DrugCalculations_Final

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Published on March 15, 2014

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IV DRUG ADMINISTRATION: IV DRUG ADMINISTRATION Drug Calculations Best Innovative Approach Mr. Brijesh Sharma, Sr. Nursing Tutor cum Asst. Manager Nursing (Academic) National Heart Institute, New Delhi 15 March 2014 1 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Pretest Knowledge Questionnaire 15 March 2014 2 National Heart Institute East of Kailash New Delhi Objectives of the session: Objectives of the session At the end of the session participants will be able to: Identify the principles of drug administration Explain the prescription principles of drug administration List the nurses responsibility in the administration of drugs Identify the route by which drugs are administered Undertake simple drug calculations 15 March 2014 3 National Heart Institute East of Kailash New Delhi Principles of Drug Administration: Principles of Drug Administration Right Drug Right Dose Right patient Right Route Right time Right Documentation 15 March 2014 4 National Heart Institute East of Kailash New Delhi Continue.....: Continue..... The Nurse should : certain to identify of the patient. check prescription is clearly written/ unambiguous consider the dosage, method of administration, route and timing check that the patient is not allergic to the medicine . 15 March 2014 5 National Heart Institute East of Kailash New Delhi Patients Right on Drug Administration: Patients Right on Drug Administration Patient’s right in drug administration To be informed of the drug name, purpose, action and potential undesired effects. To refuse a drug regardless of the consequences To have a qualified nurse or doctors to assess medication history including allergies. To receive label drugs safely without discomfort. To receive appropriate supportive therapy with relation to drug therapy Not to receive any unnecessary medications. 15 March 2014 6 National Heart Institute East of Kailash New Delhi Nurses Responsibilities: Nurses Responsibilities Professional Judgment Knowledge Skills Competency Storage and security of medicines Reduce medicine Administration errors Adverse Incidents 15 March 2014 7 National Heart Institute East of Kailash New Delhi Purpose of Drug administration: Purpose of Drug administration Diagnostic Prophylaxis Therapeutic 15 March 2014 8 National Heart Institute East of Kailash New Delhi Drug Administration Methods: Drug Administration Methods Orally: Tablets, capsules, lozengers, syrups Injection: Intramuscular, Intravenous, subcutaneous, intradermal, intrathecal Mucous membrane Vaginally, Rectally, Nasopharynx, conjunctiva, inhalation Topically to skin Ointments, creams, transdermal patches PEG Gastrostomy tube 15 March 2014 9 National Heart Institute East of Kailash New Delhi Drug Calculation Assessment: Drug Calculation Assessment SECTION 1: Units & Equivalences SECTION 2: Calculating dose as volume SECTION 3: Drug Strengths & Stated Concentrations SECTION 4: Duration of Infusion – Stated rate (dose per min) & Infusion rate (mL/hr) SECTION 5: Infusion Rate Calculations 15 March 2014 10 National Heart Institute East of Kailash New Delhi SECTION 1: Units & Equivalences: SECTION 1: Units & Equivalences 1 Kg = 1,000 g ( gram) 1 g = 1,000 mg ( mili gram) 1 mg = 1,000 micrograms( mcg) 1 L = 1,000 ml ( mili litre ) 15 March 2014 11 National Heart Institute East of Kailash New Delhi Converting from One Unit to Another: Converting from One Unit to Another To convert from a larger unit to a smaller unit , multiply by 1000 or move the decimal point three places to the right To convert from a smaller unit to a larger unit , divide by 1000 or move the decimal point three places to the left 15 March 2014 12 National Heart Institute East of Kailash New Delhi Continue....: Continue.... Example: 1. Convert 0.25 mg into micrograms 2. Convert 600 micrograms to mg 15 March 