IV Calculation

krisiepoo · Nov 8, 2013

Yes, the 1L would need to be infused over 8 hours, but within this time frame, it was only infused for 6 hours. (well, it would have kept going for another 2 hours, but you're not asking about those extra 2 hours)

This question is critical thinking, they're trying to make you think about times/amounts/infusion rates.

reasonable NURSES and NURSING STUDENTS would see that yes, the infusion time is over 8 hours, but the time you are being asked to evaluate is only 6 of those hours.

In the real world, you would do as your instructor did. If you're zeroing out the IV at midnight, you wouldn't add on an extra 2 hours of possible fluids (possible because what if the IV infiltrates and it needs to be stopped?). You would add from the time it started to the time you're evaluating.

matt1924 · Nov 8, 2013

Thanks for the reply! I understand the rationale for the answer, but I guess my dilemma is trying to figure out if my instructor was correct in using q8h as meaning "over 8 hours" instead of "every 8 hours", as all literature I can find states the definition is the latter- with no exceptions. I came to my conclusion with the understanding that if I use the literal definition I don't have an infusion time. To me, how a person interprets that changes the question altogether. The instructor has stressed the importance of reading literally and not to make assumptions. I'm just trying to understand why we are taught a system that is supposed to be standardized, it is appropriate to alter the actual definition depending on needs at the moment

krisiepoo · Nov 8, 2013

What if you thought about it this way, you hang the bag every 8 hours. That way you're not changing the meaning of 'q' but you have to think critically, what would you do with this bag every 8 hours? You set it to infuse until you hang the next bag.

And yes, your instructor was correct in using q8h for this situation.

**NICU Guy, BSN, RN** · Nov 8, 2013

Her use of the abbreviation is confusing. "Q" means every. So Q8h means every 8 hrs. The problem is that there is no infusion rate. You could have it run at 200ml/ hr at be done in 5 hrs. then wait 3 hrs and start another 1000 ml. That would be 1L Q8h.

If it was intended to be continuous infusion and you are to change bags every 8 hrs then you would calculate it for 125/hr to have it done when the next bag is hung.

Esme12, ASN, BSN, RN · Nov 8, 2013

LOOK at your question.....

At 1600, the doctor orders 1L of D5W q8h. The nurse starts the liter at 1800. The patient receives xxxxxxxx 0.5g in 100 mL 0.9% sodium chloride at 2200. Calculate the patients 8 hr parenteral intake for the 1600-0000 shift.

The MD ordered this at 1600......the patient is to receive 1 liter of fluid every (over) 8 hours or 125ml/hr......but the IVF was not started until 1800.....that means you IVF infused from 1800 to the end of the shift at 0000. That is 6 hours of IVF infused during the 8 hour shift plus the IVPB of 100 cc's.

Are you stopping the main IVF for the infusion of the IVBP? Then your IVF infusion would be 125ml/hr for 5.5 hours.....plus 100mls.

Now what is your calculation.

matt1924 · Nov 9, 2013

I'm glad you guys are responding to this, I am genuinely curious as to what other professionals think and I'm not trying to be difficult, I promise. However, I tend to agree with Don1984 in that her use of "q" instead of "over" can be misleading. Its not the mathematical portion, or my critical thinking skills, I know what the instructor is looking for. But, they tell us to only apply the information we've been given and to not assume anything. To me, I would be "assuming" the doc wants the fluid to infuse over an 8 hour period since it isn't explicit in the question. Every and over have two different definitions. I even referenced my textbook and could not find one example that was worded in that format. Every one that was asking something similar clearly stated "over 8 hours" or "infused in," etc. For example, if I were to receive an order for Ibuprofen 400 mg tab po q8h, I could assume that giving the patient a 50 mg tablet every hour would be fulfilling the docs orders. But I understand that this means I need to give a 400 mg tab or whatever combo depending on availability one time every 8 hrs. Anyway, I'm not confused or anything :blink: I just probably get too deep into trivial matters.

On another note though, several of us were also marked as wrong when we answered this question " A somewhat musical sound heard in the lungs, usually with a stethoscope, caused by partial airway obstruction."

our answer: Wheeze

instructors answer: Wheezes

us=wrong

Even though in the text it may list the vocab word as "wheezes," its also used in a sentence which indicates plurality. "musical sounds." Our question was given in singular form, so we answer singularly. Still incorrect.

-Maybe I need a break. Thank you for taking the time to respond!

JustBeachyNurse, LPN · Nov 9, 2013

Wow. Wheeze vs. Wheezes.

