Dosage Calculation Final Exam: Pediatric-focused medication math.

Dosage Calculation Final Exam: Pediatric-focused medication math. 1. A patient has an order for Chloromycetin, 500 mg every 6 hours. The drug comes in 250 mg capsules. What would the nurse administer? - ANSWER 2 tabs 2. A nurse is to administer 150 mg of a drug intramuscularly. The label on the multidose vials reads 100 mg/mL. How much would the nurse give? - ANSWER 1.5 mL 3. A nurse is to administer 30 mg of furosemide (Lasix) to a client with congestive heart failure (CHF). The vial contains 40 mg/mL. Which is the correct dose to administer? - ANSWER 0.75 mL 4. The nurse is providing discharge teaching for a client who has been prescribed 600 mg of an oral liquid medication. The mother shows the nurse the label of the medication, which reads: 250 mg/mL. The nurse would instruct the mother to give how many milliliters? - ANSWER 2.4 mL 5. A child is to receive 500 mg of an antibiotic suspension. The label on the bottle reads 250 mg/5 mL. The nurse should administer how much of the suspension in one dose? - ANSWER 10 mL 6. A health care provider orders 250 mg of an antibiotic suspension. The label on the suspension reads "500 mg/5 mL." How much would the nurse administer? - ANSWER 2.5 mL 7. The client is to be given ascorbic acid 1 g daily by mouth. The medication comes in a container labeled, "Ascorbic Acid 250 mg tablets." How much will the nurse give? - ANSWER 4 tabs 8. The PCP orders amoxicillin 250 mg by mouth two times a day. The drug label reads "Amoxicillin 125 mg/5 ml." How much will the nurse administer? - ANSWER 10 mL 9. A nurse is to administer 175 mg of a medication intramuscularly. The label on the multidose vial states that the concentration is 100 mg/mL. What volume of the drug should the nurse administer? - ANSWER 1.7 mL 10. The nurse is preparing to administer 80 mg of Solu-medrol intravenously (IV) to a client with pneumonia. The vial states that it has 120 mg per 2 mL. The nurse would correctly draw up which amount? - ANSWER 1.3 mL 11. The health care provider prescribes ascorbic acid 0.5 g daily. The drug label reads ascorbic acid 250 mg. The nurse would administer how many tablets? - ANSWER 2 tabs 12. A client is being treated for congestive heart failure (CHF) and is to receive 0.5 milligrams of digoxin, which is available in 250-microgram tablets. The nurse would correctly administer how many tablets? - ANSWER 2 tabs 13. The nurse is to administer 25 mg of meperidine (Demerol). The vial states that it contains meperidine 50mg/1 mL. How much medication should the nurse draw up for the ordered dosage? - ANSWER 0.5 mL 14. A nurse needs to convert 3 fluid ounces to the metric system equivalent. The nurse performs the calculation to find which result? - ANSWER 90 mL 15. A client has been prescribed a one-time dose of 4 mg morphine IV. The medication is available in ampules of 10 mg/mL. What volume of morphine should the nurse draw up? - ANSWER 0.4 mL 16. A physical orders 75 mcg of a drug IM daily. The drug is available in a vial labeled 0.5 mg in 5 mL. How many mL with the patient receive? - ANSWER 0.75 mL 17. The patient is to receive 750 mg of a drug PO daily. The drug bottle is labeled 0.5 g in 5 mL. How many Tbs will the patient receive? - ANSWER 0.5 Tbs 18. The order is for 1 g of a medication PO BID. The pharmacy sends the medication labeled 200 mg in 5 mL. How many mL should the nurse administer? - ANSWER 25 mL 19. The physician orders to administer Prednisolone oral solution 0.03 g daily. The label reads Predisolone 15 mg per 5 mL. How many tsp will the patient receive? - ANSWER 2 tsp 20. The physician orders granisetron 450 mcg IV 30 minutes prior to chemotherapy. The label reads 0.1 mg per mL. How many mL will the nurse administer to the patient? - ANSWER 4.5 mL 21. Fourth step of combining two insulins: - ANSWER Insert needle into NPH insulin vial and withdraw insulin to 52-unit mark 22. when combining dosages how many nurses must verify each process step - ANSWER 2 23. Medications formula - ANSWER 24. Reconstituting Medications: - ANSWER Medication in powder form or concentrated liquid form (solute) is combined with a liquid (solvent) to make a solution Reconstituted by adding a solvent / diluent (liquid) Solvent - ANSWER The solution added to reconstitute the medication ALWAYS use the solvent recommended for reconstitution-information is found on the label Typical Solvents: - ANSWER sterile water normal saline (NS) bacteriostatic water Choice of Solvent is based on.... - ANSWER -the pH -the physical properties of the product (medication) When reconstituting medications, you need to..... - ANSWER READ the information on the medication label prior to reconstituting the medication Dosage Strength/Concentration: - ANSWER Reconstitution does not change the amount of medication in the vial; it changes the concentration or dilution of the drug Displacement factor is noted by manufacturer on label The label on the medication vial states the strength (amount) of medication in the vial. That amount never changes. The only thing that can change is the amount of diluent (liquid) that is added Displacement Factor: - ANSWER amount of space that is taken up by the medication in the powder or crystal form Always label vials after reconstitution if they will be used again with the following..... - ANSWER *Name of medication *Dosage strength *Storage directions *Date and time of reconstitution -Initialed by the nurse *Expiration date *Route of administration Percents and Solutions Example Problem: Order: Give 6 ounces of 2/3 strength Ensure over 2 hours via G-tube. Available: 4 and 8 ounce cans of Ensure. How much Ensure and how much water will you use to make this 2/3 strength solution? - ANSWER 2 parts ensure 3 parts total 1 part water 2 = X __ = __ = 3x= 12, so x= 4 oz. ensure 3 = 6 oz. So if 6 oz total is ordered to be given, and 4 oz is ensure, then 6-4= 2 oz of water is to be given! Types of IV Solution Components: - ANSWER Dextrose- D W-Water S- Saline NS- Normal Saline (0.9% NaCl) NaCl- Sodium Chloride RL- Ringer's Lactate LR- Lactated Ringers D5W= Dextrose 5% in Water D - ANSWER Dextrose W - ANSWER Water S - ANSWER Saline NS - ANSWER Normal saline (0.9% NaCl) NaCl - ANSWER Sodium Chloride RL - ANSWER Ringer's lactate LR - ANSWER Lactated Ringer's Types of IV solution concentrations by osmolarity - ANSWER hypotonic, isotonic, hypertonic hypotonic - ANSWER -Less than 250 milliosmole/Liter (mOsm/ L ) - Solvent