1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7 Liquids for Injection

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Calculating Liquid Injections Formula method –DESIRE × SUPPLY = AMOUNT HAVE Proportion expressed as two ratios –SUPPLY : HAVE :: X : DESIRE Proportion expressed as two fractions –SUPPLY = X HAVE DESIRE

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Calculating Injection Problems 3 mL syringe –Carry out arithmetic to the hundredths place and then round off the answer to the nearest tenth 1 mL syringe –Carry out arithmetic to the thousandths place and then round off the answer to the nearest hundredth

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The patient is to receive Phenergan (promethazine) 25 mg IV q 6h prn. The medication is supplied as 12.5 mg/ mL. How many milliliters does the nurse need to draw up in the syringe? A.1 B.1.2 C.1.7 D.2

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. 2 –Formula method 25 mg × 1 mL = 2 mL 12.5 mg –Proportion expressed as two ratios 1 mL : 12.5 mg :: 2 mL : 25 mg –Proportion expressed as two fractions 1 mL = 2 mL 12.5 mg 25 mg

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Insulin Injections Need to know onset, peak, and duration of different types of insulin Mixed insulin combines rapid and intermediate insulin Never shake insulin vials Gently rotate cloudy insulin vials between hands to resuspend the particles Regular insulin is the only insulin that is given IV

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Preparing an Injection Using an Insulin Syringe What is the order? What is the supply? What syringe should be used?

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Mixing Two Insulins in One Syringe Always draw up the regular insulin into the syringe first. The total number of units in the syringe equals the two insulin orders added together.

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps to Mixing Two Insulins in One Syringe Inject into the NPH vial the amount of air equal to the amount of NPH insulin Inject into the regular vial the amount of air equal to the amount of regular insulin Withdraw the correct amount of regular insulin (clear) Withdraw the correct amount of NPH insulin (cloudy)

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Always draw up the regular insulin into the syringe first.

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Always draw up the regular insulin into the syringe first.

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Sliding Scale Insulin Method of administration based on blood glucose result Blood glucose result comes from a finger stick and some type of Accucheck monitor

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Order: Regular Humulin Insulin 20 units and NPH Humulin Insulin 12 units every day subcutaneously Supply: Regular Humulin Insulin 100 units/mL and NPH Humulin Insulin 100 units/mL What will be the total units in the syringe? A.12 B.20 C.32 D.42

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. 32 Regular Humulin Insulin 20 units and NPH Humulin Insulin 12 units every day subcutaneously for a total of 32 units