Calculate with Confidence-Chapter 17-25

-Check IV on adults -Check IV on child -Check IV for very concentrated

-Adults every 2 hours -Child every hour -Very concentrated every hour

Insulin Pumps

-Deliver rapid or short-acting insulin continuously for 24 hours a day through a catheter placed under the skin -Basal: delivered continuously -Bolus: delivered before meals meal

-Rapid-acting insulin: -Can be mixed

-Humulin R -Humulog -Novolog -Apidra

Long-acting insulin

-Lantus -Levemir

Cloudy insulin

-NPH-Can mix, combined mixture will be cloudy -Draw up clear mixable insulin first

Coumadin lab test

-PT/INR (normal rate 2-3) -Antidote is Vit. K

Heparin lab test

-PTT -Antidote is protamine sulfate -Normal range depends upon patient

Subcutaneous dosages are not to exceed:

0.5 mL

2.2 lbs = ________ kg

1 kg

Sequence for mixing insulins:

1. Gently roll vials in palm to even suspension 2. Cleanse tops of both vials with alcohol 3. Inject air equal to dose of cloudy insulin into that vial first (do not touch solution with needle) 4. Remove needle from cloudy vial 5. Using same syringe, inject air equal to needed dose into clear type mixable insulin; invert bottle and withdraw DO NOT SHAKE!!

7 Components for Medication Order: (Per Mrs. Vicky)

1. Name of Client 2. Medication 3. Dosage 4. Route 5. Frequency 6. Special Instruction 7. MD signature

Medication Order must be in this order:

1. Name of Medication 2. Dosage 3. Route 4. Frequency

7 RIGHTS

1. RIGHT CLIENT 2. RIGHT MED 3. RIGHT DOSE 4. RIGHT ROUTE 5. RIGHT TIME 6. RIGHT DOCUMENTATION 7. RIGHT PROGRAMMING (PUMP)

Convert Celsius to Fahrenheit

1.8 X (C) + 32

1 foot=

12 inches

1 lb=

16 oz.

1 inch=

2.5 centimeters

Calculating Heparin Examples:

20,000 units -------------- X 30 mL =. 600 units 1,000 L OR 20,000 units -------------- X 1,000 L = 600 units 30 ml

When calculating IV infusion if more than ____________ you should question it

200 mL

25,000 units Heparin 500 ml to infuse @ 17 mL/hr

25,000 units -------------- X 17 mL/hr =. 850 mL/hr 500 mL

Microdrop

60 gtt

Calculating BSA for Child Dosing Using Formula

BSA of child (m2) ------------------- X Adult dosage = 1.7 = Estimated child's dose

Formula for Calculating BSA from Pounds and Inches (Ex. calculate BSA for a adult who weighs 170 lb and is 67 inch tall

BSA= 170 (lb) X 67 (inch) / 3,131 = ___________ the hit the square root button to get final answer = 1.907 then round to nearest hundredth

Formula for Calculating BSA from Kilograms and Centimeters (Ex. calculate BSA for a child who weighs 23 kg and is 128 cm tall)

BSA= 23 (kg) X 128 (cm) / 3,600 = ___________ then hit square root button to get final answer = 0.903 then round to nearest hundredth

Insulin doses are always checked how:

BY 2 NURSES!!!

BSA

Body surface area

Sample Sliding Scale

CBG of 0-180 per dL.....No coverage CBG of 181-240 mg per dL....2 units subcut CBG of 241-300 mg per dL...4 units subcut CBG of 301-400 mg per dL...6 units subcut CBG greater than 400 per dL....8 units submit and call health care provider...Repeat CBG in 2 hr. (All above based on result of finger stick q8h)

ALWAYS DRAW UP INSULIN:

CLEAR TO CLOUDY!!

D5W

Destrose 5% in water

D5RL

Dextrose 5% and lactated Ringer (Ringer lactate)

D5 and 1/2 NS (0.45%)

Dextrose 5% in 0.45% sodium chloride

D5NS

Dextrose 5% in sodium chloride

Example of calculating BSA for Child Dose using adult dosage

Example: The prescriber has ordered a medication for which the average adult dosage is 125 mg. What is the dose a child of 1.4 (m2)? Take 1.4 (m2) / 1.7. X 125 mg (adult dosage) = 102.94 = 102.9. (always round to the tenth)

Convert Fahrenheit to Celsius

F-32 ------ 1.8

IV fluids s/b charted on:

I&O

NEVER give Heparin in what route?

IM

YOU MUST ALWAYS USE A _______________SYRINGE WHEN GIVING INSULIN

INSULIN

mL X gtt ----------- minutes

IV infusion calculation

intermediate=

Long acting

0.9 NS

Normal Saline

SAFETY ALERT

Nurse is responsible for administering IVF to the correct client at the right rate and monitoring response. Too rapid an infusion or inappropriate infusions can result in reactions that range from mild to fatal!!

KCI

Potassium chloride additive-in mEq per L

Types of Insulin

Rapid-acting-all clear solutions 1. Humalog (lispro) 5 min. before meal -Subcut 2. Novolog (aspart) Subcut or IV 3. Apidra (glulisine) Subcut orIV Short-acting -Regular (R) takes 30 min. to work-Subcut or IV, clear Intermediate: - NPH (N) cloudy Long-acting: - LANTUS, clear, subcut only (CANNOT BE MIXED) -LEVIMIRE, clear, not as long-lasting as Lantus, may need 2 daily doses, (CANNOT BE MIXED)

RL or LR

Ringer lactate or lactated Ringer solution (electrolytes)

1/2 NS

Sodium chloride 0.45%

Insulin is given how?

Subcutaneously

Which syringe should you use to give Heparin?

TB syringe

Converting 32 lb 9 ounces to kg:

Take 9 oz./16 = 0.5625 + 32lb= 14.8 kg (always round to nearest tenth)

VOLUME=

What's in the bottle

mL ----- hours

ml/hours (V infusion)

You should never __________Heparin

push

Pediatric dosages are rarely rounded to ____________; use TB so hundredths can be given:

tenths

Dosages less than 1 mL

use TB syringe