrated at 15 gtt/ml,, set the drip rate
at 38 gtt/min.
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271
272
INTRAVENOUS CALCULATIONS
KEVpaint: Flow rates are routinely rounded to the nearest whole gtt.
Let's now look at some IVs ordered to infuse in more than 1 hour.
EXAMPLE 3
An IV of2500 ml, is to infuse in 24 hr using a 20 gtt/ml, calibrated
set . Calculate the gtt/min flow rate.
■
Convert 2500 ml,/24 hr to ml,/hr.
2500 mL 7 24 hr = 104.1 = 104 ml,/hr
■
Convert the 104 ml,/hr to ml,/min.
104 mL 7 60 min= 1.73 = 1.7 ml,/min
■
Calculate the gtt/min rate for 1.7 ml,/min.
20 gtt
1 mL
X gtt = 34 gtt
1.7 mL
or
20 gtt : 1 mL = X gtt : 1.7 mL
X= 34gtt
To infuse an IV of 2500 ml, in 24 hr using an IV set calibrated at 20 gtt/ml,,
set the flow rate at 34 gtt/min.
EXAMPLE 4
■
An IV of 1000 ml, is ordered to infuse in 5 hr using a set calibrated
at 15 gtt/ ml,.
Convert 1000 ml,/5 hr to ml,/hr.
1000 mL 7 5 hr = 200 ml,/hr
■
Convert 200 ml,/hr to ml,/min.
200 mL 7 60 min= 3.3 ml,/min
■
Calculate the gtt/min rate for 3.3 ml,/min.
15 gtt
X gtt
- - = - - = 49.5 = 50 gtt
1 mL
3.3 mL
or
15 gtt : 1 mL = X gtt : 3.3 mL
X = 49.5 = 50 gtt
To infuse 1000 ml, in 5 hr using a set calibrated at 15 gtt/ml,, set the rate
at 50 gtt/min.
KE paint: Flow rate answers may vary by 1-2 gtt/ min depending on
how the numbers are rounded in calculations.
A 1-2 gtt/min variation is considered insignificant for most infusions, because flow
rates fluctuate as the infusion limb is moved, or positional changes are made.
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IV FLOW RATE CALCULATION
►►► PROBLEMS 18.2
Calculate gtt/min flow rates. Round to the nearest whole gtt.
1. An IV of 2000 mL is to infuse in 12 hr using a 10 gtt/m.L set
2. 3500 mL are ordered to infuse in 24 hr using a set
calibrated at 20 gtt/m.L
3. Infuse 500 mL in 3 hr using a 15 gtt/mL set
4. A volume of 1500 mL is to infuse in 5 hr using a 15 gtt/m.L set
5. 1750 mL are ordered to infuse in 9 hr using a 20 gtt/m.L set
6. An IV of 2500 mL is to infuse in 18 hr on a set calibrated
at 10 gtt/m.L
7. A 3000 mL volume is to infuse in 24 hr on a set calibrated
at 20 gtt/m.L
8. A volume of 2750 mL is to infuse in 22 hr on a 15 gtt/mL set
9. An IV of 750 mL is ordered to infuse in 8 hr on a 10 gtt/mL set
10. A volume of 1250 1nL is to infuse in 12 hr using a 15 gtt/1nL set
Answers 1. 28 gtt/min 2 . 49 gtt/min 3 . 42 gtt/min 4 . 75 gtt/min 5 . 65 gtt/min 6 . 23 gtt/min
7. 42 gtt/min 8. 31 gtt/min 9 . 16 gtt/min 10. 26 gtt/min
NOTE: Continue with Using Dimensional Analysis to Calculate gtt/ min Flow Rates or turn to
page 277for the Formula and Division Factor Methods ofFlow Rate Calculation.
USING DIMENSIONAL ANALYSIS TO CALCULATE
gtt/min FLOW RATES
The flow rate in gtt/min is calculated from the calibration of the IV set being used,
either 10, 15, 20, or 60 gtt/ mL, and the ml,/hr ordered. You will immediately notice a
difference fro1n the previous DA calculations you have learned because this calculation
includes two values: gtt and min. However, the DA calculation steps are identical.
Calculate a gtt/min flow rate to infuse 125 ml,/hr using a set calibrated at 10 gtt/ml,.
EXAMPLE 1
■
Enter the gtt/min to be calculated as a common fraction followed by an
equal sign.
gtt mm
•
■
Begin ratio entries as if you were calculating only the gtt numerator. Locate
the ratio containing gtt-the 10 gtt/ m.L set calibration. Enter 10 gtt as the numerator
to match the gtt numerator being calculated; 1 mL becomes the denominator.
gtt _ 10 gtt
min
lmL
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273
274
INTRAVENOUS CALCULATIONS
■
Match the rnL denominator with the 125 rnL of the 125 rnL/ hr ordered; 1 hr
becomes the denominator.
gtt = 10 gtt X 125 rnL
min
lmL
1hr
■
Enter a 1 hr equals 60 min conversion ratio, with 1 hr as the numerator and
60 min as the denominator. Notice that the min being calculated falls
automatically into place as the final denominator to complete the equation.
gtt = 10 gtt X 125 rnL X 1 hr
min
1 rnL
1 hr
60 min
■
Cancel the rnL/ rnL and hr/ hr denominator/ numerators to check for correct ratio
entry. Do the math.
_gtt
_
= _lO_gt_t X -12-5,,ml
_ X _ l_)tr
_
= 20.8 = 21 gtt/min
min
1,.m:t'
1,hf
60 min
To infuse 125 ml,/hr using a 10 gtt/ml, infusion set, the flow rate is 21 gtt/min.
KEV paint: Flow rates are rounded to the nearest whole gtt.
A 20 gtt/ml, set is used to infuse 90 ml,/hr. Calculate the gtt/min
flow rate.
EXAMPLE 2
■
Enter the gtt/min to be calculated followed by an equal sign.
gtt •
min
■
Enter the 20 gtt/ rnL infusion set ratio with 20 gtt to match the gtt numerator
being calculated; 1 rnL becomes the denominator.
gtt _ 20 gtt
min
■
Match the rnL denominator with the 90 rnL of the rnL/ hr ordered; 1 hr is the
new denominator.
gtt
min
■
lmL
= 20 gtt X 90 mL
lmL
1hr
Enter a 1 hr equals 60 min conversion ratio, with 1 hr as the numerator and
60 min as the denominator, to complete the equation.
gtt
min
= 20 gtt X 90 mL X
1 rnL
1 hr
1 hr
60 min
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IV FLOW RATE CALCULATION
■
Cancel the m.L/ m.L and hr/hr denominator/ numerators to check for correct ratio
entry. Do the math.
_gtt
_ = -20_gt_t X _90_J;HL
_ X _ l_)tr
_ = 30 gtt/min
min
1)Hi
1)1(
60 min
To infuse 90 ml,/hr using a set calibrated at 20 gtt/ml,, the rate is 30 gtt/min.
EXAMPLE 3
■
Calculate the gtt/min rate to infuse 2500 ml, in 24 hr u sing a
15 gtt/mL infusion set.
Enter the gtt/min to be calculated followed by an equal sign.
gtt •
m1n
■
Enter the 15 gtt/ m.L infusion set ratio with 15 gtt to match the gtt numerator being
calculated; 1 mL becomes the denominator.
gtt _ 15 gtt
min
■
lmL
Enter the 2500 m.L/24 hr ordered with 2500 mL as the numerator to match the previous mL denominator. Enter 24 hr as the new denominator.
gtt = 15 gtt X 2500 mL
lm.L
min
■
Enter a 1 hr equals 60 min conversion ratio, with 1 hr as the numerator and 60 min
as the denominator, to complete the equation.
gtt
= 15 gtt X 2500 mL X
1 mL
min
■
24hr
24 hr
1 hr
60 min
Cancel the m.L/ m.L and hr/hr denominator/ numerators to check for correct ratio
entry. Do the math.
gtt
min
=
15 gtt
1
...,.,,T
)-llL
X
2500 ,mL
t.L
24 µi
X
1)r(
60 min
= 26.04 = 26 gtt / min
To infuse 2500 ml, in 24 hr using a 15 gtt/ml, calibrated infusion set, the rate is
26 gtt/min.
EXAMPLE 4
■
Calculate the gtt/min rate to infuse 2000 ml, in 10 hr using a
10 gtt/ml, IV infusion set.
Enter the gtt/min to be calculated followed by an equal sign.
gtt .
min
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275
276
INTRAVENOUS CALCULATIONS
■
Enter the 10 gtt/mL infusion set ratio with 10 gtt as the numerator to match the gtt
numerator being calculated; 1 mL becomes the denominator.
gtt _ 10 gtt
min
■
lmL
Enter the 2000 mL in 10 hr ordered with 2000 mL as the numerator to match the
previous mL denominator; 10 hr is the next denominator to be matched.
gtt = 10 gtt X 2000 mL
min
lmL
10hr
■
Enter a 1 hr equals 60 min conversion ratio, with 1 hr as the numerator and
60 min as the denominator, to complete the equation.
gtt = 10 gtt X 2000 mL X 1 hr
min
1 mL
10 hr
60 min
■
Cancel the mL/mL and hr/hr denominator/numerators to check for correct ratio
entry. Do the math.
gtt = lO gtt X 2000 ;nL' X l )lt = 33.3 = 33 gtt/ min
min l ,llI[
10 Jr(
60 min
To infuse 2000 ml, in 10 hr using a 10 gtt/ml, calibrated infusion set, the rate is
33 gtt/min.
►►► PROBLEMS 18 .3
Calculate gtt/min flow rates. Round to the nearest whole gtt.
1. An N of 2000 mL is to infuse in 12 hr using a 10 gtt/mL set
2. 3500 mL are ordered to infuse in 24 hr using a set calibrated
at 20 gtt/mL
3. Infuse 500 mL in 3 hr using a 15 gtt/mL set
4. A volume of 1500 mL is to infuse in 5 hr using a 15 gtt/mL set
5. 1750 mL are ordered to infuse in 9 hr using a 20 gtt/mL set
6. An N of 2500 mL is to infuse in 18 hr on a set calibrated
at 10 gtt/mL
7. A 3000 mL volume is to infuse in 24 hr on a set calibrated
at 20 gtt/mL
8. A volume of 2750 mL is to infuse in 22 hr on a 15 gtt/mL set
9. An N of 750 mL is ordered to infuse in 8 hr on a 10 gtt/mL set
10. A volume of 1250 mL is to infuse in 12 hr using a 15 gtt/mL set
Answers 1. 28 gtt/min 2. 49 gtt/min 3. 42 gtt/min 4. 75 gtt/min 5. 65 gtt/min 6. 23 gtt/min
7. 42 gtt/min 8. 31 gtt/min 9. 16 gtt/min 10. 26 gtt/min
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Ed llorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions req uire iL
IV FLOW RATE CALCULATION
FORMULA AND DIVISION FACTOR METHODS
OF FLOW RATE CALCULATION
The formula and division factor m ethods are intrinsically relat ed because the division
factor is derived from the formula method. Let's st art by looking at the formula m ethod.
The formula m ethod h as a limitation in that it can only be used if the flow rate is
expressed as ml,/hr (60 min) or less; for example, 110 mL/ 60 min or 125 mL/60 min. It
is esp ecially suitable for small volume infusions to b e complet ed in less than 60 min; for
example, 30 mL in 20 min.
Flow R ate = m I ,/ hr
EXAMPLE 1
■
Volume X Set Calibration
Time (60 min or less)
An IV is ordered to infuse at 125 ml,/hr. Calculat e the gtt/ min rat e
for a set calibrat ed at 10 gtt/ ml,.
Convert the hr to 60 min.
125 {mL) X lO{gtt/ mL)
60(min)
■
Calculate the gtt/ min rate.
125 X 10
- - - = 20.8 = 21 gtt/min
60
. EXAMPLE 2
Administ er an IV m edication of 100 ml, in 40 min using a set
calibrat ed at 15 gtt/ ml,.
100 mL X 15 gtt / mL
- - - - - - - - = 37.5 = 38gtt / min
40min
EXAMPLE 3
A 75 ml, volume of IV m edication is ordered to infuse in 45 min.
The set is calibrat ed at 20 gtt/ ml,.
75 mL X 20 gtt/mL
- - - - - - - = 33.3 = 33 gtt/min
45 min
►►► PROBLEMS 18.4
Calculate the flow rate in gtt/ min to the nearest whole drop using the formula method.
1. Administ er an IV of 110 mL/ hr using a set calibrat ed at 20 gtt/ mL
2. An IV solution is ordered at 200 mL/ hr using a set calibrated
at 15 gtt/ mL
3. A volume of 80 mL is to be infused in 20 min using a 10 gtt/ mL set
4. An IV is ordered to infuse at 150 mL/ hr using a 10 gtt/mL
calibrat ed set
5. An IV rat e of 90 mL/hr is ordered using a 15 gtt/ mL calibrat ed set
6. An IV of 500 mL is to infuse at 120 mL/ hr using a 20 gtt/ mL
calibrated set
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277
278
INTRAVENOUS CALCULATIONS
7. A t otal of 90 mL is to infuse at 100 m.L/ hr using a 20 gtt/ m.L set
8. A 15 gtt/ m.L set is u sed to infuse 120 mL at 80 m.L/ hr
9. A r at e of 60 m.L/ hr is ordered for a volume of 250 mL using a
10 gtt/ m.L set
10. A m edication volume of 50 mL is to infuse at 20 m.L/ hr using a
20 gtt/ m.L set
Answers 1. 37 gtt/min 2. 50 gtt/min 3. 40 gtt/min 4 . 25 gtt/min S . 23 gtt/min
6 . 40 gtt/min 7 . 33 gtt/min 8 . 20 git/min 9 . 10 gtt/min 10. 7 gtt/min
When an IV is ordered to infuse in more than I hour, the formula m ethod can still
b e u sed . However, it is n ecessary to add a preliminary st ep and d et ermine the ml,/hr th e
ordered volume will represent.
Calculat e the gtt/ min flow r at e for an N of 1000 ml, to infuse in
8 hr on a set calibrat ed at 20 gtt/ ml,.
EXAMPLE 1
■
Convert 1000 ml,/8 hr to ml,/hr.
1000 m.L/8 hr= 1000 ---:- 8 = 125 ml,/hr (60 min)
■
Calculate the gtt/ min flow rate.
125 {m.L) X 20 {gtt/ m.L)
60 {min)
EXAMPLE 2
■
= 41.6 = 42 gtt/min
Calculat e th e gtt/ min flow r at e for a v olume of 2500 ml, to infuse
in 24 hr on a set calibrat ed at 10 gtt/ ml,.
Convert 2500 ml,/24 hr to ml,/hr.
2500 m.L/24 hr= 2500 ---:- 24 = 104 ml,/hr (60 min)
■
Calculate the gtt/ min flow rate.
104m.L X 10 gtt / m.L
- - - - - - - - = 17.3 = 17 gtt /min
60min
EXAMPLE 3
An N of 1200 ml, is to infuse in 16 hr on a set calibrat ed at 15 gtt/ ml,.
1200 m.L/ 16 hr= 1200 ---:- 16 = 75 ml,/hr (60 min)
75 mL X 15 gtt / mL
- - - - - - - = 18.7 = 19 gtt / min
60min
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IV FLOW RATE CALCULATION
►►► PROBLEMS 18.5
Calculate the gtt/min flow rate using the formula method.
1. A volume of 2000 1nL to infuse in 24 hr on a set calibrated
at 15 gtt/mL
2. A volume of 300 mL to infuse in 6 hr on a 60 gtt/mL microdrip set
3. A volume of 500 mL to infuse in 4 hr on a 15 gtt/mL calibrated set
4. A 10 hr infusion of 1200 mL using a 20 gtt/mL set
5. An infusion of 500 mL in 5 hr on a set calibrated at 10 gtt/mL
6. A 2000 mL volume to infuse in 18 hr using a 20 gtt/ mL set
7. A 10 gtt/ mL set to infuse 400 mL in 4 hr
8. An 8 hr infusion of 1500 mL to use a set calibrated at 15 gtt/mL
9. A volume of 250 mL to infuse in 2 hr using a 20 gtt/mL set
10. A 5 hr infusion of 750 mL using a 10 gtt/mL set
Answers 1. 21 gtt/min 2 . 50 gtt/min 3 . 31 gtt/min 4 . 40 gtt/min 5, 17 gtt/min 6. 37 gtt/min
7 . 17 gtt/min 8 , 47 gtt/min 9. 42 gtt/min 10. 25 gtt/min
DIVISION FACTOR METHOD
The division factor is derived from the formula method, and it is invaluable for use in clinical
facilities where all the macrodrip infusion sets have the same calibration-either 10,
15, or 20 gtt/mL. Once again, this method can only be used if the rate is expressed in
ml,/hr (60 min). Let's start by looking at how the division factor is obtained.
mL X gtt/ mL
= gtt/ min
60min
EXAMPLE 1
Administer an IV at 125 ml,/hr. The set calibration is 10 gtt/ml,.
Calculate the gtt/min rate. Express the hr rate as 60 min.
1
125 (mL) X }ff (gtt/ mL)
fo()(min)
= 20.8 = 21 gtt / min
6
Look at the completed equation, and notice that because the time is restricted to
60 min, the set calibration (10) will be divided into 60 (min) to obtain a constant
number ( 6). This constant ( 6) is the division factor for a 10 gtt/ml, calibrated set.
KE paint: The division factor can be obtained for any IV set by dividing
60 by the calibration of the set.
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INTRAVENOUS CALCULATIONS
►►► PROBLEMS 18.6
Determine the division factor for these IV sets.
1. 20 gtt/ rnL
2. 15 gtt/rnL
3. 60 gtt/rnL
4. 10 gtt/ rnL
Answers 1 . 3 2. 4 3. l
4. 6
Once the division factor is known, the gtt/min rate can be calculated in one step
by dividing the ml,/hr rate by the division factor. Look again at the example.
1
125
- - -(rnL
_ )_x_ ~_ _(_
g tt_l_rnL
_ ) = 20.8 = 21 gtt/min
fa(} (min)
6
or 125 {rnL/hr) + 6 = 20.8 = 21 gtt/ min
The 125 ml,/hr flow rate divided by the division factor 6 gives the same 21 gtt/
min rate.
KEV paint: The gtt/ min flow rate can be calculated for mL/ hr IV orders
in one step by dividing the rnL/ hr to be infused by the division factor of the
administration set.
EXAMPLE 1
Infuse an IV at 100 ml,/hr using a set calibrated at 10 gtt/ml,.
Determine the division factor: 60 + 10 = 6
Calculate the flow rate:
EXAMPLE 2
Infuse an IV at 125 ml,/hr using a set calibrated at 15 gtt/ml,.
60 + 15 = 4
EXAMPLE 3
100 mL + 6 = 16.6 = 17 gtt/ min
125 rnL + 4 = 31.2 = 31 gtt/ min
A set calibrated at 20 gtt/ ml, is used to infuse 90 ml, per hr.
60 + 20 = 3
90 rnL + 3 = 30 gtt/ min
►►► PROBLEMS 18.7
Calculate the flow rates in gtt/min using the division factor method.
1. A rate of 110 mL/ hr via a set calibrated at 20 gtt/rnL
2. A set is calibrated at 15 gtt/ rnL. Infuse at 130 mL/ hr
3. To infuse 150 mL/hr u sing a 10 gtt/mL set
4. A set calibrated at 20 gtt/ rnL to infuse 45 rnL/ hr
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IV FLOW RATE CALCULATION
5. A 75 mL/hr volume with a set calibrated at 15 gtt/mL
6. A rate of 130 mL/hr using a 10 gtt/mL set
7. A 200 mL rate using a 15 gtt/mL set
8. A rate of 120 mL/hr using a 10 gtt/mL set
9. A 100 mL/hr rate using a 20 gtt/mL set
10. A rate of 125 mL/hr using a 15 gtt/mL set
Answers 1. 37 gtt/min 2 . 33 gtt/min 3. 25 gtt/min 4. 15 gtt/min 5. 19 gtt/min
6. 22 gtt/min 7. 50 gtt/min 8. 20 gtt/min 9. 33 gtt/min 10. 31 gtt/min
All the preceding examples and problems using the division factor ,vere for macrodrip
sets. Let's now look at what happens when a microdrip set calibrated at 60 gtt/ml, is used.
EXAMPLE 1
Infuse at 50 01l,/hr using a 60 gtt/ml, microdrip.
60 + 60 = 1
50 mL + 1 = 50 gtt/min
Because the set calibration is 60 and the division factor is based on 60 min (1 hr),
the division factor is 1. So, for microdrip sets, the gtt/min flow rate will be identical
to the ml,/hr ordered.
KE ..paint: When a 60 gtt/ mL microdrip set is used, the flow rate in gtt/ min
is identical to the volume in mL/ hr to be infused.
►►► PROBLEMS 18 . 8
Calculate gtt/min rates for a microdrip.
1. 120 mL/hr
6. 110 mL/hr
2. 90 mL/hr
7. 60 mL/hr
3. 100 mL/hr
8. 45 mL/hr
4. 75 mL/hr
9. 70 mL/ hr
5. 80 mL/hr
10. 130 mL/hr
Answers 1. 120 gtt/min 2. 90 gtt/min 3. 100 gtt/min 4. 75 gtt/min s. 80 gtt/min
6. 110 gtt/min 7. 60 gtt/min 8. 45 gtt/min 9. 70 gtt/min 10. 130 gtt/min
The division factor can also be used to calculate the flow rate of any volume that can be
expressed in ml,/hr. Larger volumes can be divided, and smaller volumes can be multiplied and expressed in mL/hr. This does require the conversion step you used earlier.
EXAMPLE 1
2400 mL/24 hr = 2400 + 24 = 100 rnl,/hr
EXAMPLE 2
1800 mL/8 hr= 1800 + 8 = 225 ml,/hr
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INTRAVENOUS CALCULATIONS
EXAMPLE 3
10 mL/30 min = 10 X 2 (2 X 30 min) = 20 mL/hr
EXAMPLE 4
15 mL/20 min = 15 X 3 (3 X 20 min) = 45 ml,/hr
REGULATING FLOW RATE
Manual flow rates are regulated by counting the number of drops falling in the drip
chamber. The standard procedure for counting is to hold a watch next to the drip chamber
and actually count the number of drops falling. The roller clamp is adjusted during the
count until the required rate has been set. A 15 sec count is most commonly used because
there is less chance of attention wandering during the count. This means that the ordered
gtt/min (60 sec) rate must be divided by4 to obtain the 15 sec drip count (60 sec+ 4 = 15 sec).
EXAMPLE 1
An IV is to run at a rate of 60 gtt/ min. What will the 15 sec count be?
60 gtt/min + 4 = 15 gtt
Adjust the rate to 15 gtt/ 15 sec.
EXAMPLE 2
A 70 gtt/min IV rate is ordered. What will the 15 sec count be?
70 gtt/min + 4 = 17.5 = 18 gtt
Adjust the rate to 18 gtt/ 15 sec.
EXAMPLE 3
Adjust an IV to a rate of 50 gtt/min using a 15 sec count.
50 gtt/ min + 4 = 12.5 = 13 gtt
Adjust the rate to 13 gtt/ 15 sec.
►►► PROBLEMS 18.9
Answer these questions about 15 sec drip rates.
1. The 15 sec count of an IV flow rate is 7 gtt. A 29 gtt/min rate
is required. Is this rate correct?
2. You are to regulate a newly started IV to deliver 67 gtt/min.
Using a 15 sec count, how would you set the flow rate?
3. An IV is to run at 48 gtt/min. What must the 15 sec drip
rate be?
4. How many gtt will you count in 15 sec if the rate is 55 gtt/min?
5. An IV is to run at 84 gtt/ min. What will the 15 sec rate be?
6. What must the 15 sec count be to infuse 80 gtt/min?
7. A 110 gtt/min rate is ordered. What must the 15 sec count be?
8. A 100 gtt/min rate is ordered. What must the 15 sec count be?
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IV FLOW RATE CALCULATION
9. A rate of 90 gtt/min is ordered. Is a count of 15 gtt in 15 sec correct?
10. An IV is infusing at a rate of 30 gtt in 15 sec. A rate of 120 gtt/min
was ordered. Is this rate correct?
Answers 1. yes 2 . 17 gtt/ 15 sec 3. 12 gtt/ 15 sec 4. 14 gtt/ 15 sec s. 21 gtt/ 15 sec
6. 20 gtt/ 15 sec 7. 28 gtt/ 15 sec 8. 25 gtt/ 15 sec 9. no, too slow 1 O. yes
Individual clinical facilities and/or states/provinces may require a 30 or 60 sec (1 min)
count. When a 60 sec count is required, particular care must be taken not to let your attention wander during the count, which can easily happen in this longer time frame. A 60 sec
count will require a 1 min count, whereas a 30 sec count will require the gtt/min rate to be
divided by 2 (60 sec 7 2 = 30 sec).
EXAMPLE 1
An IV is to be infused at 56 gtt/min. What is the 30 sec rate?
56 gtt/min 7 2 = 28 gtt
Adjust the rate to 28 gtt/30 sec.
EXAMPLE 2
A rate of 72 gtt/min has been ordered. What will the 30 sec count be?
72 gtt/min 7 2 = 36 gtt
Adjust the rate to 36 gtt/30 sec.
