Clinical Calculations - E-Book , livre ebook

Clinical Calculations
With Applications to General and Specialty
Areas
SEVENTH EDITION
Joyce LeFever Kee, RN, MS
Associate Professor Emerita, College of Health Sciences, Department of Nursing, University
of Delaware, Newark, Delaware
Sally M. Marshall, RN, MSN
Nursing Service, Department of Veterans Affairs, Regional Office of Medical Center,
Wilmington, DelawareTable of Contents
Cover image
Title page
Inside front cover
Copyright
Dedication
REVIEWERS
Preface to the Instructor
FEATURES FOR THE SEVENTH EDITION
ANCILLARIES
Preface to the Student
ACKNOWLEDGMENTS
Part I: Basic Math Review
INTRODUCTION TO BASIC MATH REVIEW
Objectives
OUTLINE
NUMBER SYSTEMS
FRACTIONS
DECIMALS
RATIO AND PROPORTION
PERCENTAGEPOST-MATH TEST
Part II: Systems, Conversion, and Methods of Drug Calculation
CHAPTER 1. SYSTEMS USED FOR DRUG ADMINISTRATION
Objectives
METRIC SYSTEM
APOTHECARY SYSTEM
HOUSEHOLD SYSTEM
CHAPTER 2. CONVERSION WITHIN THE METRIC, APOTHECARY, AND
HOUSEHOLD SYSTEMS
Objectives
UNITS, MILLIEQUIVALENTS, AND PERCENTS
METRIC, APOTHECARY, AND HOUSEHOLD EQUIVALENTS
CONVERSION IN METRIC AND HOUSEHOLD SYSTEMS BY LIQUID VOLUME
CONVERSION IN METRIC AND HOUSEHOLD SYSTEMS BY LENGTH
CHAPTER 3. INTERPRETATION OF DRUG LABELS, DRUG ORDERS, BAR CODES,
MAR AND eMAR, AUTOMATION OF MEDICATION DISPENSING ADMINISTRATION,
AND ABBREVIATIONS
Objectives
INTERPRETATION OF DRUG LABELS
DRUG DIFFERENTIATION
UNIT-DOSE DISPENSING SYSTEM (UDDS)
COMPUTER-BASED DRUG ADMINISTRATION (CBDA)
COMPUTERIZED PRESCRIBER ORDER SYSTEM (CPOS)
ABBREVIATIONS
CHAPTER 4. PREVENTION OF MEDICATION ERRORS
Objectives
PREVENTING MEDICATION ERRORS
THE RIGHTS IN DRUG ADMINISTRATIONCHAPTER 5. ALTERNATIVE METHODS FOR DRUG ADMINISTRATION
Objectives
TRANSDERMAL PATCH
TYPES OF INHALATION
NASAL SPRAY AND DROPS
EYE DROPS AND OINTMENT
EAR DROPS
PHARYNGEAL SPRAY, MOUTHWASH, AND LOZENGE
TOPICAL PREPARATIONS: LOTION, CREAM, AND OINTMENT
RECTAL SUPPOSITORY
VAGINAL SUPPOSITORY, CREAM, AND OINTMENT
CHAPTER 6. METHODS OF CALCULATION
Objectives
DRUG CALCULATION
CHAPTER 7. METHODS OF CALCULATION FOR INDIVIDUALIZED DRUG DOSING
Objectives
CALCULATION FOR INDIVIDUALIZED DRUG DOSING
Part III: Calculations for Oral, Injectable, and Intravenous Drugs
CHAPTER 8. ORAL AND ENTERAL PREPARATIONS WITH CLINICAL
APPLICATIONS
Objectives
TABLETS AND CAPSULES
LIQUIDS
BUCCAL TABLETS
SUBLINGUAL TABLETS
ENTERAL NUTRITION AND DRUG ADMINISTRATION
CHAPTER 9. INJECTABLE PREPARATIONS WITH CLINICAL APPLICATIONS
