1. Dosages Measured in Units
Chapter 13
Dosages Measured in Units
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Units Epogen Fragmin Heparin Insulin Common drugs measured in units:
What is a unit?
A unit is the amount of a drug needed to produce a particular result.
Heparin is an anticoagulant that is used to inhibit the clotting of blood.
Insulin is a hormone secreted by the pancreas that is used to lower the blood glucose level.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Epogen
Helps combat effects of anemia caused by chemotherapy or chronic renal failure by increasing the production of red blood cells.
Nurse should monitor blood pressure and lab results on a routine basis
After administering Epogen, the nurse should monitor the patient’s blood pressure and laboratory results on a routine basis.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Fragmin
Used in the prevention of deep vein thrombosis after surgery and unstable angina/non−Q-wave myocardial infarction by preventing clotting of blood classified as an anticoagulant
Only given subcutaneously; blood work should be monitored on a regular basis
During treatment with Fragmin, the patient’s blood studies must be monitored on a routine basis.
How is Fragmin administered?
Fragmin may only be given by subcutaneous injection—never intramuscularly or intravenously.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Heparin
Used because prolongs bleeding times therefore prolong clotting
Blood work results need to be monitored
Need to monitor for bleeding, assess for bruising
During treatment with Fragmin, the patient’s blood studies must be monitored on a routine basis.
How is Fragmin administered?
Fragmin may only be given by subcutaneous injection—never intramuscularly or intravenously.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Insulin
Is a hormone produced in the pancreas in the Islets of Langerhans that helps to lower blood glucose
Refer to page 371 to see the various types of insulin available
Nurses should be able to recognize the symptoms of both insulin shock and a diabetic coma so that immediate treatment can be initiated to stabilize the patient.
What is the definition of U-100 insulin?
U-100 insulin is 100 units of insulin dissolved in 1 mL of liquid. U-100 insulin is a universal standard preparation that all people requiring insulin can use.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. 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.
ONLY INSULIN IS MEASURED IN INSULIN SYRINGES AND GIVEN IN INSULIN SYRINGES
Nurses should be able to recognize the symptoms of both insulin shock and a diabetic coma so that immediate treatment can be initiated to stabilize the patient.
What is the definition of U-100 insulin?
U-100 insulin is 100 units of insulin dissolved in 1 mL of liquid. U-100 insulin is a universal standard preparation that all people requiring insulin can use.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

8. Dosages Measured in Units Involving Oral Medications
Dimensional analysis method
For example:
The physician orders Mycostatin 400,000 units po four times a day. The drug is supplied 100,000 units/mL after reconstitution. How many milliliters will the nurse administer?
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Insulin Given With a Lo-Dose Insulin Syringe
For 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.
Draw a vertical line through the syringe to indicate the correct dosage.
In this case, the dose is 36 units of U-100 insulin. Therefore, find the 30-unit mark on the units scale of the Lo-Dose syringe. Counting the number of marks between the 30-unit mark and the 40-unit mark, it can be seen that each of the shorter marks indicates 1 unit. Therefore, the line should be drawn six shorter marks to the right (closer to the plunger) of the 30-unit mark.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Insulin Supply dosage of insulin is 100 units per mL
Abbreviated on label as U-100
Syringe must also be U-100
Think: U-100 = 100 units per mL
Think: U-500 = 500 units per mL

11. Insulin (Continued) Accuracy is critical
Nurses must understand and correctly interpret insulin order and label
The correct syringe must be selected

12. 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.
Remove any air bubbles found in syringe.
Draw insulin from cloudy insulin bottle.
Physicians sometimes prescribe two types of insulin to be administered at the same time. The two types of insulin are drawn into the same syringe to reduce the number of times that the patient needs to be injected.
The air that is injected into each vial should be equal to the amount of insulin that will be withdrawn. Do NOT touch the insulin solution with the tip of the needle when injecting air into the vials.
When the desired amount of insulin has been withdrawn from the regular insulin bottle, remove the syringe before checking it for any air bubbles.
The same syringe should be used throughout this process. Therefore, the same syringe that was used to draw up the regular insulin also should be used to draw up the cloudy insulin.
Copyright © 2020 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. Combination Insulin Dosage
40 units
NPH
U-100 insulin
12 units
regular
U-100
insulin
Total insulin dosage = 52 units

14. Preparing Combination Insulin Dosage
Inject 30 units of air
2. Inject 10 units of air

15. Preparing Combination Insulin Dosage (Continued)
3. Withdraw
10 units regular
4. Withdraw
30 units NPH for a total of 40 units
© Cengage Learning 2013

16. Procedure for Preparing Combination Insulin Dosage4)
Withdraw
30 units NPH
for a total of 40 units 1)
Inject 30 units air 2)
Inject 10 units air 3)
Withdraw
10 units regular

17. Insulin Sliding Scale Order
Humulin R regular U-100 insulin subcut based on glucose reading at 1600

18. Insulin Sliding Scale (Continued)
Insulin Dose
Glucose Reading*
No coverage
Glucose less than 160
2 units
160–220
4 units
221–280
6 units
281–340
8 units
341–400
Glucose greater than 400: Hold insulin; call MD stat

19. Insulin: Avoiding Errors
Check dosage with two nurses
When combination dosages are prepared, two nurses must verify each step of the process