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GUIDE
NURISNG 304
SPRING 2007
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Special Note: Many of you have learned D X Q to work dosage problems. It would
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be wise to also learn ratio-proportion especially when it comes to working equivalents
(conversions) and even better if you learn dimensional analysis (DA). Just keep in mind
you may have to work dosage problems in steps.
Oral Dosages
Examples
Ordered: Digoxin 0.25 mg PO each day
Available: Digoxin 0.125 mg per tablet
How many tablets will the nurse administer?
0.125 X = 0.25 mg
0.125 0.125
X = 2 tabs
Formula D X Q
A
0.25 mg X 1 = 2 tabs
0.125 mg
40 mEq : 30 ml : : 60 mEq : X ml
40 X = 1800
40 40
2
X = 45 ml
DA
Two different measures used to calculate meds dosages Apothecary & Metric system.
Currently majority of hospitals & MDs use metric, but still some physicians use
apothecary (grains, kg). As nurses you must be able to use both systems. KNOW
EQUIVALENTS, CONVERSIONS
By definition
Equivalent – a given quantity which is considered to be of equal value to a quantity that
is expressed in a different system
Be able to convert from one system to another (refer to conversion table, and learn
conversions)
Examples
Ordered: Phenobarbital grain (gr) ¾ PO BID
Available: Phenobarbital elixir 20 mg per 5 ml
How many ml will the nurse administer?
Step 1 60 mg : 1 gr : : X : ¾ gr
1 X = 60 X ¾
X = 60/1 X ¾
X = 15/1 X 3/1
3
X = 45 mg
Step 2 20 mg : 5 ml : : 45 mg: X
20 X = 225
20 20
X = 11.25 ml
Formula D X Q 45 mg X 5 = 2.25mg X 5 = 11.25ml
A 20 mg
DA
Meds
ProcessPub
for calculating dosages
Step 1: What do you have?
Step 4a: If yes, FIRST find equivalent measurement by converting “need’ to “have” then
set up an equation with what you know about basic equivalents.
Step 4b: If no, set up an equation with what you know about basic equivalents
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300 mg per tablet
Step 2 What do you need?
0.6 gm
1X = 600
X = 600 mg
Step 4b then set up equation with what you know about basic equivalents
300 x = 600
300 300
X = 2 tabs
D xQ 600 x 1 + 2 tabs
A 300
DA
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The physician orders 500 mg erythromycin base (E-mycin) PO TID. Available is
erythromycin suspension 200 mg per 5 ml. How many teaspoons should the client be
instructed to take for each dose?
Ration & Proportion
Step 1 200 mg : 5 ml : : 500 mg : x ml
200 x = 2500
200 200
X = 12.5 ml
5 x = 12.5
5 5
X = 2.5 tsp
DA
Equivalent - 30 ml =1 ounce
30 ml x 12 = 360 ml ÷ 30 = 12
There are 12 doses in a 12 oz bottle
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30 ml : 1 oz : : 30 ml : x
30 x = 30
30 30
x = 1 oz
Parenteral Dosages
Examples
Ordered: Atropine gr 1/200
Available: Atropine 0.4 mg per ml (0.4 mg/ml)
How many ml will the nurse administer?
Ratio & Proportion
Step 1 Conversion gr ≠ mg
0.3 mg x 1 = 0.75 ml
0.4 mg
DA
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Ordered: Demerol 30 mg IM every 4 hours PRN pain
Available: Demerol 25 mg per 0.5 ml
How many ml will you administer?
D x Q
A
DA
The physician orders 250 mg cefazolin (Kefzol) IVPB Q 8 hours. Available is Kefzol 0.5
g per 10 ml. How many ml will the nurse administer?
D x Q 0.25 g x 10 = 0.5 x 10 = 5 ml
A 0.5 g
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DA
Usually the pharmacist reconstitutes and mixes drugs. Because some drugs are not stable
in liquid form, on occasions you will have to reconstitute at the time of administration.
Use only the solvent designed on the label or manufacturer insert to ensure compatibility.
Meds Pub
Follow these steps
Step 1 What do you have?
100 mg per 2 ml
Solve for x ml
100 mg : 2 ml : : 25 mg : x 100 mg = 25 mg
100 x = 50 2 ml x
100 100
X = 0.5 ml Q 6 hrs 50 = 100 x
100 100
0.5 ml = x
D xQ 25 mg x 2 ml = 0.25 x 2 = 0.5 ml
A 100 mg
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DA
The physician orders 500 mg ticarcillin sodium (TICAR) IM Q 8 hours. The package
insert states: “Add 8.7 ml (D5W) to yield a concentration of 1 g per 3 ml ( lg/3 ml).
How many ml will you administer?
Solve for x ml
1 g : 3 ml : : 0.5 g : x ml 1 g = 0.5 g
1 x = 1.5 3 ml x ml
x = 1.5 ml Q 8 hrs 1 x = 1.5
1 1
X = 1.5 ml Q 8 hrs
DA
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Dosages ordered as mg/kg/day or mg/kg
Insulin Administration
Standard unit of measure for insulin is the unit. Most insulin is dispensed in “U-100”.
This means that there are 100 units of insulin in 1 ml of liquid. Most insulin is
dispensed in bottles containing 10 ml of liquid. You must draw up insulin in a U-100
insulin syringe.
Example
The physician orders 25 units isophane insulin suspension NPH (Humulin N) and 23
units regular insulin (Humulin R) S Q in AM. You have 100 units per ml available.
