Interpret This Order For Me Please

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IV 1000ml D5 1/2 NS 60ml x 24 hours

I read it as D5W 1/2 NS at 60ml hour. Total volume to be given is 1000ml. However, 60 x 24 hours is 1440. So after 1000 was given I hung an extra bag to cover the 440ml

1 hour ago, londonflo said:

Yes it is. 60 ml  every hour for 24 hours. Uh ohh.. are you thinking I should run a 60 ml bolus every 24 hours? The brain needs glucose to operate so it needs a steady supply...not all at one time.... Rather continuously. I am old. I did not have an internship. Rather I had one day orientation on the floor.The next day "my mentor" called in sick and I was on by myself. Assessment skills were vital.. Assessments. Common  machines had yet to be invented.  I did not have a device that measure peripheral O2...I used  physical assessment to see if they were SOB;  what their mucus membranes looked like and if they had dusky peripheral circulation. We called for an ABG.    Cardiac monitoring was only done in ICU. 

I didn't think a monitor machine  is better for my decisions.  For example, I went to my pulmonary MD and the nurse who usually does the primary assessment said "Let's hook you up to oxygen. I asked "why" and she said your lips are dusky., I had walked slowly to the exam room... (you betcha my pulse ox was at 80.) This is an example of physical assessment and experience. Off oxygen my numbers were dismal. "Nurse the patient not the machine". Want to be an expert nurse? use all those assessment/observational skills you learned. 

Want to be the excellent nurse....stop  using machines and learn to use your eyes, ears, and smell to collect data as a source of information  and THEN look at a machine. The physical assessment skills are far better than a machine. 

Okay I got off topic: 

We are on here discussing a 60ml IV order....what are the benefits/detriments?  Use your noggin/brain to figure WTH is going to happen with a patient getting 60 ml of the IV  solution for a couple of more hours until you see the ordering MD? What if the IV infiltrated and it took an hour or 2 to restart it?  Seems like either you can't equate what is really important in the whole realm of things or you just want to complain. I mean it is 60 ML per hour .

I know I sound mean but I worked in a city where nurses used their ability to assess fluid intake. How much fluid had the patient had for the last 24 hours? Was the patient  NPO? How much urine produced was  actually and  measured accurately ?

Use your experience and assessment skills to scroll back to the very first sentence of this thread. 

IV 1000ml D5 1/2 NS 60ml x 24 hours

No where does it state an hourly rate. It simply states 60ml. Just like we all assume the order means run the infusion for 24 hrs we are also assuming that 60ml means 60ml/hr  because a rate is not otherwise stated. 
Which returns me to my point that this debate is pretty much all semantics. 
 

 

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Specializes in oncology.
3 hours ago, JackSpratsMom said:

IV 1000ml D5 1/2 NS 60ml x 24 hours

No where does it state an hourly rate. It simply states 60ml

 

3 hours ago, JackSpratsMom said:

Which returns me to my point that this debate is pretty much all semantics. 
 

I guess it all depends on the culture of where you live. I am in the midwest. It is not unusual to see an IV order of 1000 ml of D5 1/2 per 8 hours. We extrapolated that to be D5.45 at 125 ml/ hr continuously using logic and current convention. (actually I almost wrote 1000 cc of D5 1/2 etc... I still think in terms of cc rather than ml.)

When I lived up north the order would be IV:   D5 1/2 q 8 hrs. 

Maybe one of the travelers who post here can say what they see?

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20 hours ago, londonflo said:

Yes it is. 60 ml  every hour for 24 hours. Uh ohh.. are you thinking I should run a 60 ml bolus every 24 hours? The brain needs glucose to operate so it needs a steady supply...not all at one time.... Rather continuously. I am old. I did not have an internship. Rather I had one day orientation on the floor.The next day "my mentor" called in sick and I was on by myself. Assessment skills were vital.. Assessments. Common  machines had yet to be invented.  I did not have a device that measure peripheral O2...I used  physical assessment to see if they were SOB;  what their mucus membranes looked like and if they had dusky peripheral circulation. We called for an ABG.    Cardiac monitoring was only done in ICU. 

I didn't think a monitor machine  is better for my decisions.  For example, I went to my pulmonary MD and the nurse who usually does the primary assessment said "Let's hook you up to oxygen. I asked "why" and she said your lips are dusky., I had walked slowly to the exam room... (you betcha my pulse ox was at 80.) This is an example of physical assessment and experience. Off oxygen my numbers were dismal. "Nurse the patient not the machine". Want to be an expert nurse? use all those assessment/observational skills you learned. 

Want to be the excellent nurse....stop  using machines and learn to use your eyes, ears, and smell to collect data as a source of information  and THEN look at a machine. The physical assessment skills are far better than a machine. 

Okay I got off topic: 

We are on here discussing a 60ml IV order....what are the benefits/detriments?  Use your noggin/brain to figure WTH is going to happen with a patient getting 60 ml of the IV  solution for a couple of more hours until you see the ordering MD? What if the IV infiltrated and it took an hour or 2 to restart it?  Seems like either you can't equate what is really important in the whole realm of things or you just want to complain. I mean it is 60 ML per hour .

I know I sound mean but I worked in a city where nurses used their ability to assess fluid intake. How much fluid had the patient had for the last 24 hours? Was the patient  NPO? How much urine produced was  actually and  measured accurately ?

