NURS 300 Final basics

what is Patient-Controlled Analgesia (PCA)

PCA is a system in which patients self-administer IV narcotics. The IV narcotics are administered at intervals via an infusion pump.

What are some examples of different kinds of injections?

Subcutaneous, intradermal, and intramuscular injections

Packaging of parenteral medications

ampules, vials, mix-o-vials, syringes

What are the requirements for a physician's written order?

physician's signature, date, name and dosage of the drug, route and frequency of administration, any special instructions. For drugs ordered as needed, the purpose is also listed

what are parenteral dosages?

regions outside of the gastrointestinal tract

ampule

single dose container that must be broken at the neck to withdraw the drug.

How are parenteral medications administered?

subcutaneous injection (beneath the skin), intramuscular injection (within the muscle), intradermal injection (within the skin), intravenously (within the vein).

Oral dosages come in:

tablets, capsules, liquids

Forms of how drugs are provided?

tablets, capsules, liquids, suppositories, ointments

If the pharmacy prepares the wrong medication, who is responsible?

the nurse who administers the drug

How many times should the information on the medication profile sheet or drug card be checked?

three

three parts of a syringe

tip, barrel, plunger

What are some types of central venous catheters?

triple lumen catheters, Hickman lines, Broviac catheters, and Groshong catheters.

Mix-O-Vial

used to package unstable drugs and allows the components to be combined just before administration. Pressure is applied to the top of the vial to release the stopper between the compartments and allow the drug to be mixed.

why are some medications given parenterally?

when the medications cannot be taken by mouth or when rapid action is necessary.

Calculating Micrograms/Kilograms/Minute from Milliliters/Hour: Dimensional Analysis Method basic steps

ØConvert total milligrams in IV bag to micrograms. ØCalculate concentration (mcg/mL). ØCalculate micrograms per kilogram per minute.

Calculating Micrograms/Minute from Milliliters/Hour: Dimensional Analysis Method basic steps

ØConvert total milligrams in IV bag to micrograms. ØCalculate concentration (mcg/mL). ØCalculate micrograms per minute.

Calculating Weight-Based Heparin: Formula Method A patient weighing 143 lb is to receive a bolus dose of 70 units/kg, rounded to the nearest 100 units. The infusion should begin at 17 units/kg. How many units will be needed for the heparin bolus, and what will be the rate, in milliliters/hour, at which to program the IV pump?

•(1105 units/100 units) × 1 mL = x mL •1105/100 = 11.05, or 11.1 mL/h

Calculating Pediatric IV Solutions

Pediatric patients require smaller volumes of fluids. Avoid concentrations higher than recommended. Use dimensional analysis or the formula method.

Which name will physicians use when ordering a patient's medication?

Physicians can order medication using either the generic name or a trade name. Nurses should be familiar with both trade names and generic names and cross-check references as needed.

1 millimeter= ___ cm/ ___ m

0.1/ 0.001

What is a unit?

A unit is a quantity adopted as a standard of measurement (inches, feet, pounds, and so on)

vial

glass or plastic container that is sealed with a rubber stopper. Vials generally contain more than one dose of medication.

What are unit dosages?

Unit dosages are prepared in individual doses by the manufacturer or hospital pharmacy. They are available in a form that is ready for the nurse to administer.

What is the trade name?

It is the name given to a particular medication by the drug manufacturer. Different manufacturers market the same medication under different trade names. Tylenol, Anacin-3, Datril, and Panadol are all trade names for acetaminophen.

What is the generic name?

It is the official, nonproprietary name of the drug. There is only one generic name for each drug. For example, acetaminophen is the generic name for the following trade names: Tylenol, Anacin-3, Datril, and Panadol

Before preparing the drug, the nurse must know:

Maximum drug dosage, Minimum drug dosage, Drug actions, Drug interactions, Drug contraindications, Patient allergies

total amount of medication is ____

how much medication is in the container

hypodermic syringes

identified by the amount of fluid they can measure

STAT

immediately

in what situation is a tuberculin syringe used?

in pediatrics and to measure medications administered in very small amounts.

