Chapter 15 Reconstitution and Dosages Measured in Units 1 Objectives Calculating drug dosage problems that first require reconstitution of a powdered drug into a liquid form Using a proportion to solve problems involving drugs measured in unit dosages Drawing a line through an insulin syringe to indicate the number of units desired 2 1
Units A unit is the amount of a drug needed to produce a given result. Common drugs measured in units. Epogen: a drug that increases the production of red blood cells. Helps to combat the effects of anemia. Fragmin: An anticoagulant that prevents the clotting of blood. Used to prevent deep vein thrombosis. (DVT) 3 Units Common drugs measured in units: Penicillin: an antibiotic that reduces organisms within the body that cause infection. (bacterial infection) Heparin: an anticoagulant that inhibits clotting of the blood. (a blood thinner) Insulin: a hormone secreted by the pancreas that lowers blood glucose. Used to treat Insulin dependent diabetes mellitus. 4 2
Administration Considerations: Penicillin Ask patients whether they have had previous allergic reactions to penicillin. Observe patients for signs of allergic reactions. 5 Administration Considerations: Heparin Doses that are too large might cause hemorrhage. Doses that are too small might not produce the desired result. 6 3
Administration Considerations: Insulin Doses that are too large might cause insulin shock. Doses that are too small might result in a diabetic coma. Available in prefilled insulin pens. medcinenet 7 Powder Reconstitution Required when medication is unstable over long periods of time in its liquid form. Must be performed before administration using a sterile diluent. Diluent = a diluting substance. Common diluents are sterile water, normal saline, dextrose solutions. 8 4
Powder Reconstitution (cont d) Method: Read information and directions on drug label carefully. Identify the type of diluent, amount of diluent, and route of administration. Note the drug strength or concentration after reconstitution. 9 Powder Reconstitution (cont d) Method (cont d): Note the length of time that medication is usable after reconstitution. Note the directions for storage of reconstituted medication. Video on desk top -- Reconstitution of a powder 10 5
Powder Reconstitution (cont d) Place on drug label after reconstituting: Your initials Date and time of preparation Date and time of expiration 11 Oral-Dosage Problems (Dosages Measured in Units) Example: Someone volunteer to go over this. The physician orders penicillin V 300,000 units po four times a day. Penicillin V 500,000 units/2 ml is available. How many milliliters of penicillin V will be administered? 500,000units : 2mL :: 300,000unit : xml x = 1.2mL 12 6
Parenteral-Dosage Problems (Dosages Measured in Units) Example: Another volunteer The order states heparin 8000 units subcutaneous q8 h. Heparin 6500 units/ml is available. How many milliliters of heparin will be administered? 6500 units : 1 ml :: 8000units : xml x= 1.23 ml 13 Reconstitution and Dosages Measured in Units You have a vial of Penicillin opened and reconstituted with 4.6mL of solution. You receive an order for your patient to receive penicillin 300,00units now. How many ml will you give? Read the label carefully. 14 7
Monocid 975 mg IM every 6 hours has been ordered for a patient with colitis. How much diluent will be added to the bottle? What is the concentration after reconstitution? How many milliliters will the nurse administer? 15 Insulin Given with a Lo-Dose Insulin Syringe Example: The order states Lantus U-100 insulin 36 units subcutaneous in AM. You have 10 ml of Lantus U-100 insulin and a U-100 Lo-Dose syringe. Draw a vertical line through the syringe to indicate the correct dose. 16 8
Insulin Given with a Lo-Dose Insulin Syringe (cont d) Lo-Dose Lo-Dose 5 15 5 15 25 25 35 35 45 45 0.5 1 ml 2 cc 10 10 20 2030 3040 40 50 50units 17 Mixed Insulin Administration Guidelines: Inject air into each vial. Draw insulin from regular insulin bottle first. The practice of mixing insulins is decreasing with the rise in use of Lantus insulin. Clear before Cloudy http://www.youtube.com/watch?v=gizydn2_0io 18 9
Mixed Insulin Administration (cont d) Guidelines (cont d): Remove any air bubbles found in syringe. Draw insulin from cloudy insulin bottle. Have another nurse check your insulin. 19 Mixed Insulin Administration (cont d) Example: Physician orders Humulin L Lente U-100 insulin 46 units plus regular Humulin R U-100 20 units subcutaneous every morning. You have 10 ml of Humulin L Lente insulin and 10 ml of regular Humulin R insulin. A U-100 insulin syringe is available. Draw vertical lines through the syringe to indicate the correct doses. 20 10
Mixed Insulin Administration (cont d) Insulin Insulin 20 20 40 40 60 60 80 80 100 100units 10 10 30 30 50 50 70 70 90 90 21 The physician has ordered 500,00 units of IV Pfizerpen every 4 hours. How much diluent will you add for a concentration of 500,000 units/ml? How many milliliters will you administer? 22 11
A physician orders penicillin G 750,000u IV for your patient with a bacterial infection. How many ml you give if you reconstitute this medicine with 33mL of solution? 1.5mL 23 The physician orders Cefobid 1000mg IV every 12 hours for a patient with an infection. How much diluent will be added to the bottle? What is the concentration after reconstitution? How many milliliters will the nurse administer? 24 12
Epogen 20,000units SQ is ordered for your patient with anemia. How many ml will you give? 2mL 25 13