2014 13 National Heart Institute East of Kailash New Delhi Continue....: Continue.... Answers => 0.25 × 1000 or move decimal point three places to the RIGHT = 250 micrograms => 600 ÷ 1000 or move the decimal point three places to the LEFT = 0.6 mg 15 March 2014 14 National Heart Institute East of Kailash New Delhi SECTION 2: Calculating Dose as Volume :  SECTION 2: Calculating Dose as Volume Formulla: What volume you want to administer 15 March 2014 15 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: What we WANT Frusemide( Lasix) 250mg/10mL Frusemide( Lasix) Time 0700-0900  1200-1400 Dose 200mg Route IV Start Date 18.05.07 End Date 1600-1800 2200-2400 Other Time Signature of Doctor P.Rescriber What we have GOT What it is IN Q. A patient is prescribed 200mg of Frusemide( Lasix) I.V. The ampoules available contain 250mg in 10mL. What volume containing the drug do you need to administer? 15 March 2014 16 National Heart Institute East of Kailash New Delhi Answer: Answer What you WANT X what it is IN What you have GOT 200 mg 250 mg × 10 mL = 8 mL 15 March 2014 17 National Heart Institute East of Kailash New Delhi SECTION 3: Drug Strengths & Stated Concentrations: SECTION 3: Drug Strengths & Stated Concentrations Formula : How much fluid is required ( Volume) 15 March 2014 18 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Acyclovir Time 0700-0900  1200-1400  Dose 250mg Route IV Start Date 18.05.07 End Date 1600-1800 2200-2400  Other Time Signature of Doctor Additional Comments P.Rescriber Final Concentration 5mg/ mL Q. A patient is prescribed 250mg of Acyclovir I.V. Acyclovir has to be initially reconstituted with water for injection, then added to a bag of compatible infusion fluid, giving a final concentration of 5mg/mL. How much infusion fluid should be used dilute the reconstituted Aciclovir to achieve this final concentration? What we HAVE CONCENTRATION 15 March 2014 19 National Heart Institute East of Kailash New Delhi Answer: Answer What you HAVE (mg) CONCENTRATION (mg/ml) 250mg 5mg/mL = 50 mL 15 March 2014 20 National Heart Institute East of Kailash New Delhi Q. A 1% (W/v) solution means that in every 100mL of solution you will find 1g of drug. Therefore, how many g of Glucose would there be in 500mL of 5% Glucose? : Q. A 1% (W/v) solution means that in every 100mL of solution you will find 1g of drug. Therefore, how many g of Glucose would there be in 500mL of 5% Glucose? Glucose 5% 500ml 15 March 2014 21 National Heart Institute East of Kailash New Delhi Answer: Answer A 1% (w/v) solution means that in every 100mL of solution you will find 1g of drug. 100mL = 1g Therefore a 5% w/v must mean that 100mL = 5g Multiply each side by 5 500mL = 25g Ans: 25 gm 15 March 2014 22 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Q. 1:10,000 strength means that in every 10,000ml of solution you will find 1g of Adrenaline. Therefore, how many mg of Adrenaline would there be in 10mL of 1:10,000 Adrenaline? 15 March 2014 23 National Heart Institute East of Kailash New Delhi Answer: Answer 1:10,000 means that 1g of adrenaline is dissolved in 10,000mL. 1g = 10,000mL 1000mg = 10,000mL Divide both sides by 1000 1mg = 10mL 15 March 2014 24 National Heart Institute East of Kailash New Delhi SECTION 4: Duration of Infusion Stated rate (dose per min) Infusion rate (ml/hr): SECTION 4: Duration of Infusion Stated rate (dose per min) Infusion rate (ml/hr) 15 March 2014 25 National Heart Institute East of Kailash New Delhi Q. Frusemide must be administered at a rate no faster than 4mg/minute. How many minutes would it take to give 200mg of this drug?: Q. Frusemide must be administered at a rate no faster than 4mg/minute. How many minutes would it take to give 200mg of this drug? Frusemide Time 0700-0900  1200-1400 Dose 200mg Route IV Start Date 18.05.07 End Date 1600-1800 2200-2400 Other Time Signature of Doctor Additional Comments P.Rescriber Rate of 4mg/minute Frusemide 250mg/10mL Rate (mg/min) DOSE (mg) 15 March 