CLINICAL CALCULATIONS NURS 1001 Class

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CLINICAL CALCULATIONSNURS 1001Class 3Hammond

• Module 3 Converting Between Systems of
  Measurement (continued)
• Module 4 Intake and Output (IO)
• Module 5 Reading Medication Labels
• Module 6 Administering Oral (PO) meds

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CONVERTING BETWEEN SYSTEMS OF MEASUREMENTS(CONTIN
UED)

• MODULE 3

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Metrics Clarified

• Medications dont usually come in hecto, deka,
  deci, and centi units of measurement, therefore,
  we dont worry about moving the decimal one space
  for each of these.
• Notice that the move from kilo to base unit is 3
  spaces, the move from basic unit to milli is 3
  spaces and the move from milli to micro is 3
  spaces. This makes it easy for us in converting
  between those 4 units, doesnt it?

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Moving Decimals
Remember if moving UP the ladder from a smaller
unit to a larger unit, move LEFT if moving DOWN
the ladder from a larger unit to a smaller unit,
move RIGHT!
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Practice moving the decimal space in these

• 500mcg ___mg
• 300g ___kg
• 65mg ___g
• 2500mcg ___mg
• 0.65kg ___g

(0.5 mg) (0.3 kg) (0.065 g) (2.5 mg) (650 g)
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Did you say more conversions?

• 76kg ___lbs
• 200lbs ___kg
• 12oz ___mL
• 500mL ___oz
• 3tsp ___mL
• 20mL ___tsp
• 8Tbs ___mL
• 50mL ___Tbs

• 167.2lbs (This is NOT 167 lbs and 2 oz.)
• 90.9kg
• 360mL
• 16.7oz
• 15mL
• 4tsp
• 120mL
• 3.3Tbs

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INTAKE AND OUTPUT

• MODULE 4

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Intake

• Measured in mL
• Includes
• Oral intake (liquids and items that are normally
  liquid at room temperature, such as jello, ice,
  broth, fluids inserted per NGT such as liquids,
  water, etc)
• Tube feedings
• IV (Parenteral) fluids, including blood products
• Injections such as IM or SQ are so small that we
  dont usually count them

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Output

• Measured in mL
• Includes
• Liquid output (urine, emesis, blood, watery
  diarrhea, NGT drainage, chest tube drainage,
  liquid drain output such as Hemovac or JP drains
  inserted in surgical incisions), but not
  secretions that are more solid than liquid, such
  as sputum)

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MPH Amounts(but become familiar with your
facilitys amounts)

• Fluid Intakes
• 1 water pitcher 980ml
• Carton of Milk 240ml (8 oz)
• Ice Cream or sherbet 120ml
• Small bowl of Jell-O 90ml
• Bowl of Soup or Broth
• 240ml

• 1 cup of ice (melts to ½ the original
  volume) 130ml
• One container of juice 120ml
• One ounce 30ml
• Mug of Coffee or tea 300ml
• Carbonated Beverage 360ml (12 oz)

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IO Calculation

• 11 in wkbook At 0700, the MD ordered 1L of D5
  1/2NS to infuse at 75mL/hr for the first 3hrs,
  and then at 125mL continuously. For breakfast,
  the pt took 1cup of coffee, 8oz of milk and 6oz
  of OJ. The patient voided 50mL at 0900 and 75ml
  at 1000. At 1100, the nurse inserted a Foley
  catheter per MD order and obtained 425mL of
  urine. For lunch, the pt only took 5oz of broth.
  The nurse emptied the Foley catheter at 1500 hrs
  and obtained 250mL. Calculate the pts total IO
  starting at 0700 and ending at 1500.