►►► PROBLEMS 18 . 10
Calculate a 30 sec flow rate count.
1. An IV to be run at a rate of 48 gtt/min
2. An IV ordered to infuse at 52 gtt/min
3. An IV to infuse at 120 gtt/min
4. An infusion rate of 90 gtt/min
5. An IV to infuse at 100 gtt/min
Answers 1. 24 gtt/30 sec 2. 26 gtt/30 sec 3. 60 gtt/30 sec 4. 45 gtt/30 sec 5. 50 gtt/30 sec
CORRECTING OFF-SCHEDULE RATES
Because positional changes can alter the rate slightly, IVs occasionally infuse ahead of or
behind schedule. When this occurs, the usual procedure is to recalculate the flow rate
using the volume and time remaining and to adjust the rate accordingly. However,
each situation must be individually evaluated, especially if the discrepancy is large. ff
too much fluid has infused, immediately assess the individual's response to the
increased intake and take appropriate action. If too little fluid has infused, it will be
necessary to assess the individual's ability to tolerate an increased rate because many
medications and fluids have restrictions on the rate of administration. Both of these factors
must be considered before rates can be increased to "catch up :' In addition, most clinical
facilities will have specific policies to cover over- or underinfusion due to altered
flow rates, and you will be responsible for knowing these.
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INTRAVENOUS CALCULATIONS
The following are some examples of how the rate can be recalculated. Because IVs
are usually checked hourly, the focus will first be on recalculation using exact hours. Some
recalculations have also been included using fractions of hours rounded to the nearest quarter
hour: 15 min= 0.25 hr, 30 min = 0.5 hr, and 45 min = 0.75 hr. These equivalents are close
enough for uncomplicated infusions because the exact time of completion is not totally
predictable. IVs needing exact infusion would be monitored by electronic infusion devices.
EXAMPLE 1
An IV of 1000 ml, was ordered to infuse over 10 hr at a rate of
25 gtt/min. The set calibration is 15 gtt/ml,. After 5 hr, a total of
650 mL have infused instead of the 500 ml, ordered. Recalculate
the new gtt/ min flow rate to complete the infusion on schedule.
Time remaining
10 hr - 5 hr = 5 hr
Volume remaining
1000 mL - 650 mL = 350 ml,
350 mL -:- 5 hr = 70 ml,/hr
Set calibration is 15 gtt/ml,.
70-:- 4 (division factor)= 17.5 = 18 gtt/ min
Slow the rate from 25 gtt/min to 18 gtt/min.
EXAMPLE 2
An IV of 800 ml, was to infuse over 8 hr at 20 gtt/min. After 4 hr
15 min only 300 ml, have infused. Recalculate the gtt/min rate to
complete on schedule. The set calibration is 15 gtt/ml,.
Time remaining
8 hr - 4.25 hr = 3.75 hr
Volume remaining
800 mL - 300 mL = 500 ml,
500 mL -:- 3.75 hr = 133.3 = 133 ml,/hr
Set calibration is 15 gtt/ml,.
133 -:- 4 (division factor) = 33.2 = 33 gtt/min
Increase the rate to 33 gtt/min.
EXAMPLE 3
An IV of 500 ml, is infusing at 28 gtt/min. It was to complete in 3 hr,
but after l 1/2 hr, only 175 ml, have infused. Recalculate the gtt/min
rate to complete the infusion on schedule. Set calibration is 10 gtt/ml,.
Time remaining
3 hr - 1.5 hr = 1.5 hr
Volume remaining
500 mL - 175 mL = 325 ml,
325 mL -:- 1.5 hr = 216.6 = 217 ml,/hr
Set calibration is 10 gtt/ml,.
217-:- 6 (division factor)= 36.1 = 36 gtt/min
Increase the rate to 36 gtt/min.
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IV FLOW RATE CALCULATION
EXAMPLE 4
A volume of 250 ml, was to infuse 56 gtt/min in l 1/2 hr using a set
calibrated at 20 gtt/ml,. After 30 min, 175 ml, have infused. Recalculate the flow rate.
Time remaining
1.5 hr - 30 min = I hr
Volume remaining
250 mL - 175 mL = 75 ml,
Set calibration is 20 gtt/ml,.
75 - -:- - 3 (division factor) = 25 gtt/min
Decrease the rate to 25 gtt/min.
►►► PROBLEMS18 . ll
Recalculate flow rates for infusions to complete on schedule.
1. An N of 500 mL was ordered to infuse in 3 hr using a
15 gtt/m.L set. With 1½ hr remaining, you discover that only 150 mL
is left in the bag. At what rate will you need to reset the flow?
2. An N of 1000 mL was scheduled to run in 12 hr. After 4 hr,
only 220 mL have infused. The set calibration is 20 gtt/m.L.
Recalculate the rate for the remaining solution.
3. An N of 1000 mL was ordered to infuse in 8 hr. With 3 hr of
infusion time left, you discover that 600 mL have infused.
The set delivers 20 gtt/m.L. Recalculate the drip rate,
and indicate how many drops you will count in 15 sec
to set the new rate.
4. An N of 750 mL was ordered to run in 6 hr with a set calibrated
at 10 gtt/m.L. After 2 hr, you notice that 300 mL have infused.
Recalculate the flow rate, and indicate how many
drops you will count in 15 sec to reset the rate.
5. An N of 800 mL was started at 9 am to infuse in 4 hr. At 10 am,
150 mL have infused. The set is calibrated at 15 gtt/m.L.
Recalculate the flow rate in gtt/min.
6. An N of 600 mL was to infuse in 5 hr. After 2 hr, 400 mL have
infused. Recalculate the gtt/min rate to complete on time.
A 20 gtt/m.L set is being used.
7. A volume of 250 mL was to infuse in 2 hr. With 1 hr left, 70 mL
have infused. Calculate a new gtt/min rate to complete on
time using a 15 gtt/m.L set
8. An infiltrated N is restarted with a volume of 420 mL to
complete in 3 hr. Calculate the gtt/min rate for a 20 gtt/mL set.
What will the new 30 sec count be?
9. After 1 hr 30 min, 350 mL of a 1000 mL N has infused. It was
ordered to complete in 4 hr using a set calibrated at 15 gtt/m.L.
Calculate the gtt/min rate to complete on time.
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INTRAVENOUS CALCULATIONS
10. A total of 300 mL of an ordered 1000 mL in 10 hr infusion
has completed in 4.5 hr. The set calibration is 15 gtt/mL.
What gtt/min rate is necessary to complete on time?
Calculate the 15 sec count to deliver this rate.
Answers 1. 25 gtt/min 2. 33 gtt/min 3. 44 gtt/min; 11 gtt/15 sec 4. 19 gtt/min; 4-5 gtt/15 sec
5. 54 gtt/min 6. 22 gtt/min 7. 45 gtt/min 8. 47 gtt/min; 23-24 gtt/30 sec 9. 65 gtt/min
10. 32 gtt/min; 8 gtt/15 sec
Summary
This concludes the chapter on IV flow rate calculation and monitoring. The important
points to remember from this chapter are:
IVs are ordered as mL/hr to be administered.
Manual flow rates are counted in gtt/min.
IV tubings are calibrated in gtt/mL.
Macrodrip IV sets have a calibration of 10, 15, or 20 gtt/mL.
Microdrip sets have a calibration of 60 gtt/mL.
The formula for calculating flow rates is
mL/hr Volume X Set Calibration
Time (60 min or less)
The division factor method can be used to calculate flow rates only if the volume to
be administered is specified in mL/hr (60 min).
The division factor is obtained by dividing 60 by the set calibration.
Flow rate by the division factor method is determined by dividing the mL/hr to be
administered by the division factor.
Because microdrip sets have a calibration of 60 gtt/mL, their division factor is 1,
and the flow rate in gtt/min is the same as the mL/hr ordered.
If an IV runs ahead of or behind schedule, a possible procedure is to use the time
and mL remaining to calculate a new flow rate.
If an IV is determined to have infused ahead of schedule, immediate assessment
of the individual's tolerance to the excess fluid is required and appropriate action
should be taken.
If a rate must be increased to compensate for running behind schedule, the type of
fluid being infused and the individual's ability to tolerate an increased rate must be
assessed.
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IV FLOW RATE CALCULATION
Summary Self-Test
Answer as briefly as possible.
1. Determine the division factor for the following IV sets.
a. 60 gtt/mL
b. 15 gtt/mL
c. 20 gtt/mL
d. 10 gtt/mL
2. How is the flow rate determined in the division factor method?
3. The division factor method can only be used if the volume to
be administered is expressed in ...
4. An IV is to infuse at 50 gtt/min. How will you set it using
a 15 sec count?
5. You are to adjust an IV at a rate of 60 gtt/min. What will the
15 sec count be?
Calculate the flow rate in gtt/min.
6. An infusion of 2000 mL has been ordered to run 16 hr. The set
calibration is 10 gtt/mL.
7. The order is for 500 mL in 8 hr. The set is calibrated at 15 gtt/mL.
8. Administer 150 mL in 3 hr. A microdrip is used.
9. 1500 mL has been ordered to infuse in 12 hr. Set calibration
is 20 gtt/ mL.
10. An IV medication of 30 mL is to be administered in 30 min
using a 15 gtt/mL set.
11. Administer 100 mL in 1 hr using a 15 gtt/mL set.
12. Infuse 500 mL in 6 hr. Set calibration is 10 gtt/mL.
13. The order is to infuse a liter in 10 hr. At the end of 8 hr, you notice
that there are 500 mL left. What would the new flow rate need
to be to finish on schedule if the set calibration is 10 gtt/mL?
14. An IV was started at 9 am with orders to infuse 500 mL in 6 hr.
At noon, the IV infiltrated with 350 mL left in the bag. At 1 pm,
the IV was restarted. The set calibration is 20 gtt/mL. Calculate
the new flow rate to deliver the infusion on time.
15. A 50 mL IV is to infuse in 15 min. The set calibration is 15 gtt/mL.
After 5 min, the IV contains 40 mL. Calculate the flow rate to
deliver the volume on time.
16. An IV of 1000 mL is ordered to run at 25 mL/hr using
a microdrip set.
17. An infusion of 800 mL has been ordered to run in 5 hr. Set
calibration is 10 gtt/mL.
18. Administer 1500 mL in 8 hr using a set calibrated at 20 gtt/mL.
19. The order is for 750 mL to run in 6 hr. Set calibration is 15 gtt/mL.
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287
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INTRAVENOUS CALCULATIONS
20. An IV of 1000 mL was ordered to run in 8 hr. After 4 hr, only 250 mL
have infused. The set calibration is 20 gtt/mL. Recalculate the
rate for the remaining solution to complete on time.
21. The order is to infuse 50 mL in 1 hr. The set calibration is
a microdrip.
22. An IV of 500 mL is to infuse in 6 hr using a set calibrated
at 10 gtt/ mL.
23. Infuse 120 mL in 1 hr. Set calibration is 10 gtt/mL.
24. Administer 12 mL in 22 min using a microdrip set.
25. A patient is to receive 3000 mL in 20 hr. Set is calibrated
at 20 gtt/mL.
26. Infuse l liter in 5 hr using a set calibration of 15 gtt/mL.
27. A total of 1180 mL is to infuse in 12 hr using a set calibrated
at 20 gtt/ mL.
28. A volume of 150 mL is to infuse in 30 min. At the end of 20 min,
you discover that 100 mL have infused. The set calibration
is 10 gtt/mL. Should the flow rate be adjusted? If so,
what is the new rate?
29. The order is for 1000 mL in 5 hr. The set calibration is 20 gtt/mL.
30. Infuse 15 mL in 14 min using a 20 gtt/mL set.
31. The order is for 1000 mL in 10 hr using a 20 gtt/mL calibration.
32. A microdrip is used to administer 12 mL in 17 min.
33. Infuse 2750 mL in 20 hr using a 10 gtt/mL set.
34. An IV of 1800 mL is to infuse in 15 hr using a 15 gtt/mL set.
35. Infuse 600 mL in 6 hr with a 10 gtt/m.L set.
36. Administer 22 mL in 18 min using a microdrip set.
37. An order of 1800 mL is to infuse in 10 hr. Set calibration is 20 gtt/mL.
38. Infuse 8 mL in 9 min using a microdrip.
39. Infuse 4000 mL in 20 hr. A 20 gtt/mL set is used.
40. An IV of 500 mL that was to infuse in 2 hr is discovered to have
only 150 mL left after 30 min. Recalculate the flow rate. Set
calibration is 15 gtt/mL.
Answers
1. a) 1 b) 4 c) 3 d) 6
2. ml/ hr -;- division
factor
3. mVhr (ml/60 min)
4. 13 gtt/ 15 sec
5. 15 gtt/ 15 sec
6. 21 gtt/min
7. 16 gtt/ min
8. 50 gtt/ min
9. 42 gtt/min
10. 15 gtt/ min
11. 25 gtt/min
12. 14 gtt/min
13. 42 gtt/min
14. 58 gtt/min
15. 60 gtt/min
16. 25 gtt/min
17. 27 gtt/min
18. 63 gtt/min
19. 31 gtt/min
20. 63 gtt/ min
21. 50 gtt/min
22. 14 gtt/min
23. 20 gtt/ min
24 . 33 gtt/min
25. 50 gtt/ min
26. 50 gtt/ min
27. 33 gtt/min
28. no, rate is correct
at 50 gtt/ min
29. 67 gtt/min
30. 21 gtt/ min
31. 33 gtt/min
32. 42 gtt/min
33. 23 gtt/ min
34. 30 gtt/ min
35. 17 gtt/min
36. 73 gtt/min
37. 60 gtt/min
38. 53 gtt/min
39. 67 gtt/min
40. 25 gtt/ min
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CHAPTER
There are a number of reasons for calculating IV infusion and completion times: to know when an IV solution will complete so that additional
solutions ordered can be prepared in advance and ready to hang; to discontinue an IV when it has completed; and to label an IV bag with start,
progress, and completion times so that the infusion can be monitored
and adjusted to keep it on schedule. Knowing the infusion time is also
important because laboratory studies are sometimes made before, during, or after specified amounts of IV solutions have infused. The infusion
time may be calculated in hours and/or minutes, depending on the type
and amount of solution ordered.
CALCULATING INFUSION TIME
FROM mL/hr ORDERED
The infusion time is calculated for each bag/ bottle to be hung and infused.
The largest capacity IV solution bag or bottle is 1000 mL, but 500 mL,
250 mL, and 50 mL bags are also commonly used. Calculations for oddnumbered volumes remaining when an IV infiltrates are also routinely
done. Infusion time is calculated by dividing the volume being
infused by the ml,/hr rate ordered.
Because most IVs take several hours to infuse, the unit of time being
calculated most often includes hours (hr) and minutes (min).
· .. IV infusion time is calculated by dividing the
volume to be infused by the mL/ hr flow rate.
EXAMPLE 1
Calculate the infusion time for an IV of 500 ml, to
infuse at 50 ml,/hr.
Infusion Time = volume 7 ml,/hr rate
= 500 mL 7 50 mL/ hr = 10 hr
The infusion time for an IV of 500 ml,
infusing at 50 ml,/hr is 10 hr.
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290
INTRAVENOUS CALCULATIONS
EXAMPLE 2
The order is to infuse 1000 mL at 75 mL/ hr. Calculat e the infusion
time.
1000 mL 7 75 m.L/ hr = 13.33 hr
In this example, the 13 represents hr, whereas the .33 represents the fraction of an additional hr.
KEYpaint: Fractional hr are converted to min by multiplying 60 min
by the fraction obtained.
Calculate min by multiplying 60 min by the fractional .33 hr.
60 min/ hr X .33 hr = 19.8 = 20 min
The infusion time is 13 hr 20 min.
EXAMPLE 3
An IV of 1000 mL is to infuse at 90 ml,/hr. Calculat e the infusion
time.
1000 mL 7 90 m.L/ hr = 11.11 hr
Remember that .11 represents the fraction of an additional hr. Convert this to
min by multiplying 60 min by .II
60 min/ hr X .11 hr= 6.6 = 7 min
The infusion time is 11 hr 7 min.
EXAMPLE 4
Calculat e the infusion time for 750 ml, at a rat e of 80 ml,/hr.
750 mL 7 80 m.L/ hr = 9.38 hr
60 min/ hr X .38 hr= 22.8 = 23 min
The infusion time is 9 hr 23 min.
EXAMPLE 5
A rat e of 75 ml,/hr is ordered for a volume of 500 ml,. Calculat e the
infusion time.
500 mL 7 7 5 m.L/ hr = 6.67 hr
60 min/ hr X .67 hr = 40.2 = 40 min
The infusion time is 6 hr 40 min.
►►► PROBLEMS 19.1
Calculate the infusion times.
1. An IV of 900 mL to infuse at 80 m.L/ hr
2. A volume of 250 mL to infuse at 30 m.L/hr
3. An infusion of 180 mL to run at 25 m.L/ hr
4. A volume of 1000 mL ordered at 60 m.L/ hr
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CALCULATING IV INFUSION AND COMPLETION TIMES
5. An IV of 150 mL to infuse at 80 mL/hr
6. An infusion of 1000 mL at 125 mL/ hr
7. A rate of 120 mL/ hr for 500 mL
8. A volume of 800 mL at 60 mL/ hr
9. An IV of 250 mL at 80 mL/ hr
10. A rat e of 135 mL/ hr for 750 mL
Answers 1. 11 hr 15 min 2. 8 hr 20 min 3 . 7 hr 12 min 4. 16 hr 40 min 5. 1 hr 53 min
6. 8 hr 7. 4 hr 10 min 8. 13 hr 20 min 9. 3 hr 8 min 10. 5 hr 34 min
Note: Answers may vary due to rounding or calculator setting, so variations of 1-2 min may be considered correct.
CALCULATING INFUSION COMPLETION TIMES
The completion time is the actual hour and/ or minute an infusion bag or bottle will
complete or empty. Completion times are calculat ed in either international/ military
time using the 24-hour clock, or standard time, dep ending on individual clinical facility
p olicy.
KEVpoint. The completion time is calculated by adding the infusio11 time
to the time the IV was started.
An example is th e addition of an infusion t ime of 90 min t o a 0515 international/
military or 5:15 am st andard time wh en an IV was st arted.
INTERNATIONAL/MILITARY TIME CALCULATIONS
EXAMPLE 1
An IV st arted at 0400 is to complet e in 2 hr 30 min. Calculat e the
completion time.
■
Add the 2 hr 30 min infusion time to the 0400 start time.
0400
+ 230
0630
The completion time is 0630.
EXAMPLE 2
An IV st art ed at 0750 is to complet e in 5 hr 10 min. Calculate the
completion time.
■
Add the 5 hr 10 min infusion time to the 0750 start time.
0750
+ 510
1260
Change the 60 min to 1 hr and add to 1200 = 1300
The completion time is 1300.
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291
292
INTRAVENOUS CALCULATIONS
EXAMPLE 3
An IV st arted at 2250 is to complet e in 4 hr 20 min. Calculat e th e
completion time.
■
Add the infusion time to the start time.
2250
+ 420
2670
Change the 70 min to 1 hr 10 min = 2710
Deduct24hrfrom2710 = 0310
The completion time is 0310.
►►► PROBLEMS 19.2
Calculate the international/ military completion times.
1. An IV st arted at 0415 to infuse in 1 hr 30 min.
2. An infusion st arted at 1735 to complete in 2 hr 40 min.
3. An IV to complet e in 1 hr 14 min that w as st arted at 0025.
4. An IV st arted at 2300 to complet e in 3 hr 40 min.
5. An infusion time of 6 hr 20 min for an infusion st arted at 0325.
6. An IV st arted at 0445 t o complet e in 3 hr 20 min.
7. A m edication infusion st art ed at 0740 to complet e in 90 min.
8. An IV m edication st arted at 1247 to complet e in 45 min.
9. An IV st arted at 1430 t o complet e in 4 hr.
10. An IV st arted at 1605 to complet e in 3 hr 30 min.
Answers 1. 0545 2. 2015 3. 0139 4. 0240 5. 0945 6. 0805 7. 0910 8. 1332
9. 1830 10. 1935
STANDARD TIME CALCULATIONS
EXAMPLE 1
An IV m edication will infuse in 20 minutes. It is now 6:14 pm.
When will it complet e?
■
Add the 20 minutes infusion time to the 6:14 pm start time.
6:14 pm + 20min = 6:34pm
The completion time will be at 6:34 pm.
EXAMPLE 2
An IV is to infuse in 2 hr 33 min. It is now 4:43 pm. When will it
complet e?
■
Add the 2 hr 33 min infusion time to the 4:43 start time.
4 :43pm
+ 2: 33
6: 76
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CALCULATING IV INFUSION AND COMPLETION TIMES
Change the 76 min to 1 hr 16 min to make the completion time 7:16 pm.
The infusion will complete at 7:16 pm.
EXAMPLE 3
■
An IV infusion time is 13 hr 20 min. What is its completion time if
it was st arted at 10:45 am?
Add the 13 hr 20 min infusion time to the 10:45 am start time.
10 : 45 am
+ 13 : 20
23 : 65
Change the 65 min to 1 hr 5 min = 24:05. Subtract 12 hr.
The completion time will be 12:05 am.
EXAMPLE 4
■
A IV with an infusion time of 10 hr 7 min is st arted at 9:42 am.
When will it complet e?
Add the 10 hr 7 min infusion time to the 9:42 am start time.
9 : 42 am
+ 10 : 07
19 : 49
Subtract 12 hr to make the completion time 7:49 pm.
The completion time will be 7:49 pm.
EXAMPLE 5
■
An IV wit h an infusion time of 12 hr 30 min is st arted at 2:10 am.
When will it complet e?
Add the 12 hr 30 min infusion time to the 2:10 am start time.
2 : 10 am
+ 12 : 30
14 : 40
Subtract 12 hr to make the time 2:40 pm.
The completion time will be 2:40 pm.
►►► PROBLEMS 19.3
Calculate IV completion using standard time.
1. An IV st arted at 4:40 am that has an infusion time of 9 hr 42 min.
2. An IV m edication st arted at 7:30 am that h as an infusion
time of 45 min.
3. An IV with an infusion time of 7 hr 7 min that was
r estarted at 10:42 am .
4. An IV with a rest art time of 9:07 pm that h as an infusion
time of 6 hr 27 min.
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293
294
INTRAVENOUS CALCULATIONS
5. An IV with an infusion time of 3 hr 30 min was started
at 11:49 pm.
6. An IV started at 2:43 pm to infuse in 40 min.
7. An IV medication started at 10:15 am to complete in 90 min.
8. An infusion started at 7:05 pm to complete in 8 hr.
9. An IV started at 5:47 am to complete in 5 hr.
10. An IV started at 4:20 am to complete in 12 hr.
Answers 1. 2:22 pm 2. 8:15 am 3. 5:49 pm 4 . 3:34 am 5. 3:19 am 6 . 3:23 pm 7 . 11:45 am
8. 3:05 am 9. l 0:47 am 10. 4:20 pm
LABELING SOLUTION BAGS WITH INFUSION
AND COMPLETION TIMES
IV bags/bottles are calibrated so that the
amount of fluid remaining can be checked at
any time. In the majority of clinical facilitie s,
it is routine to label bags when they are hung
with start, progress, and finish times to provide
a visual reference of the status of the infusion.
Commercially prepared labels are available for
this purpose; however, you can prepare one u sing
any tape available.
Refer to Figure 19-1, where you can see
close up the calibrations on a 1000 mL bag.
Notice that each 50 mL is calibrated but that
only the 100 mL calibrations are numbered: 1,
2, 3 ( for 100, 200, 300), etc. Also, notice that the
calibrations on the IV bag are not all the same
width. They are somewhat wider at the bottom
because gravity and the pressure of the solution
force 1nore fluid to the bottom of the bag.
The tape on the IV solution bag in Figure
19-1 is for an 8 hr infusion, from 9 am to 5 pm.
The 9A represents the start time of 9 am, and
the SP at the bottom represents the completion
time of 5 pm. An 8 hr infusion time for 1000 mL
means that 125 mL are to be infused per hour
(1000 mL + 8 hr = 125 mL/ hr). Each 125 mL
is labeled on the calibrated scale along with
the hour the IV should be at this level. Tltis
tape allows for constant visual monitoring of
the N. Regardless of your clinical responsibility,
develop the habit of reading infusion time labeling, particularly ifyou have been giving personal
care that involves movement or repositioning of
the patient.
Let's look at an example of how you could
label an IV that is just being started.
qA
,o
//
--- 3
,~ - 4
I - f-5
Z, _Hl
-]
3-
8
'I -
"'
.......i 5P
FIGURE 19-1
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Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
CALCULATING IV INFUSION AND COMPLETION TIMES
EXAMPLE 1
An IV of 1000 mL has been ordered to run at 150 mL/hr. It was
started at 1:40 pm. Tape the bag with start, progress, and completion times.
Add the tape to the bag/bottle so that it is near but does not cover the calibrations.
Enter the start time as 1:40 pm at the 1000 mL level. Next, mark each 150 mL from top to
bottom with the successive hours the IV will run.
1000 mL - 150 mL = 850 mL
850 mL - 150 mL = 700 mL
700 mL - 150 mL = 550 mL
550 mL - 150 mL = 400 mL
400 mL - 150 mL = 250 mL
250 mL- 150 mL = 100 mL
Label 850 mL for 2:40 pm
Label 700 mL for 3:40 pm
Label 550 mL for 4:40 pm
Label 400 mL for 5:40 pm
Label 250 mL for 6:40 pm
Label 100 mL for 7:40 pm
Calculate the infusion time for the remaining 100 ml,.
