3Learning ObjectivesUse formulas to determine the dosages of tablets, capsules, or liquidsUse formulas to determine the total number of tablets or capsules or the amount of liquid to be ordered for a specified timeUse information about the apothecaries', metric, and household measurements systems to accurately calculate drug dosages
4Learning Objectives (cont.) Calculate dosages for parenteral injections, including those for special preparations such as insulinCalculate flow rates for infusions
5Calculating Medication Dosages Three StepsVerify the drug available is the samemeasurement system as the drugdosage desired (convert if needed)2. Reduce to lowest terms3. Calculate dosage quantity to beadministeredWhen the measurement systems of what the physician has ordered and what is available are different, it is more efficient to convert the measurement of what is available to what the physician has ordered.If a physician ordered a mediation in micrograms and the medication comes in milligrams, what measurement do you want to end up with to check for accuracy against the original order?The techniques previously learned, such as simplifying fractions, ratios, and proportions, will all be necessary to safely solve medication problems.
6Drug Calculation Methods Fraction Method600 mg = mgx tablets tabletSolve for xRatios or Proportion Method600 mg : x tablets :: 200 mg : 1 tabletAlthough there are different methods for solving medication calculations, it is important to find a method you are comfortable with and stay with that method.Remember to label the measurement system of the numbers to avoid calculation errors.The fraction and the ratio or proportion methods are solved in a similar way. One is written as a fraction and the other in a ratio format.
7Drug Calculation Methods (cont.) Desired over Available MethodDesired units (conversion factor) xQuantity of drug form = Quantity to giveQuantity available (x conversion factor)The desired over available method combines the conversion of ordered units into available units and the computation of drug dosage into one step.For those of you who are not familiar with the ratio proportion or the fraction method, this method would be helpful in that it combines all steps into one process.Remember, all methods take practice to master.
8Forms of Oral Medications CapsulesCannot be broken or dividedIf amount to be given is more than 0.5, round to next whole numberTabletsOnly divide if scoredCoated tablets are not to be brokenLiquidsMay be measured in a medication cup, syringe, or calibrated dropperCapsules are not scored and therefore cannot be broken or divided.If you’ve calculated 1.75 capsules are to be given, 0.75 is greater than 0.5, so 2 capsules are administered. Drug manufacturers try to provide capsules in varying dosages to facilitate accuracy.Tablets that are highly irritable to the stomach lining are coated. Coated tablets do not dissolve until they enter the small intestine. Dividing a coated tablet destroys the protection against stomach irritation.The process and formulas used to calculate dosages of liquids are the same as those used to calculate dosages of capsules or tablets.
10Parenteral Medications Medication available in three forms:Prefilled syringe labeled with specific dosageFor example: meperidine (Demerol) 100 mg in 1 mLSingle-dose ampule or multiple-dose vial labeled with a specific dosage per volumeFor example: epinephrine (Adrenalin) 1:1000 in 0.1 mLA vial with powder that requires a specific fluid be added to it to obtain a specific dosage (Reconstitution)Regardless of the form of parenteral medication available, the proportion method is the standard method of calculation.It is important to read labels carefully because multidose vials will have the total volume in the vial stated, as well as the dose in a specific amount drawn from the vial. It is easy to confuse these numbers.The process of reconstituting is similar to mixing powdered drinks (such as Kool-Aid) with water.If you add 10 mL to a powdered amount of a drug, will the volume yielded be more, less, or equal to 10 mL? This is an important concept to keep in mind when choosing a syringe that holds the needed volume.
11InsulinA critical medication that replaces the insulin not being produced by the patient’s pancreasInsulin comes in a standardized measure called a “Unit”Smallest amounts may be given; errors are criticalThe “Unit” measurement is specific to insulin. There is no conversion needed for Units into any other system. What other measurement has no conversion? (mEq)In addition to the special measurement system, some forms of insulin come in vials of two different strengths, U-100 and U-500.Syringes calibrated in Units are also used with insulin.