Will drug labels always contain specific information regarding the route of administration?

no

Who generally initiates verbal orders?

nurse

Routes of medication administration

oral, per gastronomy tube, topical, injection, intravenous

Celsius to Farenheit formula

(Cx1.8)+32

Farenheit to Celsius Formula

(F-32)/1.8

Calculating the Infusion of IV Fluids and Medications by Gravity: Formula Method (Drops per minute (gtt/min))

(Total volume to be infused )/(Total amount of time in minutes) ×Drop factor =x gtt/min

Administering IV Medications to Pediatric Patients

(Total volume to be infused)/(Total time for infusion in hours) =x mL/h If gravity infusion, multiply by drop factor: (Total volume to be infused)/(Total time for infusion in hours) ×Drop factors =x ggt/min

Calculating Micrograms/Kilograms/Minute from Milliliters/Hour: Formula Method

(concentration (mcg/mL) x Rate (mL/h))

Calculating Micrograms/Minute from Milliliters/Hour: Formula Method

(concentration (mcg/mL) x Rate (mL/h))/ 60 min/h

Calculating Milligrams/Minute from Milliliters/Hour: Formula Method

(concentration (mg/mL) x Rate (mL/h))/ 60 min/h

Calculating Milliliters/Hour from Milligrams/Minute: Formula Method

(desired mg/min x 60 min/h)/ medication concentration (mg/mL)

Calculating Milliliters/Hour from Micrograms/Kilogram/Minute: Formula Method

(ordered mcg/kg/min x patients weight in kg x 60 min/h)/ medication concentration (mcg/mL)

Calculating Milliliters/Hour from Micrograms/Minute: Formula Method

(ordered mcg/min x 60 min/h)/ medication concentration (mcg/mL)

1 mL= ___ cubic centimeters (cc)

1

1 g= ____ micrograms (mcg)

1,000,000

Tuberculin syringe

1-mL syringe that has markings for milliliters and minims.

1 centimeter= ___ mm/ ___ m

10/ 0.01

1 L= ___ ml

1000

1 g= _____ mg

1000

1 kg= ___ g

1000

1 mg= ____ mcg

1000

1 meter= ___ mm/ ___ cm

1000/ 100

1 tablespoon= ___ mL

15

2.2 lbs =___Kg or ___grams

1kg or 1000 grams

1 inch = ___ cm

2.5

1 kg= ___ lbs

2.2

1 oz = ___ mL

30

1 teaspoon= ___ mL

5

1 cup= ____ ounces

8

What is a central venous catheter?

A central venous catheter is an indwelling, semipermanent central line that is inserted into the right atrium of the heart by way of the cephalic, subclavian, or jugular vein.

Other than the same required information for written orders, what are the extra requirements of verbal orders?

A notation must be made to the order to indicate that it is a verbal order (VORB). physician's name, nurse's signature, Verbal order read back The physician should sign the verbal order as soon as possible.

What is a saline lock?

A saline lock is an IV catheter that is inserted into a peripheral vein. It can be used for medications or other fluids on an intermittent basis. The catheter is flushed with saline to maintain patency.

Name the three times when the information on the medication profile sheet or drug card should be checked.

As the medicine is taken from the drawer or shelf, As the medicine is prepared, As the medicine is replaced

Calculating Milliliters/Hour from Micrograms/Kilogram/Minute: Dimensional Analysis Method basic steps

Convert the patient's weight to kilograms. Convert the total number of milligrams in the IV bag to micrograms. Calculate the concentration of the medication. Calculate the rate in milliliters per hour.

Calculating Milliliters/Hour from Micrograms/Minute: Dimensional Analysis Method basic steps

Convert the total number of milligrams in the IV bag to micrograms. Calculate the concentration of the medication. Calculate the rate in milliliters per hour.

Calculating Milligrams/Minute from Milliliters/Hour: Dimensional Analysis Method basic steps

Convert total grams in IV bag to milligrams. Calculate concentration (mg/mL). Calculate milligrams per minute.