How many total units will the nurse administer?
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The physician orders 20 units of isophane insulin (Novolin N) 100 units/ml AC Dinner
SC @ 1630 and the following sliding scale insulin (Novolin R) 100 units/ml AC and HS
SC. At 1630 your client’s blood sugar is 249. How many total units of insulin will the
nurse administer?
Sliding Scale
BS=140-169 give 3 units, BS=170-199 give 4 units, BS=200-249 give 6 units, Bs=250-
299 give 8 units, BS greater than 300 give 10 units.
Flow rate is the amount of medication to be infused over a certain time period. Flow rate
is ordered by the physician; however the nurse must set and maintain the rate.
Electronic pump
Manual IVs
Formulas
You may use the formulas taught in pharmacology or use the following:
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A provider orders 1 gram of Vancomycin in 250 ml of D5W to infuse over 90 minutes for
a patient with Urinary Tract Infection. The nurse is running the IV piggyback on the
infusion pump. What infusion rate should be set on the pump?
Pharmacology formula (You must remember when using this formula the time may
not always be 60 mins. It may be 30 min, 20 min, or 15 min.
Gtts/min = df x cc/hr
60 (time in mins)
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Meds Pub (Simple formula)
Drop factor has a standard “drop factor constant” that you can use to calculate flow
rates of manual IVs
This is obtained by dividing 60 by the drop factor
Drop factors DF Constant
60 = 6 Simple formula
10 gtts/ml Total ml/hr = flow rate (gtt/min)
Drop factor constant
60 = 4
15 gtt/ml
60 =3
20 gtt/ml
60 =1
60 gtt/ml
Examples
Ordered: 250 ml Lactated Ringers (LR) to infuse @ 50 ml/hr
Drop Factor 20 gtts/ ml
Drop factor constant is 3 (60÷20)
What is the flow rate in gtt/min?
Formulas
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100 ml x 10 = 3.33 x 10 = 33.3 or 33 gtt/min
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Medications by units/Hour
Heparin drips
Insulin drips
There are special meds that are very potent and need to be monitored closely. It is
crucial to maintain accuracy in the calculation of these drug dosages and IV flow rates. It
can mean the difference of life or death for your patient. All of these medications must
be administered by IV electronic pump ( ml/hr) for safe administration.
You have a patient who has deep vein thrombosis and has orders for heparin at 1000
units/hr. The concentration of heparin sent from pharmacy is heparin 25,000 units in 500
ml 0.9% NS. How many ml/hr should the IV pump be programmed for? ____20
ml/hr____
25000 x = 500,000
X = 500,000
25000
X = 20 ml/hr
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D x Q method
A
Formula set-up 1000 units x 500 ml (cancel out)
25,000 units
1000 units x 1
50 units
1000 = 20 ml/hr
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DA
You have an order for your patient with diabetes to receive regular insulin! V at 12
units/hr. the concentration is insulin 100 units in 250 ml of 0.9% NS. How many ml/hr
should the IV pump be programmed for __30 ml/hr_____
100 x = 3000
x = 3000
100
X = 30 ml/hr
D x Q Method
A
12 units x 250 ml
100 units
12 x 2.5 = 30 ml/hr
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DA
Using the formulas above you will also be able to determine units per hour the client
is receiving.
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Chart
IV PUMPS: There are some IV Pumps manufactured that allow the nurse to set state in tenths. Therefore, when computing dosage
problem related to rate by pump, the student may state whole number or round appropriately to tenths.
CONVERSION TO WEIGHT FROM LBS. TO KG.: When converting lbs to kg, the student should carry to third place (thousand)
and round to hundredth. The student should round the final answer to tenths after computing the entire dosage problem
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Practice Problems:
4. Ordered: Benadryl 30 mg PO TID PRN for c/o rash & itching to abdomen
Available: Benadryl 14 ounce (oz) bottle containing 12.5 mg/5 ml.
How many ml will the nurse administer?
5. Ordered Nitroglycerin 1/150 gr SL prn for chest pain. Take no more than 2 tablets
in 15 min. The patient took 2 tablets.
How many mg did he receive?
7. Ordered Novolin N (NPH) insulin U-100 32 units and Novolin R insulin U-100 4
units ac breakfast daily.
Give _______________units total
8. Order: Infuse 1 pack (350 ml) of packed red blood cells over 3 hours
Drop factor is 10gtt/ml
Flow rate: _____________ ml/hr.
10. Ordered 200 units regular insulin in 250 ml NS to infuse at 7 units per hour Iv
How many ml per hour is the patient receiving?
11. Ordered ciprofloxacin (Cipro) 400 mg /D5W 200 ml IVPB BID. To be infused
over 60 minutes.
Drop factor is 15 gtt/ml
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_____________ml/hr
_____________ gtt/min
12. The physician orders 1000 ml D5W to infuse at 125 ml per hr. The IV
administration tubing shows a drop factor of 15 gtt per ml. How many gtt per
minute will the nurse administer?
______________ gtt/min
13. The physician orders 0.5 mg per kg aminophylline (Phyllocontin) q6h. The client
weighs 98 lbs. How many mg will the nurse administer per day?
14. The physician orders 1.5 million units streptokinase (Streptase) IV. Available is
Streptase 600,000 units powder for reconstitution. Directions state to add 4.7 ml
Ns for a concentration of 600,000 units in 5 ml solution. How many ml will the
nurse administer?
Key
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