i shouldn't be asking this.

Suethestudent · Jul 14, 2010

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

Little Panda RN, ASN, RN · Jul 14, 2010

If a pt needs 0.5mg of pulmicort(the vials come in 0.5mg/2ml.) The other nurses told me to take 2 vials of 0.25mg/2ml instead because we don't have the 0.5mg. I told them they don't equal up,because 0.5mg in 4 ml solution won't give you the same concentration,and that just chart unavailable. Who is right?

Well they are equal in the respect that the milligrams would be the same. I really dont think the mls are a problem, but you can always call a pharmacist and they would be more than happy to let you know if it is acceptable to use this concentration.

kookabura777 · Jul 14, 2010

Mg/mL is an expression of concentration. 0.25 mg/2mL means that every 2 mL of med you give delivers 0.25 mg of pulmicort. I understand that with this alternative available med you have to give a total of 4 mL, however, concentration does not change with the amount you give since you are simply giving two vials of exactly the same concentration. Your fellow nurses were correct; 2 vials of 0.25 mg/2 mL will give you a total of 0.5 mg/2mLà the ordered dose.

0.25 mg x 2 = 0.5 mg/2mL

2 mL

A similar math expression goes like this:

1 x 2 = 2/4

4

Note that it is not logical nor correct to arrive with the answer 2/8

Well-Seasoned · Jul 14, 2010

In a nubulizer the volume doesn't really matter..it is the mg. dosage that counts. Some pts, especially peds, benefit from the extra NS. As long as the mg dosage is the same (which it would be using 2 0.25mg vials) you are fine.

allnurses Guide · Jul 14, 2010

As Cali said. I would not hold the neb and chart it as unavailable if that meant the patient would not get their breathing treatment, even though technically you are right that the mist would be a more concentrated form of delivery, technically not exactly the same dose, though it is such a fine point I'm not sure it matters. Then clarify with the doc as soon as possible.

And why shouldn't you be asking??? :)

CNL2B · Jul 14, 2010

As Cali said. I would not hold the neb and chart it as unavailable if that meant the patient would not get their breathing treatment, even though technically you are right that the mist would be a more concentrated form of delivery, technically not exactly the same dose, though it is such a fine point I'm not sure it matters. Then clarify with the doc as soon as possible.
And why shouldn't you be asking??? :)

:eek:

Actually, it is exactly the same dose, and the dose available is less concentrated, not more concentrated.

If you can't do med math, then by all means, ask away I guess, but I am quite sure these types of basic questions were covered when we passed NCLEX.

Well-Seasoned · Jul 14, 2010

CNL2B..It is Exactly the same dose. The only difference is that the pt would be inhaling a little more of the inert NS. Which in most cases is beneficial and in no cases in not. Most pts with breathing problems feel added reassurance when the neb runs longer. It is the same absorbed dose no matter what. It really should be a non issue,

allnurses Guide · Jul 14, 2010

Actually, it is exactly the same dose, and the dose available is less concentrated, not more concentrated.
If you can't do med math, then by all means, ask away I guess, but I am quite sure these types of basic questions were covered when we passed NCLEX.

What's with the snarky tone? I think your calculation is not applicable to this situation because you are factoring in a variable drip rate to adjust for a higher concentration of Compazine. It's incorrect to compare a nebulized drug to a drip.

As for the eye-rolling doctor comment--Smartnurse works in Home Health. She is asking about a med delivered by nebulizer either at home or at school. If she puts the med in the chamber exactly as ordered she has a higher concentration, which- puts the medication into his lungs faster. Sorry I scared you with the mix-up in my previous post. I guess I'm wrong then- I took the NCLEX a long time ago, but I was under the impression the speed with which you deliver a medication was not something the nurse could decide right then and there. Maybe it's different where you work.

I wonder if it makes no difference what the fluid to drug ratio is, why state boards exclude LVNs from IVP meds? I don't know for sure, but I thought the speed with which something enters your body has different pharmacologic effects. That may not matter in an emergency, but it doesn't mean it doesn't matter at all.

Medicare regulations are very sticky in home health, and they like every i dotted etc., so though you don't think it matters, auditors inspecting agency records actually look for weird stuff like that. I once had a 3 hour inservice on fungus drops for a guy's pinky finger.***shrug***

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.

Yeah, that.

roser13, ASN, RN · Jul 14, 2010

u r right...good gurl

Disagree. A dose is a dose is a dose. The concentration should not matter at all unless it's a matter of fluid overload in an IV solution, for instance. Or a quantity issue for an injection.

The nursing judgment that should be exercised in this example is that .5 = .5, no matter how you arrive at it.

Well-Seasoned · Jul 14, 2010

pediatrics vol. 105 no. 5 may 2000, p. e67

electronic article:

undiluted albuterol aerosols in the pediatric emergency department

david j. gutglass, md*, louis hampers, md, mba*, genie roosevelt, md, mph*, doreen teoh, md*, sai r. nimmagadda, md $dagger.gif$ , and steven e. krug, md*

from the divisions of * pediatric emergency medicine and $dagger.gif$ allergy, children's memorial hospital, chicago, illinois.

in this research article their were no observed differences in outcomes r/t the dilution of the ordered dosage of albuterl. our practice in my ed is to dilute the ordered dose with an amp of saline in the nebulizer. we have had really good results with this and the extra couple of mls of ns does not affect the theraputic onset. also many pts with breathing problems are reassured by a longer nebulised treatment

Meriwhen, ASN, BSN, MSN, RN · Jul 14, 2010

I'd make up the 0.5mg with whatever I had on hand, but I'd also call the doctor and give them a heads-up: "hey, we don't have 0.25mg/2ml, but I can make the 0.5mg with a different concentration solution, is that OK?" Then they can say Yay or Nay, and I've covered my butt.

I think overall, the dose given is what matters and not the concentration. However I'd still give the doctor a call in case the concentration matters to him/her.

klone, MSN, RN · Jul 14, 2010

I think overall, the dose given is what matters and not the concentration. However I'd still give the doctor a call in case the concentration matters to him/her.

And I would not call the doctor for that. According to the OP, the doctor did not specify a certain concentration, s/he only specified a total dosage (0.5 mg). In all likelihood, the doctor probably doesn't even know what concentrations they come in, and doesn't care, as long as the pt gets all the prescribed medicine (and as others have said, with neb treatments, having it run longer with more NS is usually beneficial).