CALCULATIONS 1.

CALCULATING A MEDICATION DOSAGE Formula: D (Desired) A (Available) x Q (Quantity)

where, D (Desired) dosage that the physician ordered A (Available) dosage strength as stated on the medication label Q (Quantity) volume that the dosage strength is available in ml such as those tablets or capsules 2. INTRAVENOUS CALCULATIONS Formulas: Flow Rates Total Volume x gtt factor Time (in minutes) Infusion Time Total Volume to infuse mL per hour being infused = Infusion Time = gtt per minute

Infusions Ordered by Unit Dosage per Hour Calculation of these problems requires a two- step process: 1. Determine the amount of medication per 1 mL. 2. Determine the infusion rate or mL per hour. Example Problem: Order: Continuous Regular Insulin by IV at 10 units per hour Available: IV bag of 100 mL NS with 50 units Regular Insulin How many Ml per hour are required to administer the correct dose? Step 1: Known amount of medication in solution Total volume of diluent 50 units 100 mL 1 mL

Amount of medication per mL

= =

0.5 units per 1 mL 0.5 units

Step 2:

Dose per hour desired Concentration per mL 10 units 0.5 units per mL

Infusion rate or ml per hour

20 mL per hour

3. METRIC SYSTEM Abbreviations cubic centimeter: cc gram: g, gm, gm kilogram: kg, kg liter: l meter: m microgram: ug, mcg milligram: mg, mgm milliliter: ml Equivalents 1l = 1000 ml 1ml= 0.001 l or 1 cc 1cc= 1ml or 0.001 l 1 g= 1000 mg 1 mg = 1000 mcg or 0.001 g 1 mcg= 0.000001 g 1 kg= 1000 g 1 kg = 2.2 lb

4. APOTHECARY AND HOUSEHOLD SYSTEM Abbreviations dram: dr drops: gtt grain: gr minim: min, m, or m ounce: oz pint: pt pound: lb Equivalents gr 5= 300 mg 1 t= 15 ml or 3 tsp gr 1= 60 mg gr 1/ 150= 0.4 mg gr 15= 1000 mg or 1 g 1 dr = 4 ml 15 min= 1 mL 60 min= 1 dr 8 dr= 1 oz 1 qt= 1000 ml or 1 L 1 qt= 2 pt or 32 oz 1 pt= 16 oz 16 oz= 1 lb 2.2 lb= 1 kg 1 oz= 30 ml 1 t or tsp= 5 ml 1 min= 1 gtt

quart: qt tablespoon: T or tbs teaspoon: t or tsp

5. CELSIUS AND FAHRENHEIT TEMPERATURE Fahrenheit to Celsius - To convert Fahrenheit to Celsius, just subtract 32 and divide result by 1.8. Formula: C= (F-32) / 1.8

Celsius to Fahrenheit - To convert Celsius to Fahrenheit, just multiply by 1.8 and add 32. Formula: F= 1.8 C + 32

6. CALCULATING EQUIVALENTS BETWEEN TWO SYSTEMS Using the method of Ratio and Proportion you may calculate equivalents between two systems. Example Problem: The physician orders nitroglycerin, gr 1/ 150. The medication label reads 0.4 mg per tablet. The nurse prepares to administer how many tablets to the client? Gr 1: 60 mg= gr 1/ 150: x mg 60 x 1/ 150= x x= 0.4 mg (1 tablet)

PARENTERAL MEDICATIONS Parenteral always means injection route and parenteral medications are administered by intravenous (IV), intramuscular (IM) or subcutaneously (SC). The nurse shouldnt administer more than 3 mL per Intramuscular or subcutaneous injection site, as volumes larger than 3 mL are difficult for a single injection site to absorb. The standard 3- mL syringe is used to measure most injectable medications; it is calibrated in tenths (0.1) of a milliliter. Tuberculin syringe: o It holds a total capacity of 1 ml (cc) and is used to measure small or critical amounts of medication, such as vaccine or a childs medicine. o It is calibrated in hundredths (0.01) of an mL, with each one tenth (0.1) marked on the metric scale.

8. SAMPLE CALCULATIONS Conversion Between Systems: 1. 2 qt = ____ ml a. b. c. d. 4,600 1,550 2,500 3,500

Correct Answer: C D/A: R/P: X (ml) 2.5 qt X (ml) X (ml) X (ml) = : = = 2.5 qt x 1000 ml 1 qt = 2500 ml

1 qt 1000 ml 2.5 x 1000 ml 1 2500 ml

2. The physician orders 1, 500 mg of ascorbic acid (vitamin C). What is the equivalent dose in grains? a. b. c. d. 25 gr 12 gr 26 gr 125 gr

Correct Answer: A D/A: R/P: X (gr) = : = 1500 mg 60 mg 1 gr 1500 x 1 gr 60 x 1 gr 60 mg = 25 gr