100 mL 7 150 m.L/ hr = 0.66 = 0.67 hr
60 min/hr X 0.67 hr = 40.2 = 40 min
7:40 pm + 40 min = 8:20 pm
The completion time is 8:20 pm.
EXAMPLE 2
An infiltrated IV with 625 ml, remaining is restarted at 5:30 pm to
run at 150 ml,/hr. Relabel the bag with the new start, progress, and
completion times.
Label the 625 ml, level with the 5:30 pm restart time.
625 mL - 150 mL = 475 mL
475 mL - 150 mL = 325 mL
325 mL - 150 mL = 175 mL
175 mL - 150 mL = 25 mL
Label 475 mL for 6:30 pm
Label 325 mL for 7:30 pm
Label 175 mL for 8:30 pm
Label 25 mL for 9:30 pm
Calculate the infusion time for the remaining 25 mL.
25 mL 7 150 m.L/ hr = 0.166 = 0.17 hr
60 min/ hr X 0.17 hr = 10.2 = 10 min
9:30 pm + 10 min = 9:40 pm
The completion time is 9:40 pm.
EXAMPLE 3
An infiltrated IV with 340 ml, remaining is restarted at 4:15 am to
run at 70 ml,/hr. Relabel the bag with the new start, progress, and
completion times.
Label the 340 ml, level with the 4:15 am restart time.
340 mL - 70 mL = 270 mL
270 mL - 70 mL = 200 mL
200 mL - 70 mL = 130 mL
130 mL - 70 mL = 60 mL
Label 270 mL for 5:15 am
Label 200 mL for 6:15 am
Label 130 mL for 7:15 am
Label 60 mL for 8:15 am
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295
296
INTRAVENOUS CALCULATIONS
Calculate the infusion time for the remaining 60 ml,.
60 mL + 70 mL/ hr = 0.857 = 0.86 hr
60 min/hr X 0.86 hr = 51.6 = 52 min
8:15 am + 52 min= 9:07 am
The completion time is 9:07 am.
►►► PROBLEMS 19.4
Calculate the infusion and completion times. Label the IV bags provided with start,
progress, and completion times. Have your instructor check your labeling.
1. The IV in Figure 19-2 of 1000 mL was st arted at 0710 to run at 75 mL/hr.
Infusion time - - - - - - - -
Completion time _ _ _ _ __
0
~
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r6
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0
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<(
i;;QJ
t:'.
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>-
-'=
a.
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en
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FIGURE 19-2
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Edilorial re view has deemed Lhal any suppressed content does noL materially affec t Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
CALCULATING IV INFUSION AND COMPLETION TIMES
-5
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-9
-7
-9
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FIGURE 19-3
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FIGURE 19-4
2. The 1000 mL IV in Figure 19-3 has an ordered rate of 125 mL/ hr. It was started
at 6:30 pm.
Infusion time______
Completion time_ _ _ _ __
3. The IV in Figure 19-4 of 1000 mL has an ordered rate of 80 mL/ hr. It was started
at 5:40 am.
Infusion time- - - - - Answers
Completion time_ _ _ _ __
1. 13 hr 20 min; 2030 2. 8 hr; 2:30 am 3. 12 hr 30 min; 6:10 pm
Summary
This concludes the chapter on calculation of infusion and completion times and
labeling of IV bags/ bottles with start, progress, and completion times. The important
points to remember from this chapter are:
The infusion time is the time required for an IV to infuse completely.
The infusion time is calculated by dividing the total volume to infuse by the
m.L/ hr rate ordered.
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297
298
INTRAVENOUS CALCULATIONS
The completion time is calculated by adding the infusion time to the start time.
When the min calculated are 60 or more, an additional hr is added to the
completion time and 60 min are subtracted from the total min.
Calculating completion times provides an opportunity to plan ahead and have the
next solution ordered ready to hang or to discontinue an IV when it has completed.
Most clinical facilities label IV solution bags/ bottles with start, progress, and finish
times to provide a visual record of the infusion status.
Summary Self-Test
Calculate the infusion and completion times.
1. The order is for 50 mL to infuse at 50 mL/ hr. The infusion was started at 10:10 am.
Infusion time______
Completion time_ _ _ _ __
2. An infusion of 950 mL is ordered at 80 mL/hr. It was started at 8:02 am.
Infusion time______
Completion time_ _ _ _ __
3. A total of 280 mL remain in an IV bag. The flow rate is 70 mL/hr. It is no,,v 11:03 am.
Infusion time______
Completion time_ _ _ _ __
4. The order is to infuse 500 mL at 90 mL/ hr. The IV was started at 2:40 pm.
Infusion time______
Completion time _ _ _ _ __
5. An infiltrated IV with 850 mL remaining is restarted at 10 am at a rate of 150 mL/hr.
Infusion time______
Completion time_ _ _ _ __
6. At 4:04 am, an IV of 500 mL is started at a rate of 50 mL/hr.
Infusion time______
Completion time_ _ _ _ __
7. An IV medication with a volume of 150 mL is started at 1:45 pm to infuse at 60 mL/hr.
Infusion time______
Completion time _ _ _ _ __
8. An IV of 520 mL is restarted at 0420 at a rate of 125 mL/ hr.
Infusion time______
Completion time_ _ _ _ __
9. It is 12:00 pm, and an IV of 900 mL is to infuse at a rate of 100 mL/ hr.
Infusion time______
Completion time _ _ _ _ __
10. An IV of 1000 mL is started at 0550 to infuse at 130 mL/ hr.
Infusion time______
Completion time_ _ _ _ __
11. An infusion of 250 mL is started at 11:20 am to infuse at a rate of 20 mL/ hr.
Infusion time______
Completion time _ _ _ _ __
12. The flow rate ordered for 1 L is 80 mL/ hr. It was started at 8:07 pm.
Infusion time______
Completion time_ _ _ _ __
13. A 250 mL volume is started at 3:40 pm to be infused at 90 mL/ hr.
Infusion time- - - - - -
Completion time_ _ _ _ __
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Edllorial review has deemed LhaLany suppressed conlenl does noL materially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions require iL
CALCULATING IV INFUSION AND COMPLETION TIMES
14. A medication volume of 100 mL is started at 4:00 pm to infuse at 42 mL/hr.
Infusion time______
Completion time_ _ _ _ __
15. At 11:00 pm, 200 mL remain in an rv. The rate is 120 mL/hr.
Infusion time______
Completion time _ _ _ _ __
16. An infusion of 350 mL is to run at 150 mL/hr. It is now 9:47 am.
Infusion time______
Completion time_ _ _ _ __
17. An IV medication of 25 mL is started at 8:17 am to run at 25 mL/hr.
Infusion time______
Completion time _ _ _ _ __
18. An IV of 425 mL is restarted at 0814 to infuse at 90 mL/hr.
Infusion time______
Completion time_ _ _ _ __
19. At 10:30 pm, there are 180 mL left in an IV that is infusing at 25 mL/hr.
Infusion time______
Completion time_ _ _ _ __
20. At 1400, 500 mL is started to run at a rate of 60 mL/hr.
Infusion time______
Completion time _ _ _ _ __
21. An infusion of 250 mL is started at 3:04 am to run at 100 mL/hr.
Infusion time______
Completion time_ _ _ _ __
22. With 525 mL remaining, a rate change to 108 mL/hr is ordered. It is 2:10 am.
Infusion time- - - - - -
Completion time_ _ _ _ __
23. A liter is started at 8:42 am at a rate of 120 mL/hr.
Infusion time______
Completion time _ _ _ _ __
24. An infusion of 1000 mL is to run at 200 mL/hr. It is started at 6:40 pm.
Infusion time______
Completion time_ _ _ _ __
25. An IV medication of 100 mL is started at 7:50 am to run at 150 mL/hr.
Infusion time______
Completion time _ _ _ _ __
26. A volume of 500 mL is started at 4:04 pm at a rate of 75 mL/hr.
Infusion time- - - - - -
Completion time_ _ _ _ __
27. An IV of 950 mL is restarted at 2:10 am at 100 mL/hr.
Infusion time______
Completion time_ _ _ _ __
28. An IV medication of 30 mL is started at 0915 at a rate of 60 mL/hr.
Infusion time______
Completion time _ _ _ _ __
29. A medication volume of90 mL was started at 6:15 am to be infused at 90 mL/hr.
Infusion time______
Completion time_ _ _ _ __
30. A rate of 80 mL/hr is set at 4:20 pm to infuse a medication with a volume of 100 mL.
Infusion time______
Completion time_ _ _ _ __
31. A volume of750 mL is started at 0303 at a rate of96 mL/hr.
Infusion time
Completion time_ _ _ _ __
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299
300
INTRAVENOUS CALCULATIONS
Label the following solution bags for the times and rates indicated. Have your
instructor check your labeling.
'
f
'
f
-03
-03
,J
,J
--1
--2
-3
-
-03
.,;
a,
-0
-
-
-3
-
-3
-
.,;
a,
-
0
!!!
!!!
..0
..0
..0
!ti
~
!ti
-'
0
-'
=
15
0
15
..0
..0
i;;"
i;;"
ie
..0
ie
ie
~
:::,
~
:::,
~
:::,
0
0
i;;"
0
u
>
..r:::
u
>
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-
0
0
C,
..r:::
a..
C,
..r:::
a..
a.
!!!
C)
u
>
..r::;
a.
!!!
C)
0
0
..r:::
a..
32.
Started: 10:47 am
Rate: 80 mUhr
33.
Started: 1315
Rate: 100 ml/ hr
a.
!!!
C)
34.
Started: 2:10 pm
Rate: 90 mUhr
0
0
1
1
2
2
-- 5
-
:-4
-- 5
-
-6
-
-5
-
Hi
.,;
a,
-
• C:
0
! ti
~
0
..0
!ti
-'
=
0
..0
..0
<(
-7
-
-8
-
9
>
Hi
.,;
a,
-
• C:
0
!!!
0
..0
Cu
-'
=
0
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..0
<(
-7
-
-8
-
9
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a,
-
• C:
0
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0
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=
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!ti
~
-
a.
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-
_,:::;
-
..r:::
a..
35.
Started: 0440
Rate: 75 mUhr
-
• C:
0
!!!
0
0
-
a,
• C:
0
· c:
-7
-8
-9
.,;
..r:::
a..
36.
Started: 0730
Rate: 50 mUhr
a..
37.
Started: 6:20 pm
Rate: 25 mUhr
Copyrig hL20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplicated, in whole or in part. Due to elec.tronic rights. some Lhird party conte nt may be s uppress.eel from Lhe cBook and/or eChapLer(s).
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CALCULATING IV INFUSION AND COMPLETION TIMES
-03
-03
-
-
-3
-
--2
-3
-
-0
-0
-0
"'
·.::
-
--2
-3
-
.9
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·.::
.9
~
~
QJ
QJ
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0
..0
_,
"'
"'
0
..0
_,
"'
:t::
~
..0
0
..0
..0
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~
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u
,,,.
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C.
C.
"'
"'
~
~
C)
C)
.9
0
~
..r:::
..r:::
Cl..
Cl..
38.
Started: 3:03 am
Rate: 50 mUhr
Answers
1. 1 hr; 11 : 10 am
2. 11 hr 53 min ; 7:55 pm
3. 4 hr; 3:03 pm
4. 5 hr 34 min; 8:14 pm
5. 5 hr 40 min; 3:40 pm
6, 10 hr; 2:04 pm
7. 2 hr 30 min; 4: 15 pm
8. 4 hr 10 min; 0830
9. 9 hr; 9 pm
10. 7 hr 41 min; 1331
11. 12 hr 30 min ; 11:50 pm
-03
39.
Started: 0744
Rate: 125 mUhr
12. 12 hr 30 min; 8:37 am
13. 2 hr 46 min; 6:26 pm
14. 2 hr 23 min; 6:23 pm
15. 1 hr 40 min; 12:40 am
16. 2 hr 20 min; 12:07 pm
17. l hr; 9:17am
18. 4hr43 min; 1257
19. 7 hr 12 min; 5:42 am
20. 8 hr 20 min; 2220
21. 2 hr 30 min; 5:34 am
22. 4 hr 52 min; 7:02 am
23. 8 hr 20 min; 5:02 pm
40.
Started: 2140
Rate: 100 mUhr
24. 5 hr; 11 :40 pm
25. 40 min ; 8:30 am
26. 6 hr 40 min; 10:44 pm
27. 9 hr 30 min; 11 :40 am
28. 30 min ; 0945
29. 1 hr; 7:15am
30. 1 hr 15 min; 5:35 pm
31. 7 hr 49 min; 1052
32-40. Verify your answers with
your instructor.
Note: Answers may vary sligh~y due to rounding.
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301
CHAPTE
Many IV drugs are used in critical and life-threatening situations to alter
or maintain vital physiologic functions; for example heart rate, cardiac
output, blood pressure, and respiration. In general, these drugs have a
very rapid action and short duration. They are frequently administered
diluted in 250-500 ml of IV solution, most commonly D5W.
Intravenous medications may be ordered by dosage (mcg/mg/units
per min/hr) or based on body weight (mcg/mg/units per kg per min/hr).
They may also be ordered to infuse within a specific dosage range-for
example, 1-3 mcg/min-to elicit a measurable physiologic response;
an example would be to maintain a systolic BP above 100 mm Hg.
This adjustment of rate is called titration, and dosage increments are
made within the ordered range until the desired response has been
established. IV drugs require close and continuous monitoring, and an
electronic infusion device (EID), either a volumetric pump or a syringe
pump, is used for their administration. If an EID is not used, a microdrip
set calibrated at 60 gtt/ml or a dosage controlled Soluset/BuretrolNolutrol burette is used.
All calculations in this chapter are for an EID or microdrip,
and the ml/hr and gtt/min rates are therefore interchangeable.
Calculations include converting ordered dosages to the flow rates necessary to administer them, and using flow rates to calculate the dosage
infusing at any given moment. Body weight is often a critical factor in IV
dosages, and its use in calculations will also be covered. A number of EIDs
display, and can be set to deliver, dosage and flow rate equivalents, but
you must know how to do these calculations in case you encounter a situation in which you will have to do one. IV drugs that alter a basic physiologic function generally have narrow margins of safety, and accuracy is
imperative in their calculation. Double-checking of math is both mandatory
and routine. As a general rule, dosages are calculated to the nearest
tenth and flow rates are rounded to the nearest ml or gtt.
y noLbe copied, scanned, or duplicated, in whole o r in part. Due Lo electronic righl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the overall learning expe.rie.oce. Cengage Leaming reserves the righLLo remove addiLional conlenl al any ti.me if subscquenl righls restricLions require it.
IV MEDICATION AND TITRATION CALCULATIONS
KEYpaint: All calculations assume the use of an EID or microdrip infusion
set; therefore, the mL/ hr and gtt/ min rates are identical and interchangeable.
If you prefer to use Dimensional Analysis for these calculations, turn to
page 310. To use Ratio and Proportion, contin11e on this page.
USING RATIO AND PROPORTION TO CALCULATE
mL/hr RATE FOR DOSAGE ORDERED
One common calculation is to determine the mL/ hr flow rate for a specific drug dosage
ordered. Let's start by looking at some examples of these.
EXAMPLE 1
A dosage of 125 mg/100 ml, is to infuse at a rate of 20 mg/hr.
Calculate the ml,/hr flow rate.
■
Use the 125 mg/100 mL solution strength to calculate the mL/ hr rate for 20 mg/ hr.
125 mg _ 20mg _
mL - XmL - 16 ml,/hr
100
or
125 mg: 100 mL = 20 mg : XmL
125X= 100 X 20
X= 16 ml,/hr
To infuse 20 mg/hr, set the flow rate at 16 ml,/hr.
EXAMPLE 2
A maintenance dose of 2 mcg/min has been ordered using an
8 mg in 250 ml, solution. Calculate the ml,/hr flow rate.
■
Convert 2 mcg/min to mcgper hr.
2 mcg/ min X 60 min/ hr= 120 mcg/hr
■
Convert 120 mcg to mg to match the 8 mg in 250 ml, solution strength.
120 mcg = 0.12 mg
■
Calculate the ml,/hr rate.
8 mg = 0.12 mg = 4 ml,/ hr
250mL
XmL
or
8 mg: 250 mL = 0.12 mg: XmL
BX= 250 X 0.12
X = 3.75 = 4 ml,/hr
To infuse 2 mcg/min, set the flow rate at 4 ml,/hr.
KEYpaint: Metric conversions may be made in either direction: solution
strength to dosage ordered or dosage ordered to solution strength.
EXAMPLE 3
■
A 50 mg in 250 ml, strength solution is used to infuse a dosage of
200 mcg/ min. Calculate the flow rate in ml,/hr.
Convert the mcg/min to mcg/hr.
200 mcg/ min X 60 min/ hr= 12,000 mcg/ hr
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303
304
INTRAVENOUS CALCULATIONS
■
Convert 12,000 mcg to mg to match the mg solution strength.
12,000 m cg = 12 mg
■
Calculate the ml,/hr flow rate.
_
12 mg
- 5_0mg
-_ - -_ 60m I , /hr
250mL
XmL
or 50 mg :250 mL = 12 mg :XmL
50X= 250 X 12
X = 60 ml,/hr
To infuse 200 mcg/ min, set the flow rate at 60 ml,/hr.
EXAMPLE 4
■
A r at e of 3 mcg/ min is ordered 11sing a 1 mg/ 250 ml, s olution.
Calcula t e the ml,/hr flow rat e.
Convert the dosage per min to dosage per hr.
3 m cg/min X 60 min/ hr= 180 mcg/hr
■
Convert 180 mcg to mg to match the mg solution strength.
180 m cg = 0.18 mg
■
Calculate the ml,/hr flow rate.
1mg _ 0.18 mg _
/
hr
- - - - - - - - 45 m 1,
or 1 mg : 250 mL = 0.18 mg : X mL
250mL
X mL
X = 250 X 0.18
X = 45 ml,/hr
To infuse 3 mcg/ min, set the flow rate at 45 ml,/hr.
►►► PROBLEMS 20. l
Calculate these mL/ hr flow rates.
1. A 20 m g/h r rat e is ordered using a 100 m g/ 100 mL
s olution strength.
2. An IV m edication is order ed at the r at e of 3 m cg/min.
The s olution strength is 8 m g in 250 mL.
3. A s olution strength of 2 g in 500 mL is used to administ er
a dosage of 2 mg/ min.
4. A r at e of 2 m cg/min is ordered . The s olution strength
is 1 m g/250 mL.
5. A r at e of 25 m g/ hr is order ed . The solution stren gth
is 125 m g/100 mL.
6. A 50 m g/200 mL solution strength is order ed at a rat e of 6 m g/hr.
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Edilori.al re view has d ee med LhaL :my suppressed content does noL materially affect the overall learning e xpe rience. Ce ngage Leaming reserves the right Lo remove additional conte nt al any time if subsequent rig hts restrictions req uire it.
IV MEDICATION AND TITRATION CALCULATIONS
7. A solution strength of 75 mg/250 mL is to infuse at 10 mg/hr.
8. A 500 mL/ 1 g solution is to infuse at 1 mg/ min.
9. A 100 mg/250 mL solution is to infuse at 8 mg/ hr.
10. A 1 g/250 mL solution is to infuse at 150 mg/ hr.
Answers 1. 20 ml/hr 2. 6 ml/hr 3 . 30 ml/hr 4. 30 ml/hr 5. 20 ml/hr 6. 24 ml/hr 7. 33 ml/hr
8. 30 ml/hr 9. 20 ml/hr 10. 38 ml/hr
USING RATIO AND PROPORTION TO CALCULATE
mL/hr RATE FOR DOSAGE PER kg ORDERED
Many drug dosages are calculated based on body weight; for example, 5 mg/kg/ hr. Body
weight, to the nearest tenth kg, is used for these calculations. A preliminary step of
calculating dosage based on weight is necessary before the flow rate can be calculated.
Fractional dosage answers are expressed to the nearest tenth and ml,/hr rates to
the nearest whole ml,.
EXAMPLE 1
■
A drug is ordered at the rate of3 mcg/kg/min for a bodyweight of
95.9 kg. The solution strength is 400 mg in 250 ml,. Calculate the
ml,/hr flow rate.
Calculate the dosage per min for 95.9 kg.
3 mcg/kg/min X 95.9 kg = 287.7 mcg/ min
■
Convert 287.7 mcg/min to mcg/hr.
287.7 mcg/min X 60 min/ hr= 17,262 mcg/ hr
■
Convert 17,262 mcg to mg.
17,262 mcg/ hr---:- 1000 mcg/ mg = 17.26 = 17.3 mg/ hr
■
Calculate the flow rate.
400 mg _ 17.3 mg
250mL
XmL
or 400 mg : 250 mL = 17.3 mg : XmL
= 10.8 = 11 ml,/hr
400X = 250 X 17.3
X = 10.8 = 11 ml,/hr
To infuse 3 mcg/kg/min, set the flow rate at II ml,/hr.
EXAMPLE 2
■
A 2.5 gin 250 ml, solution is ordered at a rate of 100 mcg/kg/ min
for a body weight of 104.6 kg. Calculate the ml,/hr flow rate.
Calculate the dosage per min for 104.6 kg.
100 mcg/ kg/min X 104.6 kg= 10,460 mcg/ min
■
Convert 10,460 mcgto mg.
10,460 mcg/ min ---:- 1000 mcg/ mg = 10.46 = 10.5 mg/ min
■
Convert 10.5 mg/min to mg/hr.
10.5 mg/ min X 60 min / hr = 630 mg/hr
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305
306
INTRAVENOUS CALCULATIONS
■
Calculate the flow rate.
2500 mg __ 630 mg __
ml, /hr
or 2500 mg : 250rnL = 630 mg :X mL
63 ___
250 rnL
XrnL
2500X = 250 X 630
X= 63 ml,/hr
To infuse 100 mcg/kg/min, set the rate at 63 ml,/hr.
EXAMPLE 3
■
An IV meilication has been ordered at 4 mcg/kg/min using a
solution of 50 mg in 250 ml,. The body weight is 107 .3 kg. Calculate
the ml,/hr flow rate.
Calculate the dosage per min.
4 mcg/kg/ min X 107.3 kg = 429.2 mcg/min
■
Convert mcg/ min to mcg/hr.
429.2 mcg/ min X 60 min/ hr= 25,752 mcg/hr
■
Convert mcg to mg.
25,752 mcg/hr -:- 1000 mcg/ mg = 25.75 = 25.8 mg/hr
■
Calculate the flow rate.
50mg
25.8mg
- - - = - - - = 129 ml,/hr or 50 mg : 250 rnL = 25.8 mg : X mL
250rnL
XmL
50X = 250 X 25.8
X = 129 ml,/hr
To infuse 4 mcg/kg/min, set the rate at 129 ml,/hr.
►►► PROBLEMS 20.2
Calculate the dosage per min to the tenths, and the mL/hr flow rates.
Dosage
•
perm1n
ml,/hr
1. A dosage of 3 mcg/kg/min has been ordered for
an 87.4 kg adult. The solution has a strength
of 50 mg in 250 rnL.
2. A dosage has been ordered at 4 mcg/kg/min
using a 400 ing/250 rnL solution. The body
weight is 92.4 kg.
3. A dosage of 2.5 mcg/ kg/ min has been ordered.
The solution is 500 mg/250 rnL. The body
weight is 80.7 kg.
4. A dosage of 150 mcg/ kg/ min has been ordered
for a body weight of 92.1 kg. The solution
strength is 2.5 g/ 250 rnL.
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IV MEDICATION AND TITRATION CALCULATIONS
5. A 5 mcg/kg/ min dosage is ordered for a body weight
of 80.3 kg. The solution strength is 1 g/100 mL.
6. A dosage of 2 mcg/kg/min has been ordered for
an adult weighing 78.2 kg. The strength of the
solution is 40 mg/200 mL.
7. A dosage of 6 mcg/kg/min has been ordered for
an adult weighing 88.7 kg. A solution strength
of 100 mg/500 mL is to be infused.
8. The body weight is 91.2 kg and a 1.5 mcg/kg/min
rate is ordered using a 0.3 g/250 mL solution.
9. A 2 mcg/ kg/min infusion is ordered for a
90.3 kg adult. The solution to be used has a
strength of 0.5 g/250 mL.
10. A 20 mcg/ kg/ min dosage is ordered for a body
weight of 81.7 kg. The solution available is
1 g/500 mL.
Answers 1. 262.2 mcg/min; 79 ml/hr 2. 369.6 mcg/min; 14 ml/hr 3. 201.8 mcg/min; 6 ml/hr
4 . 13,815 mcg/min; 83 ml/hr s. 401.5 mcg/min; 2 ml/hr 6. 156.4 mcg/min; 47 ml/hr
7 . 532.2 mcg/min; 160 ml/hr 8. 136.8 mcg/min; 7 ml/hr 9 . 180.6 mcg/min; 5 ml/hr
10. 1634 mcg/min; 49 ml/hr
USING RATIO AND PROPORTION TO CALCULATE
INFUSION TITRATIONS
Titration refers to the adjustment of dosage within a specific range to obtain a measurable
physiologic response; for example, 2-4 mcg/min to maintain systolic BP > 100. The dosage
is increased or decreased within the ordered range until the desired response is obtained.
