Pediatric Drug Dosage Problem - Need Urgent Help

[fauladi]

Hey guys I need help with a pediatric drug dosage problem. I am fine with most of the problem, except for the last question (#7 in bold) when the "antibiotic is not running" Below is one example :

Andy weighs 10 kg. He is to receive three 20cc feedings during your shift. The doctor orders an IV med that requires a 2 ml fractional dose and an 18 ml dilution.

1. What are the fluid requirements for 3/4 maintenance for 24 hours? And for your eight hours shift?

2. Is it a safe dose? What is the safe dose range?

3. What is Jeffery's po intake for your shift?

4. What IV flow rate (ml/hr), for the pump, will be needed 
to achieve 3/4 maintenance fluids for you shift?

5. what is the fractional dose

6. what is the hour the antibiotic running?

7.What IV flow rate (ml/hr) will be needed to achieve 3/4 maintenance fluids the second day when the antibiotic is not running? - As per my understanding, I would subtract the time the antibiotic is running. In this case it would be 7 hrs rather than 8.

My question is- what happens when the antibiotic IS RUNNING? Do I add the flush, dilution and fractional dose without subtracting any hours?

The other option is no antibiotic in the shift - for which I understand not to subtract any fractional, dilution or flush from the fluid maintenance, nor subtract any hours.

I need help, as this my last chance to pass the exam. Thanks in advance!

[Double-Helix, BSN, RN]

The question says that there is no antibiotic running. So you don't need to stop your fluids at any point. All you need to do is find the 3/4 maintenance dose for this patient and calculate the rate that the fluid needs to be run in order to give this dose. The IV flow RATE will be the same whether you are running the fluid for your 8 hour shift or for the entire 24 hour day. The VOLUME that you give will be different, but you don't need to know that for this problem.

Let's start here: What is the fluid maintenance requirement for a 10kg child? What's 3/4 of that amount?

[fauladi]

1.The 3/4 fluid maintenance is 750ml/ 24 hrs. Which divided in three 8hour shift would make 250ml/8hr which can be further divided to 31 ml/ hr.

2.There is no reference to any medication, therefore no safe dose range is needed.

3. PO intake is 20ml x 3: 60ml in my 8 hr shift.

4. 31ml/hr

5. 2ml

6. When not specified we use 1hr for the duration of the meds running (as said by the teacher)

7. I understand from the 250ml per 8hr shift. we subtract the PO feedings: 190ml. Then subtract the 2ml fractional dose, 18ml dilution dose and 20ml flush.

This would give us 150ml/8hr shift.

When the antibiotic is not running- we subtract 1 hr( to account for the hr it was running) which would make it 150ml/7hrs. : 21ml/hr.

This is how the teacher explained it. Honestly I dont get the running/ not running what do with it. It seems like the teacher says that we do stop it for the time the antibiotic is running

Thanks Ashley

[KelRN215, BSN, RN]

Did anybody else notice that the child's name mysteriously changes from "Andy" to "Jeffrey"?

[Double-Helix, BSN, RN]

I can see how the question 7 would be worded ambiguously. It's not clear that you are giving the antibiotic, but if you aren't giving the antibiotic then the answer would be the same as question number 4, so I'm guessing there is something more to this question 7. It's also unclear whether the question wants to know the flow rate for your shift (7 hours) or the entire day (23 hours) which will affect the answer as well.

Did you instructor tell you that you need to subtract the PO intake? I don't believe that you should. Here's why: Most patients (unless fluid restricted) need their full maintenance fluid requirements to prevent dehydration. Usually when we give 3/4 maintenance it is because the child is taking PO fluid as well.

If you look at you patient, his full fluid requirement for 24 hours is 1,000mL. He is getting 750 mL through IVF. He is getting 180 mL (20mL per feed, 9 feeds in an 8 hour period). He is getting 40 mL for the antibiotic and flush. Total that is 970, which is nearly his maintenance requirement. Subtracting the PO and antibiotic intake from the 3/4 maintenance fluid will result in deficient fluid volume and dehydration.

However, if your teach does indeed want to know his 3/4 fluid maintenance of combined intake (which would really only be for the purpose of making it a more difficult math question, not a more realistic one) then I agree with your steps, but your math need correcting.

250mL is the 3/4 requirement for your 8 hour shift. The patient is getting 3 feeds of 20mL each. That's 60mL, not 190mL. However, the final answer that you came up with: 150 mL to be given in the 8 hour shift is correct. I'd probably use the decimal in your final answer- 21.4 mL, as it's very possible to give that specific dose when using a pump.

[Double-Helix, BSN, RN]

Did anybody else notice that the child's name mysteriously changes from "Andy" to "Jeffrey"?

I didn't notice that! Maybe it's a trick question. We don't know Jeffrey's po intake because we only have orders for Andy. It makes the question a lot simpler then.

[fauladi]

Thanks Ashley,

Although I still do not know about the "running" , "not running" difference in terms of taking hours off.

[Esme12, ASN, BSN, RN]

I didn't notice that! Maybe it's a trick question. We don't know Jeffrey's po intake because we only have orders for Andy. It makes the question a lot simpler then.

Something's missing.....in the question

[KelRN215, BSN, RN]

I can see how the question 7 would be worded ambiguously. It's not clear that you are giving the antibiotic, but if you aren't giving the antibiotic then the answer would be the same as question number 4, so I'm guessing there is something more to this question 7. It's also unclear whether the question wants to know the flow rate for your shift (7 hours) or the entire day (23 hours) which will affect the answer as well.

Did you instructor tell you that you need to subtract the PO intake? I don't believe that you should. Here's why: Most patients (unless fluid restricted) need their full maintenance fluid requirements to prevent dehydration. Usually when we give 3/4 maintenance it is because the child is taking PO fluid as well.

If you look at you patient, his full fluid requirement for 24 hours is 1,000mL. He is getting 750 mL through IVF. He is getting 180 mL (20mL per feed, 9 feeds in an 8 hour period). He is getting 40 mL for the antibiotic and flush. Total that is 970, which is nearly his maintenance requirement. Subtracting the PO and antibiotic intake from the 3/4 maintenance fluid will result in deficient fluid volume and dehydration.

However, if your teach does indeed want to know his 3/4 fluid maintenance of combined intake (which would really only be for the purpose of making it a more difficult math question, not a more realistic one) then I agree with your steps, but your math need correcting.

250mL is the 3/4 requirement for your 8 hour shift. The patient is getting 3 feeds of 20mL each. That's 60mL, not 190mL. However, the final answer that you came up with: 150 mL to be given in the 8 hour shift is correct. I'd probably use the decimal in your final answer- 21.4 mL, as it's very possible to give that specific dose when using a pump.

I agree with Ashley. Unless the child is on a 3/4 maintenance fluid restriction (which this problem doesn't say), I wouldn't be subtracting his PO intake from the amount of fluids to be given. Though I am sitting here wondering what kind of 10 kg baby only takes 20 mL with each feed.

Whether or not you actually stop the fluids for the hour that the antibiotic depends. I'll tell you when I worked in the hospital, if a child's antibiotic dose was administered in 20 mL of fluid, it would run concurrently with the maintenance fluid. It would be run on a syringe pump and infused via a Y site connector with the fluids still running.