1500 mg X (gr) X (gr) X (gr)

= 25 gr

3. 2, 500 mcg = ________ kg a. b. c. d. 0.00000018 0.0000025 0.00000025 0.00018

Correct Answer : B D/A: R/P: X = 2500 mcg : = = x 1 mg 1000 mcg x x 1g 1000 mg x x 1 kg 1000 g = 0.0000025 kg

2500 mcg X (kg) X (kg) X (kg)

1000 mcg 1 mg

1000 mg 1g

1000 g 1 kg

2500 x 1 kg 1000 x 1000 x 1000 0.0000025 kg

Non-Parenteral Medications: 1. The nurse prepares to administer an order for Methocarbamol (Robaxin) 1.5 g P.O.; 500 mg tablets are available. How many tablets of this skeletal muscle relaxant should be administered? a. b. c. d. 3 4 3 2 tablets tablets tablets tablets

Correct Answer: A D/A: R/P: X = : = = 1.5 g X (tab) x 1000 mg 1g x x 1 tab 500 mg = 1500 tab 500 g = 3 tabs

1.5 g X (tab) X (tab) X (tab)

1g 1000 mg

500 mg 1 tab

1.5 x 1000 x 1 tab 500 3 tab

2. A concentrated nutrition product (Sustacal HC) for tube feeding has been ordered at 80 calories/ hour. Each 250 ml can is labeled 1.5 calories/ ml. How many milliliters will provide 80 calories? a. b. c. d. 56 63 53 46 ml ml ml ml

Correct Answer: C D/A: R/P: X (ml) = : = 80 calories 1.5 calories 1 ml 80 x 1 ml 1.5 x 1 ml 1.5 calories = 80 ml 1.5 = 53.3 or 53 ml

80 calories X (ml) X (ml) X (ml)

= 53.3 or 53 ml

3. A patient is to receive 0.25 mg P.O. of digoxin (Lanoxin). The bottle is labeled 1 ml = 50 mcg. How many millimeters of this antiarrhythmic should be administered? a. b. c. d. 15ml 5 ml 55 ml 0.50 ml

Correct Answer: B D/A: R/P: X (ml) 0.25 mg X (ml) X (ml) X (ml) = : 0.25 mg x 1000 mcg 1 mg x 50 mcg 1 ml x 1 ml 50 mcg = 250 ml 50 = 5 ml

1 mg 1000 mcg

= =

0.25 x 1000 x 1 ml 50 5 ml

Parenteral Medications 1. A vial of dactinomycin (actinomycin D, Cosmegen) reads 0.5 mg = 1 ml. A patient weighing 60 kg is to receive 15 mcg/ kg I.M. How many millimeters of this antibiotic antineoplastic drug shoul be prepared? a. b. c. d. 0.15 ml 1.8 ml 0.86 ml 2.8 ml

Correct Answer: B D/A: R/P: X = 60 kg X (ml) X (ml) X (ml) 60 kg : = = x 15 mcg 1 kg x x 1 mg 1000 mcg x x 1 ml 0.5 mg = 900 ml 500 = 1.8 ml

1 kg 15 mcg

1000 mcg 1 mg

0.5 mg 1 ml

60 x 15 x 1 ml 1000 x 0.5 1.8 ml

2. The physician orders cefoxitin (Mefoxin) 500 mg I.M. q12h. The vial label reads 1 ml = 400 mg. How many milliliters of this antibiotic should be given every 12 hours? a. b. c. d. 0.25 ml 0.128 ml 1 ml 1.25 ml

Correct Answer: D D/A: R/P: X (ml) 500 mg X (ml) X (ml) X (ml) = : = = 500 mg 400 mg 1 ml 500 x 1 ml 400 1.25 ml x 1 ml 400 mg = 500 ml 400 = 1.25 ml

3. A patient has been placed on antibiotic therapy with ampicillin sodium (Polycillin-N) 0.4 g I.M. q6h. The vial of powder states: Add 3.5 ml of diluent, and the resulting solution contains 250 mg/ml. How many milliliters of this prepared solution should the patient receive every 6 hours?

a. b. c. d.

1.7 2.6 1.6 3.7

ml ml ml ml

Correct Answer: C D/A: R/P: X (ml) 0.4 g X (ml) X (ml) X (ml) = : = = 0.4 g x 1000 mg 1g x x 1 ml 250 mg = 400 ml 250 = 1.6 ml

1g 1000 mg

250 mg 1 mg

0.4 x 1000 x 1 ml 250 1.6 ml

Pediatric Dosages 1. The antihistamine diphenyhydramine (Benadryl) has been prescribed for a child weighing 36 lb. The bottle label reads: 1 ml = 5 mg. How many milliliters should the midwife prepare if the order reads 1.25 mg/ kg P.O.? a. b. c. d. 4.9 1.8 4.1 4.2 ml ml ml ml

