heparin drip calculation

GracyMae · Apr 26, 2012

i started a new thread asking when calulations start in nursing school and how they present it..no one replied.......i am a LPN now,I have a mental block when it comes to math...i struggle...i mean realy struggle.....and dont say its just simple alg....thats what i struggle at the most......i had to work hard at it.....do the profs expect you to know this automactically..not the nursing dosage but the conversions and that...will they start from the begining?.....i am so excited to start nursing but this is haunting me every day.....thanks to who ever responds....

I'm not sure what you mean when you say "beginning," but I assume they need you to know algebra and statistics - maybe some calculus, since those are required core courses for pre-nursing majors. And we learn conversions (liter to milliliter to microliter - 10 to the zero, 10 to the negative 3, 10 to the negative 6, respectively) in core biology classes too - and those are basically just knowing in which direction to move the decimal point and how many spaces. 1 liter = 1,000 milliliters = 1,000,000 microliters. Micro is less than Milli is less than Liter, so you'll need many More of the smaller units to equal the bigger unit = decimal goes right, and on and on. I think people get confused because they often try to think of a number line, with negative numbers being on the left and positive numbers being on the right.

So in trying to convert Liters (10 to the zero) to Milliliters (10 to the negative 3), they start moving the decimal to the left and then stick the number they end up with in front of the smaller unit, and that is incorrect.

Understanding this, I believe, is crucial. I think this (not understanding these basics) might be the reason when you hear a baby is overdosed on something. Makes me think of the case of Dennis Quaid's twins, a while back, and many other cases like that. They were given 10,000 units of heparin, instead of 10. Probably a simple miscalculation, even though I think in that case, maybe the color of the bottles of different dosages were similar and maybe that contributed more than the hospital employee's calculations, but I don't know for sure.

Nevertheless, I highly recommend you go back and review that stuff before you go in to any BSN program classes. I saved all of my notes and books from those classes just so I could keep refreshed on that stuff. So if by asking whether they "start from the beginning," you mean teaching you how to do decimal conversions and basic math, etc., I'm not sure, but I doubt it. I don't start my BSN classes until June, so I don't know for sure, but they might possibly have a 5 minute refresher at the beginning of the very first class that deals w/ conversions, but I assume they expect us all to know those basics, since 1) they are required core classes, and 2) because miscalculating a dosage on someone's meds could cause a serious or fatal problem for the patient, as I'm sure you know. I have a feeling Math is going to be Extremely Important when it comes to being an RN. Just my 2 cents. Good luck :)

