Medication/fluids Administration and Calculation Flashcards
What does APINCHS stand for?
High risk medication:
Antimicrobials
Potassium and electrolyte
Insulin
Narcotics & sedatives
Chemotherapeutic drugs
Heparin and anticoagulants
Systems ( independents double checks & Medication charts)
Six rights of medication
Right drug
Right Dosage
Right route
Right date and time
Right patient ( Patient ID and med chart)
Right documentation
When are Second nurse check of medication required?
For all parenteral medication (IV, subcutaneous inj)
What does the second nurse need to check for medications?
Patient ID
Med chart
Vial of medication / dosage
amount in syringe
Compatible fluids
What other checks are necessary besides the 6 rights?
- allergies
- expiry date of medication
- compatibility of fluid to medication
- does patient have fluid restrictions
- possible side effects of medication
- patient with liver/ kidney problems
- checking vitals beforehand (BP, RR, HR) for certain medication that alter vitals
- Australian Medication Handbook or online medication site
- independent double checks
- patient education
What is Mane?
Morning
What is Nocte?
Night
What is ac?
Before meals
What is pc?
After meals
What is BD?
Twice a day
What is TDS?
Three times a day
What is QID?
Four times a day
Routes of administration: sublingual
Medication that are placed under the tongue to dissolve
Routes of administration: buccal
Medication held in mouth against mucous membranes of cheek
Routes of administration: PICC
Peripherally inserted central catheter ( arm to heart)
What are the common subcut regions ?
Abdominal umbilical region (5cm away form belly button)
Thighs
How many mls of medication is safe to deliver via subcut inj?
0.5 to 1ml
What is the pinch test when deciding the angle of a subcut inj?
If less than 25mm of tissue is grasped form the site, insert need at 45 degrees while pinching tissue
A dose of 4500mg of medication ordered. The medication comes in 5g/0.3ml. What volume will you give the patient.
Formula: dose required (mg) / stock strength (mg) x stock volume(ml)/1
4500/5000 = 0.9
0.9 x 0.3 = 0.27
A dose of 3500mg medication ordered. The med comes in 5g/2ml
What volume is given to patient.
3500/5000 = 0.7
0.7 x 2 = 1.4
Patient weighs 45kg and prescribed med for 3mg/kg/dose
Stock strength is 2mg/0.5ml. What volume will you give patient?
45 x 3mg = 135
135/2 x 0.5 = 33.75mls
A patient needs 0.075g of medicine that comes in 30mg tablets. How many tablets will the patient take?
1000mg = 1g
0.075g x 1000 = 75mg
75/30 = 2.5
The total so volume ordered is 550mls N/S 0.9%. The time which is to be given is 4 hours. The drop factor is 20. How many drops per minute is delivered?
550/4 = 137.5mls per hour
137.5/60 = 2.29mls per minute
2.29mls x 20 drop factor = 46 drops per minute
1300mL N/Saline 0.9% is running at a 6 hourly rate, which commenced at 1500hrs. At 1630hrs
the doctor requests for the remaining volume to be run over 3 hours. Calculate the mL per hour
for the remaining volume
Original rate —> 1300mls / 6 hourly
1.5 hours passed since commencement. 6/1.5 = 4
1300 / 4 = 325mls have been given to patient since commencement
Remaining volume = 1300 - 325 = 975mls
975 / 3 hours = 325mls / per hour
1200mL N/Saline 0.9% has been running for 20 minutes at a 2 hourly rate. How many mL have
been administered already?
1200mls/2 hourly
2 hours = 120 minutes
20/120= 1/6
1/6 x 1200 = 200 mls administered
The dose to be given of a medication is 5mg. The stock strength is 1mg/4mL. Calculate the mL
needed to deliver the medication.
5/1 = 5
5 x 4ml = 20mls
Your patient is receiving 350MICROg of a medication in 750mL of CSL. How many MICROg per
mL is the patient receiving?
0.5MICROG per mL
A child who weighs 5kg is ordered 0.5g/kg IV, 4 hours before surgery. The solution strength is
2mg/mL. How many mL per hour do you administer?
