MATH FOR NURSES 9TH EDITION :A GUIDE TO DOSAGE CALCULATION AND DRUG PREPARATION

MATH FOR NURSES 9TH EDITION :A GUIDE TO DOSAGE CALCULATION AND DRUG PREPARATION Math-for-Nurses 9 Math for Nurses A POCKET GUIDE TO DOSAGE CALCULATION AND DRUG PREPARATION EDITION 9 Mary Jo Boyer, RN, PhD Vice Provost and Vice President Branch Campus Operations Adjunct Nursing Faculty Former Dean and Professor of Nursing Delaware County Community College Media, Pennsylvania 9th edition protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at 2001 Market Street, Philadelphia, PA 19103, via email at , or via our website at (products and services). This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accu- racy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals' examination of each patient and consideration of, among other things, age, weight, gender, cur- rent or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a refer- ence tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diag- noses, indications, appropriate pharmaceutical selections and dos- ages, and treatment options should be made and healthcare profes- sionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com Contributors Math for Nurses was first published in 1987. At that time I was a professor of nursing at Delaware County Community College. Brian was 7 years old, and Susan was 12 months old. This is now the ninth edition. I’ve dedicated previous books to my students, professional colleagues, friends, and family. However, over the years, it is my family who has continued to energize, support, and encourage my academic and creative interests. So, for this edition, I salute, honor, and thank my family again for always being there. Ermelina: my mother, who at 95, cherishes her role of family matriarch. Susan: my daughter who works in the finance world for the government in Washington, D.C. and is also a new mom to baby Charlotte. Brian: my son, an adjunct college mathematics instructor, who works full time in business and industry. Kristen: my daughter-in-law, who works in budget and man- agement for a school system while pursuing a master’s degree. Nickolas: my son-in-law, who also works for the govern- ment in Washington, D.C. Sadie and Charlotte: my two beautiful granddaughters, who enrich the family beyond measure. Bill: my husband and partner since 1974 Thanks, Guys! iv Dedication Brian D. Boyer, BA, MED Adjunct Mathematics Instructor Delaware County Community College Media, Pennsylvania Elaine Dreisbaugh, RN, MSN, CPN Associate Professor of Nursing Delaware County Community College Media, Pennsylvania Former Nurse Educator, The Chester County Hospital West Chester, Pennsylvania Kathleen C. Jones, RN, MSN, CDE Certified Diabetic Nurse Educator The Outpatient Diabetes Program The Chester County Hospital West Chester, Pennsylvania Maria Kalinowski, RN, PCCN, PhD (c) Assistant Professor of Nursing Delaware County Community College Media, Pennsylvania Joanne O’Brian, RN, MSN Associate Professor of Nursing Delaware County Community College Media, Pennsylvania Nurse Educator, The Chester County Hospital West Chester, Pennsylvania v Judith Young Bradford, DNS, MSN, BSN, FAEN, RN Associate Professor Southeastern Louisiana University School of Nursing Hammond, Louisiana Ken Bullwinkle, MSN Clinical Professor of Nursing Widener University Chester, Pennsylvania William T. Campbell, EdD, RN Associate Professor of Nursing Salisbury University Salisbury, Maryland Pamela Fess, MS, CCRN Associate Dean of Nursing and Allied Health Mohawk Valley Community College Utica, New York Kathleen Fraley, MSN, BSN, ADN, RN Professor of Nursing St. Clair County Community College Port Huron, Michigan Sandra P. Kearns, MSN, RN Associate Professor Ocean County College Toms River, New Jersey Kathleen N. Krov, PhD, CNM, RN, CNE Associate Professor Raritan Valley Community College Somerville, New Jersey Reviewers Coleen Kumar, MSN, RN Clinical Associate Professor and Director Accelerated BS Program SUNY Downstate Medical Center Brooklyn, New York Lori-Ann Sarmiento, MSN Associate Degree Nursing Coordinator Guilford Technical Community College Jamestown, North Carolina Lynette Scianna-DeBellis, MA, RN Assistant Professor of Nursing Chairperson, Department of Nursing Westchester Community College Valhalla, New York Ann-Marie Urban, PhD, RPN, RN Assistant Professor Faculty of Nursing, University of Regina Regina, Saskatchewan, Canada Polly Gerber Zimmermann, MBA, MS, RN, CEN, FAEN Associate Professor Harry S Truman College Chicago, Illinois vi Preface The idea for this compact, pocket-sized book about dosage calculation was generated by my students. For sev- eral years I watched as they took their math-related handouts and photocopied them, reducing them to a size that would fit into the pockets of their uniforms or laboratory coats. This “pocket” reference material was readily accessible when a math calculation was needed to administer a drug. Each year the number of papers that were copied increased as each group of students passed on their ideas to the next group. I also noted that staff nurses were using this readily available and compact information as a reference for math problems. When a student asked, “Why not put together for us all the information that we need?” I thought, “Why not?” The idea was born, the commitment made, and 18 months later the first edition of Math for Nurses was published in 1987. It is my hope that it will continue, in this ninth edition, to be helpful to all who need a quick reference source when strug- gling with dosage calculations and drug preparation. How to Use This Book This book is designed for two purposes: • To help you learn how to quickly and accurately calculate drug dosages and administer medications. • To serve as a quick reference when reinforcement of learn- ing is required. The best way to use this pocket guide is to: • Read the rules and examples. • Follow the steps for solving the problems. • Work the practice problems. • Write down your answers and notes in the margin so that you have a quick reference when you need to review. Organization This pocket guide is divided into three units to facilitate quick access to specific information needed to administer vii viii Preface drugs. The preassessment test should be completed before beginning. Unit 1 presents a review of basic math. Chapters 2 and 3 cover common fractions and decimals. Chapter 4 shows how to set up a ratio and proportion and solve for x, using a colon or fraction format. Drug-related word problems are used as contemporary examples. This unit information is essential, forming a foundation for understanding the complex dosage calculations presented in Unit 3. Unit 2 explains measurement systems. The metric system, the apothecary system, and household units of measurement are given in Chapter 5. Emphasis on the apothecary system has been limited because of the need to minimize use of the system. Chapter 6 presents approxi- mate system equivalents and shows how to convert from one unit of measurement to another. Some of these system equivalents are duplicated on the insert card, to provide quick and easy access when calculating drug dosage prob- lems. Unit 3, Dosage Calculations, is the most comprehen- sive and detailed section of this pocket guide. The unit begins with a detailed description of how to read and inter- pret medication labels in Chapter 7. Sample dosage ques- tions specific to a drug label are used as examples. Chapters 8 and 9 cover oral and parenteral dosage calcula- tions. Ratio and proportion and the Formula Method are used for every problem. Dimensional analysis, presented in detail in Chapter 8, is also incorporated into every drug calculation. The intravenous therapy content has been expanded in Chapter 10. Critical care applications have also been expanded in Chapter 11. The last four chapters incor- porate intravenous insulin (Chapter 12), weight-based hepa- rin (Chapter 13), intravenous (IV) push medications for children (Chapter 14), and expanded examples of drug reconstitution (Chapter 15). Throughout this unit, problem- solving methodology is presented in a simple, easy-to-fol- low manner. A step-by-step approach is used, which will guide the reader through each set of examples. Enrichment information can be found in the appendices.