2Review 1 teaspoon = 5 mL / cc 1 tablespoon = 15 mL / cc 1 ounce = 30 mL /ccRemember the clock! grains to grams to milligrams.How to calculate medication dose using ration / proportion.16 oz = 1 pound (body weight)
3IV Fluid Calculation Adult (Review) Step # 1Total number of milliliters ordered = ml / hrnumber of hours to runStep # 2Milliliters per hour x tubing drip factor = gtt/minMinutes
4Pounds to Kilograms Pounds to kilograms = pounds 2.2 In pediatrics you need to carry out to the hundredths (do not round especially in the infant or small child)
5Kilogram Example 20 pounds 5 ounces First need to convert 5 ounces to a fraction of a pound 5 divided by 16 = 0.3120.31 pounds divided by 2.2 = 9.23 kilogramsNotes medication would be calculated based on 9.23 kilograms. DO NOT ROUND to 9.2
6New Calculations Mg / kg dosing based on weight (kg) Safe dosing rangesIV pediatric infusion ratesIV administration of meds per volutrol or syringe pump.24 hour fluid calculation
7Calculations of pounds to kilograms If a child weighs 84 lbs, what is the weight in kg?84lb : x kg84 divided by 2.2 = kgIf a child weights 6 lbs 6 ounces what is the weight in kg?6 ounces = 0.37 pounds16 ounces6.37 pounds divided by 2.89 = kg
8Medication dosageFor a dosage of medication to be safe, it must fall within the safe range as listed in a Drug Handbook, PDR or other reliable drug reference.
9Dosage based on mg/kg and Body Surface Area The dose of most pediatrics drugs is based on mg/kg body weight or Body Surface Area (BSA) in meters squared.For testing purposed mg / kg will be used.BSA method of calculations may be seen in NICU, ICU and high acuity areas.
10Safe Medication Dose Calculate daily dose ordered (Physician orders) Calculate the low and high parameters of safe range (from drug book)Compare the patient’s daily dose to the safe range to see if it falls within the safe zone.
11CalculationA child is 2 years and weighs 36 lbs is receiving Amoxicillin 215 mg po tid for a bilateral otitis media (ear infection).Patient weight in kg = kgDavis drug guide: PO (children) < 40 kg: 6.7 to 13.3 mg / kg q 8 hours.(low range)16.36 x 6.7 = mg q 8hours(high range)16.36 x 13.3 = mg q 8 hoursSafe range: to mg of Amoxicillin Q 8 hours.Is the dose safe? Yes, it falls within the safe range.
12How much medication do you give? Physician order Amoxicillin 215 mg every 8 hours.Suspension comes 250 mg per 5 ml.250 mg 215 mg5 ml = x ml1075250xGive 4.3 mL / cc po every 8 hours
13Safe Dose Ranges Read the medication ranges carefully dose range for 24 hoursdose range for q 8 hoursdose range for q 12 hours
14Fluid Control Crucial in the pediatric population Units often have policies that children under a certain age are on a fluid control pump.
15Key concepts Fluid overload must be avoided Time over which a medication should be administered is critical informationMinimal dilution (end concentration of medication) is important for medications such as aminoglycosides.Collecting therapeutic blood levels
16Fluid overload Know what the IV rate is. Hourly recording of IV fluid intake.Don’t try and catch up on fluids.Calculate fluids used to administer IV medications into the hourly fluid calculations.
17Daily Fluid NeedsFluid needs should be calculated on every patient to assure that the infant / child is receiving the correct amount of fluids.Standard formula for pediatrics needs to be memorized.
18IV fluid calculationsThe maintenance dose for administration of IV fluids is based on the following formula:100 ml of fluid for the 1st 10 kg of weight50 ml of fluid for the 2nd 10 kg of weight20 ml of fluid for and additional kgYou need to memorize this
19Practice problem Jose weighs 16 pounds Weight in kg = 7.27 kg Using the formula provided how many mls of fluid would he need in 24 hours.
20Fluid Calculation 7.27 kilograms 100 mL x 7.27 kg = 727 mL 727 mL / 24 hours or mL per hour
21Fluid Calculation 64 pound child Convert pounds to kilograms = kgFluid calculations:100 mL x 10 kg = 1000 mL50 ml x 10 kg = mL20 ml x 9.09 kg = 181 mL1681 mL / 24 hours or mL / hour
22Fluid CalculationsFluid calculations can be rounded. You cannot administer a fraction of a mL.In child #1 the calculated hourly rate of 29.7 would be rounded to 30 mL / hour.In child #2 the calculated hourly rate of would be rounded to 70 mL / hour.
23Fluid CalculationsSince children are in the hospital for various illnesses they will often have increased fluid needs: dehydration, fever, vomiting, diarrhea, inability to take po fluids.24 hour fluid calculations may be 1 ½ to 2 times maintenance.
24Fluid CalculationsChild number #1 maintenance fluid needs are 713 mL / 24 hours.1 ½ time maintenance would be 713 x 1 ½ = 1069 mL / 24 hours or 45 mL / hour.