Calculating the Individual Dose or Single Dose (Milligrams/Kilogram/24 Hours Divided)

Divide the 24-hour dosage into single doses given throughout the day. Follow formula for determining mg/kg/24 h. Then divide 24 hours by hours per single dose.

Medication Administration Record (MAR)

Drug, dose, patient, route, time

What complications can arise if the IV flow rate is irregular?

Fluid overload, dehydration, or medication overdose could result from irregular IV flow.

central venous catheters are Required for patients who need:

Frequent venipuncture, Long-term IV infusions, Hyperalimentation, Chemotherapy, Intermittent blood transfusions, Antibiotics

Three types of syringes

Hypodermic, tuberculin, insulin

dimensional analysis

Place what you are solving for, x, on the left side of the equation. Place available information on the right side of the equation that matches the measurement in the numerator on the left side. Place other available information on the right side of the equation so that abbreviations "cancel." Add any required equivalents to the right side of the equation so that the measurement abbreviation in the denominator matches the one on the left. Cancel out the abbreviations on the right side of the equation and solve for x.

Ten Rights of Medication Administration

Right Drug/Medication, Right Dose, Right Time & Frequency, Right Route, Right Patient, Right Education for the Patient, Right Documentation, Right to Refuse, Right History & Assessment, Right Evaluation to include Drug to Drug Interactions

Calculating the Single or Individual Dose (Milligrams/Dose)

Systematic approach to determining single dose: ØChange the child's weight to kilograms. ØFind the recommended dosage in a reliable source. ØMultiply kilogram weight by recommended dose. ØThe answer is the single dose.

Determine Whether the Prescribed Dose Is Safe and Therapeutic (Milligrams/Kilogram/Dose)

Systematic approach: ØChange the child's weight to kilograms. ØFind the recommended dosage in a reliable source. ØMultiply kilogram weight by recommended dose. ØThe answer is milligrams per kilogram per dose. ØCheck a drug book to confirm the dose is S&T.

What is the dosage strength?

The dosage strength is the amount of medication present in a specific unit of measure.

What is the drop factor?

The drop factor of an infusion set is the number of drops contained in 1 mL.

Determining the Actual Milligrams/Kilogram/24 Hours or Dose/Kilogram/24 Hours

The nurse must confirm that the dose received is S&T. Divide the total milligrams received per 24 hours by the patient's weight in kilograms. Compare the ordered dosage with the recommended dosage.

Requirements for PCA:

The patient must not be allergic to the narcotic, The patient must be able to understand and comply with instructions, The patient must have a desire to use PCA.

ac

before meals

How can parenteral medications be administered intravenously?

by themselves when they are diluted, in conjunction with existing IV fluids, or in addition to IV fluids.

Macrodrip

deliver fluids in large-sized drops and are therefore able to deliver large volumes of fluid per hour.

microdrip

deliver fluids in small-sized drops and are therefore unable to deliver large volumes of fluid per hour.

Time frame for IVPB

less than or equal to 60 minutes

Calculating the Infusion of IV Fluids and Medications by Pump: Formula Method (Milliliters per Hour (mL/h)) Infuse 750 mL of lactated Ringer's solution over 8 hours. How many milliliters per hour should the IV pump be programmed to deliver?

•(750 mL)/(8 h) = x mL/h •x = 93.75 mL/h

Calculating Milliliter/Hour from Units/Hour: Formula Method A patient has an order for insulin at 10 units/h. One hundred units of regular insulin has been added to 200 mL of 0.9% NS. How many milliliters per hour should the IV pump be programmed to deliver?

•(Formula setup) [(10 U)/(100 U)] × (200 mL) = x mL •(Cancel) [(10 U)/(1 U)] × (2 mL) = x mL •(Calculate) (20 mL)/1 = 20 mL

Calculating Milliliters/Hour from Milligrams/Minute: Formula Method A patient has lidocaine ordered at 2 mg/min. The concentration is lidocaine 2 g in 500 mL D5W. How many milliliters per hour should the IV pump be programmed to deliver?