Correct Answer: C D/A: R/P: X (ml) 36 lb X (ml) X (ml) X (ml) = : = = 36 lb x 1 kg 2.2 lb x x 1.25 mg 1 kg x 5 mg 1 ml x 1 ml 5 mg = 45 ml 11 = 4.1 ml

2.2 lb 1 kg

1 kg 1.25 mg

36 x 1.25 x 1 ml 2.2 x 5 4.1 ml

2. The oral sulfonamide sulfisoxazole (Gantrisin) has been ordered for a child weighing 20 kg. How many milligrams should the nurse administer if the order reads 30-mg/ kg? a. b. c. d. 600 560 585 620 mg mg mg mg

Correct Answer: A D/A: R/P: X (mg) 20 kg X (mg) X (mg) X (mg) = : = = 20 kg x 30 mg 1 kg = 600 mg

1 kg 30 mg 20 x 30 mg 1 600 mg

3. A child weighing 50 lb must receive methylphenidate (Ritalin) therapy. What would be the safe dose of this central nervous system stimulant if the recommended optimum daily dose is 2 mg/ kg P.O.? a. b. c. d. 43 46 35 45 mg mg mg mg

Correct Answer: D D/A: R/P: X (mg) 50 lb X (mg) X (mg) X (mg) = : = = 50 lb 2.2 lb 1 kg 50 x 2 mg 2.2 45 mg x x 1 kg 2.2 lb 1 kg 2 mg x 2 mg 1 kg = 100 mg 2.2 = 45 mg

Intravenous Therapy 1. An I.V. infusion of 1,000 ml of dextrose 5% in 0.45% saline solution is scheduled to start at 1:30 pm and end at 4:30 pm. The drop factor is 10 gtt = 1 ml. What is the appropriate flow rate? a. b. c. d. 56 37 66 28 gtt/minute gtt/minute gtt/minute gtt/minute

Correct Answer: A D/A: R/P: X = 1000 ml x 3 hr : = = 10 gtt 1 ml 1 ml 10 gtt x x 1 hr 60 min = 10000 gtt 180 min = 56 gtt/min

1000 ml/3 hr X X X

60 min 1 hr

1000 x 10 gtt 3 x 60 min 56 gtt/min

2. A physician orders 400 ml of hypotonic 2.5% dextrose in water, to be infused in 4 hours. The drop factor is 60 mcgtt = 1 ml. Which flow rate is correct? a. b. c. d. 160 120 100 119 mcgtt/ mcgtt/ mcgtt/ mcgtt/ minute minute minute minute

Correct Answer: C

D/A: R/P:

400 ml 4 hr : = =

60 mcgtt 1 ml x

1 hr 60 min

400 mcgtt 4 min

= 100 mcgtt/min

400 ml/4 hr X X X

1 ml 60 mcgtt

60 min 1 hr

400 x 1 mcgtt 4 x 1 min 100 mcgtt/min

3. The midwife begins an infusion of 500 ml of D5W with penicillin G, with instructions to infuse at a rate of 20 gtt/ minute. The drop factor is 10 gtt = 1 ml. How many milliliters of penicillin G solution is this patient receiving every minute? a. b. c. d. 12 ml/ minute 2 ml/ minute 7.5 ml/ minute 11 ml/ minute

Correct Answer: B D/A: R/P: X = 20 gtt 1 min : x 1 ml 10 gtt 10 gtt 1 ml 20 x 1 ml X X = 10 x 1 min = 2 ml/min = 20 ml 10 min = 2 ml/min

20 gtt/min X

Medical & Pharmacological Abbreviations

Abbreviation aa ac ad lib AM, am amp amt aq bid /c cap cc DC,disc,d/c disp dl,DL dr DW elix et fl, fld g, GM gr gtts h, hr hs, HS ID IM Meaning Of each before meals as desired morning ampule amount aqueus twice a day with capsule cubic centimeter discontinue dispense deciliter dram distilled water elixir and fluid gram grain drop(s) hour hours of sleep intradermal intramuscular Abbreviation IV kg L, l lb m, min mcg, ug mEq ml, n NaCl NKA Noc NPO OD OS OU oz pc PM, pm po, PO prn, PRN pt q qd Meaning intravenous kilogram liter pound minim microgram milliequivalent milliliter normal sodium chloride no known allergies night nothing by mouth right eye left eye both eyes ounce
post cebum/after meals

Abbreviation qh Q2h Q3h Qid QOD Qs R Rx

afternoon or evening by mouth/per orem whenever necessary pint every every day

Sc, subcu, subq, S/Q sig SL sol SOS sp ss stat, STAT supp syr tab T, tbsp t, tsp TID tinc ung

Meaning every hour every 2 hours every 3 hours four times a day every other day quantity sufficient right taken/ prescription without with subcutaneously label sublingual solution once if necessary spirits one-half immediately suppository syrup tablet tablespoon teaspoon three times a day tincture ointment