Esme12, ASN, BSN, RN · Apr 26, 2012

I teach nursing math. Yes, there are some conversion you simply will have to memorize, and then REMEMBER beyond the exam, because you will use them for the rest of your life. (pounds to kg., # of mL. in a teaspoon, tablespoon, ounce, etc.; number of mL in a cup, pint, quart, etc.) You will know how to convert among decimal units to a smaller or larger unit of measure, etc. There is no way around simply memorizing these things.
You will also need to learn several formulas for completing the problems: DD/DH x V or Q for simple dose calculations (or you could use ratio:pproportion). Some teach dimensional analysis, which allows you to do conversions as part of the problem as you go.
You will also learn how to calculate dose ranges, body surface area, drip rates, and how to set a pump if you are required to infuse something over a non-standard time.
Yes, some students struggle with this. Yes, some faculty are better at teaching this than others. But here is the problem your faculty faces: they have very limited amount of time to teach this in a jam-packed curriculum. They cannot and should not be expected to teach remedial math. They may feel bad for you, but there is not a lot they can do if you come in to this weak at math in the first place. Thus, I STRONGLY suggest that you start memorizing conversions NOW, that you locate some of the many on-line tutorial out there, etc. Go to you school's learning center and ask for homework to take home to review algebra, fractions, ratio proportion, etc. Find a tutor. Do as many problems as you can ahead of time, and more. If anxiety is a big issue here, get counseling for it. The bottom line is that you are going to be expected to "get it" quickly, so be prepared.
Math anxiety is a common issue among my students, as is poor fundamental math skills. My students did not all get the same level of math education, even if they all took HS algebra. This is unfortunate, but if your ACT scores tell you that you did not get a good basic level of education, I urge you to do whatever you have to catch up BEFORE you face nursing math, and certainly well before you face the test on which you are required to score 100%.
I lurk on this site from time to time, and often don't know what to think. As a kind-hearted nurse of 40 years, I can appreciate your struggles to get to your goal of becoming a nurse. But to be honest, a lot of what I read on this forum makes me wonder. There is a clear theme in many posts of wanting things to be easier, and a huge interest in finding the fastest, easiest, least demanding way to what seems to be today's hottest meal ticket, an RN license. (I am NOT saying it is true of you, momtojosh.)
I am not sure what to make of the poor level of understanding or the lack of appreciation for the amount of real smarts it takes to be a nurse. Nurses need to master a HUGE amount of very complex content (A&P, cell biology, chemistry, pharm, patho, human G&D, psychology, communication, algebra, and more) to do what they do safely. That's just the way it is, and I for one think that anyone who wants to be an RN would realize that and fully commit to learning these things. I think the general invisibility of nurses in the media, the naughty nurse and angel of mercy stereotypes, and public's poor understanding of what we actually do, play a role in the perception that becoming a nurse mostly requires the ability to be a kind, caring person and to look cute in a uniform, not the real brains, hard work, high level critical thinking skills, and self-discipline.
I am part of an online discussion group about issues facing nurse educators. There was a recent discussion about the requirement of a score of 100% on a math test after _____ attempts (# varies among programs) to move on in a program. Most argued for keeping the requirement. The clincher for me was this: We have known for some time that a certain level of math skills is a stand-in for reasoning ability, and that persons who cannot do math at a certain level may have problems grasping other concepts as well. It turns out that the hospitals have discerned that failure to pass their in-house math test with a score of 100% on the first try is a marker for a prolonged, difficult, or failed orientation, especially of new grads. They have found that is you are good at math, you will succeed as a nurse. So now instead of giving the math test a few weeks into the orientation, they are using it as a screening tool: if you don't score well, you don't get a second interview.
I know I will get flamed for being honest here, and for saying the following: Nursing schools and employers are currently in the driver's seat. We get to choose to admit or to hire the students whom we think will succeed. That might not be what folks want to hear, but it is the truth. So, if you want to be a nurse, you will do whatever it takes, including getting math tutoring, to get there. You will NOT waste time doing what so many do here: asking others to solve the problem for them. Neither will you ***** and moan about those mean old nursing instructors who hold you to high standards. Instead, you will realize that they are trying to do two things: see that you pass NCLEX, and get the job you want.

:yeah: :thankya::w00t: :bow: :yelclap: Well said......As another memeber of the "Crusty Old Bat Society" and a born and bred midwesterner (although I live in the northeast right now). I want to thank you for adding your wisdom. I am going to be quoting you and your post in the future I am sure. It's worth repeating.

Esme12, ASN, BSN, RN · Apr 26, 2012

I have not started my nursing classes yet, but seems to me that if you have 25,000 units of the medication in 500 mL, then you have 50 units of med per each mL of fluid. So each mL of fluid equals 50 units of med. So if for every 50 units of med, you have 1mL of fluid, then 800 units of med = 16 mL of fluid. So 16mL is your dosage amount. If you need to give 800 units per hour (per 60 minutes), then that is 16 mL per 60 min. So 16 mL is divided by 60 minutes, and that answer multiplied by 60 drops per minute. 16 divided by 60 and then multiplied by 60 just gives you 16. In this case, the time and drops are both 60, so they cancel each other out, and your answer is 16 drops per minute. Is this correct? Like I said, I have not started my BSN program yet, but I'm sure this is something we will be learning. Good Luck. :)

I think you are going to do well in school...... :smokin:

Double-Helix, BSN, RN · Apr 26, 2012

Thank you Ashley, PICU RN for posting about figuring how many units of heparin are in 1 mL. Would this also be correct for units of regular insulin? Thanks :)

The calculation for insulin is no different than heparin when you're trying to figure out how many units you have in 1mL. So if you get an insulin drip from the pharmacy and they put 200 units of insulin in 50mL of fluid, you would do 200u/50mL= your units/mL.

This is the same way you determine the concentration of any solution. Divide the total amount of the drug by the total volume of fluid. That will give you the amount of drug in one mL of the fluid.

michellet1597 · Apr 30, 2012

If I remember correctly, when we did calculations they started from the beginning and laid everything out for you. If you want to brush up on your math skills, you may want to visit the Khan Academy website. If you register you can take practice tests on all areas of mathematics. If you struggle in a certain area they will suggest videos to help and it's all free. Exercise Dashboard | Khan Academy