Transcript olsen_ch09_lecture

Medical Dosage Calculation
A Dimensional Analysis Approach
Tenth Edition
CHAPTER
9
Parenteral
Medications
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Directory
• Classroom Response System Questions
• Lecture Note Presentation
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Classroom Response
System Questions
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #1
The prescriber ordered penicillin G 300,000
unit IM every 12 hours. The label reads
600,000 units per milliliter. How many
milliliters will you administer to the patient?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #1 Choices
1.
2.
3.
4.
0.2 mL
0.3 mL
0.4 mL
0.5 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #1 Response
1.
2.
3.
4.
0.2 mL
0.3 mL
0.4 mL
0.5 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #2
The prescriber has ordered 4 milligrams of
the analgesic drug, butorphanol tartrate
(Stadol), IM every four hours PRN. The
ampule reads 2 mg per 2 mL. How many
milliliters will equal 4 milligrams?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #2 Choices
1.
2.
3.
4.
4 mL
5 mL
6 mL
7 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #2 Response
1.
2.
3.
4.
4 mL
5 mL
6 mL
7 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #3
The order: clindamycin 400 mg IM twice a
day for 5 days. The label reads 150 mg/mL.
How many milliliters will you administer to
your patient?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #3 Choices
1.
2.
3.
4.
2.4 mL
2.5 mL
2.6 mL
2.7 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #3 Response
1.
2.
3.
4.
2.4 mL
2.5 mL
2.6 mL
2.7 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #4
The order reads: a drug 0.025 g IM three
times a day. If the label states 10 milligrams
per milliliter, how many milliliters will you
prepare for the patient?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #4 Choices
1.
2.
3.
4.
2.4 mL
2.5 mL
2.6 mL
2.7 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #4 Response
1.
2.
3.
4.
2.4 mL
2.5 mL
2.6 mL
2.7 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #5
The label on the vial reads: penicillin G
1,000,000 units. The instructions are as
follows: Add 19.6 mL of sterile dilutent to
stock solution 1 mL = 50,000 units. How
many milliliters contains 100,000 units?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #5 Choices
1.
2.
3.
4.
2 mL
3 mL
20 mL
40 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Question #5 Response
1.
2.
3.
4.
2 mL
3 mL
20 mL
40 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Lecture Note Presentation
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Learning Outcomes
1.
2.
3.
4.
5.
Calculate doses for parenteral medications in liquid
form.
Interpret the directions on drug labels and package
inserts for reconstituting medications supplied in
powdered form.
Label reconstituted multi-dose medication containers
with the necessary information.
Choose the most appropriate diluent volume when
reconstituting a multiple-strength medication.
Calculate doses of parenteral medications measured
in units.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Figure 9.1 Ampules.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Figure 9.2 Vials.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Parenteral Medications
Supplied as Liquids
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 1
• The prescriber ordered 3 milligrams of
Dolophine (methadone hydochloride)
subcut stat. The strength is 10mg per mL.
How many milliliters would you administer
to the patient?
3 mg = ? mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 1
• The label reads 10 milligrams per milliliter.
This strength will be used as the unit
fraction
3 mg 1 mL

 ?mL
1
10 mg
3 mg 1 mL


1
10 mg
3 mL
 0.3 mL
10
So, 0.3 milliliter contains 3 milligrams of
methadone, and you would administer 0.3
milliliter of the drug to the patient.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 2
• The prescriber ordered 0.002 gram of a
drug IM stat. The strength is 1mg per mL.
Calculate the number of milliliters of this
solution you would administer.
• You want to convert 0.002 grams to its
equivalent in milligrams, and then change
milligrams to milliliters
0.002 g
? mg
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
? mL
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 2
0.002 g = 0 0 0 2 mg = 2 mg
• Because the strength is 1 mg = 1 mL, no
further calculations are needed to
determine that 2mg = 2 mL
• You would administer 2 milliliters of the
solution IM, which would contain 0.002
gram of the prescribed drug.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 3
• Determine the quantity of solution to be
withdrawn from the vial if the medication
order reads 250 milligrams of 10% calcium
chloride.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 3
• You want to convert 250 milligrams to
milliliters.
250 mg
2 5 0
?g
? mL
gram
The strength of “10%” means that 10 grams of
calcium chloride are in 100 milliliters of solution.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 3
0.25 g 100 mL

 ?mL
1
10 g
0.25 g 100 mL


1
10 g
2.5 mL
So, you would withdraw 2.5 mL from the vial.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Parenteral Medications Supplied
in Powdered Form
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Powdered Parenteral Medication
• Some parenteral medications are supplied
in powdered form in sealed vials.The
powder cannot be removed from these
vials. You must add sterile water or saline
(diluent) to the vial and dissolve the
powder to form a solution. You then
withdraw from the vial the liquid volume of
prepared solution that contains the proper
amount of the drug.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Figure 9.38 Drug label for Pfizerpen. (Reg.Trademark of Pfizer Inc.Reproduced with permission.)
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 5
• The prescriber ordered 150 mg of a drug
IM stat. The directions on the 500 mg vial
read, “Add 9.7 mL NS and the strength will
be 100 mg/mL.” How many milliliters of the
reconstituted solution will you administer?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 5
• You want to convert 150 mg to mL. Using
the strength of 100mg/mL.
150 mg
1 mL

 ?mL
1 yr
100 mg
150 mg
1 mL
15 mg


10
1 yr
100 mg
So, you would administer 1.5 mL of the solution.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Figure 9.8 Reconstitution of ceftriaxone.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Heparin
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 4
• The prescriber ordered:
heparin 5,000 units subcut q12h.
• The label on the vial reads 10,000 units
per milliliter. How many milliliters will you
administer to the patient?
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 4 (continued)
• You want to convert 5000 units to
milliliters.
5,000 units = ? mL
• The label on the vial reads 10,000 units
per milliliter, so the strength is
10,000 units
1 mL
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Example 4 (continued)
5,000 units
1 mL

 ? mL
1
10,000 units
1
5,000 units
1 mL


1
10,000 units
1 mL
2
2
So, 0.5 milliliter contains 10,000 units of heparin and you
would administer 0.5 milliliter of the solution to the patient
subcutaneously.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Chapter Summary
• Medications supplied in powdered form
must be reconstituted following the
manufacturer’s directions.
• You must determine the best dosage
strength when there are several options
for reconstituting the medication.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Chapter Summary
• After reconstituting a multiple-dose vial,
label the medication vial with the dates
and times of both preparation and
expiration, storage direc- tions, your
initials, and strength.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Chapter Summary
• When directions on the label are provided
for both IM and IV reconstitution, be sure
to read the order and the label carefully to
determine the necessary amount of diluent
to use.
• Heparin is measured in USP units.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Chapter Summary
• It is especially important that heparin
orders be carefully checked with the
available dosage strength before
calculating the amount to be administered.
• A tuberculin (1 mL) or a 0.5 mL syringe
should be used when administering
heparin.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.
Chapter Summary
• Heparin sodium and heparin flush
solutions are different and should never be
used interchangeably.
Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition
June L. Olsen • Anthony P. Giangrasso • Dolores Shrimpton
Copyright ©2012, ©2008 by Pearson Education, Inc.
All rights reserved.