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Answer to Problem

• Intake
• 75 ml/hr X 3 hrs 225 ml
• 125 ml/hr X 5 hrs 625 ml
• 1 C coffee 240 ml
• 8 oz 240 ml
• 6 oz 180 ml
• 5 oz 150 ml
• 1660 ml

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Answer to Problem

• Output
• 50 ml
• 75 ml
• 425 ml
• 250 ml
• 800 ml

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Output

• Remember to subtract any fluids that you put in
  for flushing or irrigation, such as a Foley
  catheter irrigation or NGT flushing, before
  determining true output.
• Ex 12 on page 27 in workbook
• Bladder irrigation at 75 ml/hr X 6 hrs 450 ml
• 1500 hrs, catheter emptied of 1575 ml
• 1575 450 1125 ml actual output

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NasoGastric (NGT) and other types of tube
feedings (PEGS, etc)

• Tube feedings are sometimes ordered to be
  diluted example Administer Isocal ½ strength
  at 50 ml/hr. Isocal comes in 240 ml cans. How
  much water would you add to make it ½ strength?
• Easy at ½ strength 240
• But what if it were a 2/3 strength
• Or ¾ strength?

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Tube Feedings

• 2/3 strength
• 240ml 2 Xml 3
• 2X 720
• X 360
• 360 240 120ml (water amt. to add to mixture)
• ¾ strength
• 240ml 3 Xml 4
• 3X 960
• X 320
• 320 240 80ml (water amt. to add to mixture)

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I O SHEETS
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READING MEDICATION LABELS

• MODULE 5

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READING MEDICATION LABELS

• Essential info
• Trade name
• Generic name
• Dosage strength
• Form of the drug
• Route of administration
• Expiration date
• Instructions for mixing
• Recommended dose

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READING MEDICATION LABELS

• Useful info
• Total quantity
• Storage information
• Controlled substance symbol
• Manufacturers name
• Lot number
• Also, any precautions or warnings!

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Jan.2010
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ADMINISTRATION OF ORAL MEDICATIONS

• MODULE 6

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COMPONENTS OF A LEGAL DRUG ORDER

• Patients full name
• Date order written
• Name of medication (generic or trade name)
• Dose
• Frequency of Administration
• Route of Administration
• Duration of order, if applicable
• What should you do if any of these items are
  missing from an order?

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NURSES RESPONSIBILITY

• That order is complete
• That order is clear, legible
• Call MD or NP if not!
• That order is safe dosage, route, etc
• That your calculations are correct
• That the expected actions, interactions, side
  effects, adverse reactions are known
• 7 rights followed for administration
• Pt., drug, dose, route, time
• Plus documentation and assessment
• Prepare appropriately
• KNOW ALLERGIES!
• Labeled correctly (JCAHO requires!)
• That you prepared it yourself!
• That you checked, checked, and rechecked!

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DOCUMENTING

• ASAP!
• Include date (on MAR), time, medication, dose,
  patient response if applicable, and correct
  signature
• All scheduled meds go on MAR only
• All PRN, stat, etc.. Meds go on MAR AND in
  Nurses Notes as well as a follow-up note on
  response.
• Example
• 0815 Administered Demerol 50mg IM right
  dorsogluteal for c/o abdominal pain of 8 on scale
  of 110.
• 0845 Pt. states pain level is now only a 3 on
  scale of 110 and that pain shot has almost
  totally relieved discomfort. Respirations even
  and unlabored at 18/minute.

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Preparation of meds

• Powders must be reconstituted
• Use correct solution to reconstitute with
• Use correct amount
• Verify correct concentration after reconstitution
• Scored tabs can be halved, capsules cant

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How many tablets and how much solution will be
given for each medication ordered? If these are
available Furosemide 20mg tabs, Digoxin 0.05mg
scored tabs, and Potassium chloride oral
solution 2.5mEq/5mL
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• Do you notice anything wrong here?

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• Which one would you use? Mark the amt. of the
  slow K to give

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Use the medicine cup for oral liquids
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Order cephalexin gr viiissAvailable
cephalexin 0.25gram tablets. How many tablets
will the nurse give?viiiss is ______
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• 0.25g 1 tab 8.5 gr xtabs
• 0.25 g 250 mg
• 8.5 gr 510 mg (using 1gr 60mg)
• So
• 250 mg 1 tab 510 mg X tab
• 250X 510
• X 2.04 tabs
• How many would we walk down the hall with?