The lowest dosage is set first and adjusted upward and downward as necessary. The
upper dosage is never exceeded unless a ne,-v order is obtained.
EIDs are u sed for administration. Flow rates are calculated in mL/hr for the lowest
and highest dosage ordered and adjusted within this range to elicit the desired physiologic
response. Let's look at some examples.
A dosage of 2-4 mcg/min has been ordered to maintain systolic
BP > 100 mm. The solution being titrated has 8 mg in 250 ml,.
Calculate the flow rate for the 2-4 mcg range.
Calculate the lower 2 mcg/min flow rate first.
EXAMPLE 1
■
Convert 2 mcg/min to mcg/hr.
2 mcg/min X 60 min/hr= 120 mcg/hr
■
Convert 120 mcg/hr to mg/hr.
120 mcg/ hr = 0.12 mg/ hr
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO fro m Lhe cBook and/or eChaplet1s).
Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
307
308
INTRAVENOUS CALCULATIONS
■
Calculate the 0.12 mg/hr flow rate.
8 mg _ 0.12mg
250mL
XmL
or
8mg : 250mL = 0.12 mg: X mL
BX = 250 X 0.12
= 3.75 = 4 ml,/hr
X = 3.75 = 4 ml,/hr
The flow rate for the lower 2 mcg/min dosage is 4 ml,/hr.
The upper 4 m cg/min flow rat e is exactly double the 2 m cg/ min rat e, so it can be
calculat ed by multiplying the 4 mL/ hr rat e by 2.
4 mL/ hr X 2 = 8 ml,/hr
The flow rate for the upper 4 mcg/ min dosage is 8 ml,/hr.
The flow rate range to titrate a dosage of 2-4 mcg/ min is 4-8 ml,/hr.
EXAMPLE 2
A drug is to b e titrat ed between 415 and 830 mcg/min. The solution concentration is 100 mg in 40 ml,. Calculat e th e ml,/hr flow
rat e ran ge.
Calculat e the lower 415 m cg/ min flow rat e first.
■
Convert 415 mcg/ min to mcg/hr.
415 m cg/min X 60 min/ hr = 24,900 mcg/ hr
■
Convert 24,900 mcg/hr to mg/ hr.
24,900 m cg/ hr ---:- 1000 m cg/ mg = 24.9 mg/ hr
■
Calculate the 24.9 mg/hr flow rate.
100 mg _ 24.9 mg
40mL
or
X mL
= 9.96 = 10 ml,/hr
100 m g: 40 mL = 24.9 mg: XmL
lOOX = 40 X 24.9
X = 9.96 = 10 ml,/ hr
The upper 830 m cg/min dosage is exactly double the lower 415 m cg/min dosage, so the
flow rat e will b e double 10 mL/ hr.
10 mL/hr X 2 = 20 ml,/hr
The flow rate to titrate a dosage of 415-830 mcg/ min is 10-20 ml,/hr.
EXAMPLE 3
An adult weighing 103.1 kg has orders for a titration between 0.3 and
3 mcg/ kg/ min. The solution concentration is 50 mg in 250 ml,.
Calculate the dosage for 103.1 kg.
■
Calculate the lower 0.3 mcg/kg dosage per min.
0.3 m cg/ kg/ min X 103.1 kg = 30.93 = 30.9 mcg/min
■
Calculate the upper 3 mcg/ kg dosage per min.
3 m cg/kg/ min X 103.1 kg = 309.3 mcg/min
The dosage range for 103.1 kg is 30.9 to 309.3 mcg/ min.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO from Lhe cBook and/or eChaplet1s).
Ed llorial review has deemed LhaLany suppress ed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenLal any time if subsequenLrig hts res trictions req uire iL
IV MEDICATION AND TITRATION CALCULATIONS
Calculate the flow rate for the lower 30.9 mcg/min dosage.
■ Convert 30.9 mcg/min to mcg/hr.
30.9 mcg/min X 60 min/hr = 1854 mcg/hr
■
Convert 1854 mcg/hr to mg/hr.
1854 mcg/hr 7 1000 mcg/mg = 1.85 = 1.9 mg/hr
■
Calculate the 1.9 mg/hr flow rate.
50mg _ 1.9mg
250mL
or
50 mg: 250 mL = 1.9 mg: XmL
XmL
50X = 250 X 1.9
= 9.5 = 10 ml,/hr
X = 9.5 = IO ml,/hr
Calculate the flow rate for the upper 309.3 mcg/min dosage.
■ Convert 309.3 mcg/ min to mcg/hr.
309.3 mcg/min X 60 min/hr = 18,558 mcg/hr
■
Convert 18,558 mcg/hr to mg/hr.
18,558 mcg/hr 7 1000 mcg/ mg = 18.55 = 18.6 mg/hr
■
Calculate the 18.6 mg/hr flow rate.
50mg = 18.6mg = 93 ml,/hr
250mL
XmL
or
50 mg: 250 mL = 18.6 mg: XmL
50X = 250 X 18.6
X= 93 ml,/hr
To deliver 0.3-3 mcg/kg/min for a 103.1 kg adult, the flow rate must
be titrated between 10 and 93 ml,/hr.
►►► PROBLEMS 20.3
Calculate these mL/hr flow rate ranges. Express answers to the nearest whole mL/hr.
1. A 2 g in 500 mL solution is ordered to titrate at 1-2 mg/min.
2. A drug is ordered to titrate between 1 and 3 mcg/min.
The solution strength is 1 mg per 250 mL.
3. The dosage range being titrated is 5-8 mcg/kg/min.
The adult weighs 103.7 kg, and the solution strength
is 100 mg in 40 mL.
4. A drug is to titrate between 50 and 100 mcg/kg/min.
The adult weighs 78.7 kg, and the solution strength
is 2500 mg in 250 mL.
5. An adult weighing 73.2 kg has a solution of 500 mg in 250 mL
ordered to titrate between 3 and 10 mcg/kg/min.
6. A dosage of 4-6 mg/min has been ordered using a solution
strength of 2.5 g/400 mL.
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309
310
INTRAVENOUS CALCULATIONS
7. A dosage of 2-4 mcg/min has been ordered using a solution
strength of 2 mg/250 mL.
8. The body weight is 99.9 kg, and a range of 5-9 mcg/kg/min
is ordered. A 120 mg/ 50 mL solution is to be used.
9. A range of 30-70 mcg/kg/min infusion is ordered for an 84.3 kg
adult. The solution to be used has a strength of 2 g/250 mL.
10. A 75-125 mcg/kg/min dosage is ordered for a body weight
of 81.2 kg. The solution available is 2.5 g/250 mL.
Answers 1. 15-30 ml/hr 2. 15-45 ml/hr 3 . 12-20 ml/hr 4 . 24-47 ml/hr 5. 7-22 ml/hr
6 . 38-58ml/hr 7.1 5-30ml/hr 8. 12-22ml/hr 9. 19-44ml/hr 10. 37-61 ml/hr
If you chose the Ratio and Proportion method, turn to the Summary Self-Test
on page 319. If you chose the Dimensional Analysis method, continue with the
DA instructional section that follows.
USING DIMENSIONAL ANALYSIS TO CALCULATE
mL/hr RATE FOR DOSAGE ORDERED
One common IV critical care calculation is to determine the mL/hr flow rate for a specific
drug dosage ordered. Let's start by looking at some examples of these.
EXAMPLE 1
A cardiac medication with a strength of 125 mg/100 ml, is to infuse at a rate of 20 mg/ hr. Calculate the ml,/hr flow rate.
mL = lOOmL X 20mg
hr
125 mg
1 hr
lOOmL
20~
125 ~
1hr
=---x--= 16ml,/ hr
To infuse 20 mg/ hr, set the flow rate at 16 ml,/hr.
EXAMPLE 2
A dosage of2 mcg/min has b een ordered using an 8 mgin 250 ml,
solution. Calculate the ml,/hr flow rate.
This equation will need a 60 min= 1 hr and a 1 mg= 1000 mcg conversion.
mL
hr
250 mL X -----=
~
X 2 mcg X 60 min
8[111g
1000 mcg
1 min
1 hr
c:._
~ -~
250 mL
1~
2-
60 ;m11
1 ;m11
1 hr
= --- X ---- X --- X --8~
1000
S
= 3.75 = 4 ml,/ hr
To infuse 2 mcg/ min, set the flow rate at 4 ml,/hr.
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IV MEDICATION AND TITRATION CALCULATIONS
A medication with a strength of 50 mg in 250 ml, is used to infuse
a dosage of 200 mcg/min. Calculate the flow rate in ml,/hr.
This equation will need a 60 min = 1 hr and 1 mg = 1000 mcg conversion.
EXAMPLE 3
mL
hr
250mL X 1 mg X 200mcg X 60min
50 mg
1000 mcg
1 min
1 hr
y:rg
200 ~
60 JlIDl
= --- X ---- X --- X --250 mL
50 ;ng'
1
1000 ~
1 ;nih
1 hr
= 60 ml,/hr
To infuse 200 mcg/min, set the flow rate at 60 ml,/hr.
►►► PROBLEMS 20.4
Calculate these mL/hr flow rates. Express answers to the nearest whole mL/hr.
1. A 20 mg/hr dosage is ordered using a 100 mg/100 mL solution.
2. A medication is ordered at the rate of 3 mcg/min.
The solution strength is 8 mg in 250 mL.
3. A solution of 2 g medication in 500 mL is used to
administer a dosage of 2 mg/min.
4. A 2 mcg/min infusion is ordered. The solution strength
is 1 mg/250 mL.
5. An initial dose of a drug is ordered at 25 mg/hr. The
solution strength is 125 mg/100 mL.
6. A 100 mg/250 mL solution strength is ordered at a
rate of 15 mg/hr.
7. A solution strength of 10 mg/250 mL is to infuse at 5 mcg/min.
8. A 500 mL/1.5 g solution is to infuse at 3 mg/min.
9. A 10 mg/250 mL solution is to infuse at 20 mcg/min.
10. A 250 mg/100 mL solution is to infuse at 30 mg/hr.
Answers 1. 20 ml/hr 2. 6 ml/hr 3. 30 ml/hr 4. 30 ml/hr 5. 20 ml/hr 6. 38 ml/hr
7. 8 ml/hr 8. 60 ml/hr 9. 30 ml/hr 10. 12 ml/hr
USING DIMENSIONAL ANALYSIS TO CALCULATE
mL/hr RATE FOR DOSAGE PER kg ORDERED
Many N medication infusions are calculated based on bodyweight; for example, 95.9 mcg/kg/hr.
Bodyweight to the nearest tenth kg is used for the calculations. There are two ways the
flow rate can be calculated. The first method requires two steps.
Two-Step Flow Rate Calculation
The dosage for the body weight is calculated to the nearest tenth, then used to determine
the flow rate.
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311
312
INTRAVENOUS CALCULATIONS
EXAMPLE 1
■
Medication is ordered at th e rate of 3 mcg/ kg/ min for an adult
weighing 95.9 kg. The solution stren gth is 400 mg in 250 mL.
Calculat e th e flow rat e.
Calculate the 3 mcg/ min dosage for 95.9 kg.
3 m cg/ kg/ min X 95.9 kg= 287.7 mcg/ min
■
Calculate the mL/ hr flow rate for 287.7 mcg/ min.
250 rnL X 1 mg X 287.7 mcg X 60 min
400 mg 1000 mcg
1 min
1 hr
rnL
hr
250ml,
1 WK'f
5
400 ~
1000 ~
= - - - X __Y"1
_ _
287.7 l ' r i ~
60 J:R111
1 JRTil
1 hr
X - -~
~==- X - - -
= 10.79 = 11 ml,/hr
To infuse 3 mcg/kg/ min, set the flow rate at 11 ml,/hr.
A solution strength of 2.5 g in 250 mL h as b een ordered at a rate
EXAMPLE 2
of 100 mcg/ kg/ min for an adult weighing 104.6 kg. Calculat e the
flow rat e.
■
Calculate the dosage for 104.6 kg.
100 m cg/kg/ min X 104.6 kg = 10,460 m cg/min = 10.5 mg/ min
■
Calculate the flow rate for 10.5 mg/ min.
mL
250m1 X
1-g X 10.5 mg X 60min
2.5 g
1000 mg
1 min
1 hr
hr
1 ,/
10.5 ~
60 Jlllil
= - - - X _ _P__ X _ _)>'15
_
X --2.5 j
1000
1 JRlll
1 hr
250 mL
;ng
= 63 = 63 ml,/hr
To infuse 100 mcg/ kg/ min, set the flow rate at 63 ml,/hr.
EXAMPLE 3
■
A medication h as b een ordered at 4 mcg/ kg/ min from a solution
of 50 mg in 250 ml,. The body weight is 107.3 kg.
Calculate the dosage for 107 .3 kg.
4 m cg/ kg/ min X 107.3 kg= 429.2 mcg/ min
■
Calculate the flow rate for 429.2 mcg/ min.
mL
hr
250 mL X 1 mg X 429.2 m cg X 60 min
50 mg
1000 mcg
1 min
1 hr
1~
= - - - X __Y"1
_ 5_
250 mL
50 yig'
1000 ~
JRlll
429.2 m ~
60
5
X - -~- - X - - -
lJRTil
1hr
= 128.7 = 129 ml,/hr
To infuse 4 mcg/kg/ min, set the flow rate at 129 ml,/hr.
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IV MEDICATION AND TITRATION CALCULATIONS
►►► PROBLEMS 20.5
Calculate the mcg/min and ml,/hr flow rates.
mcg/min
ml,/hr
1. A 3 mcg/kg/min dosage has been ordered for
an adult weighing 87.4 kg. The solution being
used has a strength of 50 mg in 250 mL.
2. IV medication has been ordered to infuse at
4 mcg/kg/min using a 400 mg/ 250 mL
solution. The body weight is 92.4 kg.
3. A 2.5 mcg/ kg/min dosage has been ordered.
The solution strength is 0.5 g/250 mL.
The body weight is 80.7 kg.
4. A rate of 150 mcg/kg/min has been ordered
for a 92.1 kg body weight. The solution
strength is 2.5 g in 250 mL.
5. A 5 mcg/kg/min infusion has been ordered
for a body weight of 80.3 kg. The solution
to be used has 1 g in 500 mL.
6. A 2 mcg/kg/min dosage has been ordered for
an adult weighing 79.9 kg. The solution
strength available is 50 mg/250 mL.
7. A dosage of 3 mcg/kg/min has been ordered
using a 350 mg/250 mL solution strength.
The body weight is 86.9 kg.
8. An adult weighing 84.3 kg has a dosage of
3 mcg/kg/min ordered. The solution to be
used is 0.75 g/300 mL.
9. A 4.5 mcg/kg/min dosage is ordered for an
84.9 kg adult. The solution strength is
1.2 g/ 500 mL.
10. A 6 mcg/kg/min dosage is ordered for an
adult weighing 85.8 kg. The solution strength
is 800 mg/ 500 mL.
Answers 1. 262.2 mcg/min; 79 ml/hr 2. 369.6 mcg/min; 14 ml/hr 3. 201.8 mcg/min; 6 ml/hr
4. 13,815 mcg/min; 83 ml/hr s. 401.5 mcg/min; 12 ml/hr 6. 159.8 mcg/min; 48 ml/hr
7. 260.7 mcg/min; 11 ml/hr 8. 252. 9 mcg/min; 6 ml/hr 9. 382. l mcg/min; l O ml/hr
10. 514.8 mcg/min; 19 ml/hr
One-Step mL/hr Flow Rate Calculation
The one-step method of flow rate calculation requires very careful entry of ratios and
equally careful cancellation of measurement units to verify accuracy in ratio entry. Let's
look at the entire equation step by step. Express flow rates to the nearest mL.
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313
314
INTRAVENOUS CALCULATIONS
EXAMPLE 1
Medication is ordered at th e rate of 3 mcg/ kg/ min for an adult
weighing 95.9 kg. The solution stren gth is 400 mg in 250 mL.
Calculat e th e flow rat e.
The first two ratios entered are the same as in the two-step method.
mL
hr
250 mL
1mg
400 mg
1000 m cg
- - - X - - --
The denominator to be matched next is mcg. This is provided by the 3 mcg/ kg/
min dosage. Enter this with 3 mcg as the numerator; two measures, kg and min,
become the new denominators.
mL
hr
250 rnL X 1 mg X 3 me
400 mg 1000 mcg kg / min
Both kg and min must be matched in the next numerators. Either can be entered
first, but min is the best choice because a conversion ratio is needed to change
min to the hr being calculated. Enter the 60 min = I hr conversion, with 60 min as
the numerator, to match the previous min denominator.
mL
hr
60min
250 mL X 1 mg X 3 mcg
X--400 ~ 1000 mcg
kg/ min
1hr
Only one measure remains to be entered: the 95.9 kg body weight. Enter this as
the final numerator to match the remaining kg denominator. This completes the
equation.
mL
hr
250 mL X 1 mg X 3 mcg X 60 min X 95.9 kg
400 mg 1000 mcg kg /min
1 hr
Cancel the alternate denominator/ numerator measures. Only ml, and hr
remain in the equation. Do the math.
J!!S
60)Bill 95.9 yg
- = --- X ---- X ---- X --- X --hr
400pig' 1000~
yg/~
1hr
rnL
250mL
1)llgJ
3
= 10.79 = 11 ml,/hr
The II ml,/hr answer is identical to the 11 ml,/hr answer obtained in the
two-step calculation previously demonstrated.
EXAMPLE 2
A dosage of 2.5 gin 250 ml, has been ordered at a rat e of 100 mcg/
kg/ min for an adult weighing 104.6 kg. Calculat e the flow rat e.
Enter the ml,/hr being calculated. The first ml, numerator is provided by the 250
ml, containing 2.5 g medication. Enter it now.
mL
250mL
hr
2.5 g
The dosage ordered is in mcg, so g to mg and mg to mcg conversion ratios are
needed. Enter these now.
rnL
250mL
hr
2.5 g
lg
lm
1000 mg
1000 mcg
X - -~.::: X
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IV MEDICATION AND TITRATION CALCULATIONS
Enter the 100 mcg/ kg/ min dosage next, with mcg as the numerator to match the
previous mcg denominator.
mL
hr
250mL
lg
1mg
2.5 g
1000 mg
1000 mcg
- - - X - -_:==. X
X
lOOmcg
kg /min
Enter the min/ hr conversion ratio.
mL
hr
250 mL
1g
1 mg
X 100 mcg
2.5 g
1000 mg
1000 mcg
kg / min
--- X --- X
60min
X ---
1 hr
Enter the 104.6 kg bodyweight to complete the equation.
mL
250 mL X
1g
hr
2.5 g
1000 mg
X
X 100 mcg X 60 min X 104.6kg
1 mg.
1000 mcg
1 hr
kg / min
Cancel the alternate denominator/ numerator entries to double-check the
accuracy of ratio entry. Do the math.
250 mL
1 ,./:
1~
-mL = - - X __
/5__ X __;,tt
_ 5J_
hr
2.5 i_
1000 ~
1000 ~
100 m ~
60 JmI1
J<g'/Jl31h
1 hr
104.6 lrA'
X - -~- 5- X - - - X _ _J'F>
_
= 62.76 = 63 ml,/hr
The 63 mL/ hr answer is identical to the 63 ml,/ hr answer obtained in the
two-step calculation.
EXAMPLE 3
A m edication h as b een ordered at 4 m cg/ kg/ min from a solution of
50 mg in 250 ml,. The body weight is 107 .3 kg.
mL
250mL
hr
50mg
mL
250mL
1mg
hr
50 mg
1000 mcg
mL
250mL
1mg
4mcg
50 mg
1000 m cg
kg / min
250mL
1mg
4mcg
hr
50 mg
1000 mcg
kg/min
mL
250mL
1mg
4mcg
50 mg
1000 mcg
kg /min
hr
mL
hr
--- X ----
---X----X
--- X ---- X
--- X ---- X
60min
X ---
1hr
X _60_rr_1i_n X _10_7_.3_kg
_
1 hr
= 128.76 = 129 ml,/hr
The 129 ml,/ hr answer is identical to the 129 ml,/ hr rate calculated in the
two-step method.
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315
316
INTRAVENOUS CALCULATIONS
►►► PROBLEMS 20.6
Calculate these mL/hr flow rates. Express answers to the nearest whole ml,/hr.
1. A 3.5 mcg/ kg/ min dosage has been ordered for an adult
weighing 90.3 kg. The solution being used has a strength
of 40 mg in 150 rnL.
2. IV medication has been ordered to infuse at 3 mcg/ kg/ min
u sing a 250 mg/250 rnL solution. The body weight is 87.3 kg.
3. A 4 mcg/ kg/ min dosage has been ordered. The s olution strength
is 600 mg/250 rnL. The weight is 90.3 kg.
4. A rate of 200 mcg/ kg/ min has been ordered for an 83.3 kg
weight. The s olution strength is 3.5 g in 250 rnL.
5. A 4.5 mcg/ kg/ min infusion has been ordered for a
79.9 kg body weight. The solution to be used has
1.5 g in 200 rnL.
6. A 4 mcg/ kg/ min dosage has been ordered for an adult
weighing 83.8 kg. The s olution strength available
is 50 mg/ 150 mL.
7. A dosage of 5 1ncg/kg/1nin l1as been ordered using a
300 mg/250 mL solution strength. The body weight is 86.6 kg.
8. An adult weighing 91.4 kg l1as a dosage of 4 mcg/ kg/ min
ordered. The s olution to be used is 700 mg/ 500 mL.
9. A 175 mcg/ kg/ min dosage is ordered for an 84.9 kg adult.
The s olution strength is 4 g/250 rnL.
10. A 5 1ncg/kg/1nin dosage is ordered for an adult
weighing 78.9 kg. The s olution strength is 2 g/250 rnL.
Answers 1. 71 ml/hr 2 . 16 ml/hr 3. 9 ml/hr 4 . 7 1 ml/hr 5. 3 ml/hr 6. 60 ml/hr 7. 22 ml/hr
8. 16 ml/hr 9. 56 ml/hr 10 . 3 ml/hr
USING DIMENSIONAL ANALYSIS TO CALCULATE
INFUSION TITRATIONS
Titration refers to the adjustment of dosage within a specific range to obtain a measurable physiologic response; for example, a drug at 2-4 mcg/ min to maintain systolic
BP > 100. The dosage is increased or decreased within the ordered range until the desired
response is obtained. The lowest dosage is set first and adjusted upward and downward as necessary. The upper dosage is never exceeded unless a new order is obtained.
Volumetric or syringe pumps are used for administration. Flow rates are calculated in
rnL/ hr for the lowest and highest dosage ordered and adjusted within this range to elicit the
desired physiologic response. Let's look at s ome examples.
EXAMPLE 1
A 2-4 mcg/min dosage has been ordered. The solution being
titrated has 8 mg in 250 ml,. Calculate the flow rate of medication
for the 2-4 mcg range.
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IV MEDICATION AND TITRATION CALCULATIONS
Calculate the lower 2 mcg/min flow rate first.
mL
hr
250 mL
1 mg
2 mcg
60 min
8 mg
1000 mcg
1 min
1 hr
250 mL
1yigi
2~
60 )Rih
8~
1000 jjieg
1,}Ri:fl
1 hr
- - - X - - - - X __!:~:c:- x - - -
= --- X ---- X --- X --= 3.75 = 4 ml,/ hr
The upper 4 mcg/min flow rate is exactly double the 2 mcg/min rate.
4 mL/hr X 2 = 8 ml,/hr
A dosage of 2-4 mcg/min is delivered by a flow rate of 4-8 ml,/hr.
EXAMPLE 2
A medication is to be titrated between 415-830 mcg/min. The
solution concentration is 100 mg in 40 ml,. Calculate the ml,/hr
flow rate range.
Calculate the flow rate for the lower 415 mcg/min dosage.
mL
hr
40 mL
1 mg
415 mcg
60 min
100 mg
1000 mcg
1 min
1 hr
40 mL
1~
415~
- - - X - -====:: . . - X -
----==~ X - - 60JB1h
--- X ---- X ---- X --100 ~
1000 ~
1,}Ri:fl
1 hr
= 9.96 = 10 ml,/hr
The 830 mcg dosage is exactly double 415 mcg.
10 mL/hr X 2 = 20 ml,/hr
A dosage of 415-830 mcg/min requires a flow rate of 10-20 ml,/hr.
EXAMPLE 3
Anadultweighingl03.lkghasdosageordersfor0.3-3mcg/kg/min.
The solution concentration is 50 mg in 250 ml,.
Calculate the dosage range for 103.1 kg.
Lower dosage: 0.3 mcg/kg/min X 103.1 kg= 30.93 = 30.9 mcg/min
Upper dosage: 3 mcg/kg/min X 103.1 kg = 309.3 mcg/ min
The dosage range for this 103.1 kg adult is 30.9-309.3 mcg/min.