13Insulin (cont.) Strengths Syringe U-100 (100 Units of insulin per 1 mL)U-500 (500 Units of insulin per 1 mL)Preparation 5 times stronger, rarely usedSyringeCalibrated in Units alsoTuberculin syringe used in emergencyMinims used; 16 minims = 1 mLOver the years there were various concentrations of insulin: U-45, U-60, U-250, etc. To prevent errors, manufactures now make only U-100 and U-500. U-500 is used in dialysis and transplant settings when large quantities of insulin are needed.Insulin syringes are marked with the U-100 calibration, which matches the U-100 calibration on the vial. If 1 Unit of U-500 insulin is to be administered, how many Units are drawn up using the U-100 syringe?Tuberculin syringes are used only if no insulin syringes are available or if you are in an emergency situation. It is critical to avoid errors in calculations when using a tuberculin syringe.When using a tuberculin syringe, the number of minims that will equal the number of Units must be calculated. The most accurate conversion is 16 minims = 1 mL.If you are using a tuberculin syringe to draw up 35 Units of insulin, how many minims are drawn up?
16Intravenous Medications Medications administered into the veinIV pushIV hanging by gravity (flow rate formula)IV pump (mL/min or hr)Nurses must be aware of the required procedures and administration guidelines when injecting medications directly into an IV or access device (saline lock, PICC line, etc.)IV infusions not attached to pumps must be regulated manually by the nurse. Drops are “counted.” The flow rate formula is used to determine how many drops equals the desired milliliters of volume per minute.IV pumps regulate or control the volume of fluid going into the patient. Although the drops are not “counted,” the nurse must monitor the accuracy of the pump. Pumps can malfunction. Equipment does not replace the critical thinking required by the nurse.
17Flow Rate Formula Gtts/min = Volume to be administered × gtt factor Time in minutesDrop factor of tubing:Macrodrip = 10, 15, or 20 gtt/mLMicrodrip = 60 gtt/mLWhen using the flow rate formula, you can solve for any variable, as long as the remaining variables are known.The drop factor of the tubing is found on the tubing box. For calculations, it must be stated in the problem.Typically, institutions carry one size of macrodrip tubing.Microdrip, or minidrip, tubing is always 60 gtt/mL. Microdrip tubing is used when the volume of fluid delivered must be closely regulated (e.g., for pediatric or geriatric patients or in the delivery of critical care medications).
19Learning ObjectivesList the rule used to calculate medication dosages for childrenCalculate flow rates for infusions for children
20Clark’s Rule Formula Weight of the child ________________ x Adult dose = Child’s doseWeight of the adultOne of the most popular methods for determining medication dosages for children.Based upon a child’s body weight and the assumption that the average normal adult weighs 150 pounds.Ratio proportions are used in this method.Practice: If the usual adult dose of a medication is 500 mg, what is the dose of medication recommended for a child who weighs 60 pounds?Clark’s rule should be used if no other formula is specified.
21Body Surface Area Body surface area (BSA) = the total tissue area A nomogram is used to easily calculate the BSA in square metersBSA formulaSurface area of the child (M2) × Usual adult doseSurface area of an adult (1.73 M2) = Child’s doseBSA calculations are more accurate, because children have a greater surface area than adults in relation to their weight.Nomogram charts are standardized and must be available to reference.Standardized charts are also found within the nomogram for children of normal height for weight. Standardized charts are inaccurate when used for very young infants.Refer to Figure 9-5. A straight edge is placed from the patient’s height in the left column to the weight in the right column, and the intersection on the BSA column indicates the patient’s BSA. The BSA value is then entered into the above formula.
22Dimensional Analysis Steps Numbers in the dosage calculation problem are placed on a grid along with their labelsThe labels are cross-canceled to assure only one label is left (one for answer)Numbers in calculation are placed along grid next to their labelsProvides a single method to use for all kinds of drug problems (even those with two to three steps).This method provides a visual guide used to construct a problem in an orderly, stepwise fashion.This method reduces the chance of incorrect placement or inversion of drug calculation factors and is especially helpful for complex problems or those that call for unit conversions.
23Dimensional Analysis (cont.) Numbers are cross-canceledNumbers are multiplied across the top and bottom of the grid to yield a fractionThe fraction is divided, and the remaining label is applied to the answerLet’s walk through the following problem to create a dimensional analysis grid.It takes practice to master this technique. If you are comfortable with other methods, stay with the calculation method that is easiest for you.Now, take out a piece of paper, and following this example on the (board, overhead, transparency), we’ll make a dimensional analysis grid. (Read the problem on page 90, and follow the step-by-step procedure on pp as a class.)