[SanskeetRN]

Can someone please help me figure out these questions. I am about to start my last semester of my ADN We were given a take home assignment to complete before our semester begins so there is no way to ask the instructor questions before it is due.

I am not sure of two of the questions. the first: calculate the hourly IV flow rate for a 27kg child receving maintance fluid.
a. 68cc/hr
b. 164cc/hr
c. 60 cc/hr
d. 70 cc/hr
I have been unable to find anything in my book regarding IV maintainance but in our power points, we have a formula for hydration maintainance. (not sure if is the same thing ) based on that formula of 100 cc/kg for the first 10 kg, 50 cc for the second 10 and 20 for the remaining, I came up with 68.3 which I would go w/ C so as not to overload. Is this even the right formula or is there one for IV maintainance?

The second: a child is receving TPN. At the end of 8 hours, the nurse observes the solution and notes that 200 ml per 8 hrs is being infused rather than the ordered 300 ml. The nurse should adjust the rate so that how much will infuse during the next 8 hours?
a. 200 ml
b. 300 ml
c 350 ml
d. 400 ml
I chose B as it is not up to the nurse to increase rates of TPN and with children, rationalized that increasing by c or d would increase potential for complications. I would say to set it at 300 ml and notify the MD of the previous infusion. *(since notifying MD isn't an option, I went with B)
Any input would be greatly appreciated. I would really like to know if there are formulas for figuring out the questions as I'm sure to encounter similar situations in the future. I know the formula for adjusting IV flow rates but couldn't find one for TPN.
Thank you all so much for your help!!

[KellieNurse06]

Well on B why do you say complications such as stomach cramps etc can occur? One of the reasons people are put on TPN is for gut rest..also you NEVER speed up TPN to play catch up ....they can end up with a Pneumothorax or air embolism.... complications also occur such as, infection from the catheter itself, from the TPN itself are fluid overload, hpyo/hyperglycemia...which is why they constantly check blood glucose & give insulin usually...never ever abruptly stop TPN either due to the blood glucose issue....if it is the glucose gets rechecked within 1 hour...and also the TPN gets decreased gradually by the diet the patient starts orally ...and also weights are done daily.......and check lung sounds / respiratory status as often as ordered/necassary because one of the 1st places fluid overload affects is the lungs/cardiac system.......I think thats most of what I know from TPN....or what I remember from lecture & clinicals...good luck......

[SanskeetRN]

KellieNurse~ thanks for your catch on my mistake w/ TPN. I was thinking tube feeding w/ the stomach cramps. I would still go w/ B as that was ordered, but wouldn't increase it beyond what was ordered. Does that make sense or would it be correct to give 200 ml since that was what was previously given although it isn't what was ordered and then call the MD to increase to the ordered 300 ml? Can you tell I"m confused LOL

[KellieNurse06]

ok sanskeet...lol..sorry I wasn't trying to be a nitpicker..lol! Just didn't want you to be stuck on the spot with the instructor...you probably know how those things can be with some being very particular...but excellent on the gtube!
Ummm.....lets see....on the TPN being increased.......I actually went & looked this up after being curious myself as I am only familiar with the info I previously posted off the top of my head.....in my Saunders NCLEX review book it says to never speed up TPN to play catch up if it is behind time...so I think that being said I would probably leave it at 200ml/hr.......I could be wrong..won't be the 1st time nor last time, & I will be the 1st to admit it if so........but according to my NCLEX review book it says never speed up TPN to play catch up because it can cause fluid overload if administered too quickly, I would say get a MD order for the 200ml/hr since it can't be sped up due to safety issues........maybe you can google TPN on the web?????Good luck! I'm sure you'll be fine for class....don't sweat the small stuff!

[SanskeetRN]

My 'brain reaction' was to change it to 300 ml, but my 'gut reaction' was to leave it at 200 ml since changing it would increase the fluid by 1/3 which is a large amount for anyone, let alone a child. I think I will leave it at 200 ml for now but I will try going through my book yet again! I just love some of these questions would it be that much more work to be a little more clear LOL

and you are very right about nit picky instructors LOL But you remember how it is to have 5 new theories, 5 new skills and a bunch of other information all thrown at you at once and trying to recall which fact goes with what. Gotta love nursing school!!

[analee23]

On the first question, calculate the hourly flow rate, there's a little formula that you need to use to figure out maintenance fluid for a child. It's based on the child's weight.

For the first 10kg, it's 4cc/kg
Then for the next 10 kg (so 10-20 kg) it's 2cc/kg
Then for each kg after that it's 1 cc

This formula is also useful to double-check an MD's order.

You should be able to figure it out from there. Good luck!

I'm editing this to add an example...

For a 34kg child I'd take the first 10kgx4cc which is 40
plus the second 10kgx2 which is 20 plus (already calculated) 40 which is 60
Then for the last 14kg I calculate 1 cc per kg, so 14 now add the 60
The maintenance fluid for a 34kg child is 74cc/1hr

[SanskeetRN]

ok, I have to admit that I missed the forest for the trees on that first one! For some reason my brain didn't process until this morning that A. is 68 LOL here I was trying to figure out if I should round 68 down to 60 or up to 70. I guess presemester jitters and trying to do too much all at once caught up with me! (I am a good student but guess I can still sometimes miss the obvious LOL)

analee~ thank you for your formula. It is easier to use than the one we were given. We were given the way to figure for 24hr and then divide to to get the hourly. (using the 100,50 and 20) but yours eliminates a step thereby eliminating a chance for a calculation error! Thank you

[SanskeetRN]

just a quick update....the answer for the TPN question is 300 cc/hr. The rationale was along the lines that it's not considered speeding up or playing catch up if you administer what is ordered and not above.
Thanks for all the replies!

[nurs4kids]

I sorta/kinda disagree with the answer on the TPN question. If the child is on long-term TPN, an increase of 1/3 at one time could cause hyperglycemia. At least I would think it could. I would lean more toward calling the MD to see if he wanted it tapered up to 300. For NCLEX, go with 300. Practicing, you've got to call the MD anyway to inform him of error, check and see what he wants you to do, IMO.