ObjectivesINJECTABLE PREPARATIONS
INTRADERMAL INJECTIONS
SUBCUTANEOUS INJECTIONS
INSULIN INJECTIONS
TYPES OF INSULIN
MIXING INSULINS
Insulin Pen Devices
INSULIN PUMPS
INTRAMUSCULAR INJECTIONS
Reconstitution of Powdered Drugs
MIXING OF INJECTABLE DRUGS
CHAPTER 10. INTRAVENOUS PREPARATIONS WITH CLINICAL APPLICATIONS
Objectives
INTRAVENOUS ACCESS SITES
DIRECT INTRAVENOUS INJECTIONS
CONTINUOUS INTRAVENOUS ADMINISTRATION
CALCULATION OF INTRAVENOUS FLOW RATE
THREE-STEP METHOD
TWO-STEP METHOD
ONE-STEP METHOD
INTERMITTENT INTRAVENOUS ADMINISTRATION
FLOW RATES FOR INFUSION PUMPS AND SECONDARY SETS
One-Step Method for IV Drug Calculation with Secondary Set
Part IV: Calculations for Specialty Areas
CHAPTER 11. PEDIATRICS
Objectives
FACTORS INFLUENCING PEDIATRIC DRUG ADMINISTRATION
PEDIATRIC DRUG CALCULATIONSPEDIATRIC DOSAGE FROM ADULT DOSAGE
CHAPTER 12. CRITICAL CARE
Objectives
CALCULATING AMOUNT OF DRUG OR CONCENTRATION OF A SOLUTION
CALCULATING INFUSION RATE FOR CONCENTRATION AND VOLUME PER
UNIT TIME
CALCULATING INFUSION RATES OF A DRUG FOR SPECIFIC BODY WEIGHT
PER UNIT TIME
BASIC FRACTIONAL FORMULA
TITRATION OF INFUSION RATE
TOTAL AMOUNT OF DRUG INFUSED OVER TIME
CHAPTER 13. PEDIATRIC CRITICAL CARE
Objectives
FACTORS INFLUENCING INTRAVENOUS ADMINISTRATION
CALCULATING ACCURACY OF DILUTION PARAMETERS
CHAPTER 14. LABOR AND DELIVERY
Objectives
FACTORS INFLUENCING INTRAVENOUS FLUID AND DRUG MANAGEMENT
TITRATION OF MEDICATIONS WITH MAINTENANCE INTRAVENOUS FLUIDS
INTRAVENOUS LOADING DOSE
INTRAVENOUS FLUID BOLUS
CHAPTER 15. COMMUNITY
Objectives
METRIC TO HOUSEHOLD CONVERSION
PREPARING A SOLUTION OF A DESIRED CONCENTRATION
PREPARING A WEAKER SOLUTION FROM A STRONGER SOLUTION
HYDRATION MANAGEMENT
BODY MASS INDEX (BMI)Part V: Post-Test: Oral Preparations, Injectables, Intravenous, and
Pediatrics
INTRODUCTION TO POST-TEST: ORAL PREPARATIONS, INJECTABLES,
INTRAVENOUS, AND PEDIATRICS
ORAL PREPARATIONS
INJECTABLES
DIRECT IV ADMINISTRATION
INTRAVENOUS
PEDIATRICS
APPENDIX A. GUIDELINES FOR ADMINISTRATION OF MEDICATIONS
GENERAL DRUG ADMINISTRATION
ORAL MEDICATIONS
INJECTABLE MEDICATIONS
INTRAVENOUS FLUID AND MEDICATIONS
APPENDIX B. NOMOGRAMS
REFERENCES
INDEX
Inside back cover
Drug Calculations Basic Formula
Body Weight (Kilograms)
IV Flow Rate: Intermittent Secondary Sets
Drug Calculations Ratio and Proportion
IV Flow Rate: Continuous Method II
IV Flow Rate: Intermittent Volumetric PumpInside front cover
The Joint Commission (TJC) list of abbreviations that should be spelled out.