2014 26 National Heart Institute East of Kailash New Delhi Answer: Answer Dose (mg) = Time Rate (mg/min) 200mg 4mg/min = 50 minutes 15 March 2014 27 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Infusion rate – ml/hr Volume (mL) = Rate (ml/min) Time (Min) X 60 = Rate (ml/Hr) * Tip if rate is in hours omit “X 60” 15 March 2014 28 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Omeprazole 40mg/100mL Q. Omeprazole (Losec ®) 40m g is diluted in 100mL of compatible infusion fluid. This infusion has to be given over 20 minutes. What rate should you set the infusion pump at, in ml/hr, to deliver this dose? 15 March 2014 29 National Heart Institute East of Kailash New Delhi Answer: Answer Volume (ml) = Time (ml/hr) x 60 Rate (hr) 100ml 20 mins x 60 = 300mL/hr 15 March 2014 30 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Acetylcysteine 7.5g/1000mL Q. Acetylcysteine (Parvolex ®) 7.5g is diluted in 1000mL of compatible infusion fluid. This infusion has to be given over 16 hours. What rate should you set the infusion pump at, in ml/hr, to deliver this dose? 15 March 2014 31 National Heart Institute East of Kailash New Delhi Answer: Answer Dose (mL) = Time (mL/hr) Rate (hr) 1000 16 = 62.5 mL/hr 15 March 2014 32 National Heart Institute East of Kailash New Delhi SECTION 5: Infusion Rate Calculations: SECTION 5: Infusion Rate Calculations What you WANT x 60 (60 mins per hr) What you have GOT X what it is IN = the volume you want to administer 15 March 2014 33 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: NTG Time 0700-0900 1200-1400 Dose 25 micrograms/ minute Route IV Start Date 18.05.07 End Date 1600-1800 2200-2400 Other Time Signature of Doctor Additional Comments P.Rescriber Continuous Infusion Q. You are required to give a patient NTG as a continuous I.V infusion at 25 micrograms/minute. You have prepared a 50mg in 50mL infusion. What rate should you set the infusion pump at, in ml/hr, to deliver this dose? What we WANT NTG 50mg/50mL What we have GOT What its IN 60 mins per hr 15 March 2014 34 National Heart Institute East of Kailash New Delhi Answer : Answer What you WANT x 60 (60 mins per hr) What you have GOT X what it is IN 25 micrograms x 60 = 1500 micrograms/hr 1500 ÷ 1000 = 1.5 mg 1.5 mg x 50mL 50 mg = 1.5 mL/hr 15 March 2014 35 National Heart Institute East of Kailash New Delhi Flow Rates: Flow Rates The flow rate is the speed at which the IV infuses into the body. It is often measured in gtt/min or dpm Three things affect the flow rate: The amount of solution to be infused. The time over which it is to be infused. The size of the tubing. 15 March 2014 36 National Heart Institute East of Kailash New Delhi Tubing Size: Tubing Size The size of the tubing is called the drop factor. It measures the number of drops in each milliliter of fluid (gtt/ml) Macrodrip tubing is larger: 10, 15, 20 gtt/mL. Microdrip tubing is smaller: 60 gtt/mm (always) 15 March 2014 37 National Heart Institute East of Kailash New Delhi Formula for Flow Rate Calculation: Formula for Flow Rate Calculation Time must be converted to minutes. Drop factor is in gtt/mL. 15 March 2014 38 National Heart Institute East of Kailash New Delhi Examples: Examples Q. No. A patient weighing 60kg is prescribed 2.5mg per kg per day of a drug to be administered every 8hrs. What is the size of each dose? Q. No. The total daily dose of a drug is 180mg. If this is to be given every 8hrs. What is the size of each dose? Q. No. A child weighing 30kg is prescribed 80mg per kg per day of paracetamol to be given every 6hrs. What is the size of each dose? Q. No. The stock strength of a particular drug is 0.8mg in 4mls. The patient requires 0.6mgs. How many mls will you give? 15 March 2014 39 National Heart Institute East of Kailash New Delhi PowerPoint Presentation: Any Questions? Assessment time…… Post Test Questionnaire 15 March 2014 40 National Heart Institute East of Kailash New Delhi

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