Dosage question....

morte, LPN, LVN · Jun 2, 2009

in long term care that is pretty much the case......you will note i did not say always.....but hospital you will need those skills at least occasionally.....a little story (on myself) working long term care...a pt had liq antibiotic...pharm labeled how much to give,, the label was wrong....i didnt catch it, several other nurses didnt either...so he recieved multiple doses that were twice what it was supposed to be.....so get in that book!

J9G2008 · Jun 2, 2009

There are three people responsible for checking dosages: the doctor, the pharmacist, and the nurse. The nurse is the final person responsible for making sure that it is the correct medication. Even if you gave what was on the order, if it is an incorrect medication or amount, it is your license that can be suspended independent of any action taken against the doctor.

It is a good habit to always check your dosages, most especially on IV push meds...if one of those are wrong, you have no time to get it back!

And some meds, like insulin, are administered on a sliding scale, so you just take what you need out of a vial-those aren't prepackaged.

My nursing instructor had us make a list of our "Top 5" people in our lives. Imagine that anyone of them is in the hospital and someone is too busy to check the medication, and they die. Gulp. I'm checking my meds.

cursedandblessed · Jun 2, 2009

not always. when you're picking meds out of the pixis(the machine on the floor where the meds are kept/locked up and dispensed with the computerized system), you may need to give 2 or 3 of a pill (for example my last rotation the k+ only came in 20 meq and my patient was taking 40 meq po so i had to get 2 of them) to equal the dose required/ordered.

it's your responsibility to ultimately give the patient whatever medication, dosage of the medication, at the right time and to catch errors made by the doc and the pharmacist. the nurse is the patient's last hope when it comes to errors.

at my nursing home rotation, the meds were dispensed a little differently than in the actute setting. a med cart with individual drawers for each patient was used. each patients medications were put into their drawers by someone (i don't know who) in dose specific packages.

each facility is different a bit, but in all cases the nurse giving the medication is responsible for the five/six rights: right drug, right patient, right dose, right time, right route, right documentation.

CrunchyMama, ASN, RN · Jun 2, 2009

Ok thanks! I was thinking maybe it's because she's in a nursing home. All the residents are the same all the time (until they die or go home) and most times the resident is there for an extended period of time....so the correct dosage is there all the time. I knew not to trust her experience 100% since she's been an LPN in the same nursing home, that's why I came here. I'm glad to know, I won't be learning this for nothing, lol.

Daytonite, BSN, RN · Jun 2, 2009

That's pretty much the case. I also worked in the acute hospital a great deal of my career. I mentioned in another post recently that most of the math I ever had to do involved liquids and using the formula dose desired divided by the dose on hand multiplied by the amount the dose on hand comes in to get the amount to give. With a pocket calculator the answer is obtained in seconds. It was usually only the IV push stuff that had to be reconstituted and given on the spot that we had to do calculations for although the pharmacy also did the math and included it on the label that came with the meds.

You need 8th grade level math skills to do these calculations. That is the equivalent of a Pre-Algebra class.

CrunchyMama, ASN, RN · Jun 2, 2009

Thanks Daytonite!

JessicaSN · Jun 2, 2009

I work in an ER and these are the types of dosage problems I have:

1. A child weighs 58 lbs and the doctor writes for 10 mg of ibuprofen per kg. How much do I give? I then go to the Pyxis and it comes 100 mg per 5 mL. How many mL's do I give?

Additional nursing thoughts: Was the child's weight estimated by the parents at triage or did someone weigh him today? Can the child tolerate PO meds or has he been vomiting all day? Is the child allergic to ibuprofen/motrin? Do I need to ask for a 2nd person to come into the room with me to help hold the child or will the parent/s help? Is the child old or well enough to hold the little cup of medicine or do I need to draw it up?

2. A woman is have an AMI and the doctor orders Heparin IV bolus and IV drip based on her weight. She stated she weighs 184 lbs. You quickly find the Weight Based Heparin Orders paperwork. It states to give 5,000 units IVP and 16 units/kg/hour with a max of 2,000 units per hour. You go (more like run) to the Pyxis and find Heparin in 10,000 units per mL. How many mL's do you give for the IV push? Next you take out the bag of Heparin for the drip. How many units are you supposed to give per hour? The bag of Heparin is 25,000 units per 500 mL of D5W. How many mL's are you going to give per hour?

Additional nuring thoughts: Is this patient on any other anti-coagulants and does the doctor know this? What is the antidote for Heparin? What labs should I be monitoring and would be the expected results of those labs? What meds are compatible with Heparin and D5W or do I need to start a 2nd line (duh!)? Does the patient understand why she is receiving Heparin?

3. A patient has a K+ level of 3.2 and the doctor orders potassium elixer 40 mEq PO. You go to the Pyxis and it comes in cups of 25 mEq per 5 mL. How many mL's do you give?

Additional nursing thoughts: Is this patient on any diuretics? When should the next potassium level be drawn? What are signs and symptoms of hyopkalemia and hyperkalemia? What is causing the patient's potassium to be low? What is the patient's magnesium level? Should this be taken with or without food?

I didn't intend for this to be a long, drawn out post but I wanted nursing students to see what goes on in the brain of a nurse when s/he is administering meds.

CrunchyMama, ASN, RN · Jun 3, 2009

Thank you so much Jessica!!!!!! I'm definitely printing this out. You've helped a lot. So, my dads wife has it easy, lol. Anyway....thank you!! Now, I'm scared again, lol.