I think I would need a nap/break after that one

Esme12, ASN, BSN, RN · Nov 9, 2013

I'm glad you guys are responding to this, I am genuinely curious as to what other professionals think and I'm not trying to be difficult, I promise. However, I tend to agree with Don1984 in that her use of "q" instead of "over" can be misleading. Its not the mathematical portion, or my critical thinking skills, I know what the instructor is looking for. But, they tell us to only apply the information we've been given and to not assume anything. To me, I would be "assuming" the doc wants the fluid to infuse over an 8 hour period since it isn't explicit in the question. Every and over have two different definitions. I even referenced my textbook and could not find one example that was worded in that format. Every one that was asking something similar clearly stated "over 8 hours" or "infused in," etc. For example, if I were to receive an order for Ibuprofen 400 mg tab po q8h, I could assume that giving the patient a 50 mg tablet every hour would be fulfilling the docs orders. But I understand that this means I need to give a 400 mg tab or whatever combo depending on availability one time every 8 hrs. Anyway, I'm not confused or anything I just probably get too deep into trivial matters.
On another note though, several of us were also marked as wrong when we answered this question " A somewhat musical sound heard in the lungs, usually with a stethoscope, caused by partial airway obstruction."
our answer: Wheeze
instructors answer: Wheezes
us=wrong
Even though in the text it may list the vocab word as "wheezes," its also used in a sentence which indicates plurality. "musical sounds." Our question was given in singular form, so we answer singularly. Still incorrect.
-Maybe I need a break. Thank you for taking the time to respond!

I mean this in the BEST way......You...need to take a break.

First your math, in the first question, according to the question, was wrong.

My answer is 1,100 mL. This is total intake for the 8 hr period

The IVF didn't infuse over an 8 hour period. If you are working from

1600-0000

and you hang a 1000ml bag at 1800

The nurse starts the liter at 1800.

1800 to 0000 is that time the IV infused on your shift....which is a total of...6 hours. Period. There is NO IVF hanging from 1600 to 1800 therefore no IVF has infused during that time. So your instructor was correct in her math. My point is that you need to be very careful on how questions are worded so that you don't make a mistake....again.

Second there are certain rules in nursing, called standard of care, that defy common grammatical etiquette. The standard of care is that IVF when ordered Q8 hours implies rate. That is the standard. Look up the IVF and the standard of administration....they are administered over a period of time so that Q8 hours implies a rate to infuse the entire bag over 8 hours..... that standard administration is to divide the administration over a period of time. That is the standard of care. No arguments....it's the standard. Fortunately most physician orders are written at XX/mls/hr to avoid this mistake/misinterpretation of the order and I believe it is a JACHO requirement to be written in this manner.... begin IVF D5W @ 125mls/hr..... instead of Q8 hours. To avoid this issue.

To give a large quantity of fluid is called and ordered as a bolus.

Solid medication is given in a single dose as they are absorbed released over time (as per drug monographs/PDR) unless other wise indicated by the MD order.

I can't even address your instructor marking wheeze wrong when the answer was wheezes....:no:while you never really hear just one "wheeze" while auscultating therefore it is wheezes....to mark it wrong on a test is insane. :banghead:

Personally..... I'd be taking that to the dean. :whistling:

matt1924 · Nov 11, 2013

Thank you for the clarification. That's the justification I was looking for. And for the other issue with the wheeze, we had a question today that threw us all for a loop as well. We were given a simulated chart with two oral and two parenteral medications listed along with the times administered during the day. One oral med was given once a day and the other four times a day. The two IV meds once per day each. The question precisely asked " How many oral medications is this patient receiving?" We answered "2" but she was looking for "5." How do we justify that? Her rationale was that she was asking how many times a day the patient was taking oral medication, but that isn't in the question.

And thanks for the advice to take a break, I had plenty of rest this weekend!

4boysmama · Nov 11, 2013

I would argue that question on up to the dean as well! Instructors often know what they *mean* to ask, and then key the answer to that goal, but questions must accurately reflect what it is they are asking. In order to get her intended answer of 5, the question would have to be worded something like "How many oral medication administrations is this patient receiving?"

Esme12, ASN, BSN, RN · Nov 11, 2013

Thank you for the clarification. That's the justification I was looking for. And for the other issue with the wheeze, we had a question today that threw us all for a loop as well. We were given a simulated chart with two oral and two parenteral medications listed along with the times administered during the day. One oral med was given once a day and the other four times a day. The two IV meds once per day each. The question precisely asked " How many oral medications is this patient receiving?" We answered "2" but she was looking for "5." How do we justify that? Her rationale was that she was asking how many times a day the patient was taking oral medication, but that isn't in the question.
And thanks for the advice to take a break, I had plenty of rest this weekend!

Good...I'm glad....sometimes the more we look at something the worse it gets....the question is vague the question should have read...how many total (key word total) oral doses of meds does this patient receive in a day....I would have answered 2 oral meds as well with the way the question was asked.