OAKLAND UNIVERSITY SCHOOL OF NURSING MEDICATION ADMINISTRATION MODULE A Basic (Sophomore Year) and Accelerated 2 nd Degree (1 st Semester) Nursing Programs Faculty: JOANN KAPA, MSN, RN Adjunct Instructor DEBORAH TIERNEY, MS, RN Adjunct Assistant Professor 1
MATH FOR MEDICATION ADMINISTRATION INTRODUCTION Welcome to the medication mathematics review, module A. Nurses have many responsibilities related to care of patients. One of the essential functions is the safe calculation and accurate administration of medications. Nurses must calculate patient drug dosages accurately and quickly, verify that the dosages that have been provided by the pharmacy are correctly calculated, and safely administer the medications every time a medication is given. OBJECTIVES At the completion of this module, the student will: 1. Convert dosages within and between measurement systems using metric, household and apothecary systems. 2. Correctly interpret medical abbreviations and medication orders. 3. Demonstrate correct calculation of oral and parenteral medication dosages. 4. Correctly calculate intravenous flow rates, intravenous piggyback infusion rates, and duration of infusion. REQUIRED TEXTBOOK Pikar, G. D., & Abernethy, A. P. (2013). Dosage calculations (9 th ed.). Clifton Park, NY: Delmar, Cengage Learning. (ISBN 978-1-4390-5847-3) MEDICATION TEST The medication test will be scheduled and the date announced at the beginning of the semester. On the medication test, you will be expected to show all calculations, label the answer (ml, mg, kg, gtt/hr, mg/dose, etc.), and circle your answer. WHERE TO BEGIN The perfect place to begin is with the pre -Mathematics Diagnostic Evaluation on page 4-20 of Pikar, G. D., & Abernethy, A. P. (2013). Dosage calculations (9 th ed.). 2
REQUIRED READINGS Section 1: Mathematics Review Complete the basic math review on pages 28-30. After completing your math review turn to pages 587 and 588 to check your answers. If you score less than 90% in this area please review basic math skills in Section 1, chapters 1 & 2. Any student needing additional assistance with this module can schedule an appointment with the instructor to review problem areas. The Oakland University Study Skills Center located in the North Foundation Hall provides tutoring services for basic math skills. Section 2: Systems of Measurement Chapters 3, 4, 5, 6, 7, 8, and 9. Read and review these chapters. Complete each review set with in the chapters and the self-evaluation starting on page 199-204. Focus areas: Recognize and express the basic systems of measurements used to calculate dosages. Differentiate metric, apothecary and household systems of measurements. Learn, do not memorize, metric and house notations and equivalents. You must have a thorough knowledge of the measurement systems used to prescribe, measure, and administer medications. Section 3: Drug Dosage Calculations Chapter 10, 11, 12 and 14 Read and review these chapters. Complete each review set with in the chapters and the self-evaluation starting on page 423-436. Focus areas: Appling clinical reasoning skills to prepare safe and accurate oral dosages of drugs. Use formulas do calculate drug dosage o Set up and solve drug dosage calculation o Use method of dosage calculations that works best for the medication type and that you are the most comfortable with Calculating the amount of medication that needs to be given Reconstitute and administer injectable and noninjectable medications 3
Section 4: Chapter 15 Intravenous Solutions, Equipment and Calculations Read and review these chapters. Complete each review set with in the chapters and the self-evaluation starting on page 439-488. Focus areas: Calculating intravenous (IV) solution flow rates for electronic or manual infusion systems. 4
Table A TABLE OF EQUIVALENTS/CONVERSIONS APOTHECARY METRIC HOUSEHOLD 1 Milliliter (ml) 15 drops (gtt) 5 ml 1 teaspoon (t, tsp.) 15ml 1 tablespoon (T, tbsp.) 1 fluidounce (fl oz) 30 ml 2 tablespoons 16 fluidounces 480 ml 1 pint (pt) 32 fluidounces 960 ml 1 quart (qt) 1 grain (gr) 60* 65 Milligrams (mg) 15 grains 1 gram (g) 2.2 pounds (lb) 1000 gm or 1 Kilogram (Kg) 2.2 lb 2.54 cm 1 inch *These numbers are the normal ones used for conversions Table B COMMON METRIC CONVERSIONS 1 Liter (L) 1000 milliliters (ml) 1 Kilogram (Kg) 1000 grams (g) 1 Gram (g) 1000 milligrams (mg) 1 Milligram (mg) 1000 micrograms (mcg) ISMP & JCAHO Guidelines for Abbreviations Do Not Use or suggestions for Do not Use U IU QD QOD HS SC or SQ DS or D/C cc AD, AS, AU @ Trailing O (x.o mg) Abbreviation for drug names SS OD, OS, OU Per OS Write units Write international unit Write daily Write every other day Write bedtime or half strength Write subcut or subcutaneously Write discontinue or discharge Write ml Write left ear, right ear, or both ears Write at Write x mg or o.x mg in med in orders Write drug names in full Write sliding scale or one-half Write right eye, left eye, both eyes Write by mouth 5
* ISMP/Institute for Safe Medical Practice JCAHO/Joint Commission on Accreditation of Healthcare Organizations 6
A. Drug Dosage Calculations METHODS OF CALCULATION D = Desired Dose H = Dose on Hand V = Vehicle (form and amount drug comes in, tabs, caps, ml. May also be referred to as Q = Quantity) Rounding: For purposes of this module, calculate all problems to 2 decimal points (e.g., 1.75963 ml would be rounded to 1.76 ml). In actual clinical practice, these numbers may be rounded to 1 decimal point or a whole number (e.g. 1.75963 would round to 1.8) for the purpose of drawing up medication into a syringe, pouring into a medication cup, or providing a tablet to the patient. Formula-Basic Formula (most current method) Convert Units to One System X (amount) = D (desired) x Q (quantity) H (have) Evaluate answer. B. IV Infusion Rates 1. Infusion Pump : Calculate ml/hr of infusion Amount of fluid Hours to administer = ml/hr 2. Regulation of flow rate (gtt/min) by gravity flow a. 1 step formula for primary and secondary (IVPB infusion) Amount of solution x gtt/ml of the IV tubing set ----------------------------------------------------------- = gtt/min Minutes to Administer b. 2 Step method for primary infusions Step 1: Amount of fluid hours to administer = gtt/min Step 2: ml/hr x IV tubing (set) drop factor = gtt/min 60 min Evaluate answer. 3. If a medication is added to an IV bag, then add the volume of the medication to the amount in the bag for a total amount of fluid. This total will be used for calculation purposes. For example, if 20 ml of KCL is added to 1000 ml NS, then the total amount of solution is 1020 ml. (Kee and Marshall presents two thoughts on this rule, but it is always safe practice to add the medication volume and is especially important when caring for infants and children.) 7
4. Work the problem to 2 decimal places and then round to the whole number for setting the drop rate in clinical practice. (e.g. 83.95 =84 gtt/min) 3. Reconstitution/Solutions from powders. A powdered drug is reconstituted (dissolved) with fluid (sterile water, sterile saline, or bacteriostatic water) following manufacturer s directions and becomes a solution. The powder will increase the volume of the fluid. The reconstituted solution will always be more than the volume of added diluent. The drug dosage is based on the total volume. 8