•1 g : 1000 mg :: 2 g : x mg •x = 2000 mg •(Conversion) (2000 mg)/(500 mL) = 4 mg/mL •(Formula setup) (2 mg/min × 60 min/h)/(4 mg/mL) = x mL/h •(Calculate) (120/4) = 30

Calculating Weight-Based Heparin: Ratio/Proportion method A patient weighing 143 lb is to receive a bolus dose of 70 units/kg, rounded to the nearest 100 units. The infusion should begin at 17 units/kg. How many units will be needed for the heparin bolus, and what will be the rate, in milliliters/hour, at which to program the IV pump?

•100 units : 1 mL :: 1105 units : x mL •100x = 1105 •x = 11.05, or 11.1 mL/h

Calculating Units/Hour from Milliliters/Hour: Ratio/Proportion and Formula Methods A patient has a continuous insulin infusion at 8 mL/h. The insulin concentration is regular insulin 100 units in 200 mL of 0.9% NS. The nurse needs to calculate how many units per hour of insulin the patient is receiving.

•100 units : 200 mL :: x units : 8 mL •200x = 800 •x = 800/200 •x = 4 units

Calculating Milliliter/Hour from Units/Hour: Ratio/Proportion Method A patient has an order for insulin at 10 units/h. Two hundred units of regular insulin has been added to 400 mL of 0.9% NS. How many milliliters per hour should the IV pump be programmed to deliver?

•200 units : 400 mL :: 10 units : x mL •200x = 4000 •x = 4000/200 •x = 20 mL

Calculating Weight-Based Heparin: Ratio/Proportion and Formula Method A patient weighing 143 lb is to receive a bolus dose of 70 units/kg, rounded to the nearest 100 units. The infusion should begin at 17 units/kg. How many units will be needed for the heparin bolus, and what will be the rate, in milliliters/hour, at which to program the IV pump?

•Convert pounds to kilograms: •2.2 lb : 1 kg :: 143 lb : x kg •x = 65 kg •Calculate units required for IV bolus: •1 kg : 70 units :: 65 kg : x units •x = 70 × 65 •x = 4550 or 4600 units IV bolus •Calculate units need for patient: •1 kg : 17 units/h :: 65 kg : x units/h •x = 17 × 65 x = 1105 units

Calculating Milligrams/Minute from Milliliters/Hour: Formula Method A patient is receiving lidocaine at 60 mL/h. The concentration of lidocaine is 1 g/500 mL of D5W. The nurse needs to calculate the milligrams per minute the patient is receiving.

•Convert: •1 g = 1000 mg •Calculate the concentration: • 1000 mg/500 mL = 2 mg/mL •Calculate the mg/min: (2 mg/mL × 60 mL/h)/(60 min/h) = 2 mg/min

Calculating Micrograms/Kilograms/Minute from Milliliters/Hour: Formula Method A patient is receiving dopamine at 12 mL/h. The concentration of dopamine is 200 mg in 250 mL of 0.9% NS. The nurse needs to calculate the micrograms per kilogram per minute the patient is receiving. The patient's weight is 70 kg.

•Convert: •1 mg : 1000 mcg :: 200 mg : x mcg •x = 1000 × 200 •x = 200,000 mcg •Calculate concentration: •200,000 mcg/250 mL = 800 mcg/mL •Calculate mcg/kg/min: •(800 mcg/mL × 12 mL/h)/(60 min/h × 70 kg) •800/5 × 70 = 800/350 = 2.28 or 2.3 mcg/kg/min

Calculating Micrograms/Minute from Milliliters/Hour: Formula Method A patient is receiving nitroglycerin at 3 mL/h. The concentration of nitroglycerin is 50 mg in 500 mL of 0.9% NS. The nurse needs to calculate the micrograms per minute the patient is receiving.