EXCEEDS solute= Used to dilute excess serum electrolytes, as in hyperglycemia •Ex. 0.45% saline (154 mOsm/L) -lower tonicity or osmolarity than blood and other body serums Isotonic - ANSWER -250 to 375 mOsm/L - Solvent solutes are BALANCED=Used to expand volume and maintain normal tonicity •Examples= 0.9% saline, lactated Ringer's (273 mOsm/L), 5% dextrose in water (D5W) -same tonicity or osmolarity as blood and other body serums Hypertonic - ANSWER -Greater than 375 mOsm/L - solutes EXCEED solvent= Used to correct electrolyte imbalances, as in loss from excess vomiting and diarrhea •E.g., 5 percent dextrose and 0.9 percent NaCl, 5 percent dextrose and lactated Ringer's -higher tonicity or osmolarity than blood and other body serums Advantages of IV Med Administration - ANSWER -Rapid onset of action -Decreased drug loss to tissues Disadvantages of IV Administration - ANSWER Phlebitis Air emboli Infiltration Sepsis Three methods for giving medications/ fluids IV - ANSWER -Direct IV injection (IV push) -Continuous IV infusion -Intermittent IV infusion (IVPB) IV Sites: - ANSWER *Peripheral venous access- inserted into a vein in hand, arm, leg, foot or scalp (infants). *Peripheral inserted central catheter (PICC) - inserted in antecubital area and tip is in superior vena cava *Central venous access - inserted in jugular or subclavian vein and tip is in superior vena cava. Long-term therapy. ***Note: All types need to be flushed to maintain patency!!***** Peripheral line - ANSWER -Rate of infusion should not exceed 200 mL in one hour Central line - ANSWER -Accommodates larger concentrations and volumes of fluid monitoring IVs is.... - ANSWER the nurse's responsibility Check every 30 min to 1 hour: - ANSWER -Fluid volume remaining -Infusion rate -Signs of complications •Phlebitis •Infiltration •Infection phlebitis - ANSWER occurs when the vein becomes irritated, red, or painful THINK: warm and cordlike vein infiltration - ANSWER when the IV catheter becomes dislodged form the vein and IV fluid escapes onto the subcutaneous tissue THINK: cool and puffy skin Should phlebitis or infiltration occur, the IV is.... - ANSWER discontinued and another IV site is chosen to restart the IV. Patient with an IV should notify the nurse of... - ANSWER any pain or swelling at the site Infusion pump - ANSWER maintain flow by displacing fluid at the prescribed rate Syringe pump - ANSWER infuses fluids or medications directly from a syringe Patient-controlled analgesia - ANSWER (PCA) pump continuous infusions - ANSWER used when patient needs to receive continuous (around the clock) or maintenance IV fluid therapy. intermittent infusions - ANSWER Sometimes the patient needs to receive supplemental fluid therapy and/or IV medications but does not need continuous replacement or maintenance IV fluids. Types of Intermittent Infusions: - ANSWER -IVPB (IV Piggy Back) -IV Locks for IV push drugs -ADD-Vantage systems and volume control sets Primary IV - ANSWER I also like to call it "the main/first IV" -Used for a typical IV or with primary tubing Primary tubing includes: drip chamber, one or more injection ports, and a roller clamp and is long enough to be attached to the hub of the IV catheter positioned in the patient's vein. The drip chamber is squeezed until it is half full of IV fluid, and IV fluid is run through the tubing prior to attaching it to the IV catheter to ensure that no air is in the tubing (priming the tubing!) Ex. used for things like NS, D5W, Lactated Ringers, etc. Secondary IV - ANSWER -used when giving medications -Is "piggybacked" into the primary line! This type of tubing is generally shorter and also contains a drip chamber and roller clamp.Gives access to the primary IV catheter without having to start another IV. Hung higher than the primary IV fluids When hanging piggybacks, choose secondary tubing! Saline/Heparin Locks - ANSWER Iv locks can be attached to the hub of the IV catheter that is positioned in the vein. The lock may be referred to as a saline lock, meaning that saline is used to flush or maintain the IV catheter patency, or a heparin lock if heparin is used to maintain the IV catheter patency. IV Piggyback (IVPB) - ANSWER A medication may be ordered to be dissolved in a small amount of IV fluid (usually 50-100 mL) and run piggyback to the regualr IV fluids. IV piggyback (or secondary IV) requires a secondary IV tubing set. May come premixed by manufacturer or pharmacy, or the nurse may need to prepare it. Infusion time may be less than 60 minutes, so it is important to carefully read the order and recommended infusion time. IV Push: - ANSWER -are given directly into the patient's venous system -Fast delivery and action (most timed IV push recommendations are for 1-5 minutes) -Can be fatal if drug dose error occurs!! *First, calculate dose in milliliters *Second, calculate safe rate of administration (must check drug book for this information!) Example IV Push Problem: Order: Lasix 60mg IV push, now, over 2 minutes Available: Lasix 10mg/ml in a vial for IV use How many milliliters will you give? Over how many minutes? What is the rate of administration (ml/min)? - ANSWER 60 mg ______ x 1 mL = 6 mL 10 mg 6 mL _____ = 3 mL/min 2 min You will give 6 mL Over 2 minutes 3 ml/min is the rate of administration IV pumps are.... - ANSWER -usually used to deliver IV medications and fluids They use pressure to deliver or push medication through the tubing and into the patient's vein! regulate IV volume by - ANSWER electronic infusion pump or controller calibrated in mL per hour IV flow rate is measured in - ANSWER mL/hour and gtt/min Drop Factor: - ANSWER Sometimes, a pump is not available Some meds are given without using a pump Gravity is used to allow medication to "drip" in Drip rates must be calculated as gtt/min You must know the drop factor of the tubing that is being used in order to calculate a drip rate for a gravity infusion This is found on the IV tubing package Or, it will be given to you in a problem on a test Common drop factors: - ANSWER 10 gtt/mL - macro-drip tubing 15 gtt/mL 20 gtt/mL 60gtt/mL- pedi-drip tubing or micro-drip tubing Drops per Minute (gtt/min) - ANSWER •Carry calculations to one decimal •Round drops per minute to nearest whole number •Can watch-count only whole drops Calculated as= gtt/min Gravity Infusions (Drops per minute!) Formula: - ANSWER ML ordered x drop factor _________________________ = gtt/min Time ordered in minutes Example Gravity Infusion Problem: Order: 2 units of PRBCs (approx 500 mL) over 3 hours. Drop factor of tubing is 100 gtt/mL. What is the flow rate (gtt/min)? - ANSWER 3 hours x 60 minutes= 180 minutes 500 mL x 10 gtt/mL ____________________ = 28 gtt/min 180 minutes IV Pump- Flow Rate Ratio Proportion Method: - ANSWER Total mL ordered -------------------- = mL/ hour Total hours ordered Flow Rate Formula: - ANSWER (amount of solution in mL) x (60min/hr) = mL ______________________________________ = ___ minutes to give = hr Example IV Pump-Flow Rate Problem with Ratio Proportion Method: Order: Give 1000 mL of Lactated Ringers over 4 hours, IV. Available: 1 L bag of Lactated Ringers. What is the flow rate for the infusion pump? - ANSWER mL = 1000 mL = 250 mL/hr ___ _________ hr 4 hours Example Flow Rate Problem w/ Formula Method: Order: Give 500 mg Ampicillin IVPB over 45 minutes. Available: Ampicillin 500 mg in 150 mL NS What is the flow rate? - ANSWER 150 mL x (60 min/hr) _____________________ = 200 mL/hr 45 minutes IV flow rate is ordered by the...... - ANSWER physician Nurse may not arbitrarily - ANSWER speed up or slow down flow rate to catch up IV Check institutional policy regarding - ANSWER correction of off-schedule IV rates and percentage of variation allowed -Should not exceed 25 percent If adjustment permitted: - ANSWER -Use formula to recalculate mL per hour and gtt per minute for time remaining and percentage of variation Percent variation will be positive (+) - ANSWER if administration is too slow; rate must be increased Percent variation will be negative (-) - ANSWER if administration is too fast; rate must be decreased End Time Problems - ANSWER Often useful in the clinical setting to determine when an IV solution bag will be empty. End-Time Problem Example: A 1 Liter bag of LR (lactated ringers) was hung at 1100 and is infusing at 125 mL/hr. How many hours will it take for the infusion to be complete? What time is this in military time? - ANSWER 1 liter= 1000 mL 125 mL = 1000 mL = 125x= 1000 = 8 hours _______ _____________ _____ ______ 1 hour = x Hours = 125 = 125 It will take 8 hours for infusion to be complete The time to complete in military time will be 1900 (1100 + 8 hrs= 1900 Rounding Rules to Know: - ANSWER *Round flow rates ( pump rates and gravity rates) to a whole number *Round weights in kilograms to the tenths place *Round subcut insulin dosages to a whole number *When calculating IM, IV push, and subcut dosages: *Round amounts less than 1 mL to the hundredths place and use a 1 mL syringe *Round amounts greater than 1 mL to the tenths place and use a 3 mL syringe Pediatric Dosage Calculations: - ANSWER -Are based on body weight or BSA for safe and accurate dosing -Important to obtain an accurate weight on children in ER, hospital and in clinics -Droppers and oral syringes are often used to give meds to young children under 2 years of age -Parenteral injections: vastus lateralis is preferred site for IM injections such as vaccines for infants up to age 7 months. After 7 months, use vastus lateralis or ventrogluteal until deltoid muscle is well-developed -Volume-control devices help prevent fluid overload in children that require IV fluids and medications Pediatrics-Safe Dose Range (SDR): - ANSWER - Are Individualized & must be calculated for each pediatric patient based on his/her body weight or BSA. -This is compared to the doctor's order. Then, decide if dose is therapeutic and within safe dose range OR if not, hold med and call prescriber -You will use the "Teddy Bear Book" to calculate safe dose ranges for your patients in your Pediatrics class Peds Safe Dose Range Problem: Child with nausea after surgery Order: Phenergan 20mg, IM, q6hours Child's weight: 45kg Pediatric dose parameters: 0.25-0.5 mg/kg/dose, repeat 4-6 hours Available: Phenergan 25mg/ml Is 20mg a safe dose? How many milliliters will you give? - ANSWER 45 kg (don't need to convert) 45 kg x 0.25 mg/kg= 11.25 mg q6h 45 kg x 0.5 mg/kg= 22.5 mg q6h Yes, 20 mg is a safe dose Ordered = 20 _______ x Quantity = _____ x 1 mL =0.8 mL Available = 25 Practice Problems to Do in Book..... - ANSWER Chapter 12 pg. 383-390 Chapter 13 pg. 422-434 Chapter 15 pg. 523-528 Also make sure to complete Homework 5,6, &7 problems!! Review...... - ANSWER Concepts from Dosage Exams 1 &2 (Conversions; oral, liquid, and injection dosage calculations, etc.) A nurse is preparing to administer amoxicillin 500 mg PO. Available is amoxicillin 250 mg tablets. How many tablets should the nurse administer? - ANSWER 2 tablets To avoid drug error the label should be read 3 times - ANSWER 1. At the time of contact with the drug bottle 2. Again before preparing the drug 3. After preparing the drug The form identifies the structure and composition of the drug - ANSWER Solid forms (tablets, caps), gel caps, powder forms, suspension (cloudy), injectable, suppositories, creams, patches Label alert - ANSWER Refrigerate at all times, keep in dry place, replace cap and close tightly before storing, protect from light, do not dive or operate heavy machinery while taking this medication, keep this and all medication away from children Kilo - ANSWER 1000 Hecto - ANSWER 100 Deca - ANSWER 10 Deci - ANSWER 0.1 Centi - ANSWER 0.01 Milli - ANSWER 0.001 Micro - ANSWER 0.001 tsp/t - ANSWER 5mL Tsp/T - ANSWER 1T=3t 1T=15mL oz - ANSWER 1oz=2T 1oz=30mL C - ANSWER 1C=8oz 1C=240mL pt - ANSWER 1pt=2C 1pt=16oz 1pt=500mL qt - ANSWER 1qt=4C 1qt=2pt 1qt=32oz 1qt=1000mL lb - ANSWER 1lb=16oz 2.2lb=1kg kg - ANSWER 1kg=1000g Celsius to Fahrenheit - ANSWER (1.8 x C) + 32 Fahrenheit to Celsius - ANSWER (F-32)/1.8 Centimeter to millimeter - ANSWER 1 cm = 10 mm Inches to centimeter - ANSWER 1 inch = 2.54 cm kilogram to pounds - ANSWER 1 kg = 2.2 lbs types of administration of medication - ANSWER Medicine cup, calibrated dropper, oral syringe, soufflé cup, nipple, parental syringe QSEN - ANSWER Quality and Safety Education for Nurses ā - ANSWER Before aa, āā - ANSWER Of each ac - ANSWER before meals ad lib - ANSWER as desired, freely am - ANSWER morning, before noon amp - ANSWER ampule aq - ANSWER aqueous, water bid - ANSWER twice a day biw - ANSWER twice a week c with line of it - ANSWER with C - ANSWER Cup cap - ANSWER capsule CD - ANSWER controlled dose CR - ANSWER controlled release dil - ANSWER dilute DS - ANSWER double strength ES - ANSWER enteric coated elix - ANSWER elixir fl, fld - ANSWER fluid GT - ANSWER gastrostomy tube gtt - ANSWER drop h, hr - ANSWER hour ID - ANSWER intradermal IM - ANSWER