Week 10

What is the drop factor?

the number of drops in one mL coming out of the drip chamber.

Why is the intravenous route used?

used to replace fluids, provide nourishment, infuse medications and replace electrolytes.

Order theophylline 0.5g IV in 250 ml D5W to run over 2 h.

250 mL/2h = 125 mL/h 250 mL* 60 gtt/mL/60m= 125 gtt/min

Calculating by weight when not given in kg example: The patient was ordered 2 mg/kg and weighs 15 pounds. Calculate dosage to one decimal place.

1 kg = 2.2 lb, so x kg = 15 lb Set it up as a ratio and divide 15 by 2.2, round to the digit specified: weight is 6.8181818181 kg (Note: Do NOT round until the end of the question!) 6.81818181818 kg x 2 mg/kg = 13.6 mg (rounded to one decimal place)

The patient is ordered 1000 cc 0.9% NS to infuse over 8 hours via minidrip. What is the drip rate for this IV?

1 000/ 8 = 125 gtt/min

The surgeon orders 1500 cc D5W to infuse over 12 hours. The drop factor of the IV tubing is 10. What is the drip rate of this IV?

1 500 * 10/ 720 = 20.83= 21 gtt/min

The patient is ordered 1800 cc D5RL over twelve hours. The tubing has a drop factor of 15. What is the drip rate of this IV?

1 800 * 15/ 720 = 37.5 = 38 gtt/min

What is the flow rate?

The rate at which the IV fluid is being infused into the patient.

What do we need to know to calculate the drip rate?

The volume in mL to infuse The drop factor (gtt/mL)

What is the formula for calculating flow rate?

Amount of solution (mL) / = flow rate in mL/hour Time in hours

What is the formula for calculation drip rate?

Amount of solution (mL) x drop factor = gtts/min Time in minutes

What do you need to know to hang a new bag of fluid?

Amount to be infused (TBI or TBA) and the flow rate.

What is a micro drip tubing with a drop factor of 60gtt/mL known as?

Buretrol

How is the drop factor determined?

By the type of IV tubing you are using.

Calculating by weight example: dosage is 2 mg/kg, patient weight is 32 kg.

To figure out how much to give, just multiply the mg/kg by the weight in kg, and this will leave you with mg 32 x 2 = 64, therefore you will give 64 mg

IV fluids are typically ordered in?

ML/ number of hours E.g. "2/3 and 1/3 1500 mL in 4 hours"

Electronic pumps administer in?

ML/hour E.g. 200 mL/hr

The surgeon orders 0.9% NS 2000 mL, to be infused over 8 hours, via microdrip tubing. What is the drip rate of this IV?

Microdrip tubing= 60 gtt/mL ML * DF / t (m) 2 000 mL /8h= 250 mL 250 mL * 60 gtt/mL /60 min = 250 gtt/min

Pediatric calculation examples: 1) The doctor orders 40 mg/kg for a baby who weighs 15.6 pounds. 2) The doctor orders 0.5 mg/kg for a toddler who weighs 27 pounds. Calculate mg per dose given, to the nearest 10th. 3) The doctor orders 0.25 mg/kg for a newborn who weighs 3687 g. Calculate mg per dose given, to the nearest 10th.

1) 15.6 / 2.2= 7.090909 * 40= 283.636 = 284 mg. 2) 27/ 2.2= 12.272727 * 0.5= 6.13636 = 6.1 mg 3) 3.687 * 0.25= 0.92175 = 0.9 mg

Drip rate calculation example: Your client is ordered NS to infuse at 100 mL/ hour. The drop factor of your tubing is 10 gtt/mL. (the drop factor is often given "the drop factor is 10"). What is the drip rate of this solution?

100 mL x 10 gtt/mL = x gtt/min is the formula to use. 60 min So, we divide 1 000 by 60 = 16.6. Since you CANNOT have a fraction of a drop, you round to the nearest whole number, in this case 17. Therefore, your drip rate is 17 gtt/min.