•Convert: •1 mg : 1000 mcg :: 50 mg : x mcg •x = 1000 × 50 = 50,000 mcg •Calculate concentration: •50,000 mcg/500 mL = 100 mcg/mL •Calculate mcg/min: •(100 mcg/mL × 3 mL/h)/(60 min/h) •100/20 = 5 mcg/min

Calculating Milliliters/Hour from Micrograms/Kilogram/Minute: Formula Method A physician orders 1000 mg of dopamine added to 250 mL of 0.9% NS to be infused at 5 mcg/kg/min. The patient's weight is 90 kg. How many milliliters per hour should the IV pump be set to deliver?

•Convert: •1000 mg = 1,000,000 mcg •Calculate the concentration: •(1,000,000 mcg)/(250 mL) = 4000 mcg/mL •Calculate the rate (mL/h): •(5 mcg/kg/min × 90 kg × 60 min/h)/(4000 mcg/mL) = (27,000)/(4000 mL) = 6.75 mL/h

Calculating Milliliters/Hour from Micrograms/Minute: Formula Method A physician ordered a vasopressor at 10 mcg/min. The concentration is vasopressor 5 mg in 250 mL D5W. For how many milliliters per hour should the IV pump be programmed?

•Convert: •5 mg = 5000 mcg •Calculate the concentration: •(5000 mcg)/(250 mL) = 20 mcg/mL •Calculate the milliliters per hour: •(10 mcg/min × 60 min/h)/(20 mcg/mL) = 30 mL/h

Calculating the Infusion of IV Fluids and Medications by Pump: Formula Method (Milliliters per Hour (mL/h)) Hespan 650 mL is ordered to be infused over 3.5 hours. The drop factor is 20 gtt/mL. How many drops per minute should be administered to infuse 650 mL of Hespan over 3.5 hours?

•[(650 mL)/(210 min)] × (20 gtt/mL) = x gtt/min •x = 61.9 gtt/min

Calculating the Infusion of IV Fluids and Medications by Gravity: Dimensional Analysis Method (Drops per minute (gtt/min)) The physician orders gentamicin 50 mg in 80 mL D5W to be infused over 45 minutes. The tubing drop factor is 60 gtt/mL. How many drops per minute should be administered to infuse the gentamicin over 45 minutes?

•[(80 mL)/(45 min)] × (60 gtt/mL) = x gtt/min •x = 106.67 gtt/min

Calculating Weight-Based Heparin: Dimensional Analysis Method A patient has an order to start heparin using the weight-based heparin protocol. The patient weighs 68 kg. Using the weight-based heparin protocol, how many units of heparin should be administered for the bolus? 4800 units NOW: Continuing with the heparin order, how many milliliters will infuse heparin at 17 units/kg/min?

•x mL = [(1 mL)/(100 units)] × [(17 units)/(1 kg)] × [68 kg)/(1 kg) •x mL = 1156/100 •x mL = 11.56 or 11.6 mL The answer is 11.6 mL/h.

Calculating Milliliters/Hour from Micrograms/Kilogram/Minute: Dimensional Analysis Method The order is to begin a dopamine infusion at 3 mcg/kg/min; 800 mg of dopamine is added to 250 mL of 0.9% NS. The patient's weight is 70 kg. The nurse needs to calculate the rate, in milliliters per hour, at which to set the pump.

•x mL/h = (250 ml)/(800 mg) × (1 mg)/(1000 mcg) × (3 mcg/kg)/(1 min) × (60 min)/(1 h) × (70 kg)/1 •x mL/h = (250 ×3 ×60 ×70)/(800 ×1000) •x mL/h = 3,150,000/800,000 •x mL/h = 3.93, or 3.9 mL/h

Calculating Milliliters/Hour from Milligrams/Minute: Dimensional Analysis Method Lidocaine 1 g has been added to 500 mL of D5W. The order states to infuse the lidocaine at 2 mg/min. The nurse needs to calculate the rate, in milliliters per hour, at which the IV pump should be set.

•x mL/h = (500 mL)/(1 g) × (1 g)/(1000 mg) × (2 mg)/(1 min) × (60 min)/(1 h) •x mL/h = (500 ×2 ×60)/1000 •x mL/h = 60,000/1000 •x = 60 mL/h

Calculating the Infusion of IV Fluids and Medications by Pump: Dimensional Analysis Method (Milliliters per Hour (mL/h)) Infuse 1000 mL of lactated Ringer's solution over 12 hours. How many milliliters per hour should the IV pump be programmed for?