intramuscular IV - ANSWER intravenous IVPB - ANSWER intravenous piggyback IVSS - ANSWER intravenous soluset KVO - ANSWER keep vein open LA - ANSWER Long acting LOS - ANSWER Length of stay Min - ANSWER minute NAS - ANSWER intranasal noc - ANSWER At night NPO - ANSWER nothing by mouth NGT - ANSWER nasogastric tube NS - ANSWER normal saline p with a line over it - ANSWER after pc - ANSWER after meals per - ANSWER by, through pm - ANSWER evening, before midnight po - ANSWER by mouth pr - ANSWER by rectum prn - ANSWER as needed q - ANSWER every qid - ANSWER four times a day qs - ANSWER As much needed rect - ANSWER rectum s with a line over it - ANSWER without SL - ANSWER sublingual sol - ANSWER solution sos - ANSWER may be repeated once if necessary SR - ANSWER sustained release S&S - ANSWER swish and swallow STAT - ANSWER immediately Subcut - ANSWER subcutaneous supp - ANSWER suppository susp - ANSWER suspension syp, syr - ANSWER syrup tab - ANSWER tablet tid - ANSWER three times a day tr, tinct - ANSWER tincture ung, oint - ANSWER ointment vag, v - ANSWER vaginally XL - ANSWER long acting XR - ANSWER extended release Reading prescription bottles - ANSWER 1. Generic name is a name with an element name 2. Or generic name is in parentheses under trade name Reading labels - ANSWER Dosage, route, generic name, trade name, NDC#, form always use a leading zero - ANSWER True Always have trailing zeros - ANSWER False Desire units using dimensional analysis - ANSWER Caps/dose, tab/dose, mL/hr Wanted quantity - ANSWER The answer to the problem, what are you being asked to find Conversion factors - ANSWER Equivalents necessary to convert between measurements and allow unwanted units to be cancelled Label - ANSWER The descriptor of type (3 eggs, 3mL, 2tablets) Numerator - ANSWER Top portion of problem Denominator - ANSWER Bottom portion of problem Dose - ANSWER A quantity of medication to be taken at a particular time Medication assessment - ANSWER Medication history, allergies and intolerance, medical history, pregnancy and lactation status Enteral- drugs administered directly into the alimentary tract from the mouth to the rectum - ANSWER Oral, rectal, nasogastric, buccal A nurse is caring for a client who has a percutaneous endoscopic gastrostomy (PEG) tube and a prescription to receive 25 mL of fluid replacement every 4 hr for each 100 mL of output. The client's output over the last 4 hr was 500 mL. How much water should the nurse administer to the client? - ANSWER 125 mL A nurse is preparing to administer acetaminophen 10/mg/kg PO to a preschool child for fever. The child weighs 22 lb. Available is acetaminophen liquid 160 mg/ mL. How many mL should the nurse administer? - ANSWER 3.1 mL A nurse is preparing to administer potassium chloride 30 mEq PO daily. The amount available is potassium chloride 20 mEq/15mL. How many mL should the nurse administer? - ANSWER 22.5 mL Before administering client medications, the nurse must identify the client. Which of the following methods of identification should the nurse use? A) Ask the client's full name and date of birth. B) Verify the client's room number. C) Check the client's name on the medication administration record (MAR). D) Ask a family member to verify the client's identity. - ANSWER A) Ask the clients full name & date of birth A nurse is completing the 8-hr I&O record for a client who consumed 4 oz of clear soda, 1 piece of toast, 12 oz of water, 1 cup of fruit-flavored gelatin, and 1/2 cup of chicken broth. The client also received 300 mL of 0.9% sodium chloride IV. The nurse should record how many mL of intake on the client's record? - ANSWER 1,140 mL A nurse is preparing to administer amoxicillin 320 mg PO every 12 hr to an infant. The amount available is amoxicillin suspension 400 mg/5 mL. How many mL should the nurse administer per dose? - ANSWER 4 mL A nurse is preparing to administer haloperidol 5 mg IM to a client. Available is haloperidol 50 mg/mL. How many mL should the nurse administer per dose? - ANSWER 0.1 mL A nurse is preparing to administer amoxicillin 30 mg/kg/day divided doses every 12 hr to a toddler who weighs 33 lb. Available is amoxicillin 200 mg/5 mL suspension. How many mL should the nurse administer every 12 hr? (Round the answer to the nearest tenth. - ANSWER 5.6 mL A nurse is calculating a client's intake and output for an 8-hr shift. The client's intake included 1,000 mL 0.9% sodium chloride IV solution, one 6-oz cup of coffee, 6 oz of water, one 180-mL bowl of soup, 3 oz of flavored gelatin, and 3 oz of ice cream. How many mL should the nurse document as the client's total intake for the shift? - ANSWER 1,720 mL A nurse is preparing to administer ondansetron 4 mg IM stat. The amount available is ondansetron for injection 2 mg/mL. How many mL should the nurse administer? - ANSWER 2 mL A nurse is conducting a nutritional assessment on a client who weighs 165 lb. RDA recommendation for protein is 0.8 g/kg. How many grams of protein should the nurse recommend the client to consume per day? - ANSWER 60 g A nurse is calculating the total fluid intake for a client during an 8-hr period. The client had an IV bolus of 150 mL and consumed 4 oz of juice, 6 oz of hot tea, 100 mL of water, and 8 oz of clear broth. The nurse should record how many mL of intake on the client's record? - ANSWER 790 mL A nurse is preparing to administer a dexamethasone 1.5 mg/kg/day PO to divide equally every 6 hr to a preschool-age child who weighs 22 lb. Available is dexamethasone oral solution 1 mg/mL. How many mL should the nurse administer per dose? - ANSWER 3.8 mL A nurse is preparing to administer clindamycin palmitate 225 mg PO to a client. Available is clindamycin palmitate oral suspension 75 mg/5 mL. How many mL should the nurse administer? - ANSWER 15 mL A nurse is calculating a client's fluid intake over the past 8 hr. The client had one 8-oz cup of coffee, 3 oz of juice, and 12 oz of soda. The client's water pitcher had 800 mL and 200 mL remain. The client also had IV fluids infusing at 40 mL/hr via an IV pump. How many mL should the nurse document as the client's total intake for the shift? - ANSWER 1,610 mL A nurse is calculating a client's fluid output over a 12-hr period. It includes Jackson-Pratt UP) drainage 35 mL, NG suction 120 mL, and incontinence pads weighing 240 g, 275 g, 310 g, and 270 g. The dry weight of the incontinence pads is 90 g. The nurse should record how many mL of output on the client's record? - ANSWER 890 mL A nurse is