Calculate the flow rate for the lower 30.9 mcg/min dosage.
mL
hr
250 mL
1 mg
30.9 mcg
60 min
50 mg
1000 mcg
1 min
1 hr
250 mL
1~
30.9 ~
60 JHill
50 ~
1000 ~
l,}Ri:fl
1 hr
--- X ---- X --- X ---
= --- X ---- X ---- X --= 9.2 = 9 ml,/hr
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317
318
INTRAVENOUS CALCULATIONS
Calculate the flow rate for the upper 309.3 mcg/min dosage.
mL
hr
250 mL
1 mg
309.3 m cg
60 min
50 mg
1000 mcg
1 min
1 hr
--- X ---- X ---- X ---
lptg
309.3~
60)Bifi
= --- X ---- X ---- X --50 ptg
1000~
l;Hifi
1 hr
250mL
= 92. 7 = 93 ml,/hr
To deliver 0.3-3 mcg/kg/min, the flow rate must be titrated from 9-93 ml,/hr.
►►► PROBLEMS 20 .7
Calculate these mL/hr flow rate ranges. Express answers to the nearest whole mL/hr.
1. A 2 gin 500 mL solution is ordered to titrate at 1-2 mg/min.
2. A drug is ordered to titrate between 1-3 mcg/min.
The solution strength is 1 mg per 250 mL.
3. The dosage range is 5-8 mcg/kg/min. The body weight
is 103.7 kg, and the solution strength is 100 mg in 40 mL.
4. A drug is to titrate between 50-100 mcg/kg/min.
The body weight is 78.7 kg, and the solution strength
is 2500 mg in 250 mL.
5. An adult weighing 73.2 kg has a solution of 500 mg medication in
250 mL ordered to titrate between 3-10 mcg/kg/min.
6. A 2-3 mg/min dosage has been ordered. The solution
strength available is 1.5 g/400 mL.
7. A dosage of 6-7 mcg/min has been ordered using a
5 mg/ 500 mL solution strength.
8. An adult weighing 101.6 kg has a dosage of 4-7 mcg/kg/min
ordered. The solution to be used is 75 mg/50 mL.
9. A 30-70 mcg/kg/min dosage is ordered for an 80.4 kg adult.
The solution strength is 3 g/250 mL.
10. A 4-8 mcg/kg/min dosage is ordered for an adult
weighing 72.1 kg. The solution strength is 400 mg/250 mL.
Answers 1. 15-30 ml/hr 2 . 15-45 ml/hr 3. 12-20 ml/hr 4. 24-47 ml/hr 5. 7-22 ml/hr
6. 32-48 ml/hr 7 . 36-42 ml/hr 8. 16-28 ml/hr 9. 12-28 ml/hr 1 O. 11-22 ml/hr
Summary
This concludes the chapter on titration of IV medications. The important points to
remember about these medications are:
They have a rapid action and short duration.
They have a narrow margin of safety, and continuous monitoring is required
in their use.
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IV MEDICATION AND TITRATION CALCULATIONS
They are frequency titrated within a specific dosage/ flow rate to elicit a measurable
physiologic response.
When titrated, they are initiated at the lowest dosage ordered and increased or
decreased slowly to obtain the desired response.
They are infused using an EID or 60 gtt/mL microdrip set.
The mL/ hr flow rate for EIDs and the gtt/min microdrip rate are identical and
interchangeable.
Summary Self-Test
Calculate dosages to the nearest tenth and flow rates to the nearest whole number
using the calculations method, Ratio and Proportion or Dimensional Analysis, that
you choose.
1. A 6 mcg/kg/min dosage is ordered for an adult weighing 75.4 kg. The solution available
is 500 mg in 250 mL.
1ncg/min dosage _ _ _ _ __
mL/ hr flow rate - - - - - -
2. The order is to infuse a solution of 50 mg in 250 mL at 0.8 mcg/kg/ min. Calculate the
dosage and flow rate for a 65.9 kg adult
mcg/ min dosage______
mL/ hr flow rate _ _ _ _ __
3. A solution of 250 mg in 500 mL is to infuse between 0.5 and 0.7 mg/kg/hr. The adult
weighs 82.4 kg.
mg/hr dosage range ______
mL/hr flow rate range _ _ _ _ __
4. A solution of 400 mg in 250 mL is infusing at 20 mL/ hr.
mcg/ min dosage _ _ _ _ __
5. A 1-6 mg/ min dosage is ordered. The solution strength is 2 g/500 mL.
mL/ lrr flow rate range _ _ _ _ __
6. An infusion of 2 g in 500 mL is ordered at 60 mL/hr.
mg/ min dosage _ _ _ _ __
mg/ hr dosage _ _ _ __
7. The solution available is 25 mg in 50 mL. Tl1e order is to infuse at 8 mg/ hr.
mL/ hr flow rate - - - - - 8. A solution of 100 mg in 40 mL is ordered to infuse at 5 mcg/kg/ min
for an adult weighing 77.1 kg.
mL/ hr flow rate - - - - - 9. A drug is ordered at 4 1ncg/min. The solution available is 1 mg in 250 mL.
mL/ hr flow rate - - - - - 10. An adult weighing 80 kg has an infusion ordered at 8 mcg/kg/ min. The solution strength
is 800 mg in 500 mL.
mcg/min dosag e _ _ _ _ _
mL/ hr flow rate_ _ _ __
11. A dosage of 400 mg is added to 250 mL and infused at 451nL/ hr. Calculate the mcg/ min
and mg/ hr infusing.
1ncg/min dosage _ _ _ _ __
mg/ hr dosage _ _ _ __
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319
320
INTRAVENOUS CALCULATIONS
12. An adult has orders for a dosage of 1 mg/min. The solution strength is 250 mg in 250 mL.
mL/hr flow rate - - - - - 13. An adult weighing 77.9 kg is to receive 80 mcg/kg/min. The solution strength is 2.5 gin
250 mL.
mcg/min dosage _ _ _ _ __
mL/hr flow rate - - - - - -
14. A dosage of 4 mcg/min has been ordered using an 8 mg in 250 mL solution.
mL/hr flow rate - - - - - 15. An adult who weighs 81.7 kg has orders for 8-10 mcg/kg/min. The solution strength is
400 mg in 250 mL.
mcg/min dosage range _ _ _ _ __
16. A 6 mcg/kg/min dosage has been ordered for a 90.7 kg adult. The solution strength is
50 mg in 250 mL.
mcg/min dosage _ _ _ _ __
mL/hr flow rate - - - - - -
17. A dosage of 5 mcg/ kg/min is ordered. The solution available is 400 mg in 250 mL. The
adult weighs 70.7 kg.
mcg/min dosage _ _ _ _ __
mL/hr flow rate - - - - - -
18. A 3 mg/min dosage is ordered. The solution strength is 2 gin 500 mL.
mL/hr flow rate - - - - - 19. A solution of 50 mg/250 mL is infusing at 15 mL/hr.
mcg/min infusing _ _ _ _ __
20. A 2 gin 500 mL solution is to infuse at a rate of 2 mg/min.
mL/hr flow rate - - - - - 21. An adult whose weight is 102.4 kg is to receive a dosage of 2 mg/kg/hr. The solution
strength is 1 g in 500 mL.
mg/hr dosage _ _ _ __
mL/hr flow rate - - - - - -
22. A solution strength of 1 gin 100 mL is to infuse at a rate of 15 mcg/kg/min. The body
weight is 94.4 kg.
mcg/min dosage _ _ _ _ __
mL/hr flow rate - - - - - -
23. An adult is receiving 4 mL/hr of a solution that contains 8 mg in 250 mL.
mcg/min infusing _ _ _ _ __
24. A drug is ordered to titrate between 5 and 10 mcg/kg/min. The body weight is 97.1 kg,
and the solution strength is 100 mg/40 mL.
mcg/min range ______
mL/hr flow rate range _ _ _ _ __
25. A 500 mg in 250 mL solution is ordered for a 101.2 kg adult to titrate between 3 and
10 mcg/kg/min. _ _ _ __
mcg/min dosage range ______ mL/hr flow rate range _ _ _ _ __
26. An infusion of 500 mg in 250 mL is infusing at a rate of 14 mL/hr.
mcg/min infusing _ _ _ _ __
27. A 5-10 mcg/kg/min dosage is to be titrated for an adult patient weighing 79.6 kg. The
solution strength is 100 mg in 40 mL.
mcg/min dosage range _ _ _ _ __ mL/hr flow rate range _ _ _ _ __
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IV MEDICATION AND TITRATION CALCULATIONS
28. A 400 mg in 250 mL solution is to be titrated at 2-20 mcg/kg/min. The body weight is
62.3 kg.
mcg/min dosage range______ mL/hr flow rate range _ _ _ _ __
29. A drug has been ordered for an adult weighing 84. 9 kg to titrate at 2.5-10 mcg/kg/min.
The solution strength is 500 mg in 250 mL.
mcg/min dosage range______ mL/hr flow rate range _ _ _ _ __
30. A drug is ordered at a rate of 1-4 mg/min. The solution strength is 2 gin 500 mL.
mL/hr flow rate range _ _ _ _ __
31. A 10 mcg/min dosage is ordered using an 8 mg/250 mL solution.
mL/hr flow rate - - - - - 32. A 2 gin 500 mL dosage is to infuse at 3 mg/min.
mL/hr flow rate - - - - - 33. A 250 mL solution with 1 mg of medication is to be infused at 5 mcg/min.
mL/hr flow rate - - - - - 34. A 4 mcg/min dosage is ordered. The solution is 250 mL with 8 mg of medication.
mL/hr flow rate - - - - - 35. A 2 g in 500 mL solution is ordered to infuse at a rate of 6 mg/min.
mL/hr flow rate - - - - - 36. A 2 gin 500 mL solution is ordered to infuse at 4 mg/min.
mL/hr flow rate - - - - - 37. A 12 mcg/min dosage using an 8 mg in 250 mL of solution is ordered.
mL/hr flow rate - - - - - 38. A 40 mg/hr dosage is ordered, and a 100 mg in 100 mL solution is ordered.
mL/hr flow rate - - - - - 39. The order is to infuse 4 mcg/min from a 250 mL solution containing 1 mg of medication.
mL/hr flow rate - - - - - 40. Infuse 10 mg/hr from a 125 mg/ 100 mL solution.
mL/hr flow rate - - - - - -
Answers
1. 452.4 mcg/min; 14 ml/hr
2. 52.7 mcg/min; 16 ml/hr
3. 41.2-57.7 mg/hr;
82-115 ml/hr
4. 533.3 mcg/min
5. 15-90 ml/hr
6. 4 mg/min; 240 mg/hr
7. 16 ml/hr
8. 9 ml/hr
9. 60 ml/hr
10. 640 mcg/min; 24 ml/hr
11. 1200 mcg/ min; 72 mg/hr
12. 60 ml/hr
13. 6232 mcg/min; 37 ml/hr
14. 8 ml/hr
15. 653.6-817 mcg/min
16. 544.2 mcg/min; 163 ml/hr
17. 353.5 mcg/min; 13 ml/hr
18. 45 ml/hr
19. 50 mcg/min
20. 30 ml/hr
21. 204.8 mg/hr; 102 ml/hr
22. 1416 mcg/min; 9 ml/hr
23. 2.1 mcg/min
24. 485.5-971 mcg/min;
12-23 ml/hr
25. 303.6-1012 mcg/min ;
9-30 ml/hr
26. 466.7 mcg/min
27. 398-796 mcg/min;
10-19 ml/hr
28. 124.6-1246mcg/min;
5-47 ml/hr
29. 212.3-849 mcg/min;
6-25 ml/hr
30. 15-60 ml/hr
31. 19 ml/hr
32. 45 ml/hr
33. 75 ml/hr
34. 8 ml/hr
35. 90 ml/hr
36. 60 ml/hr
37. 23 ml/hr
38. 40 ml/hr
39. 60 ml/hr
40. 8 ml/hr
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321
CHAPTE
Heparin is a powerful anticoagulant drug that inhibits new blood clot
formation or the extension of already-existing clots. Heparin dosages
are expressed in USP units and may be given subcutaneously, mixed
in IV solutions, or by IV push or bolus. Heparin is so commonly given,
often postoperatively to prevent clot formation from venous stasis,
that it is actually prepared in ready-to-hang IV bags; frequent checks of
coagulation times during heparin therapy is essential. Heparin dosages are
ordered based on clotting time and/ or on an individual's body weight
in kg. Subcutaneous heparin injections are given deeply at a 45° angle,
to discourage medication leakage through the injection track, and
subsequent bruising.
There is no essential difference in the calculations you have already
practiced for critical care dosages and those for heparin dosages, except
that heparin dosages for subcutaneous injection are measured using a
TB syringe. However, heparin's action is so critical that it does deserve to
be addressed separately. In this chapter, you will be introduced to labels
of a variety of heparin dosages, practice measuring heparin dosages for
addition to IV solutions, and calculate units per hour infusing from ml/ hr
flow rates.
HEPARIN IV AND VIAL LABELS
Let's start by taking a look at the heparin IV solution bag in Figure 21-1.
This is an example of a premixed IV solution 1nentioned earlier. Notice
tl1e gray "Heparin Sodium 1000 units in 0.9% Sodium Chloride Injection"
labeling on this 500 mL bag and the additional red labeling below. The
red labeling draws particular attention to the fact that these bags contain
heparin and make the bags instantly recognizable. They serve as an
important safety factor in solution identification.
If a commercially prepared IV heparin dosage strength that you require is not available, you may be required to prepare the solution yourself
from a number of available vial dosage strengths. Let's stop and look
at several vial labels now so that you can refresh your memory with some
typical calculations.
y noLbe copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the overall learning expe.rie.oce. Cengage Leaming reserves the rig hL Lo remove addiLional conle nl al any ti.me if subscquenl righls restricLions require it.
HEPARIN INFUSION CALCULATIONS
LOT
EXP
~=ai~-;;;-~;;;;;;;..;..;;; ; ; ; ; ; ; ;~ ~::::....1111im:<., ••, •
1000 units
lllteparBn
(2 unlll/ml)
Heparin Sodium and
11.ftt SodlmnCNcMtdeln)rflN
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FIGURE 21-1
►►► PROBLEMS 21.1
Read the heparin labels provided to determine how many mL of heparin will be
necessary to prepare the solutions indicated.
1. Refer to the label in Figure 21-2 to determine how many mL
will be required to add 20,000 units to an IV solution.
2. Refer to the label in Figure 21-3 to determine how many mL
will be required to add 20,000 units to an IV solution.
3. Refer to the label in Figure 21-4 to determine how many mL
of heparin will be required to add 25,000 units to an IV solution.
4. Refer to the label in Figure 21-5 to determine how many
mL will be required to add 10,000 units to an IV solution.
Answers
1. 4 ml 2. 2 ml 3. 12 .5 ml 4. 10 ml
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Editorial re view has d ee med LhaL any s uppressed content does noL materially affect Lheoverall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts restrictions req uire it.
323
324
INTRAVENOUS CALCULATIONS
IRx only! NIX 0000-0000-00
iiiiiiii 0
=I
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=o
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Injection, USP
Injection, USP
5,000 USP Units/ml
10,000 Units/ml
-
-
i iiiiiii 0
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=I
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See insert for usual dosage.
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.. _
.. = I
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!!!!!!!!!: 0
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HEPARIN SODIUM
.!:
.. _
--o
.µ
HEPARIN SODIUM
Derived from porcine
Intestinal mucosa
For Intravenous or subcutaneous use
=:o
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4 mL IRx only! NIX 0000000000
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!!!!!!!!!:0
For subcutaneous or intravenous
use. See package insert for complete
product Information.
Store at controlled room temperature
20° to 25° c (68° to 77°F) [see USP].
Each ml contains: Heparin sodium
10,000 USP units.
x -o
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FIGURE 21-2
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HEPARIN SODIUM
2,000 USP Units/ml
(1,000 USP Units/ml} IRx only!
Derived from porcine
intestinal mucosa
For Intravenous or subcutaneous use
Derived from porcine Intestinal mucosa
For Intravenous or subcutaneous use
,,.;
0
N
Cl
Cl
c::
1ml Multiple Dose Vial
E
See Insert for usual dosage.
J!:! iii-io
d ~o
Cl
.!:
INJECTION, USP
Injection, USP
=o
=o
N
NOC 0000-0000-00
HEPARIN SODIUM
-1
0
FIGURE 21-3
IRx o nly] NIX 0000-0000-00
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Exp. Date:
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FIGURE 21-5
CALCULATING mL/hr IV FLOW RATE
FROM units/hr ORDERED
Because heparin is most frequently ordered in units/hr to be administered-for example,
1000 units/hr-and infused using an EID, a common calculation will be the 1nL/hr flow
rate. Let's look at these calculations first, keeping in mind that the ml,/hr flow rate for an
EID is identical to the gtt/rnin rate for a microdrip.
CALCULATION USING RATIO AND PROPORTION
EXAMPLE 1
The order is to infuse heparin at 1000 units/hr fro1n a solution of
20,000 units in 500 ml, of D5W
20,000 units
500 mL
1000 units = 25 ml/hr
XmL
or
20,000 units : 500 mL = 1000 units : X mL
20,000X = 500 X 1000
X= 25 rnl,/hr
The flow rate to infuse I 000 units/hr from a solution of 20,000 units in 500 ml,
is 25 rnl,/hr.
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HEPARIN INFUSION CALCULATIONS
EXAMPLE 2
The order is for h ep arin 800 units/ hr. The solution available is
40,000 units in 1000 ml, ofD5W
40,000 units = 800 units = 20 ml,/hr
1000 mL
XmL
or
40,000 units: 1000 mL = 800 units: X mL
40,000X = 1000 X 800
X = 20ml,/hr
The flow rate to infuse 800 units/ hr from a solution of 40,000 units in 1000 ml,
is 20 ml,/ hr.
EXAMPLE 3
The order is to infuse h ep arin 1100 units/ hr from a solution of
60,000 units in 1 L of D5W
60,000 units
1100 units
1000 mL
XmL
= 18.3 = 18 ml,/hr
or
60,000 units: 1000 mL = 1100 units: XmL
60,000X = 1000 X 1100
X = 18.3 = 18 ml,/hr
The flow rate to infuse 1100 units/ hr from a solution of 60,000 units in 1 Lis
18 ml,/ hr.
CALCULATION USING DIMENSIONAL ANALYSIS
EXAMPLE 1
The order is to infuse h ep arin 1000 units/ hr from a solution of
20,000 units in 500 ml, D5W Calculat e the ml,/ hr flow rat e.
Enter the mL/ hr b eing calculat ed frrst . Locat e the ratio containing mL, the 20,000 units/
500 mL strength, and enter this as the starting ratio with mL as the numerator, to m atch
the mL numerator of the units b eing calculat ed; 20,000 units b ecom es the den ominator.
mL
500 mL
hr
20,000 units
The st arting ratio denominator, units, must b e mat ch ed in the n ext numerator. Enter the
1000 units/hr rate ordered, with units as the numerator. This complet es the equation .
mL
hr
500 mL
1000 units
----- X ---20,000 units
1 hr
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325
326
INTRAVENOUS CALCULATIONS
Cancel alternate denominator/numerator units in the equation to double-check that the
ratios have been entered correctly. Only mL and hr should remain. Do the math.
mL
hr
500 mL
X 1000 J}Rits = 25 ml,/hr
20,000 )lHits
1 hr
A rate of 25 mL/hr is required to infuse 1000 units/hr from a solution strength of
20,000 units in 500 ml,.
EXAMPLE 2
The order is for heparin 800 units/hr. The solution available is
40,000 units in 1000 ml, D5W Calculate the ml,/hr flow rate.
Enter the mL/hr being calculated. Enter the 1000 mL/40,000 units ratio, with mL as the
numerator.
mL
1000 mL
hr
40,000 unit s
Enter the next ratio, 800 units/hr, with 800 units as the numerator to match the starting
ratio denominator.
mL
hr
1000 mL
800 units
40, 000 unit s
1 hr
----- X ----
Cancel to double-check for correct ratio entry, and do the math.
mL
hr
1000 mL X 800 )lHits = 20 ml,/hr
40,000 ~
1 hr
A rate of 20 ml,/hr is required to infuse 800 units/hr from a solution strength of
40,000 units in 1000 ml,.
EXAMPLE 3
The order is to infuse heparin 1100 units/hr from a solution
strength of 60,000 units in 1 L D5W Calculate the ml,/hr flow rate.
1000 mL
1100 units
hr
60,000 units
1 hr
mL
1000 mL
1100 )lHits
/ hr
.. ~ X
= 18.33 = 18 m 1,
60,000 JJHlL:s
1 hr
mL
hr
----- X ----
A rate of 18 ml,/hr will be required to infuse 1100 units per hour from a solution
strength of 60,000 units in 1 L.
►►► PROBLEMS 21.2
Calculate these mL/ hr flow rates using the calculation method you prefer.
1. The order is to infuse 1000 units heparin per hour from
an available solution strength of 25,000 units in 500 mL D5W
2. Heparin has been ordered at 2500 units per hour. The solution
strength is 50,000 units in 1000 mL D5W
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HEPARIN INFUSION CALCULATIONS
3. Th e order is to infuse 1100 units per hour from a
15,000 units in 1 L D5W solution.
4. An adult has orders for 50,000 units of h ep arin in 1000 mL
D5W to infuse at a rat e of 2000 units p er hour.
5. Administ er 1500 units p er hour of h ep arin from an
available strength of 40,000 units in 1 L.
Answers 1. 20 ml/h r 2. 50 ml/hr 3. 73 ml/hr 4. 40 ml/hr 5. 38 ml/hr
CALCULATING units/hr INFUSING FROM
mL/hr FLOW RATE
On occasion it may b e necessary to calculat e the units/hr of h ep arin infusing from the
mL/hr flo,v rat e. This is done using the units/mL solution strength and mL/hr rat e of infusion.
CALCULATION USING RATIO AND PROPORTION
EXAMPLE 1
An IV of 1000 ml, containing 40,000 units of h ep arin is running at
30 ml,/hr. Calculat e the units/ hr infusing.
1000 mL
40,000 units
30mL
- - - = 1200units/ hr
X units
or
1000 mL : 40,000 units = 30 mL : Xunits
X = 1200 units/hr
A 1000 ml, solution containing 40,000 units heparin running at 30 ml,/hr
is infusing 1200 units/ hr.
EXAMPLE 2
A solution of 1 L of D5W with 20,000 units h ep arin is running at
80 ml,/hr. Calculat e the units/ hr infusing.
1000 mL
80mL
20,000 units
X units
- - - - - = - - - = 1600 units/hr
or
1000 mL : 20,000 units = 80 mL : Xunits
X = 1600 units/hr
A 1 L (1000 ml,) solution containing 20,000 units heparin running at 80 ml,/hr
is infusing 1600 units/ hr.
EXAMPLE 3
An IVofD5W 500 ml, containing 10,000 units h ep arin is running
at 40 ml,/hr. Calculat e the units/ hr infusing.
500 mL
10,000 units
40 mL
- - - = 800 units / hr
X units
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327
328
INTRAVENOUS CALCULATIONS
or
500 mL : 10,000 units = 40 mL : Xunits
X = 800 units/ hr
A 500 ml, solution containing 10,000 units heparin running at 40 ml,/hr is
infusing 800 units/ hr.
CALCULATION USING DIMENSIONAL ANALYSIS
EXAMPLE 1
An IV of 1000 ml, containing 40,000 units of heparin is running at
30 ml,/hr. Calculat e the units/ hr infusing.
units
hr
40,000 units
30 mL
1000 mL
1 hr
----- X ---
units
40,000 units
30 mL
/hr
- - = - - - - - X - - - = 1200 units
hr
1000 mL
1 hr
A 1000 ml, solution containing 40,000 units heparin running at 30 ml,/hr is
infusing 1200 units/ hr.
EXAMPLE 2
A solution of 1 L of D5W with 20,000 units hep arin is running at
80 ml,/ hr. Calculat e the units/ hr infusing.
units
hr
units
hr
20,000 units
80 mL
----- X --lOOOmL
1 hr
/hr
- - - - - X - - - = 1600 units
20,000 units
80 mL
1000 mL
1 hr
A 1 L (1000 ml,) solution containing 20,000 units heparin running at 80 ml,/hr
is infusing 1600 units/ hr.
EXAMPLE 3
An IVofD5W 500 ml, containing 10,000 units heparin is running
at 40 ml,/hr. Calculat e the units/ hr infusing.
units
hr
10,000 units
40 mL
----- X --500 mL
1 hr
units
10,000 units
40 mL
/hr
- - = - - - - - X - - - = 800 units
hr
500 mL
1hr
A 500 ml, solution containing 10,000 units heparin running at 40 ml,/hr is
infusing 800 units/ hr.
Copyrig hl 20 15 Ce ng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.a led. in whole or in pan . Due to elcc.tronic rig hts. some Lhinl party content may be s uppressed from Lhe e Book and/or eChapte11s}.
Edilori.al review has deemed LhaL any s uppressed content does, noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves, Lhe right Lo remove additional content al any time if subsequent rig hts restrictions req uire iL
HEPARIN INFUSION CALCULATIONS
►►► PROBLEMS 21.3
Use your calculation method of choice to determine the units/hr of heparin infusing
in the following IV administrations.
