i shouldn't be asking this.

u r right...good gurl

I may be wrong, but I would think 0.5 mg is 0.5 mg. I would think it would be the same thing as a pt needing 2 mg of morphine but you don't have a 2 mg/1 ml vial available, so you pull up 0.5 ml of a 4 mg/1 ml vial instead to give you the 2 mg. 2 mg is 2 mg, just like 0.5 mg is 0.5 mg.

I think. :)

Sure they are right. The dosage is right. If the order demands then you administer a specific concentration, then it's wrong, but .5 mg is still .5 mg, even if it's .25 mg + .25 mg.

The 4ml dose should be fine.

My son uses a nebulizer all the time at home. I have to mix up the albuteral with sterile NS. I usually use about 2ml, but a little more or less isn't going to hurt him, it will just make it take a little longer to go in.

I would have given the two on the premise that the total dose delivered would have been the same - a breathing treatment is better than none for someone with dyspnea - and charted that I had done it that way.

But I think it's one of those nursing judgment issues, in which right/wrong is grey.

Never mind, I think my post was wrong!! Sorry

actually they are right...if you double the ml you will have 4 mL, and .5 mg which is ordered.

I would think its better to give it in a slighter lower concentration, but same dose, then missing a treatment altogether.

From what has been written here, the order is to administer 0.5mg. The nursing judgement in the variances in concentrations in neb treatments is whether or not to add saline to provide sufficient volume -- the dose does not change.

I would use the 2 0.25mg vials.

I go with giving the 0.5 mg. I would call the doctor to clarify the order for what is available and if it is the 0.5 mg he is concerned with, or the concentration he is concerned with. He will most likely want you to give the 0.5 mg; but that is not to say that he doesn't insist it is delivered in the concentration that he originally ordered. Be on the safe side, get the order clarified.

I would seriously not bother with calling the doctor. Nurses dilute meds at their own discretion all the time without physician direction -- it's called practicing nursing. This would totally be a call where the doctor would roll his eyes and wonder why he has to carry a beeper. If you really, really felt you needed some direction, I would say place a call to the/a pharmacy, but I would be very comfortable administering the medication listed in the OP without any calls at all.

Here is an example along the same lines --

You want to give an ordered dose of compazine, 10 mg. It comes in a 1 ml vial out of the pyxis. What do you want to do -- dilute it in 10ml of saline and put it on a mini-infuser, shoot it into a 50ml bag of something (saline or D5W) and hang it as a piggyback, or give it undiluted slow IVP? It's your call. None of the 3 ways is wrong unless you have been given specific directions to give it one way or the other, or the hospital has a policy stating how they want it given.

When you have a doctor shouting at you in the ICU to mix and hang a pressor and start it at X mcg/kg/min, you better know what you want to mix as far as a concentration, because the doctor sure as hell isn't going to be able to tell you.

I believe that if the order stated the dose required, but not the concentration (ie:mass/volume) then the final volume used to administer the dose is irrelevant as long as the dose is correct and the full volume can be given. An exception to this would be parenteral administration where the increased volume would be an issue.

JMHO