•x mL/h = 1000 mL/12 h •x mL/h = 1000/12 •x mL/h = 83.3 mL/h

Calculating Milliliter/Hour from Units/Hour: Dimensional Analysis Method A patient has an order for regular insulin IV at a rate of 5 units/h. The concentration is insulin 100 U in 200 mL 0.9% NS. At what rate, in milliliters per hour, should the IV pump be programmed?

•x mL/h = [(200 mL)/(100 units)] × [(5 units)/(1 h)] •x = [(1000 mL)/(100 h)] •x = 10 mL/h •The answer is 10 mL/h.

Calculating Milliliters/Hour from Micrograms/Minute: Dimensional Analysis Method The order is to infuse the nitroglycerin at 5 mcg/min; 50 mg of nitroglycerin has been added to 500 mL of 0.9% NS. The nurse needs to calculate the rate, in milliliters per hour, at which to set the IV pump.

•x mL/h =(500 ml)/(50 mg) × (1 mg)/(1000 mcg) ×(5 mcg)/(1 min) (60 min)/(1 h) •x ml/h = (500 × 5 × 60 )/(50 × 1000) •x mL/h = 150,000/50,000 •x mL/h = 3 mL/h

Calculating Micrograms/Kilograms/Minute from Milliliters/Hour: Dimensional Analysis Method A patient is receiving dopamine at 12 mL/h. The concentration of dopamine is 200 mg in 250 mL of 0.9% NS. The nurse needs to calculate the micrograms per kilogram per minute the patient is receiving. The patient's weight is 70 kg.

•x mcg/(kg/min) = (1000 mcg)/(1 mg) × (200 mg)/(250 mL) × (12 mL)/(1 h) × (1 h)/(60 min) × /(70 kg) •x mcg/(kg/mcg) = (1000 × 200 × 12)/(250 × 60 × 70) •x = 2.28, or 2.3 mcg/kg/min

Calculating Micrograms/Minute from Milliliters/Hour: Dimensional Analysis Method A patient is receiving nitroglycerin at 3 mL/h. The concentration of nitroglycerin is 50 mg in 500 mL of 0.9% NS. The nurse needs to calculate the micrograms per minute the patient is receiving.

•x mcg/min = (1000 mcg)/(1 mg) × (50 mg)/(500 mL) × (3 mL)/(1 h) × (1 h)/(60 min) •x mcg/min = (1000 × 50 × 3)/(500 × 60) •x = 5 mcg/min

Calculating Milligrams/Minute from Milliliters/Hour: Dimensional Analysis Method A patient is receiving lidocaine at 60 mL/h. The concentration of lidocaine is 1 g/500 mL of D5W. The nurse needs to calculate the milligrams per minute the patient is receiving.

•x mg/min = (1000 mg)/(1 g) × 1g/(500 mL) × (60 mL)/(1 h) × (1 h)/(60 min) •x mg/min = (1000 × 60)/(500 ×60) •x = 2 mg/min

Calculating Weight-Based Heparin: Dimensional Analysis Method A patient has an order to start heparin using the weight-based heparin protocol. The patient weighs 68 kg. Using the weight-based heparin protocol, how many units of heparin should be administered for the bolus?

•x units = [(70 units)/(1 kg)] × [(68 kg)/(1 kg)] •x units = 4760 •x = 4800 units

Calculating Units/Hour from Milliliters/Hour: Dimensional Analysis Method A patient has a continuous insulin infusion at 8 mL/h. The insulin concentration is regular insulin 100 units in 200 mL of 0.9% NS. The nurse needs to calculate how many units per hour of insulin the patient is receiving.

•x units/h = 100 units/200 mL •x units/h = 100 units/200 mL × 8 mL/h •x units/h = 100 × 8/200 •x = 4 units/h