1. An IV of 750 mL containing 30,000 units heparin
running at 25 mL/hr
2. A solution of 20,000 units in 500 mL running at 30 mL/hr
3. A 1 L volume of D5W containing heparin 30,000 units
running at 40 mL/hr
4. An IV of 1 L DNS containing 20,000 units heparin
running at 30 mL/hr
5. A 25,000 units heparin in 500 mL solution
running at 30 mL/hr
6. An IV of 1000 mL containing 40,000 units
heparin running at 25 mL/hr
7. A 1000 mL solution with 45,000 units heparin
running at 25 mL/hr
8. A solution of 1000 mL containing 25,000 units
heparin running at 30 mL/hr
9. A 1 L solution with 35,000 units heparin running
at45 mL/hr
10. A 20,000 units in 500 mL solution running at 20 mL/hr
Answers 1. 1000 units/hr 2. 1200 units/hr 3. 1200 units/hr 4. 600 units/hr 5. 1500 units/hr
6. 1000 units/hr 7. 1125 units/hr 8. 750 units/ hr 9. 1575 units/hr 10. 800 units/hr
Summary
This concludes the chapter on heparin administration. The important points to
remember are:
Heparin is a potent anticoagulant that is frequently added to IV solutions.
It is measured in USP units.
Heparin therapy requires a frequent check of coagulation times.
Subcutaneous heparin injections are given deeply at a 45 ° angle, to discourage
medication leakage through the injection track, and subsequent bruising.
IV heparin may be ordered by mL/hr flow rate or by units/hr to infuse.
An EID or microdrip is used for heparin infusion.
Commercially prepared IV heparin solutions are available in several strengths.
Additional IV solution strengths may require the preparation of heparin from
available vial strengths.
Frequent blood tests for clotting time are required to monitor dosage.
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in pan. Due to elec.tronic rig hts. some Lhlrd party conlenl may be .supprcs..,;,00 from Lhe cBook and/or eChapLer(s).
Ed llorial review b:is deemed LhaL any suppressed content does noLmaterially affec t Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts res trictions req uire iL
329
330
INTRAVENOUS CALCULATIONS
Summary Self-Test
Calculate these mL/hr heparin flow rates using the calculation method of your choice.
1. An adult is to receive heparin 1000 units/hr. The IV solution
available has 25,000 units in 1 L DSW, and a pump will be used.
2. A solution of 35,000 units heparin in 1 L D5W is to infuse via
volumetric pump at 1200 units/hr.
3. The order is for 1000 units heparin per hour. The solution
strength is 20,000 units in 500 mL D5NS.
4. The order is for 1250 units/hr heparin from a solution
strength of 15,000 units in 500 mL D5W A pump is used
to monitor the infusion.
5. A solution of 10,000 units heparin in 500 mL D5W is
ordered to infuse at 1000 units/hr.
6. An IV of 1000 mL D5W with 40,000 units heparin is to
infuse at 1200 units/hr via a pump.
7. The order is to infuse 500 mL D5W with 25,000 units
heparin at 1500 units/hr.
8. 500 mL D5W with 30,000 units of heparin is to infuse
via a pump at 1500 units/hr.
9. The order is to infuse 1 L D5W with 45,000 units of
heparin at 1875 units/hr.
10. A rate of 500 units/hr is ordered using a 250 mL
with 10,000 units IV solution.
11. A solution of 40,000 units in 1000 mL is to be used
to infuse 1500 units/ hr.
12. A rate of 1500 units/hr is ordered using a 30,000 units
in 500 mL solution.
13. Heparin 750 units/hr is ordered using an IV solution of
500 mL containing 5000 units heparin.
14. An IV solution of 10,000 units in 1000 mL heparin is
to infuse 500 units/hr.
15. Heparin 1500 units per hour is to be infused using a
solution strength of 15,000 units in 500 mL.
Answers
1. 40 ml/hr
2. 34 ml/hr
3. 25 ml/hr
4. 41.6 or 42 ml/hr
S. 50 ml/hr
6. 30 ml/hr
7. 30 ml/hr
8. 25 ml/hr
9. 41.6 or 42 ml/hr
10. 12.5 or 13 ml/hr
11. 37.5 or 38 ml/hr
12. 25 ml/hr
13. 75 ml/hr
14. 50 ml/hr
15. 50 ml/hr
Copyrig hL 20 15 Ce ng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplica ted, in whole or in pan. Due Lo elec.tronic rig hts. some Lhinl party content may be s uppressed from LhecBook and/or eChaple t1s).
Edilorial re view has deemed LhaL :my suppressed content does noL materially :iffecL Lheove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions req uire iL
I
CHAPTER 22
CHAPT
Two differences between adult and pediatric dosages will be immediately apparent: Most oral drugs are prepared as liquids because infants
and small children cannot be expected to swallow tablets easily, if at all,
and dosages are dramatically smaller. The oral route is used whenever
possible, but when a child cannot swallow or the drug is ineffective given
orally, drugs will be administered by a parenteral route.
Both the subcutaneous and intramuscular routes may be used
depending on the type of drug to be administered. However, the smaller
size of infants and children limits the use of both routes, as does the nature
of the drug being used. For example, many antibiotics are administered
intravenously rather than intramuscularly.
ORAL MEDICATIONS
Most oral pediatric drugs are prepared as liquids to facilitate ease in swallowing. If the child is old enough to cooperate, these dosages may be measured in
a medication cup. Solutions are also frequently measured using oral syringes,
such as the ones shown in Figure 22-1. Notice that oral syringes have the
same metric calibrations as hypodermic syringes, but they may also include
household measures; for example, tsp. Oral syringes have different-sized
tips to prevent use with hypodermic needles. On some oral syringes, the tip
is positioned off center (termed eccentric), to further distinguish them
from hypodermic syringes, or they may be amber-colored, as in Figure 22-1.
If oral syringes are not available, hypodermic syringes (without the
needle) can also be used for dosage measurement In addition to accuracy,
syringes provide an excellent method of administering oral liquid drugs to
infants and small children. Some oral liquid preparations incorporate a
calibrated medication dropper as an integral part of the medication bottle.
These may be calibrated in ml, like the dropper sho,-vn in Figure 22-2 or
in actual dosage; for example, 25 mg or 50 mg. Animal-shaped measures
such as those sho"\<\lll in Figure 22-3 are also helpful in enticing reluctant
toddlers to take necessary medications. In each instance, the goal is to
ensure that the infant or child actually swallows the total dosage.
y noLbe copied, scanned, or duplicated, in whole or in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the o verall learning experience. Cengage Leaming reserves the rig hL Lo remove addiLional conle nl al any ti.me if subscq uenl rig hls restricLions req uire it.
PEDIATRIC ORAL AND PARENTERAL MEDICATIONS
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Care must be taken with liquid oral drugs to identify those prepared as suspensions.
A suspension consists of an insoluble drug in a liquid base; for example, the cefaclor
oral suspension in Figure 22-4. The drug in a suspension settles to the bottom of the bottle
between uses, and thorough mixing immediately prior to pouring is mandatory. Suspensions must also be administered to the child promptly after measurement to prevent
the drug from settling out again and an incomplete dosage being administered.
Copyrig hL 20 15 Ceng age Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplicated, in whole or in part. Due to electronic rig hts. some Lhlrd party conte nt may be .s:upprcssOO from Lhe c Book and/or eChaplet~s).
Edilorial review has deemed Lhal any suppressed content does noL materially affecL LheoveraU learning e xpe rience. Cengage Leaming reserves Lhe right Lo remove additlonal conte nt al any time if subsequent rig hts res trictions req uire iL
333
334
PEDIATRIC MEDICATION CALCULATIONS
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KE paint: Suspensions must be thoroughly mixed before measurement
and promptly administered to prevent the settling out of their insoluble drugs.
When a tablet or capsule is administered, the child's mouth must be checked to be certain
the medication has actually been swallowed. If swallowing is a problem, some tablets can
be crushed and given in a small amount of applesauce, ice cream, or juice if the child has
no dietary restrictions to contraindicate this. Keep in mind, however, that enteric-coated
and timed-release tablets or capsules cannot be crushed because this would destroy
the coating that allows them to function on a delayed-action basis.
INTRAMUSCULAR AND SUBCUTANEOUS MEDICATIONS
The drugs most often given subcutaneously are insulin and immunizations that specifically require the subcutaneous route. Any site with sufficient subcutaneous tissue may be used, with
the upper arm being the site of choice for immunizations. The inh·amuscular route is used
most frequently for preoperative and postoperative medications for sedation and pain, and
for immunizations such as DPT (diphtheria, pertussis, tetanus), which must be administered
deep IM. The intramuscular site of choice for infants and small children is the vastus lateralis
or rectus femoris of the thigh because the gluteal muscles do not develop until a child has
learned to walk. Usually, not more than 1 mL is injected per site, and sites are rotated regularly.
Dosage calculation is the same as for adults, except dosages are sometimes calculated to the nearest hundredth and measured using a tuberculin syringe (refer
to Chapter 8 if you need to review the calibrations and use of a TB syringe). There is less
margin for error in pediatric dosages, and calculations and measurements are carefully
double-checked.
Summary
This concludes the introduction to pediatric oral, IM, and subcutaneous medication
administration. The important points to remember from this chapter are:
Care must be taken when administering oral drugs to ensure that the child has
actually swallowed the dosage.
If liquid medications are prepared as suspensions, mix thoroughly prior to measurement, and administer promptly to prevent the settling out of their insoluble drugs.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlnl party conle nl may be s uppressed fro m Lhe c Book and/or eChapLe 1ts).
Edilori.al review has deemed LhaL any suppressed conlenl does nol materially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLlonal conte nl al any time if subsequenl rig hts restrictions require iL
PEDIATRIC ORAL AND PARENTERAL MEDICATIONS
Care must be taken not to confuse oral syringes, which are unsterile, with hypodermic syringes, which are sterile.
The IM site of choice for infants and small children is the vastus lateralis or rectus
femoris of the thigh.
Usually not more than 1 mL is injected per IM or subcutaneous site, and sites are
rotated regularly.
Pediatric parenteral dosages are frequently calculated to the nearest hundredth
and measured using a TB syringe.
Summary Self-Test
For Part I, use the pediatric medication labels provided to measure the following oral
dosages. Indicate in the second column if the medication is a suspension.
PART I
ml,
Suspension
1. Prepare a 10 mg dosage of oxycodone.
2. Prepare a 125 mg dosage of penicillin V potassium.
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Edilori.al review has deemed LhaL any suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Lea.ming reserves Lhe righLLo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
335
PEDIATRIC ORAL AND PARENTERAL MEDICATIONS
Care must be taken not to confuse oral syringes, which are unsterile, with hypodermic syringes, which are sterile.
The IM site of choice for infants and small children is the vastus lateralis or rectus
femoris of the thigh.
Usually not more than 1 mL is injected per IM or subcutaneous site, and sites are
rotated regularly.
Pediatric parenteral dosages are frequently calculated to the nearest hundredth
and measured using a TB syringe.
Summary Self-Test
For Part I, use the pediatric medication labels provided to measure the following oral
dosages. Indicate in the second column if the medication is a suspension.
PART I
ml,
Suspension
1. Prepare a 10 mg dosage of oxycodone.
2. Prepare a 125 mg dosage of penicillin V potassium.
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Edilori.al review has deemed LhaL any suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Lea.ming reserves Lhe righLLo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
335
PEDIATRIC ORAL AND PARENTERAL MEDICATIONS
Care must be taken not to confuse oral syringes, which are unsterile, with hypodermic syringes, which are sterile.
The IM site of choice for infants and small children is the vastus lateralis or rectus
femoris of the thigh.
Usually not more than 1 mL is injected per IM or subcutaneous site, and sites are
rotated regularly.
Pediatric parenteral dosages are frequently calculated to the nearest hundredth
and measured using a TB syringe.
Summary Self-Test
For Part I, use the pediatric medication labels provided to measure the following oral
dosages. Indicate in the second column if the medication is a suspension.
PART I
ml,
Suspension
1. Prepare a 10 mg dosage of oxycodone.
2. Prepare a 125 mg dosage of penicillin V potassium.
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Edilori.al review has deemed LhaL any suppressed conlenl does noL materially affecl Lheoverall leaming e xpe rience. Cengage Lea.ming reserves Lhe righLLo remove addiLlonal conte nL al any time if subsequenL rig hts res trictions require iL
335
PEDIATRIC ORAL AND PARENTERAL MEDICATIONS
Use the labels provided to calculate the dosages for Parts II and ID. Calculate
all dosages to hundredths.
PART II
10. Prepare a 20 mg dosage of meperidine.
11. A dosage of morphine 10 mg has been ordered.
12. Draw up a 100 mg dosage of clindamycin.
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PART III
13. Prepare a 40 mg dosage of meperidine.
14. A dosage of Dilantine 50 mg has been ordered.
15. Prepare a 6 mg dosage of morphine.
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Answers
1. 0.5 ml; no
2. 2.5 ml; no
3. 2 ml; suspension
4. 5 ml; suspension
5. 10 ml; no
6. 3 ml; suspension
7. 3 ml; no
8. 1 .2 ml; no
9. 5 ml; suspension
10. 0.8 ml
11. 0.67 ml
12. 0.67 ml
13. 0.8 ml
14. 1 ml
1 s. 0.6 ml
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Edilori.al review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming expe rience. Cengage Leaming reserves Lhe righLLo remove :iddiLlonal contenLal any time if subsequenL rig hts res trictions require iL
337
Pediatric IV medication administration involves a challenge and a responsibility that is multifaceted. Infants and children, particularly under
the age of 4, are incompletely developed physiologically, and drug
tolerance, absorption, and excretion are ongoing concerns. In addition,
infants and acutely ill children can tolerate only a narrow range of hydration, making administration of IV drugs, which are diluted for administration, a critical and exact skill. Drug dilution protocols may specify a range
for dilution, and on many occasions the smallest possible volume may
have to be used in order to not overhydrate a child. Dosage and dilution
decisions may have to be made on a day-to-day or even a dose-to-dose
basis and will involve the team effort of nurse, physician, and pharmacist.
In addition, the suitability of any flow rate calculated for administration
must be made on an individual basis. For example, a calculated flow rate
of 100 gtt/min for a 2-year-old child is too high a rate to administer.
The fragility of infants' and children's veins, and the irritating nature
of many medications, mandate careful site inspection for signs of inflammation and infiltration. This should be done immediately before, during,
and after each infusion. Signs of inflammation include redness, heat,
swelling, and tenderness. Signs of infiltration include swelling, coldness,
pain, and lack of blood return in the IV tubing. Either complication necessitates discontinuance of the IV and a restart at a new site.
IV medication guidelines are always used to determine drug
dosages, dilutions, and administration rates.
Let's start by looking at the different methods of IV medication
administration.
METHODS OF IV MEDICATION
ADMINISTRATION
Intravenous medications may be administered over a period of several
hours or on an intermittent basis involving several dosages in a 24-hour
y noLbe copied, scanned, or duplicated, in whole o r in part. Due Lo electronic rig hl.'i, some Lhinl party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecLthe overall learning experience. Cengage Leaming reserves the righLLo remove addiLional conlenl al any time if subscquenLrighls restricLions require it.
PEDIATRIC INTRAVENOUS MED I CATIONS
period. When ordered to infuse over several hours, medications are usually added to an IV
solution bag. Adding the drug to the IV bag may be a hospital pharmacy or nurse responsibility. The steps for adding the drug to the solution are as follows:
STEP
1
Locate the type and volume of IV solution ordered
STEP
2
Measure the dosage of drug to be added.
STEP
3
Use strict aseptic technique to add the drug to the solution bag
through the medication port.
STEP
4
Mix the drug thoroughly in the solution.
STEP
5
Label the IV solution bag with the name and dosage of the drug added.
STEP
6
Add your initials and the time and date you added the drug.
STEP
7
Hang the IV and then set the flow rate for
the infusion. Chart the administration when
it has completed
For intermittent administrations, the medication may also be prepared in small-volume solution bags, or using a calibrated burette
such as the one illustrated in Figure 23-1. Because the total capacity
ofburettes is between 100 and 150 mL, calibrated in 1 mL increments,
the exact measurement of small volumes is possible.
Regardless of the method of intermittent administration, the
medication infusion is routinely followed by a flush to make sure
the medication has cleared the tubing and that the total dosage has
been administered. The volume of the flush ,vill vary depending on
the length of IV tubing from the medication source- that is, the
burette or syringe-to the infusion site. If a primary line exists, the
medication may be administered by IVPB (IV piggyback) via a secondary line. If no IV is infusing, a saline or heparin lock (heplock) is
frequently in place and used for intermittent administration.
When IV medications are diluted for administration, it is necessary to determine hospital policy on inclusion of the medication
volume as part of the volume specified for dilution. For example,
if 20 mg has a volume of 2 mL, and it is to be diluted in 30 mL, does
this mean you must add 28 mL of diluent to the burette or 30 mL?
Hospital policies may vary, but in all examples and problems
in this chapter the drug volume will be treated as part of the
total diluent volume. The sequencing of medication and flush administration covered next for burette use is also representative of the
procedure that might be followed for IVPB administrations.
MEDICATION ADMINISTRATION
VIABURETTE
When a burette is used for medication administration, the entire
preparation is usually done by nurses. Volumetric and syringe pumps
are used extensively to administer intermittent IV medications to infan ts
and children. When these are used, the alarm will sound each time
the burette or syringe empties to signal when each successive step is
necessary. For example, it will alarm ,vhen the medication has infused
and the flush must be started and again when the flush is completed.
-
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FIGURE 23-1
Calibrated burette.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be supprcssOO fro m Lhe cBook and/or eChaplet1s).
Edllorial review has deemed LhaLany suppress ed conlenl does noL materially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
339
340
PEDIATRIC MEDICATION CALCULATIONS
Let's look at some sample orders and go step by step through one procedure that may
be u sed.
EXAMPLE 1
A dosage of 250 mg in 15 ml, of D5 ½ NS is to be infused in
30 minutes. It is to be followed with a 5 ml, D5 ½ NS flush . A volumetric pump will be used, and the tubing is a microdrip burette.
STEP
1
Read the drug label to determine what volume the 250 mg dosage is
contained in. Let's assume this is 1 ml,.
STEP
2
The dilution is to be 15 ml,. Run a total of 14 ml, ofD5 ¼ NS into
the burette, then add the I ml, containing the medication dosage of
250 mg. This gives the ordered volume of 15 ml,. Roll the burette
between your hands to mix the drug thoroughly with the solution.
STEP
3
Calculate the flow rate for this microdrip.
Total volume = 15 ml, Infusion time = 30 min
Using Ratio and Proportion
15 mL
x mL
30min
60min
or
15 mL : 30 min = X mL : 60 min
30X= 60 X 15
X = 30 ml,/hr
X= 30 ml,/hr
Using Dimensional Analysis
mL = 15 mL X 60 min = 30 ml,/hr
hr
30min
1 hr
STEP
4
Set the pump to infuse 30 mL/hr.
STEP
5
Label the burette to identify the drug and dosage added. Attach a label
that states ''medication infusing;' This makes it possible for others to
know the status of the administration if you are not present when the
infusion is complete and the pump alarms.
STEP
6
When the medication has infused, add the 5 ml, D5 ¼ NS flush.
Remove the ''medication infusing'' label and attach a ''flush
infusing'' label. Continue to infuse at the 30 ml,/hr rate until the
burette empties for the second time.
STEP
7
When the flush has been completed, restart the primary IV or
disconnect from the saline/heparin lock. Remove the ''flush
infusing'' label. Chart the dosage and time.
EXAMPLE 2
STEP
1
An antibiotic dosage of 125 mg in 1 ml, is to be diluted in 20 ml, of
D5 ¼ NS and infused over 30 min. A flush of 15 ml, D5 ¼ NS is to
follow. A volumetric pump will be u sed .
125 mg has a volume ofl ml,.Add 19 ml, ofD5 ¼ NS to the burette, add
the I ml, of medication, and mix thoroughly.
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PEDIATRIC INTRAVENOUS MED I CATIONS
STEP
Calculate the ml,/hr flow rate.
2
Total volume = 20 ml,
Infusion time = 30 min
Using Ratio and Proportion
20 rnL
X mL
30 min
60 min
or
20 rnL: 30 min= XmL: 60 min
30X = 60 X 20
X= 40 ml,/hr
X= 40 ml,/hr
Using Dimensional Analysis
rnL = 20 rnL X 60 min = 40 ml,/hr
hr
30min
1 hr
STEP
3
Set the pump to infuse 40 mL/hr.
STEP
4
Label the burette with the drug and dosage, and attach a ''medication
infusing'' label.
STEP
5
When the medication has infused, start the 15 ml, flush. Remove the
''medication infusing'' label and add the ''flush infusing'' label.
STEP
6
When the flush has completed, restart the primary IV or disconnect
from the saline lock. Remove the ''flush infusing'' label. Chart the
dosage and time.
KEYpoint. If a 60 gtt/ rnL calibrated burette is used without a pump, the
gtt/ min rate will be the same as the rnL / hr rate.
EXAMPLE 3
An antibiotic dosage of 50 mg h as been ordered diluted in 20 ml,
of D5W to infuse over 20 min. A 15 ml, flush of D5W is to follow. A
microdrip will be used but an infusion control device will not be used.
STEP
1
Read the medication label to determine what volume contains 50 mg.
You determine that 50 mg is contained in 2 ml,.
STEP
2
Run 18 ml, of D5W into the burette and add the 2 ml, containing 50 mg
of drug. Roll between your hands to mix thoroughly.
STEP
3
Calculate the flow rate in gtt/ min necessary to deliver the medication.
Total volume = 20 ml,
Infusion time = 20 min
Using Ratio and Proportion
20 rnL
X mL
20 min
60 min
or
X= 60 ml,/hr
20 rnL : 20 min = X mL : 60 min
20X = 20 X 60
X= 60 ml,/hr
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Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts restrictions require iL
341
342
PEDIATRIC MEDICATION CALCULATIONS
Using Dimensional Analysis
60 gtt
20 mL
.
gtt
- - = - - X - - - = 60 gtt/m1n
min
1 mL
20 min
STEP
4
The ml,/hr and gtt/ min rates are identical for a microdrip. Set the rate
at 60 gtt/ min.
STEP
5
Label the burette with drug name and dosage, and attach a
''medication infusing'' label.
STEP
6
When the medication has cleared the burette, add the 15 ml, D5W
flush. Continue to run at 60 gtt/ min. Remove the ''medication
infusing'' label and replace with a ''flush infusing'' label.
STEP
7
When the burette empties for the second time, restart the primary
IV or disconnect from the saline lock. Remove the ''flush infusing''
label. Chart the dosage and time administered.
EXAMPLE 4
An IV m edication dosage of 100 mcg h as b een ordered diluted
in 35 ml, of NS and infused in 50 min. A 10 ml, flush is to follow.
A microdrip burette will b e used.
STEP
1
Read the medication label to de term in e what volume contains
100 mcg: 100 mcg = 1.5 ml,.
STEP
2
Run 33.5 ml, of NS into the burette, and add the 1.5 ml, of medication.
Roll the burette between your hands to mix thoroughly.
STEP
3
Calculate the gtt/ min flow rate.
Using Ratio and Proportion
Total volume = 35 ml,
Infusion time = 50 min
35 mL
XmL
35 mL : 50 min = X mL : 60 min
50min
60min
or
50X= 35 X 60
X = 42mL/hr
X = 42 ml,/hr
= 42 gtt/ min
= 42 gtt/ min
USING DIMENSIONAL ANALYSIS
gtt
60 gtt
35 mL
min
1 mL
50 min
- - = - - X - - - = 42 gtt / min
STEP
4
Set the flow rate at 42 gtt/ min.
STEP
5
Label the burette with the drug name and dosage and ''medication
infusing'' label.
STEP
6
When the medication has cleared the burette, add the 10 ml, flush.
Continue to run at 42 gtt/ min. Replace the ''medication infusing''
label with the '' flush infusing'' label.
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplic.ated, in whole or in pan . Due to elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 fro m Lhe c Book and/or eChapLer(s).
Edllorial review has deemed LhaLany suppressed content does noLmaterially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional content al any time if subsequent rig hts restrictions require iL
PEDIATRIC INTRAVENOUS MED I CATIONS
STEP
7
When the burette empties of the flush solution, restart the primary IV
or disconnect from the saline lock. Remove the ''flush infusing''
label, and chart the dosage and time administered.
►►► PROBLEMS 23.1
Determine the volume of solution that must be added to a burette to mix the following
IV drugs. Then, calculate the flow rate in gtt/ min for each administration using a
microdrip, and indicate the mL/hr setting for a pump.
1. An IV medication of 75 mg in 3 mL is ordered diluted to 55 mL
to infuse over 45 min.
Dilution volume
gtt/ min _ _ _ __
mL/ hr- - - - - -
2. A dosage of 100 mg in 2 mL is diluted to 30 mL of D5W to infuse in 20 min.
Dilution volume_____
gtt/ min _ _ _ _ _
mL/ hr_ _ _ __
3. The volume of a 10 mg dosage of medication is 1 mL.
Dilute to 40 mL and administer over 50 min.
Dilution volume
gtt/ min _ _ _ __
mL/ hr- - - - - -
4. A dosage of 15 mg with a volume of 3 mL is to be diluted to 70 mL and
administered in 50 min.
Dilution volume
gtt/ min _ _ _ __
mL/ hr- - - - - -
5. A medication of 1 gin 4 mL is to be diluted to 60 mL and infused over 90 min.
Dilution volume
gtt/ min _ _ _ __
mL/ hr_ _ __
Answers 1. 52 ml; 73 gtt/min; 73 ml/hr 2. 28 ml; 90 gtt/min; 90 ml/hr 3. 39 ml; 48 gtt/min; 48 ml/hr
4. 67 ml; 84 gtt/min; 84 ml/hr S. 56 ml; 40 gtt/min; 40 ml/hr
COMPARING IV DOSAGES ORDERED WITH
AVERAGE DOSAGES
Knowing how to compare dosages ordered with average dosages for a particular
medication is a nursing responsibility.