5kg x 0.5g = 2.5g
2.5g = 2500mg
2500/2 = 1250mg
1250\4 hrs = 312.5mls
1.5L N/Saline 0.9% is running at a 12 hourly rate, which commenced at 0800hrs. At 1200hrs the
doctor requests for the remaining volume to be run over 4 hours. Calculate the mL per hour for
the remaining volume.
Original rate: 1.5L / 12 hourly
4 hours have past since commencement. 12/4 = 3
1.5/3 = 0.5L has been administered to patient.
1.5 - 0.5 = 1L volume remaining
1L / 4 =
New rate: 0.25mls / hr
A child who weighs 14kg is ordered 55MICROg/kg IV, 2 hours before surgery. The solution
strength is 2mg/mL. How many mL do you administer?
14 x 55 = 770 microg
770 microg / 2000 microg = 0.385 mls
A child who weighs 5kg is ordered 0.5g/kg IV, 4 hours before surgery. The solution strength is
2mg/mL. How many mL per hour do you administer?
5kg x 0.5 = 2.5g
2.5g = 2500mg
2500mg / 2mg = 1250mls
1250mls / hour
What does hypotonic IV fluids do ? And give example
Fluids goes into cells to expand the cell and increase total body fluid volume
Example: 0.45% normal saline
Hypotonic solutions have a lower concentration of dissolved solutes than blood - the 0.9% solute concentration (homeostasis) in blood is lowered so fluid need to move into cells intracellular space
What does isotonic IV fluids do? And give example
The fluid replenishes cells from a fluid loss without changing shape
Example: 0.9% normal saline,
Because the concentration of the IV fluid is similar to the blood, the fluid stays in the intravascular space and osmosis does not cause fluid movement between compartments
When is hypotonic fluids used ?
DKA
TO increase total body fluid of patient
Cellular dehydration ( if you don’t have enough water circulating through your body, water will be drawn from the inside of the cells due to increased osmotic pressure — causing those cells to shrink)
When is isotonic solution used in patient ?
HYPOVOLAEMIA
hypotension
Burns
Blood loss
Anaphylaxis
Sepsis
Dehydration
What does hypertonic IV fluids do ? Give example
Fluid goes out of cell to shrink cells and to decrease fluid levels (dehydrate cells)
Example: 3% normal saline
Hypertonic solutions have a higher concentration of dissolved particles than blood
causes the osmotic movement of water out of the cells and into the intravascular space to dilute the solutes in the blood
When is hypertonic fluid used?
Fluid overload
Cerebral oedema
Ketosis
What nursing consideration are needed for hypertonic and isotonic IV fluids ?
Hypervolaemia fluid overloading
What is used to treat severe Hypernatremia?
Hypernatremia occurs due to net water loss or excess sodium intake
Hypotonic solution 0.45% normal saline provide
What nursing consideration is needed for hypotonic IV fluids ?
Hypovolaemia x low fluid volume in body
What is considered in an Independent double checks
Medication
Prescription
Dose
Rate
Diluent compatibility
Labels - expiry
What’s checked at the bedside double checks
Patient ID
Allergies
Infusion lines
Pump settings
Writing medication dose as whole numbers
500mg ✅
0.5g 🚫
125mcg ✅
0.125mg 🚫
NEVER USE A TRAILING 0 example: 1.0g 🚫
ALWAYS WRITE 1g
Common symbols abbreviations used when nurse does not administer medication
A - Absent
F - Fasting
R - Refused
V - Vomiting
W - Withheld
N - Not available (med)
Patient due for 1.5g Vancomycin antibiotics
Stock strength is1g reconstituted with 20mls water for injection
Stock strength —> 1000mg / 20mls = 50mg/ml
Calculate how many mls you will need to draw up to obtain required dose of 1.5grams
1500/ 50 = 30mls
What does a ratios of strength 1:1000 for adrenaline represent ?
1g of adrenaline in 1000mls of solution.
Amount of unit per volume = 1mg/ml
1mg/ml is common IM dose for Anaphylaxis
