i shouldn't be asking this.

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.

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

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.

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??? :)

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.

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,

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.

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, and steven e. krug, md*

from the divisions of * pediatric emergency medicine and 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

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).

as you can see, i went to bed last night thinking about this and woke up thinking about it after getting my email to this thread!

so i pulled out the drug book from school, and yes, you should be asking. we should always be learning.

so here goes. clrn2b is correct in saying that the dose available is a lesser concentration.

so to compensate for that, you would be sure to give at least 4ml's, which is what the 2 vials add up to. so your colleagues are correct, which at first, i thought they were not.

a method to calculate this: dose ordered x volume (of dose avail)

dose available

so: .50 x 2ml = 4ml

.25

hope this helps, cause it helped me to refresh my own memory!