KEVpoint. Dosages of IV medications are calculated 011 the basis of body
weight, or BSA.
Average dosages may be listed in ter1ns of 1ng, mcg, or units per day or per l1our. BSA in m 2
is most often used to calculate chemotherapeutic drugs, which are administered only by
certified nursing staff. The following examples will demonstrate how to use average dosage
to check dosages ordered.
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Edllorial review has deemed LhaL any suppressed content does noL materially affect Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe right Lo remove additional conte nt al any time if subsequent rig hts res trictions require iL
343
344
PEDIATRIC MEDICATION CALCULATIONS
EXAMPLE 1
STEP
A child weighing 22.6 kg has an order for 500 mg of m edication
in 100 ml, of D5W every 12 hours. The norm al dosage range is
40-50 mg/ kg/day. Determine if the dosage ordered is within the
normal ran ge.
Calculate the normal daily dosage range for this child.
1
40 m g/ day X 22.6 kg = 904 mg
50 m g/day X 22.6 kg = 1130 mg
STEP
Calculate the dosage infusing in 24 hr.
2
500 mg in 12 hr = 1000 mg in 24 hr
STEP
3
Assess the accuracy of the dosage ordered.
The 500 mg in 12 hr, or 1000 mg in 24 hr, is within the 904- 1130 mg/ day
dosage range.
A child with a body weight of 18.4 kg is to receive a m edication
with a dosage ran ge of 100-150 mg/ kg/ day . The order is for
600 mg in 75 ml, ofD5W every6 hours. Det ermine if the dosage is
within normal range.
EXAMPLE 2
STEP
Calculate the normal daily dosage range.
1
100 m g/day X 18.4 kg= 1840 mg/ day
150 mg/ day X 18.4 kg = 2760 mg/ day
STEP
Calculate the daily dosage ordered.
2
The dosage ordered is 600 mg every 6 hours (4 doses/24 hours)
600 mg X 4 = 2400 mg/ day
STEP
3
Assess the accuracy of the dosage ordered.
The dosage ordered, 2400 mg/ day, is within the normal range of
1840-2760 m g/day.
EXAMPLE 3
STEP
1
A child weighing 17.7 kg is receiving an IV of 250 ml, of D5W cont aining 2000 units of m edication, which is to infuse at 50 mL/ hr.
The dosage range is 10-25 units/ kg/ hr. Assess the accuracy of this
dosage.
Calculate the dosage range per hour.
10 units/kg/ hr X 17.7 kg = 177 units/ hr
25 units/kg/ hr X 17.7 kg= 442.5 units/ hr
STEP
2
Calculate the dosage infusing per hour.
Using Ratio and Proportion
2000 units
Xunits
250mL
50mL
or
X = 400 units/ hr
2000 units : 250 mL = X units : 50 mL
250X = 2000 x 50
X = 400 units/ hr
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Ed llorial re view has deemed LhaLany suppressed content does noLmaterially affec t Lhe ove rall leaming e xpe rience. Ce ngage Leaming reserves Lhe right Lo remove additional c onte nt al any time if subsequent rig hts res trictions require iL
PEDIATRIC INTRAVENOUS MED I CATIONS
Using Dimensional Analysis
units
2000 units
50 mL
. /hr
- - = - - - - X - - = 400 units
hr
250 mL
1 hr
STEP
3
Assess the accuracy of the dosage ordered.
The IV is infusing at a rate of 50 mL per hour, which is 400 units/hr.
The normal dosage range is 177-442.5 units/hr. The dosage is within the
normal range.
EXAMPLE 4
STEP
1
A child weighing 32.7 kg has an IV of250 ml, ofD5 ¼ S containing
400 mcg of medication to infuse in 5 hours. The normal range for
this drug is 1-3 mcg/kg/hr. Determine if this dosage is within the
normal dosage range.
Calculate the hourly dosage range.
1 mcg/ kg/ hr X 32. 7 kg = 32. 7 mcg/hr
3 mcg/ kg/ hr X 32. 7 kg = 98.1 mcg/ hr
STEP
2
Calculate the dosage infusing per hour.
400 mcg -=- 5 hr = 80 mcg/hr
STEP
3
Assess the accuracy of the dosage ordered.
The dosage of 80 mcg/hr infusing is within the normal range of
32.7-98.1 mcg/ hr.
►►► PROBLEMS 23 .2
Calculate the normal dosage range to the nearest tenth and the dosage being
administered for the following medications. Assess the dosages ordered.
1. A child weighing 24.4 kg has an IV of 250 mL of D5W containing 2500 units of a drug.
The dosage range for this drug is 15-25 units/kg/ hr. The pump is set to deliver
50 mL/ hr.
Dosage range per hr _ _ _ _ __
Dosage infusing per hr _ _ _ _ __
Assessment - - - - - -
2. A solution of D5W containing 25 mg of a drug is to infuse in 30 min. The dosage range
is 4-8 mg/kg/ day every 6 hours. The child weighs 18.7 kg.
Dosage range per day _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
3. An IV solution containing 125 mg of medication is infusing. The dosage range
is 5-10 mg/kg/ dose, and the child weighs 14.2 kg.
Dosage range per dose______
Assessment _ _ _ _ __
4. A child weighing 14.3 kg is to receive an IV drug with a dosage range of
50-100 mcg/ kg/ day in two divided doses. An infusion of 50 mL of D5W
containing 400 mcg to run 30 min has been ordered.
Daily dosage range______
Daily dosage ordered _ _ _ _ __
Assessment
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Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts restrictions require iL
345
346
PEDIATRIC MEDICATION CALCULATIONS
5. A dosage of 4 mg (4000 mcg) of drug in 500 rnL of D5 ½ S is to infuse in 4 hours. The
dosage range of the drug is 24-120 mcg/kg/hr, and the child weighs 16.1 kg.
Dosage range per hr _ _ _ _ __
Dosage infusing per hr _ _ _ _ __
Assessment - - - - - -
6. A child weighing 20.9 kg is to receive a medication with a normal dosage range of
80-160 mg/kg/ day in divided doses every 6 hours. The IV ordered contains 500 mg.
Dosage range per day _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
7. A child weighing 22.3 kg is to receive 750 rnL ofD5 ¼ S containing 6 g of a drug, which
is to run for 24 hours. The dosage range of the drug is 200-300 mg/kg/day.
Dosage range per day______
Assessment _ _ _ _ __
8. An IV of 50 rnL of D5W containing 55 mcg of a drug is infusing in a 30-min period. The
child weighs 14.9 kg and the dosage range is 6-8 mcg/kg/day, every 12 hours.
Dosage range per day _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
9. A child weighing 27.1 kg is to receive a medication with a normal range of
0.5-1 mg/kg/ dose. An IV containing 20 mg of medication has been ordered.
Dosage per dose _ _ _ _ __
Assessment - - - - - -
10. An IV medication of 60 mcg in 200 mL is ordered to infuse in 2 hr. The normal dosage
range is 1.5-3 mcg/kg/hr. The child weighs 16.7 kg.
Dosage range per hr _ _ _ _ __
Dosage infusing per hr _ _ _ _ __
Assessment
Answers 1. 366-610 units/hr; 500 units/hr; normal range 2. 74.8-149.6 mg/day; 100 mg/day;
normal range 3. 71-142 mg/dose; normal range 4. 715-1430 mcg/day; 800 mcg; normal range
s. 386.4-1932 mcg/hr; 1000 mcg; normal range 6. 1672-3344 mg/ day; 2000 mg; normal range
7. 4460-6690 mg/day; normal range 8. 89.4-119.2 mcg/day; 110 mcg; normal range
9. 13.6-27.1 mg/dose; normal range 10. 25.1-50.1 mcg/hr; 30 mcg; normal range
Summary
This concludes the chapter on administration of IV drugs to infants and children. The
important points to remember from this chapter are:
IV medications may be ordered to infuse in several hours or minutes.
IV medications are diluted for administration, and it is important to determine
hospital policy on inclusion of the medication volume as part of the total dilution
volume.
A flush is used following medication administration to make sure the medication
has cleared the tubing and the total dosage has been administered.
The volume of flush solution on intermittent infusions will vary depending on the
amount needed to clear the infusion line.
Average dosage ranges are used to assess dosages ordered.
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PEDIATRIC INTRAVENOUS MEDICATIONS
Pediatric IV medication administration requires constant assessment of the child's
ability to tolerate dosage, dilution, and rate of administration.
Children's veins are very fragile, and intravenous sites must be checked for
inflammation and infiltration immediately before, during, and after each
medication administration.
Summary Self-Test
Determine the volume of solution that must be added to a calibrated burette to
mix the following IV drugs. The medication volume is included in the total dilution
volume. Calculate the flow rate in gtt/ min for each infusion. A microdrip with a
calibration of 60 gtt/ m.L is used.
Volume
of diluent
gtt/min
rate
1. An IV antibiotic of 750 mg in 3 mL has been ordered
diluted to a total of 25 mL of D5W to infuse
in 40 minutes.
2. A dosage of 500,000 units of a penicillin preparation
with a volume of 4 mL has been ordered diluted to
50 mL D5 ½ NS to infuse in 60 min.
3. A dosage of 1.5 g/2 mL of an antibiotic is to be
diluted to a total of 40 mL of D5W and
administered in 40 min.
4. An antibiotic dosage of 200 mg in 4 mL is to be
diluted to 50 mL and administered in 70 min.
5. A dosage of 20 mg in 2 mL has been ordered
diluted to 30 mL to be infused in 35 min.
6. A dosage of 25 mg in 5 mL has been ordered
diluted to 40 mL and administered in 50 min.
7. A 10 mg in 2 mL dosage has been ordered
diluted to 20 mL to infuse in 30 min.
8. A medication dosage of 800 mg in 4 mL is to be
diluted to 60 mL and infused in 80 min.
9. A dosage of 0.5 g in 2 mL is to be
diluted to 40 mL and run in 30 min.
10. A medication of 1000 mg in 1 mL is to be
diluted to 15 mL and administered in 20 min.
The following IV drugs are to be administered using a volumetric or syringe pump.
Determine the amount of diluent to be added and the flow rate in mL/ hr to set the pumps.
Volume
of diluent
ml,/hr
rate
11. A dosage of 40 mg in 4 mL is to be diluted to
50 mL and administered in 90 min.
12. A 2 g in 5 mL dosage has been ordered diluted to a
total of 90 mL and administered in 45 min.
Copyrig hl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conle nl may be .supprcs..,;,00 fro m Lhe cBook and/or eChapLer(s).
Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal conte nL al any time if subsequenL rig hts restrictions require iL
347
348
PEDIATRIC MEDICATION CALCULATIONS
13. An 80 mg dosage with a volume of 2 mL is to be
diluted to 80 mL and administered in 60 min.
14. A 60 mg dosage with a volume of 4 mL is ordered
diluted to 30 mL and run in 20 min.
15. A 5 mg per 2 mL dosage is to be diluted to
80 mL and administered in 50 min.
16. The dosage ordered is 0.75 gin 3 mL to be
diluted to 30 mL and infused in 40 min.
17. A medication of 100 mg in 2 mL is ordered
diluted to 30 mL and run in 25 min.
18. The dosage ordered is 100 mg in 1 mL to be
diluted to 50 mL and infused in 45 min.
19. A 30 mg dosage in 1 mL has been ordered
diluted to 10 mL to infuse in 10 min.
20. A dosage of 250 mg in 5 mL has been ordered
diluted to 40 mL and infused in 60 min.
Calculate the normal dosage range to the nearest tenth and the dosage being
administered for the following medications. Assess the dosages ordered.
21. A child weighing 15.4 kg is to receive a dosage with a range
of 5-7.5 mg/kg/ dose. The solution bag is labeled 100 mg.
Dosage range______
Assessment _ _ _ _ __
22. The order is for 200 units in 75 mL. The child weighs 13.1 kg,
and the dosage range is 15-20 units/kg per dose.
Dosage range______
Assessment _ _ _ _ __
23. A dosage of 1.5 mg in 20 mL has been ordered. The normal
dosage range is 0.1-0.3 mg/kg/day in two divided doses.
The child's weight is 12.4 kg.
Dosage range per day _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
24. A dosage of 400 mg in 75 mL of medication is to be infused
every 8 hours. The normal range is 15-45 mg/kg/ day, and the
child weighs 27.9 kg.
Dosage range per day _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
25. A child weighing 15.7 kg is to receive a medication with a normal
hourly range of 3-7 mcg/kg. A 250 mL solution bag containing
350 mcg is infusing at a rate of 50 m.L/hr.
Dosage range per hr _ _ _ _ __
Dosage infusing per hr _ _ _ _ __
Assessment - - - - - -
26. A child weighing 19.6 kg is to receive a medication with a normal
dosage range of 60-80 mg/kg/ day. A 90 mL infusion containing
375 mg has been ordered every 6 hours.
Dosage range per day _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment
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PEDIATRIC INTRAVENOUS MED I CATIONS
27. Two infusions of 250 mL, each containing 300 mg of medication, are to
infuse continuously over a 24 hr period. The child receiving the infusion
weighs 11.7 kg, and the normal dosage range of the drug is
50-100 mg/kg/ day.
Dosage range per day _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment
28. The order is for 100 mL of D5W containing 150 mg of medication
to infuse every 8 hours. The normal dosage range is 3-12 mg/kg/ day,
and the child weighs 40.1 kg.
Dosage range per day _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment
29. A child has an infusion of 250 mL containing 500 units of
medication to run at 50 mL/hr. The normal dosage range
is 10-25 units/kg/hr. The child weighs 10.3 kg.
Dosage range per hr _ _ _ __
Dosage infusing per hr ______
Assessment _ _ _ _ __
30. The normal dosage range of a ch·ug is 0.5-1.5 units/kg/hr.
A child weighing 10.7 kg has a 150 mL volume of solution
containing 45 units infusing at a rate of 20 mL/hr.
Normal dosage range per hr _ _ _ _ __
Dosage infusing per hr ______
Assessment _ _ _ _ __
31. A child weighing 12.5 kg is receiving an IV of 2500 units of
medication in 250 mL of D5W at 40 mL/hr. The normal
Normal dosage range per hr _ _ _ _ __
dosage range is 10-25 units/kg/hr.
Dosage infusing per hr _ _ _ _ __
Assessment - - - - - -
32. A child with a weight of 10 kg is to receive a medication with a
normal dosage range of 60-80 mg/kg/day. The order is
for 200 mg every 6 hours.
Normal dosage range per hr _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
33. The order is for 0.5 gin 100 mL of D5W every 6 hours. The normal
dosage range is 100-200 mg/kg/day. The child weighs 15 kg.
Normal dosage range per hr _ _ _ _ __
Daily dosage ordered______
Assessment _ _ _ _ __
34. A continuous IV of 500 mL with 20 mEq KCl is infusing at
30 mL/hr. The dosage for potassium chloride is not to
exceed 40 mEq/ day.
Dosage infusing per hr _ _ _ _ __
Dosage infusing per day _ _ _ _ __
Assessment - - - - - -
35. A 24 kg child is receiving 116 mg of medication via IV 3 times each day
(every 8 hours). Dosage range for this drug is 10-20 mg/kg/day.
Normal dosage range per day _ _ _ _ __
Dosage received after 3 doses ______
Assessment _ _ _ _ __
36. A child weighing 15 kg has an order for 40 mcg of medication in 75 mL D5W
to infuse every 12 hours. The normal dosage range is 8-10 mcg/kg/ day.
Normal dosage per day _ _ _ _ __
Dosage ordered _ _ _ _ __
Assessment - - - - - -
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Edilorial review has deemed LhaL any suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenL al any time if subsequenL rig hts res trictions req uire iL
349
350
PEDIATRIC MEDICATION CALCULATIONS
37. The usual dosage for children is 50 mg/kg/24 hr in equally divided doses. The order is
to infuse 50 rnL with 290 mg every 6 hours. The child weighs 51 lb.
Normal dosage per day _ _ _ _ __
Daily dosage ordered _ _ _ _ __
Assessment - - - - - -
38. Order: 500 rnL D5RL with 30 mEq KCl to infuse at 40 mL/hr. A maximum of
10 mEq/hr of KCl should not be exceeded, and the total 24 hr dosage
should not exceed 40 mEq/ day.
Dosage infusing per hr _ _ _ _ __ Dosage infusing per day _ _ _ _ __
Assessment - - - - - 39. A child weighing 30 kg has an IV of 100 mL of D5W containing 600 mcg of
medication to infuse in 2 hours. The normal range for this drug is 2-4 mcg/kg/hr.
Normal dosage range per hr _ _ _ _ __
Dosage infusing per hr _ _ _ _ __
Assessment - - - - - -
40. 150 rnL with 18 mg of medication is ordered to infuse in 10 hours. The normal
range for this drug is 0.2-0.6 mg/kg/hr. The child weighs 9 kg.
Normal dosage range per hr _ _ _ _ __
Dosage infusing per hr _ _ _ _ __
Answers
1. 22 ml; 38 gtt/min
2. 46 ml; 50 gtt/min
3. 38 ml; 60 gtt/min
4. 46 ml; 43 gtt/min
5. 28 ml; 51 gtt/min
6. 35 ml; 48 gtt/min
7. 18 ml; 40 gtt/min
8, 56 ml; 45 gtt/min
9. 38 ml; 80 gtt/min
10. 14 ml; 45 gtt/min
11. 46 ml; 33 ml/hr
12. 85 ml; 120 ml/hr
13. 78 ml; 80 ml/hr
14. 26 ml; 90 ml/hr
15. 78 ml; 96 ml/hr
16. 27 ml; 45 ml/hr
17. 28 ml; 72 ml/hr
18. 49 ml; 67 ml/hr
19. 9 ml; 60 ml/hr
20. 35 ml; 40 ml/hr
21. 77-115.5 mg/dose;
norma l
22. 196.5-262 units/dose;
norma l
23. 1.2-3.7 mg/day; 3 mg;
normal
24. 418.5-1255.5 mg/day;
1200 mg; normal
25. 47 .1-109. 9 mcg/hr;
70 mcg; normal
26. 1176-1568 mg/day;
1500 mg; normal
27. 585-1170 mg/day;
600 mg; normal
28. 120.3-481.2 mg/day;
450 mg ; normal
29. l 03-257.5 units/hr;
l 00 units/hr; too low
30. 5.4-16. l units/hr;
6 units/hr; norma l
Assessment
31. 125-312 .5 units/hr;
400 units/hr; too high
32. 600-800 mg/day;
800 mg; normal
33. 1500-3000 mg/ day;
2000 mg; normal
34. 1.2 mEq/hr;
28.8 mEq/day; norma l
35. 240-480 mg/day;
348 mg; normal
36. 120-150 mcg/day;
80 mcg/ day; too low
37. 1160 mg/day; 1160 mg;
normal
38. 2.4 mEq/hr; 58 mEq/day;
too high
39. 60-120 mcg/hr;
300 mcg ; too high
40. 1.8-5.4 mg/hr;
1.8 mg; normal
Copyrig hl 20 15 Ceng age Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be .supprcssOO from Lhe cBook and/or eChaplet1s).
Ed llorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenLal any time if subsequenLrig hts res trictions req uire iL
APPENDI
The ancient and now extinct apothecary system was based on the
weight of a grain of wheat, which immediately points out its inaccuracy.
Thus the basic unit of measure was named a grain (gr). Liquid measures
in the system were based on a drop; liquid measures included minim
(min), dram (dr, or~), and ounce (oz, or :Y). Metric measures started
to displace apothecary use in the 1950s, but some physicians continued
to use it apothecary notations, necessitating a conversion chart from
apothecary to metric measures (see below). While these charts still appear occasionally in literature, they are rapidly disappearing. The oz and
dr measures still appear on some disposable medication cups as part
of the household system of measures, necessitating careful distinction
when using medication cups for liquid metric measures.
The apothecary measures and their abbreviations were as follows:
WEIGHT
VOLUME
•
gram
•
minim
m
•
min
drain
dr
fluid dram
ounce
oz
gr
.
J-fluid ounce :Y
(41nL)
(30 mL)
APOTHECARY/ HOUSEHOLD/ METRIC EQUIVALENTS
Liquid
mL
oz
"\oVeight
•
min
gr
mg
gr
= 1000
-- 600
1/4
--
15
1/6
---
10
6
mg
= 30
45
--
3
15
½ = 15
30
---
2
10
1
1/8
0.75
0.6
7½ = 500
5 -- 300
4 -- 250
1/15
---
1
15
7.5
mL
12
2½ = 10
2 -8
10
---
8
--
0.5
3
--
200
1/20
--
3
l¼ =
1 --
5
5
0.3
1/30
120
1/40
---
2
4
2½ =
2 --
150
4
---
3
--
0.2
100
1/60
--
1
l½ =
1 --
0.1
l½ =
1 --
60
1/100
---
0.6
dr
11nin =
lT
lt
mL
1 gtt
= 15 1nL
-5mL
0.25
0.06
¾ =
45
1/10
1/120
¾ =
0.05
½ =
30
1/150
½ =
0.03
½=
20
1/200
---
1/250
--
4
1.5
Lri
c :,
N
0.5
Cl
c::
c::
0.4
.,
_,
.,
0.3
Cl
<ti
Cl
~
0.25
<ti
.,c::
<...)
(Q)
351
CopyrigbL 20 15 Cengage Learning. All RighL'i Reserved May noL be copied.scanned, or dupHc-:.Hed, in whole o r in part. Due to electronic rig hts• .some Lhird party conlenl may be s uppressed from Lhe
Edilori.al review has deemed thal :my s uppressed content does nol mat.erially affecL Lheoverall learning experience. Ce.ngage Leaming re.iierves Lhe right Lo remove additional contenL al any time if s ubscqu
APPENDI
I
y noLbe copied, scanned, or duplicated, in whole o r in part. Due Lo electronic righi.o;, some lhird party conLenLmay be suppressed rmm tl1e eBook and/or eChapLet~s).
m.at.erially affecl the overall learning experience. Cengage Leaming re.,;erves the righLLo remove additional conlenl al any time if subscquenl righls restricLions require it.
353
ISMP's LIST OF ERROR-PRONE ABBREVIATIONS, SYMBOLS, AND DOSE DESIGNATIONS
ISM P's List of Error-Prone Abbreviations, Symbols, and Dose Designations
he abbreviations, symbols, and dose designations found in
this table have been reported to ISMP through the ISMP
National Medication Errors Reporting Program (ISMP MERP) as
being frequently misinterpreted and involved in harmful
medication errors. They should NEVER be used when commu-
T
Abbreviations
AD, AS, AU
00, OS, OU
BT
cc
DIC
IJ
IN
HS
hs
o.d. er OD
Intended Meaning
Microgram
Right ear, left ear, each ear
Right eye, left eye, each eye
Bedtime
t'Albic centimeters
Oischarge or discontinue
lnJecbon
Intranasal
Half-strength
Al bedtime, hours of sleep
International unit
Once dai~
OJ
Orange julce
Per OS
q.d. or QD..
By mouth, orally
Every day
qhs
qn
q.o.d. or QO o-
Nightly at bedtime
Nightly or at bedtime
Every other day
qld
q6PM. etc.
Every evening at 6 PM
SC, SQ, sub q
Subcutaneous
ss
SSRI
Daily
Sllding scale Qnsulin) or Vt
(apothecary)
Sliding scale regular Insulin
nicating medical information. This includes internal communications, telephone/verbal prescriptions, computer-generated
labels, labels for drug storage bins, medication administration
records, as well as pharmacy and prescriber computer order
entry screens.
rA1s1nlerpretatmn
Correction
Mistaken as "mg"
Mistaken as OD, OS, OU (right eye, left eye, each eye)
Mistaken as AD, A~ AU (right ear, left ear, each ear)
Mistaken as "BIO" (twice daily)
Mistaken as "u" (units)
Premature discontinuation at medications if 0/C ~ntended to mean
"discharge") has been misinterpreted as •discontinued'' when
foDowed by a list of discharge medications
Mistaken as "IV" or "intrajugular''
Mistaken as "IM" or "IV"
Mistaken as bedtime
Use "mcg"
Use "right ear," •iett ear," or "each ear"
Use "right eye," "left eye,8 or "each eyefl
Use "bedtime"
Use "ml"
Use "discharge" and "discontinue"
Mistaken as half-strength
Mistaken as IVOntravenous) or 10 (ten)
Mistaken as "right eye• (00-oculus dexter), leading to oral liquid
medicatmns administered in the eye
Mistaken as OD or OS (right or left eye); drugs meant to be diluted
In orange juice may be given In the eye
The "os" can be mistaken as "left eye" (OS-oculus sinister)
Mistaken as Q.i.d., especially if the period after the •qn or the tail or
the •q• is misunderstood as an "i"
Mistaken as "qhr" or BYl:lry hour
Mistaken as "qh" (every hour)
M1staken as "q.d:' (dai~) or "q.i.d. (four times dai~) if the "o" is
poorly written
PAistaken as q.i,d. {four times dai~)
Mistaken as every 6 hours
SC mistaken as SL (sublingual); SQ mistaken as "5 every;" the "q"
In •sub q" has been mistaken as "every" (e.g., a heparin dose
ordered ''sub q 2 hours before SUJllery" misunderstood as every 2
hours before StJrgery)
Mistaken as "55''
Use "injection"
Use "intranasal'' or "NAS"
Use "half-strength" or "bed11me"
Use "units''
Use "orange juice''
Use "PO,' "by mouth," or "orally"
Use "daily"
Use "nightly"
Use "nightly" or "at bedtime"
Use "every other day"
Use ''daily"
Use "daily at 6 PM" or "6 PM daily"
Use "subcut'' or "subcutaneously"
Spell out "sliding scale;" use ''one-hair or
u½"
Mistaken as selective-serotonin reuptake Inhibitor
Spell out "sliding scale Qnsulln)"
TIW or tlw
Sliding scale insulin
One daily
3 limes aweek
Mistaken as Strong Solution or Iodine (Lugol's)
PA istll ken as "tid"
Mistaken as "3 times a day" or ''twice In a \\!eek•
Use "1 daily"
Use "3 times weekly"
U or u•·
Unit
Mistaken as the number Oor 4, causing a 10-fold overdose or
greater {e.g., 4U seen as "40" or 4u seen as "44"); mistaken as
"cc" so dose given in volume instead of units (e.g, 4u seen as 4cc)
Use "unit"
Mistaken as unit dose (e.g.. dilliazem 125 mg IV infusion "UO" m1Slnterpreted as meaning to gJve the entire lflMiln as a unit [bolus] dose)
Use "as directed"
SSI
i/d
uo
As directed ("ut dictum")
lntenrled tAeaning
Dose Designations
a11d Other lnforinalion
Trailing zero after
decimal paint
(1-11 .. to muJ··
"Naked" decimal point
(1.0., .511111) ...