preparing to administer dexamethasone 3 mg PO. Available is dexamethasone 1.5 mg tablets. How many tablets should the nurse administer? - ANSWER 2 tablets A nurse is calculating the protein needs of a client who is a physical trainer. The client weighs 220 lb and requires an increase of protein by 2.0 g/kg/day. The client has taken 0.8 g of protein/kg/day in the past. How much total protein/day should the nurse recommend? - ANSWER 280g / day A nurse is assisting in preparing an in-service program about preventing medication errors when transcribing a prescription. The nurse is using a dosage example of two tenths of a milligram. Which of the following transcription examples should the nurse use? A) .2 mg B) 0.2mg C) 0.20 mg D) 2.0 mg - ANSWER B) 0.2mg A nurse is preparing to administer morphine 15 mg subcutaneously. The amount available is morphine injection 10 mg/mL. How many mL should the nurse administer? - ANSWER 1.5 mL The physician ordered 30mg of an oral solution that is available as 20mg/5ml. The nurse will administer how many mL? - ANSWER 7.5 mL Oral drug forms - ANSWER Tablet, enteric-coated, caplet, time-released (sustained-release) capsule, capsule, sublingual tablet, buccal tablet, lozenge (troche), suspension, oral disintegrating tablet (ODT) Tablet - ANSWER disk of compressed drug, may be scored Enteric-coated - ANSWER tablet with a special coating that resists disintegration by the gastric juices Caplet - ANSWER Oblong shaped compressed drug, may be scored Time-released (sustained-release) capsule - ANSWER Capsule that contains drug particles with various coating that differ in the amount of time required to dissolve Capsule - ANSWER Drug contained within a gelatin-type container Sublingual tablet - ANSWER A tablet placed under the tongue Ex: nitroglycerin Buccal tablet - ANSWER A tablet placed in the cheek pouch or between the lip and gum Lozenge (troche) - ANSWER Tablet with flavoring dissolved in the mouth for local soothing effect on throat or mouth Suspension - ANSWER Liquid form of medication that must be shaken will before giving d/t particles settle at the bottom Oral disintegrating tablet (ODT) - ANSWER Solid forms that disintegrate rapidly, usually within a matter of seconds, when placed upon the tongue Ex: maxalt MLT (rizatriptan)-migraines, Zofran ODT (ondabsetron)- nausea Standard drug forms - ANSWER Emulsion, elixir (fluid extract), syrup Emulsion - ANSWER liquid drug preparation that contains oils and fats in water Elixir (fluid extract) - ANSWER liquid drug forms with alcohol base Syrup - ANSWER Sweet flavor liquid drug, cherry is the most common for kids Important facts for oral meds - ANSWER 1. Give the most important med 1st 2. Never dilute a medication unless ordered to do so 3. Use and oral syringe or med cup to measure 10% rule - ANSWER No more than 10% variance should exist between dose ordered and dose administered Capsules are administered whole only - ANSWER True Tablets are available in different strengths - ANSWER True (Choose the least number of tablets or capsule without dividing a tablet) It is safer to give whole tablets equal to the dose than to cut tablets - ANSWER True Maximum number of tablets or capsule used to deliver a dose is usually 3 - ANSWER True Exceptions exist, such as some HIV meds— always double-check dosags Some measures and units such as mEq and units do not convert to metric - ANSWER True Most common method used for calculating pediatric dosage, also used for adukts - ANSWER True Pediatric and adult medication dosage - ANSWER Drug name, dosage, frequency of administration, the patients weight in kilograms, dosage as listed by the manufacture Body surface area - ANSWER BSA, is a superior to weight-based dosing for specific medication such as anti neoplastic drugs, antibiotics Ex: vincristine, methotrexate, gentamicin For BSA nurses are expected to be able to - ANSWER Define BSA, distinguish among m2, mg, and mcg when reading orders, interpret a monogram, calculate BSA using formulas nomogram - ANSWER Used for measuring BSA How to read nomogram - ANSWER Find patient's height in inches or cm-plot, find weight in lbs or kg-plot, draw a line with a straight edge between the 2 plots, you have found your patient's BSA in square meters BSA formulas metric formula - ANSWER (kg x cm)/3600 Then square root of the answer BSA formulas English formula - ANSWER (lb x in) /3131 then square root the answer Heparin administration - ANSWER Unit/mL Why do patients have IV's? - ANSWER Fluid replacement, electrolyte replacement, vitamins/lipids, medications, used for direct and rapid absorption, continuous infusion, Iv push (bolus), piggy back (diluted in 50-250mL of fluid), PCA pump D - ANSWER Dextrose W - ANSWER Water S - ANSWER Saline NS - ANSWER normal saline (0.9% sodium chloride) 1/2 NS - ANSWER 0.45% sodium chloride RL - ANSWER Ringer's lactate LR - ANSWER Lactated ringer's Pump - ANSWER If less than 100 can leave in 10th, do not need to know drop factor, set rate mL/hr on pump, infuses against resistance, alarm when occluded Gravity - ANSWER Need IV tubing drop factor, set rate gtts/min with roller clamp, not ideal for small veins or antecubital insertion, no alarm.....must visualize, can't get half drop D5W - ANSWER 5% dextrose in water D5NS - ANSWER dextrose 5% in normal saline Drop factor - ANSWER Number of drops per mL is printed on the package, macrodrip, microdrip, KVO, TVO Macrodrip - ANSWER Large drops (10-20 grr/mL) Microdrip - ANSWER Small drops (60 gtt/mL) Buretrok-used for pediatric clients KVO (keep vein open) or TVO (to keep open) - ANSWER Slow rate to keep a line open (10-30 mL/hr) IV with piggyback (IVPB) intermittent IV therapy - ANSWER Small amounts (50-250mL) Usually infuse over 15 min to 1 hr Secondary set tubing Formulas for calculating daily fluid requirements (DFR)/maintenance fluid: 0-10kg - ANSWER 100mL/kg/day Formulas for calculating daily fluid requirements (DFR)/maintenance fluid: 11-20kg - ANSWER 1000 mL/day (for first 10 kg) + 50 mL/kg/day (for each kg between 10 and 20) Formulas for calculating daily fluid requirements (DFR)/maintenance fluid: more than 20kg - ANSWER 1500 mL/ (for first 20 kg) + 20mL/kg/day (for each kg over 20 kg) Formulas for calculating daily fluid requirements (DFR)/maintenance fluid: per day - ANSWER mL/day Formulas for calculating daily fluid requirements (DFR)/maintenance fluid: per hour - ANSWER mL/hr Lasix 10mg PO three times a day is ordered. Available is Lasix 15mg/mL. The child weighs 