At 1600, the nurse started D5W 1200mL at 100mL/h. The infusion set used is calibrated for a drop factor of 15 gtt/mL.

1200 mL / 100 mL/h= 12h Completion time: 0400-15min= 0345h

Your client has had 130 mL of juice, 5 ounces of ginger ale and 1 100 mL NS IV during your shift. What is her total intake?

130 mL juice +150 mL ginger ale (30 mL/ounce x 5 ounces) +1 100 mL NS IV = 1 380 mL

The PSW reports to the PN that the resident had 150 mL juice, one and a half cups of tea, six ounces of water and 750 cc NS via IV. What is the total intake of this patient in litres?

150 + 375 + 180 + 750= 1 455 mL = 1. 455 L

Order: D5W 1500mL IV for 12 h; drop factor 15 gtt/mL

1500mL /12h =125 mL/h 125mL * 5 gtt/mL / 60m= 31 gtt/m

The midwife orders an IV of 2/3 and 1/3,1 500mL/8 hours. The tubing has a drop factor of 10. What is the drip rate for this IV?

188 mL/h (flow rate) * 10 gtt/ml /60 m = 31.333 = 31 gtt/min

The doctor orders IV 0.9% NS, 2400 mL/12h. What is the flow rate of this IV?

2 400/ 12= 200 mL/h

Practice question #1: Your client has an order for 3000 mL D5W over 24 hours.

3000 mL = x mL/hr 24 hours I.e. So, dividing 3000 by 24, we get 125, therefore the flow rate is 125 mL/hour

Practice question #2: When the nurse starts his shift at 0700h, his client, Mrs. Nagata, has 400 mL of D5W infusing at 100 mL/h. What time should the nurse hang a new bag of D5W?

400 mL ➗ 100 mL/h = 4 hours I.e. Count forward four hours from 0700h, which takes you to 1100h...but...Don't let the IV run "dry"!!! Doing so might require a new line to be started, which is a hassle and puts your patient in needless discomfort! You should hang a new bag about 15-30 minutes before the bag would run dry, so the answer to this question would be 1030h or 1045h.

The PN starts his shift at 1900h. At report, he hears that his patient has 800 mL TBI at 150 mL/h. What time should the PN hang a new bag of fluid?

800 mL / 150 mL/h= 5. 3333 1/3 hr = 20 mins 5h 20 min = 0020h (run dry) = 0000 h

At the start of shift at 0700h, the PN is informed that the patient has 2/3 and 1/3 running at 125 cc/h, with 875 cc TBI. What time should the PN hang a new bag of 2/3 and 1/3?

875 / 125 = 7, 0700 + 7 = 1400h - 15 mins= 1345h

Order: NS IV 1000 mL at 50mL/h, Drop factor: 60 gtt/min

ATBI (mL) * DF (gtt/mL)/ time (m) 50 mL * 60 gtt/mL /60 m= 50 gtt/min

Names of solutions I will encounter

D5W: 5% dextrose in water RL: Ringer's lactate (sometimes referred to as lactated Ringer's) NS: Normal saline, which is isotonic and the most commonly used IV solution. 0.9% NS: This is another way of saying normal saline. 0.45% NS: This is a hypotonic saline solution, which would be used only in very specific conditions. 2/3 and 1/3: This is a mixture of 2/3 NS and 1/3 D5W, and it is also a commonly used solution. D5RL: 5% dextrose in Ringer's lactate

What is the drip rate?

How many drops per minute of solution will give us the ordered flow rate.

What is the advantage of the GI route?

It bypasses the GI tract and allows medication to infuse directly into the bloodstream

The midwife orders an IV of 2/3 and 1/3, 1 500mL/8 hours. What is the flow rate of this IV?

TBI/t = 1 500/ 8= 187.5= 188 mL/h

When should a new bag of fluid be hung?

divide the amount to be infused by the flow rate, which will give us the number of hours until the IV bag runs dry: Amount TBI (mL) ➗ Flow rate (mL/h) = Number of hours until the fluid in the IV bag is gone.