Urinary System Disorders Calculating Doses

Chapter 28 Chapter 9

Made up of Organs which form & excrete urine

(see Fig.28-1 on pg 585) (2) Kidneys (2) Ureters Bladder Urethra

Anorexia, Nausea, Vomiting Fatigue, Lethargy, Malaise Dysuria, urgency, frequency, hematuria Pain in lower-back (kidney area), flank

(sides) Fever, disorientation

Drying of secretions Drowsiness, dizziness, sedation Rash, hives, ‘urticaria’ GI effects (nausea, vomiting, diarrhea) Headache Discoloration of urine (see Table 28-1,

p.585)

Reference Textbook Chart page 584 Diuretics – modify kidney function Electrolytes/Fluids “replacement

therapy” (see Table 28-2 page-586) examples … Sodium Potassium Calcium Magnesium … more detail, next

slide

Electrolyte level symptoms

SODIUM high Edema, thirst, high temp, flushing

low Stomach-cramps, vomiting, diarrhea

POTASSIUM high Abdominal-distension, diarrhea

low Paralysis, weakness, muscle function

CALCIUM high Anorexia, nausea, coma, weakness

low Muscle-cramp/twitching, numbness/tingling of fingers, toes, lips

MAGNESIUM high Flushing, sweating, low temp, cardiac depression

low Abnormal heart rhythms, neurotoxicity

Most common bacterial infection in the U.S.

10 – 20% of females have a UTI during lifetime

E.Coli causes ~90 % of all cultured UTI’s Upper UTI (kidneys/ureters) -

symptoms include> *lower-back/flank pain *fever *headache *nausea/vomiting

Lower UTI (bladder/urethra) - symptoms include> *frequency *urgency *dysuria *hematuria *oliguria *incontinence

Anything that results in urine being ‘held’ in the bladder (more common in females)

If you gotta go … you BETTER go! Dietary factors – certain foods (see Box 28-

1 p 587) Enlarged Prostate (males) – constricts

the urethra, causing urine to be ‘retained’ in the bladder

Female ‘Plumbing’ – due to the short length of urethra, and the proximity of the urethra, vagina, and the anus

Anti-Bacterials (sulfa-drugs, trimethoprim) kill bacteria, in the urine and systemically Anti-septics (Macrobid, methenamine) antibiotic activity ONLY in the urine ! Analgesics (Pyridium, AZO-standard otc) by topical and local anesthesia on the

lining of the urinary-tractStudy --- Table 28-3 on page 589

Sulfonamides (sulfa-drugs) – take on empty-stomach with a full glass of water

Drink plenty of water throughout the day (eight to ten 8-oz glasses if on a sulfa-drug)

If taking sulfa-drug, avoid prolonged exposure to sunlight, unless using a good sunscreen !

Complete entire course of UTI drug treatment … even if symptoms improve

Pyridium (phenazopyridine) – changes urine color to orange-red color! May stain clothing

Cranberry juice, Vit-C, prunes make urine more acidic, making antiseptics more effective

Carbonated drinks, citrus fruits make urine less acidic, making antiseptics less effective !

FEVER after starting the drugs may be a sign of a drug-reaction, not a UTI-symptom

small, spastic-like bladder (‘tiny-tank’) that empties automatically when filled to a certain point

Tofranil (imipramine) – anti-depressant DDAVP (desmopressin) – an anti-

diuretic that actually increases the re-absorption of water ◦ available as a nasal spray or tablet

Oral tablets, capsules Oral liquids

We will be able to calculate the dose a patient should receive based on the drug order

Remember The Five Steps1.What are we converting to & from?2.What is our conversion factor?3.Set up equation. Start with what

you’re given.4.Solve. Cancel units.5.Review – does our answer make

sense?