18lbs 4 oz. The SDR is 1 to 2 mg/kg every 6 to 8 hours not to exceed 6mg/kg/day. What are you going to administer? - ANSWER 0.7mL A physician ordered 500mg of liquid medication that was available as 250mg/0.5ml, how many ml will be administered? - ANSWER 1 mL A nurse is preparing to administer fluoxetine 30 mg PO daily. The amount available is fluoxetine 10 mg/ tablet. How many tablets should the nurse administer per dose? - ANSWER 3 tablets A nurse is preparing to administer clonidine 0.2 mg PO. The amount available is clonidine 0.1 mg/tablet. How many tablets should the nurse administer? - ANSWER 2 tablets 27mg =?mcg - ANSWER 27,000 mcg 6tsp=? mL - ANSWER 30 mL The doctor writes an order for a liquid oral medication. The order says to administer 15 mg by mouth every 4 hours as needed for sore throat. Pharmacy dispenses you with 30 mg/3ml. How many mi will you administer per dose? - ANSWER 1.5 mL The doctor writes an order a liquid oral medication. The order says to administer 20 grams by mouth BID. Pharmacy dispenses you with 10 gram/15 ml. How many mL will you administer per dose? - ANSWER 30 mL The doctor writes an order for a medication. The order says to administer 12.5 mg PO BID. Pharmacy dispenses you with 6.25 mg tablets. How many tablets do you administer with this dose? - ANSWER 2 tablets The doctor writes an order for a medication. The order says to administer 0.1 gram by mouth daily. Pharmacy dispenses you with 100 mg per tablet. How many tablets will you administer per dose? - ANSWER 1 tablet The doctor orders an IV bolus. The order says to administer IV now 12.5 mg. You are supplied with a via that is labeled 50mg/ml. How many ml will you draw up and administer per dose? - ANSWER 0.25 mL The doctor writes an order for an IV bolus. The order says to administer 20 mg IV BID. You're supplied with a vial that is labeled 40mg/ml. How many mi will the patient receive DAILY (NOT per dose)? - ANSWER 1 mL/day The doctor writes an order to infuse a solution. The order reads: "Infuse 1500 mL over 12 hours". The drip factor is 15 gtt/mL. How many drops per minute (gtts/min) will be administered? - ANSWER 31 gtt/min The doctor writes an order to infuse a solution. The order reads: "Infuse 650 mL over 6 hours. The drip factor is 10 gtt/mL. How many drops per minute (gtts/min) will be administered? - ANSWER 18 gtt/min The doctor writes an order to infuse a solution. The order reads: "Infuse 300 mL over 6 hours". What is the hourly rate (mL/hr)? - ANSWER 50 mL/hr The doctor writes an order to infuse a solution. The order reads: "Infuse 2,500 mL over 1 day.". What is the hourly rate (mL/hr)? - ANSWER 104 mL/hr The doctor writes an order to infuse a solution. The order reads: "Infuse 2 L at 150 mL/hr". How long will it take for the infusion to complete? - ANSWER 13 hrs 20 mins The doctor writes an order to infuse a solution. The order reads: "Infuse 500 mL bag at 20 gtt/min". The drip factor is 10 gtt/mL. You start the IV infusion at 0500. At what time will the infusion be complete? - ANSWER 0910 The doctor orders an IV weight-based medication to be infused at 4 mcg/kg/min. The patient weighs 198 lbs. You are supplied with a bag of the IV medication that reads 250mg/250 ml. How many mL/hr will you administer? - ANSWER 21.6 mL/hr The doctor orders an IV weight-based medication to be infused at 12 mg/kg. The patient weighs 115 lbs. You are supplied with a bag of the IV medication that reads 100 mg/2mL. How many mL/hr will you administer? - ANSWER 12.5 mL/hr The doctor orders your patient to start an IV Heparin drip at 16 units/kg/hr and to administer a loading bolus dose of 60 units/kg IV before initiation of the drip. You're supplied with a Heparin bag that reads 12,500 units/250 mL. The patient weighs 198 lbs. What is the flow rate you will set the IV pump (mL/hr)? - ANSWER 28.8 mL/hr Ampicillin suspension 200mg PO every 6 hours is ordered. What's available is Ampicillin suspension 125mg/5mL. The child weights 30lbs. the SDR is 25 to 50mg/kg/day equally divided every 6 hours. How much would you administer? - ANSWER 8mL Morphine 2mg subcutaneous every 6 hours is ordered. Available is Morphine 1 mg/mL for subcutaneous injection. The Child weighs 46lbs. The SDR is 0.1 to 0.2 mg/kg/day in 4 divided doses. How much are you going to administer? - ANSWER 2mL Benedryl 100mg is ordered. Available is Benedryl 12.5mg/5mL. How much are you going to administer? - ANSWER 40mL Mysoline 100mg every 8 hours is ordered, available is Mysoline suspension 250mg/5mL. The child weighs 28kg. The SDR is 10-25mg/kg. How much are you going to administer? - ANSWER 2mL A nurse receives a prescription to administer olanzapine 2.5 mg IM to an older adult client who has bipolar disorder. Available is olanzapine 5 mg/mL reconstituted solution for injection. How many milliliters should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) - ANSWER 0.5 mL Diazepam 4mg is ordered. The drug on hand is Diazepam 5mg/mL. Calculate the correct dose in mL. - ANSWER 0.8mL Erythromycin 250mg oral suspension every 6 hours is ordered. Available is Erythromycin 200mg/5mL suspension. The child weighs 84 Ibs. the SDR is 30-50mg/kg. How much are you going to administer? - ANSWER 6.25 mL Synthroid 150mcg IV is ordered daily. After reconstituting the vial contains a total of 5mL and there is 100mcg/mL. How much are you going to administer? - ANSWER 1.5mL Diuril 1500mg is ordered. Available is Diuril 500mg/1 tablet. How much are you going to administer? - ANSWER 3 tablets A nurse is administering a powdered medication to a client. Which of the following actions should the nurse take first? •Mix the medication at the client's bedside. • Determine the client's response to the medication. • Document that the medication was administered. • Check the client for allergies. - ANSWER Check the client for allergies. Clindimycin 0.2g IV is ordered. Available is Clindimycin 150mg/mL. How much are you going to administer? - ANSWER 1.3mL Ceftazidime 1 gram IV every 8 hours is ordered. After reconstitution the vial contains 100mg/mL. How much are you going to administer? - ANSWER 10mL Rights of Medication Administration - ANSWER Right patient, right medication, right dose, right route, right time, right documentation, right assessment, right to refuse, right to education 6 rights to medication administration - ANSWER Right patient, right medication, right dose, right route, right time, right documentation medication error - ANSWER Failure to follow 6 