Abbrevlatlans sucll a m1.
• ml with a perie~
following the -. ewiation
tAisinteipretation
Correction
1mg
Mlstaken as 10 mg if the decimal point is not seen
Do not use traDing zeros for doses
expressed in whole numbers
0.5 mg
Mistaken as 5 mg if the decimal point Is not seen
mg
The period Is unnecessary and could be mistaken as the number 1 If
written poorty
Use zero before a decimal point vlhen the
dose is less than a whole unit
Use mg, ml, etc. without a terminal
period
1nl
(continues)
Copyrighl 20 15 Cengage Leaming. All Rig hL'i Reserved. May noLbe copied, scanned, or duplica ted, in whole or in part. Due to elec.tronic rights. some I.bird party conte nt may be .suppressed from Lhe cBook and/or eChapter(s).
Editorial review has deemed LhaLany suppressed conlcnl does nol materially :iffecl Lheoverall leaming e xpe rience . Cengage Leaming re.serves Lhe righl Lo remove :iddiLiona..l conte nl al any time if subsequenl rig hts res trictions require iL.
354
ISMP's LIST OF ERROR-PRONE ABBREVIATIONS, SYMBOLS, AND DOSE DESIGNATIONS
ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations (conhnued)
'
Dose Designations
and Other Information
Drug name and dose run
Intended Meaning
~,isinterpretation
Ind era I 40 mg
Mistaken as lnderal 140 mo
Tegretol 300 mg
Mistaken as Tegretol 1300 mg
10 mo
The "m" is sometimes mistaken as a zero or two zeros, risking a
10- to 100-fold overdose
Place adequate space bet\veen the dose and
unit of measure
100000 has been mistaken as 10,000 or 1,000,000; 1IIXIIXK) has
been mistaken as 100,000
Use co~ for dosing units at or above
\000, or use words such as 100 "thousand"
or 1 "milbon" to improve readabiity
tlgether (especially
problematic for drlg
Correction
Place adequate space bet\wen the drug
name, dose, and ullit of measure
names that end in '1"
such as lnderal40 mg;
Te1ret11300 mg)
Numerical dose and unit
11 measlft run together
(e.g.. l>mg, 100ml)
Large doses wltllout
100 ml
100,IJXJ units
pror:r==~ 1,000,IJXJ units
mmlunltJ)
On1g fJamr. Ahhreviations
lntcnr1r.d Meaning
Misinterpretation
Correction
To avoid contusion, do not abbreviate drug name., when communicating medlcal information. Examples of drug name abbreviations involved in medlcatton errors include:
APAP
acetaminophen
Not recognized as acetaminophen
Use complete drug name
ARA A
vitlarabirle
Mistaken as cylarabine (ARA C)
Use complete drug name
AZT
zidovudine (Retrovir)
Mistaken as azathioprine or aztreonam
Use complete drug name
CPZ
Cornpazine (prochlorperazine) Mistaken as chlorpromazine
Use cnmplete drug name
DPT
Demerol-Phenergan-Thora2ine Mistaken as diphtheria-pertussis-tetanus (vaccine)
Use complete drug name
OTO
Diluted bncture of opium1 or
Mistaken as tincture of opium
Use complete drug name
deodonzed tincture of opium
(Paregoric)
HCI
hydrochloric acid or
Mistaken as potassium chloride
Use complete drug name unless expressed
hydrochloride
(The "H" is misinterpreted as "K")
as a salt of a drug
HCT
hydrocortisooe
Mistaken as hydrochlorothiazfde
Use complete drug name
HCTZ
hydrochlorothlazlde
Mistaken as hydrocortisone (seen as HCT250 mg)
Use complete drug name
Use complete drug name
magnesium sulfate
Mistaken as morphine sulfate
morphine sulfate
Mistaken as magnesium sulfate
Use complete drug name
Use complete drug name
MTX
methotrexate
Mistaken as mitoxantrone
PCA
procainamide
Mistaken as patient controlled analgesia
Use complete drug name
propylthiouracH
Mistaken as mercaptopurine
Use complete drug name
PTU
T3
Tylenol with codeine No. 3
Mistaken as liolhyronine
Use complete drug nan1e
Use complete drug name
TAC
triamcinolone
Mistaken as tetracaine, Adrenalin, cocaine
TNK
TNKase
Mlsta ken as "TPA"
Use complete drug name
ZnS04
Mistaken as morphine sulfate
Use complete drug name
ZJnc sulfate
Stemmed Drug Names
Intended Meaning
Misinterpretation
Correctio11
nitroglycertn infusion
Mistaken as sodium nitroprusslde infusion
Use complete drug name
"Nitro" drip
"N1rflox"
norfloMcin
Mistaken as Norflex
Use complete drug nanie
''IY Vane"
Intravenous vancomycin
Mistaken as lnvanz
Use complete drug name
Symbols
lntenr1ecl Meaning
~,isinterpretation
Correction
Use the metric system
Dram
Symbol f dram mistaken as "3"
°'
Minim
For three days
Greater than and less than
Symbol f(l( minim mistaken as "ml'.'
Mistaken as k3 doses"
x3d
Use "for three days"
> and <
Mistaken as opposite of intended; mistakenly use incorrect
Use "greater than" or ~less than"
symbol; "< 10" mistaken as "40.,
I (slash mark)
Separates two doses or
Mistaken as the number 1 (e.g., "25 unlts/10 units'' misread as
Use "per" rather than a slash marl< to
__.., "25 units and 110" units)
_._;._
__.~-o
indEates uper''
separate doses
@
Al
Mistaken as k2"
Use ''at"
~
- - - - - - - -- + - - - - - - - - - - - + - - - - - - - - - - - - - - - - - ~ - - - - - - - - - - - - - - <
&
And
Mlstaken as •·2"
Use "and"
~
.g,
Plus or and
Mistaken as H4•
Use "and"
<(
+
> - - - -0 - - - - -- + - - - - - - - - - - - + - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - < " "
Hour
Mistaken as a zero (e.g., q2° seen as q 20)
Use "hr," "h,'' or "hour"
;;;
___________ ____ ______ _________
...;._
;_
_________
------------------t-------------------------------1
1-------------------t------------------------------N
·
MiSta
'
I 4 6 8 dg
Use Oor zero,
~
zero, II
i.-
as
s , , ,
describe
_ _ _ _ _ _ _ __ _ _
________
_ _ _ _ an
___________
__
_ whole
_ _~vords
_ _ ____,@
nu _
S1gn
11t:n_ _
numera
or_ _ _intent
using
Cl)
"These a~reviaoons are ilduded on The Joint Commission's "mirlmum llst" of ~erous ablnviatioos, acronyms, and symbols that must be included on
an o,uani2ation's "Do Not~- Ost, effecwe JanlDJY 1, 2004. YJSlt mJo)ntcmnmlsslon.0111 for more lnformatloo about this Jmnt Commission requirement
© ISMP 2013. Permi.5sioo is 1J3111ed to reproduce material with proper attlibullon for iltemal use within heallll:are org1r1izatlons.
Other reinductlon is prohibited without vniltlill pennission from ISMP. Report ao1ual and pob!ntial meticabon errora lo the ISMP
National Medication Errors Reprilg Program (ISMPMERP) via the Web at \\WW.lsmp.org or by calling 1-8(XH=All-SAF(E).
vlSMP
mn1m•w1-11W1m
www.ismp.org
Copyrig hl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplk ated, in whole or in part. Due to elec.tronic rights. some Lhlrd party content may be .supprcs..,;,00 from Lhe cBook and/or eChaplc1ts).
Edllorial review has deemed Lhal any suppressed content does nol materially affec t Lheoverall leaming experience. Cengage Leaming reserves Lhe right Lo remove additional content al any Lime if subsequent rig hts res trictions require iL.
3 mL syringe, 87
5 mL syringe, 95
10 mL syringe, 95
20 mL syringe, 98
24-hour clock, 81
30 unit syringe, 150
50 unit syringe, 150
100 unit syringe, 150
C
A
Abbreviations
diug administration errors with, 83
household measures, 49
metric/ international (SI) system,
38-39
Action times, insulin, 155-156
Addition
with calculator, 6
of decimals, 6-8
ADD-Vantage System®, 257, 258
Adult dosages, based on
body surface area (BSA), 243-250
bodyweight, 228-236
Alaris System, 261,262,263
Analgesia (PCA) devices, patient-controlled,
263-264
Apothecary measures, 49,351
on labels, 57
B
BD SafetyGlide- syringes, 92
Body surface area (BSA)
assessing orders based on, 246-250
calculated from kilogram and centimeters,
243-245
calculated from pound and inch,
245-246
dosage calculations based on, 246
Body weight dosage calculations
converting kg to lb, 229-230
converting lb to kg, 228-229
from drug label information,
230-232
from drug literature, 232-236
forIVtherapy, 302, 311-316
Burettes
pediatric medications via, 339-343
volume-controlled, 259
Calculator
addition and subtraction of decimals with, 6
addition ,vith, 6
decimal fraction equations with, 26-28
dividing fractions with, 18, 21
division of decimal fractions with, 13, 18
multiple-number equations, 29-31
multiplying decimals with, 20, 21
solution of equations, 22, 23-25
using, 17
Calibrated burette chamber, 259
Calibrated medication cup, 66, 67
Calibrations, syringe, 87-99
Capsules, 54
dosage calculation, 59-64
labels, 55-59
Centi, 38
abbreviation, 38
Centimeters, calculating body surface area from,
243-245
Central line, 256
Clinical ratios, 194
Colons, ratios expressed as, 164-167
Common fraction equations, 22
Completion time, calculating IV infusion, 291
Controlled-release capsules, 54, 55
Conversion of metric/SI units, 40-42, 43, 80
Conversion ratio, 200-202
Covidien- syringe, 92
Creams and suppositories, 81
D
Decimal fraction equations, 26-29
Decimal points
elimination of, 13-14
movement in metric system conversions,
41-42,80
placement of, 11-12
Decimals
addition of, 6-8
division of, 13
multiplication of, 11-13, 20
relative value of, 2-6
subtraction of, 6-8
Denominator, 195-196
Diluent, 130
Dilution of IV medications, 339
355
CopyrigbL20 15 Cengage Leaming. AU RighL'i Reserved May noLbe copied.scanned, or duplicated, in whole or in part. Due to elec.tronic rights• .some Lhiltl party conlenl may be suppressed from Lhe
Edilori.al review bas deemed thal any suppres.i;;ed contcnl does nol materially affee-LLheoverall learning expe.rie.nce. Ce.ngage Leaming re.lierves Lhe righLLo remove additional content al any time if subscqu
3 mL syringe, 87
5 mL syringe, 95
10 mL syringe, 95
20 mL syringe, 98
24-hour clock, 81
30 unit syringe, 150
50 unit syringe, 150
100 unit syringe, 150
C
A
Abbreviations
diug administration errors with, 83
household measures, 49
metric/ international (SI) system,
38-39
Action times, insulin, 155-156
Addition
with calculator, 6
of decimals, 6-8
ADD-Vantage System®, 257, 258
Adult dosages, based on
body surface area (BSA), 243-250
bodyweight, 228-236
Alaris System, 261,262,263
Analgesia (PCA) devices, patient-controlled,
263-264
Apothecary measures, 49,351
on labels, 57
B
BD SafetyGlide- syringes, 92
Body surface area (BSA)
assessing orders based on, 246-250
calculated from kilogram and centimeters,
243-245
calculated from pound and inch,
245-246
dosage calculations based on, 246
Body weight dosage calculations
converting kg to lb, 229-230
converting lb to kg, 228-229
from drug label information,
230-232
from drug literature, 232-236
forIVtherapy, 302, 311-316
Burettes
pediatric medications via, 339-343
volume-controlled, 259
Calculator
addition and subtraction of decimals with, 6
addition ,vith, 6
decimal fraction equations with, 26-28
dividing fractions with, 18, 21
division of decimal fractions with, 13, 18
multiple-number equations, 29-31
multiplying decimals with, 20, 21
solution of equations, 22, 23-25
using, 17
Calibrated burette chamber, 259
Calibrated medication cup, 66, 67
Calibrations, syringe, 87-99
Capsules, 54
dosage calculation, 59-64
labels, 55-59
Centi, 38
abbreviation, 38
Centimeters, calculating body surface area from,
243-245
Central line, 256
Clinical ratios, 194
Colons, ratios expressed as, 164-167
Common fraction equations, 22
Completion time, calculating IV infusion, 291
Controlled-release capsules, 54, 55
Conversion of metric/SI units, 40-42, 43, 80
Conversion ratio, 200-202
Covidien- syringe, 92
Creams and suppositories, 81
D
Decimal fraction equations, 26-29
Decimal points
elimination of, 13-14
movement in metric system conversions,
41-42,80
placement of, 11-12
Decimals
addition of, 6-8
division of, 13
multiplication of, 11-13, 20
relative value of, 2-6
subtraction of, 6-8
Denominator, 195-196
Diluent, 130
Dilution of IV medications, 339
355
CopyrigbL20 15 Cengage Leaming. AU RighL'i Reserved May noLbe copied.scanned, or duplicated, in whole or in part. Due to elec.tronic rights• .some Lhiltl party conlenl may be suppressed from Lhe
Edilori.al review bas deemed thal any suppres.i;;ed contcnl does nol materially affee-LLheoverall learning expe.rie.nce. Ce.ngage Leaming re.lierves Lhe righLLo remove additional content al any time if subscqu
357
INDEX
calculating infusion/ completion times
completion times, 291
international/ military time
calculations, 291-292
labeling solution bags, 294-297
from mL/ hr ordered, 289-291
standard time calculations,
292-294
correcting off-schedule rates,
283-286
drip chamber, 254-255
flow rate calculations. See Flow rate IV
calculations
fluids, 264-265
percentagesin,265
heparin, 322-329
indwelling infusion po1ts/
intermittent locks, 259-260
infusion ports, 259
injection ports, 256
medication/ titration calculations,
302-318
parenteral nutrition, 266
patient-controlled analgesia (PCA)
devices, 263- 264
pediatric 1nedications, 338-346
piggybacks (IVPB), 256-257
primary line, 254-256
roller clamp, 255
secondary line, 256-258
slide clamp, 255
solution bags, labeling, 294-297
syringe pumps, 262-263
,,olumetric pumps, 261-262
ISMP (Institute for Safe Medication
Practice), 77, 84
List of Error-Prone Abbreviations, 352
IVPB (IV piggybacks), 256-258
IV piggybacks, 256
J
Joint Commission, 7, 83
K
Kilo-, 37
Kilograms, 37
calculating body surface area from,
243-245
converting pound to, 228- 229
converting to pound, 229- 230
L
Labels
bodyweight dosage calculations
from, 230-232
calculating dosages from drug,
230-232
capsule, 55-59
heparin IV; 322-324
oral solution, 64-66
parenteral medications, 102-128
reconstitution directions on,
129-130
tablet, 55-59
Length, in metric system, 36-37
Liquids applied to the skin, 80
Liter, 36-37
abbreviation, 38
Long-acting insulins, 156
M
Magellan Safety Needle, 92
MARs (medication administration
records), 59, 64, 77-79
Measurement, of oral solutions, 66-68
Medication administration, 77-85
common errors in, 83-85
medication administration records
(MARs), 77-79
partnering with patient, 82
right dosage, 80
right drug, 80
right person, 82
right recording, 82
right route, 80-81
right time, 81
Medication Administration Record
(MAR), 59, 64, 77
Medication droppers, 49
Medication ,rial port, 257
Meter, 36-37
abbreviation, 38
Metric conversions, equations requiring,
200-203
Metric dosages, errors in writing,
83-84
Metric/ international (SI) system,
36-45
abbreviations, 38- 39
basic units o( 36-37
common errors in dosages, 43,
83-84
conversion within, 40-42, 43, 61
equivalents with apothecary and
household, 351
formula method conversions with,
221-222
household measures, 49
notation rules, 39-40
overview, 36
prefixes, 37-38
Metric/SI solution labels, 102-105
Micro-, 38
Microdrip infusion, 302-303
Military/ international time, 81
calculating IV infusion times, 291-292
Milli-, 38
Milliequivalent (mEq) measures,
47-48
formula method calculations with,
222-223
solutions measured in, 108-110
rnL/hr flow rate, calculating units/ hr
infusing from, 327 -328
rnL/ hr ordered, calculating infusion time
from, 289-291
rnL/hr rate for dosage ordered,
303- 305
per kg, 305-307
Multiple-number equations, 29-31
Multiple-strength solutions,
reconstitution of, 136-138
Multiplication, of decimals, 11-13, 20
N
N (NPI-I) insulin, 144
National Formulary (NF), 56-57
Nearest hundredth, expressing to,
18-19, 21
Nearest tenth, expressing to, 17- 18
Notation rules, meh·ic/ international (SI)
system, 39-40
Numbers
ending in zero, 16-17
multiple-number equations,
29-31
whole-number equations, 23-26
Numerator, 195-196
Nutrition, parenteral, 266, 267
0
Official "Do Not Use" List, 83, 84
Ointments, 80
One-step dosage calculations, formula
method for, 219-223
One-step mL/ hr flow rate calculation,
313- 316
Ophthalmic oinhnents, 80
Oral medications, 80
dosage calculations, 59- 64
labels and dosage calculation,
54-59
pediah·ic, 332-334
solution labels, 64-66
solution measurement, 66-68
Oral solutions
labels, 64- 66
measurement of, 66-68
Oral syringes, 67, 332, 333
Ounce, 49
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rig hts. some Lhlrd party conlenl may be .supprcssOO from Lhe cBook and/or eChaplet1s).
Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenLal any time if subsequenLrights restrictions require iL
358
INDEX
p
Parenteral medications, 81, 102-128
dosage calculations, 102-110
measured as milliequivalents (mEq),
108-110
measured in International Units,
107-108
percent and ratio solution labels
for, 105- 107
reading met1ic/SI solution labels,
102-105
Parenteral nutrition, 266
Partial parenteral nutrition (PPN), 266
Patient, partnering with, 82
Patient-controlled analgesia (PCA)
devices, 263-264
Pediatric dosages, based on
body surface area (BSA), 243-250
bodyweight, 228-236
Pediatric medications
intramuscular, 334
intravenous
administration methods,
338-339
administration via burette,
339-343
comparing dosages ordered
with average dosages,
343-346
oral, 332-334
subcutaneous, 334
Peninsulins, 145-149
Percentage (%) measures, 47
Percentages, in IV fluids, 265
Percentage(%) solution labels, 105-107
Percocet label, 56
Peripheral line, 256
Physiciarzs' Desk Refererzce {PDR), 228
Potassium chloride (KCI), 265
Pound
calculating body surface area from,
245-246
converting kg to, 229-230
converting to kg, 228-229
Powdered drugs, reconstitution of
129-143
multiple-strength solutions, 136-138
from package insert directions,
134-136
single-strength solution, 129-134
Prefixes, metric/international (SI)
system, 37 -38
Primary IV line, 254-256
Product, 11-12
Proportion
calculating heparin dosages using,
324-325,327-328
calculating infusion titration with
ratio and, 303-305
dosage calculation using, 167-171,
173-178
expressed as colons, 171-173
expressed using fractions, 165-167
heparin calculations using, 324-325,
327-328
pediatric IV medication
calculations using,
340-342, 344-345
used to calculate gtt/min flow rates,
271-273
used to calculate mL/hr rate
for dosage ordered,
303-305
Pumps, syringe IY, 262-263
R
R (Regular) insulin, 144
Ratio
calculating gtt/min flow rates and,
271-273
calculating heparin dosages and,
324-325,327-328
calculating infusion titration with
proportion and, 303-305
calculating mL/hr rate for dosage
ordered and, 303-305
clinical, 194
dosage calculations and, 167-171,
173-178
expressed using colons, 171-173
expressed using common fractions,
165-167
expressing/writing, 164-165
pediatric IV medication calculations
and,340-342,344-345
solution labels, 105-107
Ratio measures, 48-49
Ratio strengths, parenteral medications
expressedin,106-107
Recombinant DNA, 144
Reconstitution of powdered drugs.
See Powdered drugs,
reconstitution of
Records, medication administration,
77-79
Reduction
of fractions, 14-16
of numbers ending in zero, 16-17
Relative value of decimals, 2-6
Ringer's lactate, 265
Roller clamp, 255
s
Safety syringes, 92- 93
Saline locks/ports, 259
Scored tablets, 54, 55
Secondary IV line, 256-258
Short-acting, regular insulins, 155
Sigma Spectrum Electronic Infusion
device, 261, 262
Single-strength solution, reconstitution
of, 129-134
Six rights of medication administration,
77,79-82
Slide clamp, 255
Solution bags, labeling, 294-297
Solution labels
metric/SI, 102-105
oral, 64-66
percent and ratio, 105-107
Solutions
measured in International Units,
107-108
measured in milliequivalents (mEq),
108-110
measurement of oral, 66-68
Standard time calculations, 81, 292-294
Subcutaneous parenteral route,
81,102
Subcutaneous pediatric
medications, 334
Sublingual medications, 80
Subtraction, of decimals, 6-8
Suppositories, 81
Suspensions, 333
Sustained capsules, 54
Syringe IV pumps, 262-263
Syringes, 87-99
insulin, 150-154
oral, 67, 332, 333
safety, 91-92
tuberculin (TB), 92-95
T
Tablespoon, 49
Tablets
dosage calculation, 59-64
labels, 55-59
Teaspoon, 49
Tenth, expressing to the nearest,
17-18
Time calculations, 291-292
Time conversion cha1t, 81
Time sensitive drugs, 81
Timed-release tablets, 334
Titration, of infusions, 307-310
using dimensional analysis to
calculate, 316-318
IV medication and titration
calculations, 302-318
Topical drugs, 80
Total parenteral nutrition (TPN), 266
Trade name (drug), 55, 56
Trailing zero, 83
Copyrighl 20 15 Cengage Leaming. All RighL'i Reserved. May noLbe copied, scanned, or duplkated, in whole or in part. Due Lo elec.tronic rights. some Lhlrd party conlenl may be .supprcssOO from Lhe cBook and/or eChaplet1s).
Edllorial review has deemed LhaLany suppressed conlenl does noLmaterially affecl Lheoverall leaming experience. Cengage Leaming reserves Lhe righl Lo remove addiLlonal contenLal any time if subsequenLrights restrictions require iL
359
INDEX
Transdermal p atches, 80
Tuberculin (TB) syringe, 92-95
Tubing calibration, 269-271
u
Unit dosage label, 55
Units, formula method calculations
with, 222-223
Units conversion, 194. See also
Dimensional analysis
Units/ hr infusing, calculating from
ml./ hr flow rate, 327-328
U.S.P. (United States Pharmacopeia),
56-57
V
Vanish.Point®syringe, 92
Volume, in metric system, 36-37, 40
Volume-controlled burettes, 259
Volumeh·ic IV pumps, 261-262
w
Weight, in metric system, 36-37, 40
Whole number equations, 22-25
z
Zero
metric/ SI dosages and, 43, 83
reduction of numbers ending
in, 16-17
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Edilorial review has deemed LhaLany .suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLional conle nl al any time if subsequenLrighls restric:Lions require iL
CopyrighL20 15 Cengage Leaming. All Rig hL'i Reserved May noLbe copied, scanned, or duplica ted. Cn whole or Cn part. Due Lo electronic rights, .some Lhird party conlenl may be .supprcs..,;;ed fro m Lhe cBook and/or eCl1aplc11s}.
Edilorial review has deemed LhaLany .suppressed conlenl does noLmaterially affecl Lheoverall leaming e xpe rience. Cengage Leaming reserves Lhe righLLo remove addiLional conle nl al any time if subsequenLrighls restric:Lions require iL