Do not open or divide capsules Only break or divide scored tablets Do not crush or divide enteric coated

tablets Do not crush or divide extended or

sustained release products unless scored

Check the “Do not crush” list at your facility

Check out the Grains! and Micrograms! Worksheet in Doc Sharing

Grains are the apothecary system of weight measurement

1 grain = 60 mg Written with gr first and followed quantity

◦ Either a Roman numeral or fraction The metric and household systems have the

quantity followed by the unit

First step is to convert Roman numeral or fraction into a metric number

gr ¼ = 0.25 grainsgr ss = ½ grains = 0.5 grainsgr V = 5 grains

Next step is to use conversion factor to convert to mg Remember: 1 grain = 60mg

0.25 gr x 60mg/1gr = ___gr 0.5 gr x 60mg/1gr = ___5 gr x 60mg/1gr = ___

Dr. Stoneage ordered: gr 1/100 On hand: mg

◦ What do we do first?

◦ What is our conversion factor?

Dr. Feelgood ordered: gr 1/100 On hand: mg

◦ First step is to convert gr 1/100 into a metric number

gr 1/100 = 0.01 grains

◦ Our conversion factor is 1 grain = 60mg 0.01 gr x 60mg/1 = 0.6mg

Dr. Worksheetzhelpme ordered: gr ss On hand: 250mg/5ml

How many ml do we need?

First step?

Second step?

Third step?

Dr. Studeehard ordered: gr ss On hand: 250mg/5ml

How many ml do we need? 1. gr ss = gr ½ = 0.5 grains

2. 0.5 grains x 60mg/1 grain = 30 mg

3. 30mg x 5ml/250mg = ?

Dr. Mathrulz ordered: gr 1/15 On hand: 5mg/10ml

How many ml do we need?

◦ First step?

◦ Second step?

◦ Third step?

Dr. Urthebest ordered: gr 1/15 On hand: 5mg/10ml

How many ml do we need?

◦ 1. gr 1/15 = 0.066 or 0.067 grains◦ 2. 0.067 gr x 60mg/1 gr = 3.99 or 4 mg◦ 4mg x 10ml/5mg =8 ml

Dr. Skoolizfun ordered: Tylenol gr X q8 hr On hand: Tylenol liquid 160mg/tsp

What is the dose in ml?

◦ 1. gr x = 10 grains◦ 2. 10gr x 60mg/1gr = 600mg◦ 3. Also need to convert our conversion factor:

1 tsp = 5ml so 160mg/tsp = 160mg/5ml◦ 4. 600mg x 5ml/160mg = 18.75 ml

Dr. Knowitall ordered: 250 mcg On hand: 0.125mg tablets

How many tablets do we need?

What is our first step? How many micrograms in 1mg?

Dr. Straightas ordered: 250 mcg On hand: 0.125mg tablets

How many tablets do we need?

◦ 1. 250mcg x 1mg/1000mcg = 0.25mg◦ 2. 0.25mg x 1tab/0.125mg = 2 tablets

What units cancelled in step 2?

Dr. Useyourquizreview ordered 1g of metformin. We have 500 mg tablets.

◦ 1. 1g x 1000mg/g = 1000mg◦ 2. 1000mg x 1 tab/500mg = 2 tablets

Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle.

◦ If the patient is to receive 200mg, what is the dose in ml?

Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle.

◦ How many teaspoons is 200mg?

200mg x 5ml/100mg = 10ml

10ml x 1tsp/5ml = 2 tsp

Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle.

◦ If the patient takes 200mg q12h, how many days should the bottle last?

We already calculated 10mg per dose: 10ml x 2 doses/day = 20ml

30ml x 1day/20ml = 1.5 days or 1 and ½ days

Dr. Ucandoit ordered keeps changing our patient’s dose. We have azithromycin suspension 100mg/5ml in a 30 ml bottle.

If the patient takes 100mg daily, how many doses are provided in the bottle?

100mg x 5ml/100mg = 5ml per dose 30ml x 1 dose/5ml = 6 days

Happy Studying!