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A comprehensive review from basic math review to critical care intravenous calculations • Always check your answer against common sense. • Have an idea if your answer will be big or small. • Calculators calculate EXACTLY as you put it in. YOU need to remember order of operations. • When in doubt, put it into the calculator again to confirm your answer. Hundreds Tens Ones . (and) Tenths Hundredths Thousandths Thousandths Hundredths Tenths . (and) Ones Tens Hundreds Place value 5 3 1 . 0 6 7 What place value is the 6 in? Hundreds Tens Ones . (and) Tenths Hundredths Thousandths To round a number: 1. Look at the number after the requested place value 2. If that number is 5 or above (5, 6, 7, 8, 9) round the requested place value number up to the next numeric value 3. If that number is below 5 (1, 2, 3, 4) leave the requested place value alone. 4. The numbers after the requested place value either become zeroes (if before the decimal) or are left off entirely (if after the decimal) 5 3 1 . 0 6 7 Round 531.067 to the nearest hundredth: 1. Number after: 7 2. It is 5+ so round up: 6 becomes 7 3. New number is 531.07 (leave off thousandths) Round 531.067 to the nearest tens place: 1. Number after: 1 2. It is below 5 so leave alone: 3 remains 3 3. New number is 530 (zero for the ones place and everything else after is left off) • Addition and Subtraction – Line up decimals – Add trailing zeroes as necessary – Perform the necessary function 53.45 + 21.3 + 7.0006 = 53.45 21.3 +7.0006 81.7506 53.4500 21.3000 +7.0006 81.7506 • Value – Line up decimals – Compare numbers from left to right Compare 3.1 & 3.2 3.1 3.2 3.1 < 3.2 Compare 3.1 & 3.01 3.1 3.01 3.1 > 3.01 Put 4.1, 4.4, 3.1 and 3.06 in order from least to greatest 4.1 4.4 3.1 3.06 3.06, 3.1, 4.1, 4.4 • Parts of a fraction Numerator 1 Fraction bar 4 Denominator • Add and subtract with like denominators – Simply add (or subtract) the numerators – Keep the denominator the same 2 5 1 5 3 5 • Equivalent fractions 3 ? = 5 10 3 x2 6 x?...2 10 Start here! 5 • Add and subtract with unlike denominators 1 2 4 5 1 LCD is 10 (2x5) Find equivalent fractions with LCD then add 2 4 5 x5 x5 5 10 x2 8 x2 10 5 10 8 10 13 10 or 1 103 • Value – Find equivalent fractions with the same denominator – Compare the numerators 2 1 3 Write , , in order from least to greatest 3 2 5 Common denominator is 30 (3*2*5) New fractions : 20 30 15 1 18 In order : , 30 2 30 , 15 , 18 30 30 3 20 2 , 5 30 3 • I=1 • V=5 • X = 10 • Add if numbers to right are smaller than those immediately preceding them (ex: VI = 6) • Subtract if numbers to right are larger than those immediately preceding them (ex: IV = 4) BID TID • Twice a day • Bis in die PRN • Three times a day • Ter in die NPO • As needed • Pro re nata IV SubQ PR • Nothing by mouth • Nil per os PO • intravenous • Subcutaneous • Intramuscular q__h (q2h) • By rectum • Per rectum ac • By mouth • Per os IM • Every __ hours • Quaque __ hora pc • Before meals • Ante cibum • After meals • Post cibum Abbreviation Potential Problem Preferred Term U (for unit) Mistaken as zero, four or cc Write “unit” IU (for international unit) Mistaken as IV or 10 Write “international unit” QD, QOD (daily and every other day) Mistaken for each other Write “daily” and “every other day” Trailing zero (X.0 mg), No leading zero (.X mg) Decimal point is missed Do NOT use trailing zero (use X mg), USE leading zero (0.X mg) MS, MSO4, MgSO4 Confused for one another, can mean morphine sulfate or magnesium sulfate Write “morphine sulfate” or “magnesium sulfate” g (for microgram) Mistaken for mg Write “mcg” HS (for half-strength or at bedtime) Mistaken for each other, qHS mistaken for every hour Write “half-strength” or “at bedtime” TIW (for three times a week) Mistaken for 3 times a day or twice weekly Write “3 times weekly” or “three times weekly” SC, SQ (for subcutaneous) Mistaken for SL (sublingual) or “5 every” Write “Sub-Q”, “subQ” or “subcutaneous” D/C (for discharge) Mistaken for discontinue whatever medications follow (discharge meds) Write “discharge” cc (for cubic centimeter Mistaken for U (units) Write “ml” for milliliters as, ad, au, os, od, ou (for left, right and both ears and eyes respectively) Mistaken for each other Write out “left ear”, etc. Volume Length Weight Cup [c] Meter [m] Pound [lb/#] Gram [g] (pt, qt, gal) (cm, km) (oz) (mg, mcg) Liter [L] Foot [ft] (ml) (inch, yard) Kilogram [kg] Grain [gr] Fluid ounce [fl. oz] Tablespoon [tbs/tbsp] (tsp) Mass Measurements - Systems • Military time – Enables quick look at AM/PM distinction • (eliminates confusion) – No colon (:) – AM is always the normal time • Single digit numbers have a leading 0 (ex – 0800) – PM is the normal time plus 12 • 3:3O PM would be (3 +12 = 15) 1530 • Adding and subtracting time – 42 minutes, 1 hour 12 minutes and 38 minutes (what is the total time this IV bag has infused?) – Convert all to minutes by multiplying the number of hours by 60 minutes and add the minutes. – 42 min + 72 min + 38 min = 152 minutes – Now convert back to hours by dividing by 60 