I really appreciate all your feedback about how one day I might develop into a competent nurse.  I will be sure to incorporate it in my various roles as triage, charge, preceptor, and hospital code team leader.  The first 18 years have been a bit tricky, but maybe when I have some real mileage, it will all come together for me.  I especially appreciate the stories about nursing back in the day with none of these fancy machines, when nurses had to rely on their senses and smarts to care for patients  I will draw on that as I maintain my board certification in emergency nursing.  That spidey sense sure would come in handy with covid when patients who have good skin color speaking in full sentences and SPO2 in the 70's.

But- we aren't talking about me.  I regularly start lines, run fluids, insert foleys and NG tubes without orders.  I am pretty sure I could manage that fluid order.

We are talking about the OP, and their work environment.

And, despite the fact that you are 100% sure of what this order means, your interpretation, (and mine) is very different from that of the OP's supervisor.

And, to be clear:  no amount of obstinance or condescension changes the fact that there is not rate specified in the order.

And, in return for your coaching about how I might develop my critical thinking skills, I will share some information about technology.  You mentioned it's not your strong point.  The bold button does not make incorrect information right any more than typing in ALL CAPITALS.  

"60 ml per hour is CLEARLY stated in the order. "

Above is the digital equivalent of yelling.  Yelling something does not make it right.  To quote a very experienced nurse: "Use your noggin".

Good talk.

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Specializes in oncology.
2 hours ago, hherrn said:

I really appreciate all your feedback about how one day I might develop into a competent nurse. 

Where did I say this? 

2 hours ago, hherrn said:

The first 18 years have been a bit tricky, but maybe when I have some real mileage, it will all come together for me.  I especially appreciate the stories about nursing back in the day with none of these fancy machines, when nurses had to rely on their senses and smarts to care for patients 

 We paved the way for you and your machines. Nurses still have to rely on their knowledge base for assessment. 

 

2 hours ago, hherrn said:

And, in return for your coaching about how I might develop my critical thinking skills, I will share some information about technology.  You mentioned it's not your strong point. 

Where the heck did I say technology is not my strong suit. Physical assessment is the most important....what do you see, hear and then combine with the numbers. Please share how you used technology to confirm your physical assessment data. 

I had a patient whose accucheck was in critical levels several times (she was on a general floor)  Each done several times by an RN. .Each event was a 'Rapid Response'.  Every time she was alert, and her lab glucose (done every time)  came out normal. I remember the physician who had been there before, saying, "this is like Ground Hog's Day". The MD knew not to depend on the technology of bedside glucose machines. 

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Specializes in oncology.
2 hours ago, hherrn said:

I regularly start lines, run fluids, insert foleys and NG tubes without orders.  I am pretty sure I could manage that fluid order.

I agree.. Then what is our disagreement? 

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On 1/21/2022 at 12:02 PM, sleepwalker said:

why not just hang the 1000mL bag and set it to run at 60mL/hr then clarify the order in the morning since you'd still be well under the total volume even 8-10hrs later? 

I see this post was written by a provider. I always tried to handle an issue like this on my own, without bothering the provider. However, the nurse could be written up for not clarifying before carrying out the order.

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On 1/30/2022 at 11:06 AM, londonflo said:
On 1/29/2022 at 10:36 PM, hherrn said:

But- the rate is not specified. 

Yes it is. 60 ml  every hour for 24 hours. ...

[...]

While that is the most logical interpretation of the order in the OP, that is all it is: The nurse's interpretation.  And, neither this, nor many of the alternative orders used as examples throughout this thread, are correct.

On 1/30/2022 at 3:57 PM, londonflo said:
On 1/30/2022 at 12:50 PM, JackSpratsMom said:

Which returns me to my point that this debate is pretty much all semantics. 
 

I guess it all depends on the culture of where you live. I am in the midwest. It is not unusual to see an IV order of 1000 ml of D5 1/2 per 8 hours. We extrapolated that to be D5.45 at 125 ml/ hr continuously using logic and current convention. (actually I almost wrote 1000 cc of D5 1/2 etc... I still think in terms of cc rather than ml.)

When I lived up north the order would be IV:   D5 1/2 q 8 hrs. 

[...]

When you say that you "extrapolated" the first order to mean the infusion was to run at 125 mL/hour, you did so based on the unit/facility culture.  Considering this, I think it likely that some of these orders would be misinterpreted at another facility.  For example, while I would have reached the conclusion that the order in the OP meant to run the IV fluid at 60 mL/hour for 2h hours.  And, while I see how you came to the conclusions above, I would not, based upon my experience, reached the same conclusions that you have posted here.

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Specializes in Peds.

It’s so interesting how we all interpret the order differently,although  I had to squint at the posters saying the rate isn’t specified. 

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1 hour ago, Runsoncoffee99 said:

It’s so interesting how we all interpret the order differently,although  I had to squint at the posters saying the rate isn’t specified. 

As you wrote the order in your original post "IV 1000ml D5 1/2 NS 60ml x 24 hours," a rate (60 mL/hour) is not designated, a volume (60 mL) is.  And, while I agree with your interpretation (and would have come to the same conclusion) that the intended rate is 60 mL/hour, this is just your interpretation of an incorrectly written order.

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Specializes in Peds.

I don’t see how anyone could think 60ml is the volume, because 1000ml is listed as the volume.

The order I wrote is the exact same one I saw in the chart. 

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Specializes in ACNP.

Order needs to be clarified but not urgently. I would start at 60ml an hour and clarify at a reasonable time. Provider will likely round before the 1000ml is given. 

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Specializes in Travel, Home Health, Med-Surg.
On 1/29/2022 at 6:16 PM, Runsoncoffee99 said:

60ml is the hourly rate 

How does one know that if it isn’t written/stated. If not written if is an assumption.

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