25Fluid CalculationIn child # 2 maintenance fluid needs are 1681 mL / 24 hours.1 ½ times maintenance would be 1681 x 1 ½ = 2522 mL / 24 hours or 105 mL / hour.
26IV bolusA 6 year old with dehydration is admitted to your unit. The referring hospital has an adult IV set-up. (drip factor of 15 gtt/ml) The physician order is to infuse 90 mL of normal saline over 1 hour. At what rate will you set the IV rate?(90 ml x 15 gtts) divided by 60 minutesHourly rate would be 23 gtts/minute
28IV BuretrolA buretrol or volutrol is an inline receptacle between the client’s IV catheter set and the bag of fluids.Capacity is 120 to 150 mLRationale: the nurse can fill the buretrol to a certain level and if the IV pump malfunctions, only the volume in the buretrol will flow to the client.
30Parenteral Pediatric Medications Step 1: Convert lb to kgStep 2: Determine the safe range in mg/kgStep 3: Decide whether the dose is safe by comparing the order with safe dose rangeStep 4. Calculate the dose neededStep 5. Check reference for diluent and duration for administration.
31Example #1 Child: 5 years: weight 44 lbs Order: famotidine (Pepcid) 5 mg IV bidDrug guide: 0.25 mg / kg q 12 hr IV up to 40 mg/day.
32Example #1 Convert pounds to kg: 44 lb = 20 kg Determine safe dose: 20 kg x 0.25 mg = 5 mg5 mg is safe it meets mg / kg rule and does notexceed 40 mg/day.5 mg bid = total of 10 mg/day
33Example #1 Calculate the dose Pepcid is provided as 10 mg/mL 10 mg = 5 mg1 mL x mL5 =10x mL of Pepcid
34Example #1Drug guide: dilute with 5 or 10 mL and infuse over 2 minutes.The medication would be injected directly into the tubing of actively running IV; inject slowly over 1 to 2 minutes.
35Example #2 Child: 4 years: weight 17 kg Physician order: Fortaz (Ceftazidime) 280 mg IV q 8 hoursDrug guide:Safe dose 30 to 50 mg/kg/day50 mg/mL over 30 minutesDrug supplied as 1 gram powder. Directions: Dilute with 10 mL of sterile water to equal 95 mg/mL.
36Example #2 Safe dose is 30 to 50 mg/kg/day Low range: 17 kg x 30 mg = 510 mg/dayHigh range: 17 kg x 50 mg = 859 mg/daySafe range is 510 to 859 mg/day or 170 to 286 per dose.If the order is to give the drug q 8 hours you would need to divide the safe range by 3 or multiple the q 8 hour dose x 3.
37Example #2 Drawing up the medication: 1 gram / 10 mL or 95 mg / 1 mL 95 mg = 280 mg1 mL x mL x = 2.94 mL
38Example # 2 Adding medication to the volutrol Take the 2.94 mL of Ceftazidine – inject it into the port on the volutrol and add additional IV fluid to = 10 mL.
39Example # 2The flush: evidence based practice has demonstrated that in an effort to get the IV medication from the volutrol to the patient the line needs to be flushed with 20 mL of IV fluid after the medication is into the IV line.
40What about the flush?THE PHYSICIAN ORDER WILL NEVER STATE TO FLUSH THE LINE – YOU MUST DO THIS WITH EACH IV MEDICATION
41Example #2The drug guide states that the drug can be safely administer over 30 minutes.Formula:10 mL (medication) + 20 mL flush following the medication = 30 mL of fluid that needs to infuse over 30 minutes.The pump would need to be set at 60 mL for the medication + the flush to be infused over ½ hour.
42NG – cc/cc replacementIn and infant or child has a nasogastric tube in that is draining fluid the physician will often write and order for:NG drainage – cc/cc replacementWhat does this mean?
43Nasogastric Output NG output is measures q 4 hours. At the beginning of the shift the night nurse reports that the drainage was 150 cc’s for the last 4 hours and you need to replace this over the next four hours.Note: this is in addition to the IV hourly rate ordered.
44Sample problem IV hourly rate is 115 mL/hour NG output to be replaced over the next 4 hours is 150 cc’s or 37 mL/hour.You IV would be set at 115 mL + 37 mL = 152 mL / hour for the next four hours.
45Practice Problems Do the practice problems. Can be done individually or in groups.Testing will be on like problems.You must achieve 80% or better to be able to safely administer medications in the clinical setting.
46NG Fluid Replacement Order to replace NG suction loss Often written by MD to readReplace cc / cc NG output every 4 hours
47Practice ProblemAt 0700 report the NG output for the last 4 hours is 120 mL.Divide 120 mL by 4 (hours) = 30 mLAdd the 30 mL to the hourly IV rateExample: IV rate is 120 mL per hour120 mL + 30 mL = 150 mLRun the IV at 150 mL over the next 4 hours