minutes (152/60 = 2 hours 32 minutes) – The remainder is the minutes • Syringe – Needle syringe – withdraw and measure in upright position with syringe below medication vial. – Oral syringe – withdraw and measure vertically with syringe above medication vial. • Dose cup – ALWAYS measure with the cup flat on a counter or other flat surface. – Eyes should be level with the dose cup – Be sure to note the dosage increments • Distracters – extra information that is NOT needed to solve the problem. An adult patient comes into the hospital with an acute infection. The doctor orders Ampicillin 500 mg IM q4h. The hospital stores Ampicillin 500mg in powdered form. The directions for reconstitution state to add 1.8 ml of diluent to yield a concentration of 250 mg/ml. How much Ampicillin will the nurse give the patient? • What information is unnecessary for the solving this problem? • After getting rid of the distracters, re-read the problem. The doctor orders Ampicillin 500 mg IM q4h. After reconstituting, Ampicillin yields a concentration of 250 mg/ml. How much Ampicillin will the nurse give the patient? Skim the problem. Note the requested information What answer is the problem looking for? Underline IMPORTANT information If distracters are distracting, cross them out. When you get an answer ALWAYS go back and look to see if it makes sense. Rework problem if necessary You wouldn’t give 20 pills, would you? • • • • • 1 cc = 1 ml 1000mg = 1 g 1000 mcg (µg) = 1 mg 1 tbsp = 3 tsp 1 tsp = 5 ml • • • • 1 oz = 30 ml 1 gr = 60 – 65 mg 1 cup = 8 fl. oz 1 kg = 2.2 lb • Use units to help determine how to set up the problem… – if the units are right, you KNOW you’re right. • Process of cancelling units • No memorized formulas • Works with ANY kind of problem! • Go back to the question and determine the unit requested What unit is wanted Wanted unit on TOP • Always start with the unit that is specified in problem on top • Fill in the other units such that they cancel out • If an undesired unit is on top, put it on bottom in the next part Fill in units The doctor orders spironolactone 25mg for a patient experiencing mild heart failure. The nurse has 50 mg tablets of spironolactone on hand. How many tablets will the nurse administer? x tab x tab 1 tab x tab 1 tab 50 mg The doctor orders Diabinese 0.1 g po daily for a patient with type 2 diabetes. The nurse has Diabinese 100 mg tablets in the Pyxis. How many tablets will the nurse administer? x tab x tab 1 tab x tab 1 tab 100 mg x tab 1 tab 100 mg x 1000 mg 1g A client is ordered 50 milligrams of Amoxicillin trihydrate orally. 125 milligrams in 5 milliliters of Syrup is available. How many milliliters will you administer? x ml x ml 5 ml x ml 5 ml 125 mg The doctor has ordered promethazine with codeine gr 1/6 po q6h prn for cough. On hand is promethazine with codeine solution 10mg per 5 ml. How much syrup should the nurse administer? x ml x ml 5 ml x ml 5 ml 10 mg x ml 5 ml 10 mg x 60 mg 1 gr The medication order states that 12,000 units of heparin are to be added to 250 milliliters of D5W. The patient is to receive 1200 units per hour IV. How many milliliters per hour will your patient receive? x ml hr 250 ml 12000 units x 1200 units 1hr 25 ml hr The doctor orders D5LR 1500 ml IV to run for 12 hours on a postoperative patient. The tubing has a drop factor of 20 gtt/ml. How many gtt/min will the nurse count out in order to comply with this order? x gtt min x gtt min 20 gtt 1ml x gtt min 20 gtt 1ml x 1500 ml 12 hrs Your shift is 0700 to 1500. You make rounds at 0730 and find an IV of D5 ½ NS is regulated on an electronic infusion pump at the ordered rate of 75 ml/hr with 400 ml remaining. The order specifies a continuous infusion. At what time should you anticipate hanging the next IV bag? How long until the bag is empty Convert it to hours 0730 5 hr 20 min 1250 Check and change IV bag on or before 1250 or 12:50 PM Order: dicloxacillin sodium 125 mg po q6h for a child who weighs 55 lb. The recommended dosage of dicloxacillin sodium for children weighing less than 40 kg is 12.5 to 25 mg/kg/day po in equally divided doses q6h for moderate to severe infections. Is this dosage safe? Safe Dose! The recommended dosage of tobramycin for adults with serious infections that are not life-threatening is 3 mg/kg/day in 3 equally divided doses q8h. What should you expect the total daily dosage of tobramycin to be for an adult with a serious infection who weighs 80kg? x mg day 3 mg kg day x 80 kg 240 mg day The doctor orders Procainamide 1 g IV in 500 ml D5W to infuse at 2 mg/min for a patient you are caring for in the ICU. You should program the IV pump at what rate? x ml hr 500 ml 1g x 1g 1000 mg x 2 mg 1 min x 60 min 1hr 60 ml hr The doctor orders dobutamine IV to increase the patient’s cardiac output. The dobutamine is supplied at a concentration of 250 mg in 250 ml D5W. The doctor orders the dobutamine to infuse at 5 mcg/kg/min. The patient weighs 176 lbs. At what rate should the nurse program the IV pump? x ml hr 250 ml 250 mg x 1mg 1000 mcg x 5 mcg 1kg min x 60 min 1hr x 1kg 2 . 2 lb x 176 lb 24 ml hr