1. Medical Dosage Calculation Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton CHAPTER Tenth Edition A Dimensional Analysis Approach Flow Rates and Durations of Enteral and Intravenous Infusions 10

2. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Directory Classroom Response System Questions Lecture Note Presentation

3. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Classroom Response System Questions

4. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #1 The prescriber ordered a tube feeding of Sustacal 480 milliliters in 2 hours. The drop factor is 20 drops per milliliter. Calculate the flow rate in drops per minute.

5. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #1 Choices 1.800 gtt/min 2.8.0 gtt/min 3.80 gtt/min 4.75 gtt/min

6. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #1 Response 1.800 gtt/min 2.8.0 gtt/min 3.80 gtt/min 4.75 gtt/min

7. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #2 The order reads: 900 mL NS IV 5 hr. Calculate the flow rate in milliliters per hour when the drop factor is 10 drops per milliliter.

8. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #2 Choices 1.1.80 mL/hr 2.180 mL/hr 3.2.45 mL/hr 4.55 mL/hr

9. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #2 Response 1.1.80 mL/hr 2.180 mL/hr 3.2.45 mL/hr 4.55 mL/hr

10. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #3 The rate ordered by the physician is 80 microdrops per minute. How many milliliters per hour will this patient receive?

11. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #3 Choices 1.4 mL/hr 2.60 mL/hr 3.80 mL/hr 4.80 mL/min

12. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #3 Response 1.4 mL/hr 2.60 mL/hr 3.80 mL/hr 4.80 mL/min

13. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #4 An IV of N.S. is infusing at a flow rate of 45 mL/hr. Calculate the flow rate in microdrops per minute.

14. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #4 Choices 1.15 mcgtt/min 2.4.5 mcgtt/min 3.45 mcgtt/min 4.90 mcgtt/min

15. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #4 Response 1.15 mcgtt/min 2.4.5 mcgtt/min 3.45 mcgtt/min 4.90 mcgtt/min

16. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #5 A patient with end stage renal disease (ESRD) is on limited fluid intake. An I.V. pump has been coded at 50 mL/h. How many milliliters per minute is the patient receiving?

17. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #5 Choices 1.0.8 mL 2.0.1 mL 3.5 mL 4.0.5 mL

18. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Question #5 Response 1.0.8 mL 2.0.1 mL 3.5 mL 4.0.5 mL

19. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Lecture Note Presentation

20. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Learning Outcomes 1.Describe the basic concepts and standard equipment used in administering enteral and intravenous (IV) infusions. 2.Calculate the flow rates of enteral and IV infusions. 3.Convert flow rates between gtt/min and mL/h. 4.Calculate the durations of enteral and IV infusions. 5.Determine fluid replacement volumes.

21. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Introduction to Intravenous and Enteral Solutions

22. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Intravenous and Enteral Solutions Fluids can be given to a patient slowly over a period of time –through a vein (intravenous) or –through a tube inserted into the alimentary tract (enteral).

23. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.1 A patient with a nasogastric tube.

24. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.2 A percutaneous endoscopic jejunostomy (PEJ) tube.

25. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.3 Enteral feeding via pump. (Photographer; Elena Dorfman)

26. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.4 Examples of IV bags and labels. (10-04a AI Dodge/AI Dodge. 10-04b Courtesy of Baxter Healthcare Corporation. All rights reserved. 10-04c AI Dodge/AI Dodge. 10-04d Reproduced with permission of Abbott Laboratories)

27. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.4 (continued) Examples of IV bags and labels. (10-04a AI Dodge/AI Dodge. 10-04b Courtesy of Baxter Healthcare Corporation. All rights reserved. 10-04c AI Dodge/AI Dodge. 10-04d Reproduced with permission of Abbott Laboratories)

28. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.4 (continued) Examples of IV bags and labels. (10-04a AI Dodge/AI Dodge. 10-04b Courtesy of Baxter Healthcare Corporation. All rights reserved. 10-04c AI Dodge/AI Dodge. 10-04d Reproduced with permission of Abbott Laboratories)

29. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.4 (continued) Examples of IV bags and labels. (10-04a AI Dodge/AI Dodge. 10-04b Courtesy of Baxter Healthcare Corporation. All rights reserved. 10-04c AI Dodge/AI Dodge. 10-04d Reproduced with permission of Abbott Laboratories)

30. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.5 Examples of intravenous fluids. (Reproduced with permission of Abbott Laboratories.)

31. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.5 (continued) Examples of intravenous fluids. (Reproduced with permission of Abbott Laboratories.)

32. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.5 (continued) Examples of intravenous fluids. (Reproduced with permission of Abbott Laboratories.)

33. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.5 (continued) Examples of intravenous fluids. (Reproduced with permission of Abbott Laboratories.)

34. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.6 Primary intravenous line (gravity flow).

35. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.8 Samples of IV tubing containers with drop factors of 10 and 60. (10-8a Courtesy of Baxter Healthcare Corporation. All rights reserved. 10-8b AI Dodge/AI Dodge)

36. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.8 (continued) Samples of IV tubing containers with drop factors of 10 and 60. (10-8a Courtesy of Baxter Healthcare Corporation. All rights reserved. 10-8b AI Dodge/AI Dodge)

37. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Table 10.1 Common Drop Factors

38. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.9 Volumetric infusion pump.

39. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Figure 10.10 Patient-Controlled Analgesia (PCA) (a) pump (b) control button.

40. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Finding the Flow Rate

41. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Order: NS 1,000 mL IV stat infuse in 8 hr. Find the flow rate (pump setting) in mL/h. Example 10.1 Flow Rate =

42. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton 1,000 mL of NS must infuse via IV over 8 hours. The drop factor is 20 gtt/mL. Find the flow rate in gtt/min. Example 10.2 Flow Rate =

43. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Example 10.2 1 3 125 1

44. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Example 10.3 The order is 775 mL of 5% D/W b.i.d infuse in 6 hours. Initially, the flow rate was set at 26 drops per minute. You assess the infusion 3 hours later, and the patient has received 500 mL. The drop factor is 10 gtt/mL. Recalculate the flow rate so that the infusion finishes on time.

45. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton The remaining IV fluid (275 mL) must infuse in the remaining time (3 h). Convert the flow rate from 275 mL/3 h to gtt/min. Example 10.3

46. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Example 10.3 1 6

47. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Calculating the Duration of Flow for IV and Enteral Solutions

48. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Example 10.4 An infusion of 5% D/W begins with 300 mL in the IV bag. The pump is set at 60 mL/h. How many hours will it take for the infusion to complete?

49. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Convert the volume in the bag (300 mL) to hours using the flow rate as the unit fraction. 5 h Example 10.4 300 mL = ? h 5 1

50. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Example 10.5 If the drip rate is 30 gtt/min, how many mL will infuse in 6 hours? The drop factor is 10 gtt/mL.

51. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Convert the time (6 h) to volume infused (mL) using the flow rate as a unit fraction. 1,080 mL Example 10.5 6 h = ? mL

52. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Chapter Summary Fluids can be given to a patient slowly over a period of time through a vein (intravenous) or through a tube inserted into the alimentary tract (enteral). Enteral and IV fluids can be administered continuously or intermittently.

53. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Chapter Summary In IV solutions, letters indicate solution compounds, whereas numbers indicate solution concentration (e.g., D5W). An intravenous infusion can flow solely by the force of gravity or by an electronic infusion pump.

54. Copyright ©2012, ©2008 by Pearson Education, Inc. All rights reserved. Medical Dosage Calculations: A Dimensional Analysis Approach, Tenth Edition June L. Olsen Anthony P. Giangrasso Dolores Shrimpton Chapter Summary Flow rates are usually given as either mL/h or gtt/min. The drop factor of the IV administration set must be known in order to calculate gravity system flow rates. Microdrops/minute are equivalent to milliliters/hour.