© 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 12-1 Math and Dosage Calculations for Health Care Third Edition Booth & Whaley

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Text of © 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 12-1 Math and Dosage...

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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 12-1 Math and Dosage Calculations for Health Care Third Edition Booth & Whaley Chapter 12: Specialized Calculations
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Learning Outcomes 12.1 Measure insulin doses accurately. 12.2 Measure heparin dosage and flow rates, verifying that they fall within the normal daily range. 12.3 Calculate the hourly flow rate for IV infusions ordered in milligrams per minute. 12-2
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Learning Outcomes (cont.) 12.4 Calculate IV flow rates for medications ordered in mg/kg doses. 12.5 Calculate IV flow rates for titrated medications. 12.6 Determine the percentages of solutions, dilutions, and solids. 12.7 Prepare solutions from a concentrate. 12-3
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Introduction Specialized calculations include Insulin Heparin Critical care IV fluids Preparation of solutions Alligations These special calculations require extra effort 12-4
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin High Alert Medication Pancreatic hormone that stimulates glucose metabolism With low or no insulin production Insulin-dependent diabetes Routine injections of insulin needed to keep glucose (blood sugar) from rising Generally administered Sub-Q (rotate sites) 12-5 Pancreas
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin TYPES Beef and pork derived from the pancreas Human insulin Replaced beef and pork in the U.S. Produced using genetically engineered bacteria Insulin Lispro Synthetic form 12-6
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin TIMING OF ACTION Rapid-acting Administer 30 to 60 minutes before meals Regular (R) and Semi-lente (S) Very rapid acting Administer 15 minutes before meal Insulin Lispro 12-7
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin TIMING OF ACTION (cont.) Intermediate-acting Lente (L), NPH (N), and Protamine Zinc (P) Long-acting Ultralente (U) Lantus Newer type Maintains constant blood levels 12-8
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin TIMING OF ACTION (cont.) Onset Time when insulin begins to lower blood glucose Peak Time when insulins effect is the greatest Duration Length of time the effect of insulin lasts Measured from the time of onset 12-9
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Regular insulin injection administered at 0700 Onset 30 minutes, 0730 Peak 2.5 to 5 hours post administration, between 0930 and 1200 Duration 8 h, until 1530 12-10 Insulin TIMING OF ACTION (cont.) Example
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 12-11 TypeExamplesOnsetPeakDuration Rapid-actingHumulin R30 min2.5-5 hrs8 hrs Rapid-actingHumalog15 min30-90 min6-8 hrs Intermediate- acting Novolin L2.5 hrs7-15 hrs22 hrs Long-actingHumulin U4-8 hrs10-30 hrs28 hrs MixedHumulin 70/30 30 min2.5-12 hrs24 hrs Insulin TIMING OF ACTION (cont.)
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 12-12 Insulin LABELS Expiration date and lot # Manufacturer Concentration Brand name Species Type Storage information
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin LABELS (cont.) Concentration Usually listed twice as 100 units/mL traditional form U-100 (100 units/mL) insulin Source Beef Pork Human 12-13
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Syringes Marked in units Measures amount of insulin (units) not volume of solution 100 unit capacity 50 unit capacity 30 unit capacity Calibrated in 1 or 2 unit increments 12-14
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Syringes (cont.) Rule 12-1 For more accurate measurements use a 50 unit capacity insulin syringe for insulin doses less than 50 units, and a 30 unit capacity insulin syringe for doses less than 30 units. 12-15
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Ordered: Humulin N 66 units Use a 100 unit capacity syringe Ordered: Humulin R 8 units Use a 30 unit capacity syringe Insulin Syringes (cont.) 12-16 Example
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Syringes (cont.) Rule 12-2 When using U-500 or a dose of insulin over 100 units use a tuberculin or standard syringe. Calculate the amount to administer in milliliters. 12-17
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Syringes (cont.) Determine amount of insulin to give. Ordered: Humulin R U-500 insulin, 120 units Amount to administer = 0.24 mL Use a tuberculin syringe 12-18 Example
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Patient Education: MEASURING A SINGLE INSULIN DOSE 1.Always wash your hands before handling insulin and syringes. 2.If you are using an intermediate- or long-acting insulin (Lente, NPH, Ultralente, 70/30, or 50/50), roll the vial between your palms to mix the insulin until all of the insulin looks cloudy. 12-19
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Patient Education: MEASURING A SINGLE INSULIN DOSE (cont.) 3.Cleanse the rubber stopper of the vial with an alcohol wipe, using a circular motion. Start at the center of the circle and work outward. 12-20
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Patient Education: MEASURING A SINGLE INSULIN DOSE (cont.) 4.Draw up an amount of air equal to your insulin dose in the syringe. Pull back the plunger until the leading ring is aligned with the correct marking on the syringe. 12-21
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Patient Education: MEASURING A SINGLE INSULIN DOSE (cont.) 5.Inject the air into the insulin vial. 6.Keep the needle inserted through the stopper and turn the vial upside down. Draw up your ordered dose of insulin. 12-22
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill 7.Avoid touching the needle during the procedure. 12-23 23 Patient Education: MEASURING A SINGLE INSULIN DOSE (cont.)
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations Provide greater control over glucose levels Two types of insulin Intermediate-acting Short-acting 12-24
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Manufacturer combines some types Novolin 70/30 70% NPH insulin 30% regular insulin Humulin 50/50 50% NPH insulin 50% regular insulin 12-25
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Insulin pens Self-administration without having to draw up medication from separate bottles 12-26
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Rule 12-3 When preparing a combined insulin dose, always draw up the rapid- acting insulin first. Remember: the insulin with a quicker onset is drawn up first. Clear then Cloudy 12-27 ClearCloudy
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Ordered: Novolin R 20 units and Humulin N 15 units Sub-Q now Draw up the rapid-acing (clear) insulin first 20 units of Novolin R Then draw up the intermediate-acting (cloudy) insulin 15 units of Humulin N 12-28 Example
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Rule 12-4 Rule 12-4 To prepare a combined insulin dose: 1.Calculate the total dose of insulin: dose of rapid-acting insulin + dose of intermediate-acting insulin total dose insulin 12-29
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Rule 12-4 Rule 12-4 (cont.) 2.Draw up an amount of air equal to the dose of intermediate-acting insulin. Inject it into the intermediate insulin vial, but do not draw up the dose. Withdraw the needle from this vial. 3.Draw up an amount of air equal to the dose of rapid-acting insulin. Inject it into the rapid-acting insulin vial. 12-30
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  • 2010 The McGraw-Hill Companies, Inc. All rights reserved McGraw-Hill Insulin Combinations (cont.) Rule 12-4 Rule 12-4 (cont.) 4.Without withdrawing the needle from the stopper, invert the vial. Draw up the dose of rapid-acting insulin. 5.Carefully insert the needle through the stopper of the intermediate-acting insulin vial. Invert the vial, without injecting any of the rapid- acting insuli