Abbreviation Use Instead
q.d., Q.D. Write “daily” or “every day”.
q.o.d., Write “every other day”.
Q.O.D.
U Write “unit”.
IU Write “international unit”.
MS, MSO Write “morphine sulfate”.4
MgSO Write “magnesium sulfate”.4
.5 mg Write “0.5 mg,” use zero before a decimal point when the dose is
less than a whole.
1.0 mg Do not use a decimal point or zero after a whole number.
Copyright The Joint Commission, 2011. Reprinted with permission.
The following abbreviations could possibly be included in future Joint Commission
“Do Not Use” lists. These abbreviations are as follows:
Abbreviation Use Instead
c.c. Use “mL” (milliliter).
μg Use “mcg” (microgram).
> Write “greater than”.
Write “less than”.
Drug name abbreviations Write out the full name of the drug.
Apothecary units Use metric units.
@ Write “at”.Other abbreviations can be found in Chapter 3, page 53.
Metric and Apothecary Conversion
Metric Apothecary
1 1000 15
0.5 500 7½
0.3 300 (325) 5
0.1 100 1½
0.06 60 (64) 1
0.03 30 (32) ½
0.015 15 (16) ¼
0.010 10 1/6
0.0006 0.6 1/100
0.0004 0.4 1/150
0.0003 0.3 1/200
Liquid Conversion (Approximate)
30 mL = 1 oz = 2 tbsp (T) = 6 tsp (t)
15 mL = ½ oz = 1 T = 3 t
1000 mL = 1 quart (qt) = 1 liter (L)
500 mL = 1 pint (pt)
5 mL = 1 tsp (t)
4 mL = 1 fl dr
1 mL= 15 (16) minims (m) = 15 (16) drops (gtt)C o p y r i g h t
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CLINICAL CALCULATIONS WITH APPLICATIONS TO GENERAL AND SPECIALTY
AREAS
ISBN: 978-1-4557-0384-5
Copyright © 2013, 2009, 2004, 2000, 1996, 1992, 1988 by Saunders, an imprint
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Notices
Knowledge and best practice in this field are constantly changing. As new
research and experience broaden our understanding, changes in research
methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience
and knowledge in evaluating and using any information, methods,
compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.With respect to any drug or pharmaceutical products identified, readers
are advised to check the most current information provided (i) on
procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and
duration of administration, and contraindications. It is the responsibility
of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment
for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors,
contributors, or editors, assume any liability for any injury and/or damage
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instructions, or ideas contained in the material herein.
Previous editions copyrighted 2009, 2004, 2000, 1996, 1992, 1988
Library of Congress Cataloging-in-Publication Data
Kee, Joyce LeFever.
Clinical calculations : with applications to general and specialty areas / Joyce
LeFever Kee, Sally M. Marshall. – 7th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4557-0384-5 (pbk. : alk. paper)
I. Marshall, Sally M. II. Title.
[DNLM: 1. Drug Dosage Calculations–Nurses’ Instruction. 2. Pharmaceutical
Preparations–administration & dosage–Nurses’ Instruction. QV 748]
615.1′4–dc23
2011045966
Senior Content Strategist: Yvonne Alexopoulos
Senior Content Development Specialist: Danielle M. Frazier
Publishing Services Manager: Jeffrey Patterson
Senior Project Manager: Mary G. Stueck
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Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2Dedication
To my granddaughter, Kimberly Cibroski,
Nursing Student, Neumann University, Aston, Pennsylvania
Joyce Kee
To my mother and to my children, Drew and Sarah
Sally Marshall
To our nursing colleaguesREVIEWERS
Jennifer Clark, MSN, ARNP-BC, FNP, Associate Professor, Florida Hospital,
College of Health, Sciences, Orlando, Florida
Susan K. Cristofori, RN, MSN, Professor of Nursing, St. Clair County Community
College, Port Huron,