rights, inaccurate transcribing, lack of knowledge about medication, calculation errors, lack of patient assessment, documenting errors, look alike/sound alike meds, abbreviations, incomplete delivery of drugs Nurse's role in error prevention - ANSWER Communication, education, reporting of errors Intervenous - ANSWER IV Intramuscular - ANSWER into the muscle Subcutaneous - ANSWER under the skin topical - ANSWER applied to the surface of the skin Routes of delivery - ANSWER Intravenous, subcutaneous, tropical, inhalation, oral, rectal, sublingual, transdermal, enteric, buccal, parenteral, insertion, intranasal ISMP - ANSWER Institute for Safe Medication Practices TJC - ANSWER The Joint Commission Sublingual - ANSWER under the tongue Inhalation - ANSWER breathing in oral - ANSWER Given through the mouth rectal - ANSWER through the anus, in the rectum intrathecal - ANSWER injection into the meningeal space surrounding the brain and spinal cord transdermal - ANSWER Adhesive patch to the skin Most common medication administration - ANSWER Oral oral advantages - ANSWER Cheaper, nonsteriol, easy access, easy to administer, convenient oral disadvantages - ANSWER takes time to kick in, pts that can't swallow can't take it, horrible taste sometimes, takes time (30-60 mins), Oral types - ANSWER Tablets, capsules, suspensions, dissolvable, liquid Measuring cups - ANSWER 1 tsp= 5 mL, measure at meniscus Measuring Syringe - ANSWER Less thank 5 mL Organizations - ANSWER Institute for safe medication practices (ISMP), the joint commission (TJC), us food and drug administration (FDA), quality and safety education for nurses (QSEN), the health and medicine division of the national academies of science,engineering, and medicine (HMD formally known as IOM) Institute for Safe Medication Practices (ISMP) - ANSWER An organization devoted to safe medication practices and the prevention of errors The joint commission (TJC) - ANSWER Come to hospitals to check them out, make sure healthcare is safe for public and tell facilities what they are doing wrong, they can find facilities, can shut down Quality and Safety Education for Nurses (QSEN) - ANSWER Drug/foods/medical devices are safe and secure, radiation, medical equipment, medication The health and medicine division of the national academics of science, engineering, and medicine (HMD formally known as IOM) - ANSWER Research on anything medical Medication Order Components - ANSWER The patient's full name, date of the order, name of medication, dosage medication, route of administration, time and frequency of administration, signature Base units in metric system - ANSWER Weight- gram, volume- liter, length- meter kilo - ANSWER 1000 centi - ANSWER 0.01 milli - ANSWER 0.001 Micro - ANSWER 0.000001 Kilogram - ANSWER kg Gram - ANSWER g or gm Microgram - ANSWER mcg miligram - ANSWER mg cubic centimeter - ANSWER cc Meter - ANSWER m Liter - ANSWER L Centimeter - ANSWER cm Milliliter - ANSWER mL millimeter - ANSWER mm kg to g - ANSWER 1 kg = 1000 g gram to milligram - ANSWER 1 g = 1000 mg Milligram to microgram - ANSWER 1 mg = 1000 mcg liter to milliliter - ANSWER 1 L = 1000 mL milliliter to cubic centimeter - ANSWER 1mL to 1cc meter to centimeter to millimeter - ANSWER 1m= 100cm= 1000mm Centimeter to millimeter - ANSWER 1 cm = 10 mm conversion within the metric system- change from LARGER to SMALLER unit - ANSWER multiply by 1000 or move 3 decimal places to the right, kggmmgmcg conversion within the metric system- change from SMALLER to LARGER unit - ANSWER Multiply by 1000 or move 3 decimal places to the left, kggmmgmcg Weight - ANSWER kggmmgmcg Volume - ANSWER LmL length - ANSWER Meter, centimeter, millimeter I= - ANSWER 1 V= - ANSWER 5 X= - ANSWER 10 Grain - ANSWER gr, 60mg or 65mg ASA ASA gr x - ANSWER 650mg Coding gr ss - ANSWER 30mg Phenobarbitals gr 1/4 - ANSWER 15mg Nitroglycerin gr 1/150 - ANSWER 0.4mg Quart - ANSWER qt Quart to pint - ANSWER 1 qt = 2 pt Quart to ounces - ANSWER 1 qt = 32 oz pint - ANSWER pt pint to ounces - ANSWER 1 pt = 16 oz pint to cups - ANSWER 1 pt = 2 cups Ounce - ANSWER oz ounce - ANSWER 1 oz Drop - ANSWER gtt teaspoon - ANSWER tsp, 5 mL tablespoon - ANSWER Tbs or T tablespoon to teaspoon - ANSWER 1 tbsp = 3 tsp Tablespoon to milliliter - ANSWER 1 tbsp = 15 mL Tablespoon to ounces - ANSWER 1T = 0.5oz Ounces to milliliters - ANSWER 1 oz = 30 mL Ounces to teaspoons - ANSWER 1oz = 6t liter to quart - ANSWER 1L = 1qt liter to pint - ANSWER 1L = 2pt Liter to ounces - ANSWER 1L = 32oz Liter to cups - ANSWER 1L = 4 cups Pint to milliliter - ANSWER 1pt = 500 mL Pint to ounces - ANSWER 1pt = 16 ounces Pint to cups - ANSWER 1 pt = 2 cups cups to milliliters - ANSWER 1 cup = 250mL Kilogram to pounds - ANSWER 1kg = 2.2lbs Pound to ounces - ANSWER 1lbs = 16 oz Six Rights of Medication Administration: - ANSWER Right Patient RIght Drug Right Dose/Amount Right Route Right Time Right Documentation Check the Six Rights at 3 Different Points During Med Administration: - ANSWER 1. Check meds against MAR before/during administration and also check for med allergies 2. Check meds AFTER preparation 3. Check meds at the bedside: also check blood pressure and/or pulse or blood sugars if needed BEFORE giving meds that affect the BP, pulse, or blood sugars. AND always check allergy band. ***You will check patient name and DOB as well as check MR # on armband against MAR before giving meds at bedside as well*** Oral meds come in 3 forms: - ANSWER 1. tablets 2. capsules 3. liquids tabs and capsules are supplied in - ANSWER strengths or dosages in which they are commonly prescribed only _________ tabs are intended to be divided - ANSWER scored _____ tabs cannot be crushed - ANSWER enteric-coated _____ capsules cannot be opened and mixed with food or fluid - ANSWER sustained-release Never use sustained-release or enteric-coated oral medications in a..... - ANSWER Nasogastric/NG or G-tube! it is safest & most accurate to give the ______ number of whole, undivided tabs possible - ANSWER fewest Three step approach: - ANSWER 1. convert 2. think 3. calculate Convert: - ANSWER - all units of measurement must be in same system and all units must be in same size -if not, convert before proceeding Think: - ANSWER estimate reasonable amount of drug to administer Calculate: - ANSWER dosage on hand = dosage desired amount on hand = X amount desired If dosage is not in same size unit of measurement - ANSWER convert to same system or same size units dosages for oral liquids: - ANSWER calculated in mL question giving more than ___ tabs or capsules per dose - ANSWER 3 route of administration other than gi - ANSWER 1. intramuscular (IM) 2. subcutaneous (SC) 3. intradermal (ID) 4. IV Subcutaneous Injections - ANSWER Injected into fatty tissue Angle of injection= 45 degrees, depending on patient size Areas appropriate for injection= abdomen, fatty back part of upper arm, some fatty tissue in lumbar area, fatty tissue on thighs Needle Length: 3/8th to 5/8th inches Needle Gauge: 25-27 gauge typically 1 mL syringe! Subcutaneous (SC) Injections - ANSWER Intradermal Injections: - ANSWER Usually used for TB skin tests and allergy tests Injected into the dermal layer, under epidermis Use tuberculin or 1 mL syringe Angle of injection= 10-15 degress 1mL syringe Needle is typically 25-27 guage 1/4 to 5/8 inches in length Intradermal (ID) Injections - ANSWER Intramuscular (IM) - ANSWER -Absorbed more rapidly than subcutaneous or intradermal injections -Typical volume to inject ranges from 0.5ml-3ml, depending on site and age and size of person -More than 3 ml is typically divided -Angle of injection: 90 degrees, depends on individual -ASPIRATE Intramuscular (IM) Injections - ANSWER Needle gauge: 19-24 gauge Needle length: 1-2 inches Typical: 22 gauge, 1 ½ length needle Sites for administration: deltoid muscle (up to 1ml), vastus lateralis muscle, dorsogluteal and ventrogluteal muscle most meds prepared in liquid form and packaged in: - ANSWER 1. dosage vials es 3. prefilled syringes injectable drugs measured in: - ANSWER syringes IM max dosage for 150lb adult - ANSWER 3mL IM max for deltoid site - ANSWER 1mL IM max dosage for children age 6-12 - ANSWER 2mL IM max dosage for children birth to age 5 - ANSWER 1mL Parenteral dosages you round amount to: - ANSWER be administered to tenths if amount greater than 1mL in a 3mL syringe Parenteral dosages measures less than 1mL you round to - ANSWER hundreths if less than 0.5mL you measure in a - ANSWER 1mL syringe amounts of 0.5 mL to 1mL calculate in tenths and measured in - ANSWER 1mL or 3mL syringe standard doeses more than 1mL you would: - ANSWER round to tenths and measure in 3mL syringe 3mL syringe would be calibrated to - ANSWER 0.1 mL increments small (less than 1mL) critical care or childrens doses - ANSWER round in hundreths and measure in 1 mL syringe 1 mL syringe calibrated in - ANSWER 0.01 mL increments (0.257 to 0.26) amounts of 0.5 to 1mL calculated in - ANSWER tenths high alert parenteral meds - ANSWER drugs that bear a heightened risk of causing significant pt harm when they are used in error EX: heparin and insulin insulin supply dosage is - ANSWER 100 units per mL abbreviated on label as U-100 insulin also available as - ANSWER 500 units per mL (U-500) insulin available as 500 units per mL are only used in - ANSWER special circumstances and with extreme caution accidental overdose of insulin may result in - ANSWER irreversible insulin shock or death U-500 insulin syringes - ANSWER are not available you have to use a 1 mL syringe insulin analog - ANSWER is the newest type of insulin that has been chemically modified to act faster or slower than the type of insulin naturally made in the body most people with type 1 diabetes should - ANSWER use insulin analogs to reduce hypoglycemia risk Types of Insulin: - ANSWER -Rapid-acting: Lispro, begins working in 15 minutes -Short-acting: Regular insulin, begins working in 30 minutes -Intermediate-acting: NPH, begin working in 2-3 hours and lasts 14-24 hours -Long-Acting: Glargine, begin working 2-4 hours, and last 24 hours Insulin Onset and Peak - ANSWER rapid acting insulin onset - ANSWER 5-15 min rapid acting insulin peak - ANSWER 45-75 min rapid acting insulin duration - ANSWER 2-4 hours short acting (regular) insulin onset - ANSWER 30 min short acting insulin peak - ANSWER 2-4 hours short acting insulin duration - ANSWER 5-8 hours intermediate acting (NPH) insulin onset - ANSWER 2 hours intermediate acting (NPH) insulin peak - ANSWER 6-10 hours intermediate acting (NPH) insulin duration - ANSWER 18-24 hours long acting insulin onset - ANSWER 2 hours long acting insulin peak - ANSWER none long acting insulin duration - ANSWER up to 24 hours Two type of premixed combination insulin are: - ANSWER short acting (regular) & Intermediate acting (NPH) Guidelines to Administer Insulin: - ANSWER -Insulin is a High-Alert Medication: 2 licensed nurses check -Insulin is measured in units (strength is more accurately determined than weight) -Units are used to measure dosages in drugs that are made from animal or plant products -Do not use the abbreviation "U". Spell out the word "units" when writing an insulin order. Guidlines to Administer Insulin: - ANSWER -In hospitalized patients with diabetes, blood glucose levels are usually checked 30 minutes before meals and at bedtime. Additional insulin is administered according to the blood glucose level. -Always use an insulin syringe to administer insulin -Insulin is given subcutaneously. -Regular insulin is clear and odorless; can be given IV order must include - ANSWER brand name, generic name, action time, supply dosage (concentration), number of units, route, and time frequency purpose of insulin sliding scale - ANSWER to cover or correct elevation in pt's blood glucose level insulin sliding scale order: - ANSWER humulin R U-100 insulin SC based on glucose reading at 1600 insulin dose: no coverage - ANSWER glucose reading less than 160 insulin dose of 2 units - ANSWER 160-220 insulin dose of 4 units - ANSWER 221-280 insulin dose of 6 units - ANSWER 281-340 insulin dose of 8 units - ANSWER 341-400 use U-100 insulin syrings to ONLY measure - ANSWER U-100 insulin measure U-500 insulin in - ANSWER 1mL syringe how many nurses must check insulin dosage before administration to pt - ANSWER 2 what kind of insulins cannot be mixed in syringe with another insulin? (LIFE THREATHENING) - ANSWER long-acting insulins Clear to cloudy rule - ANSWER draw up clear insulin (regular) first then draw up cloudy (NPH) insulin what do you do to cloudy insulin before mixing? - ANSWER roll it in hands First step of combining two insulins: - ANSWER Draw back and inject 40 units of air into NPH insulin vial -Withdraw needle Second step of combining two insulins: - ANSWER Draw back and inject 12 units of air into regular insulin vial -Leave needle in vial Third step of combining two insulins: - ANSWER Turn vial of U-100 regular insulin upside down and draw out insulin to 12-unit mark