This is a question from a MedMath test I just took. I think the correct answer is actually a med error. I just wanted to see what others thought.
"Your patient has a doctor's order for 1000mL of NS to run at 125mL/hr. How many mL will your patient receive after 24 hrs?"
I answered 1000mL but the correct answer was 3000mL.
If the doctor orders 1000mL and you give the patient 3000mL wouldn't you have to report to the doctor that you gave their patient 3X's the prescribed dose?
To me it doesn't matter that the 1000mL would be totally infused in 8 hrs. If the order is for 1000mL then the patient should only receive 1000mL.
What is done outside of a hospital setting is something that may be different, but in the realm of the hospitals and that is what I go by when training nurses as well is to follow the instructions that are given as they are written. And if an order for only one liter, then it would tell you what they want you to do next such as hep lock or saline lock the line, or run it at TKO, etc.
125 ml/hour is standard maintenance level of fluid and is not excessive by any means, if the patient was to get a bolus, then it would be written as such or a dialysis patient that is dry. The docs will write for one liter at what ever rate and it will state x one liter only.
The question is asking what you would run in over 24 hours and I still stick with the answer that was in that book, 3000 ml. And I have always passed my math questions with 100% correct.
If the instructor could not answer you immediately, then that is where the issue is as well. This is just something that is based on common sense.
sorry suzanne, but i've gotten many orders to run a liter only, w/o any f/u.
furthermore, just by virtue of having 1000 or 3000cc's as a choice, it shows this question was trying to confuse the reader.
and to me, when it says give 1000ml's, it is common sense to give only 1000, and f/u w/md.
Suzanne, I believe you are answering based on your experience, as are the rest of us.
Working in a hospital setting, I have never seen an order for maintenance fluids (yes, 125 mL/hr is a common rate) that specified 1000mL. I have never seen an order that told me what to do when an infusion was completed. That's where my common sense/nursing judgement comes in -- leave the pt. with a saline lock, run some fluid at KVO, discontinue the line, ... whatever is appropriate.
I stand by my comment earlier. The writer of that test item may have mistakenly thrown in a "twist" to the question without realizing that it changed the meaning.
And I stand by my answer that, as written, the correct answer to the question is 1000mL.
Why in the heck would they care, just so that what they want is infusing at the rate they want?
If at the moment you need to hang a liter of NS your stock of 1 L bags is out and you hang 500mL instead ... is it a med error?
I'm not trying to be persnickety ... I've just never seen an order written that way.
Regional differences are interesting.
If our unit is out, I just go get some from the supply closet. We never run out of liters of NS.
Yes, the docs write on the physician order, following the IV FLUIDS line:
One liter NS to infuse at 125 ml/hr . . . .that means it continues to infuse until the doc write another order to stop it.
If he wants only a certain amount, he then writes to saline lock, or keep it as TKO. We only d/c the IV if they are being discharged or if the IV infiltrates. Even so, on the discharge order the doc HAS to write "D/C IV". That is NOT left to the nurses' discretion. We do d/c IV's to change sites q72h but that is written in the policy and needs no order.
I don't think you were reading into the question at all. You read it actually as it was stated. Ordered 1000ml at 125ml/hr. I would assume that it meant 125ml/hr indefinitely, but thats not what the question is stated as. I would have clarified it with the doctor.
In reference to what UCHOZME stated, saying that you would only infuse 1000 ml in your shift is assuming that you are there for 8hrs, which IS reading into the question (who said you're not working 12hrs?).
If you passed the test, I wouldn't even bother with it. I've also had trouble with these kinds of questions in school. I would just ask the teacher to change the wording of the question so there is no confusion for future classes.
Specializes in Tele, Renal, ICU, CIU, ER, Home Health..
I would also take that order to mean 1000ml should be infused over 125 cc/hr. If it were continuous, it would have just said NS @ 125 cc/hr. Maybe it is a regional thing. Better be careful with travelers, because they are going to read the order as written and not know how things are normally done in different areas. I also wonder if insurance will pay for the additional bags when the order says 1000cc to infuse. It's scary to me that things can be so different, depending on where you are located.
It's scary to me that things can be so different, depending on where you are located.
Let me pose a few questions here for everyone's consideration.
Take the order "NS @ 125 hr/ml - 1000 ml" or some form thereof.
Let's say that during the course of treatment this patient has an adverse outcome and two years later you find yourself in a courtroom defending your implementation of this order.
If you gave one liter and then stopped, could you convince a judge or jury that this was the intent of the order and that you executed that order accurately?
If you continued to infuse fluids at this rate after the first liter, could you convince a judge or jury that this was the intent of the order and you executed that order accurately?
How would a non-medically trained judge or jury interpret this order?
In a medical math question you have to eliminated useless info and plug the necessary data into your equation. The parts of this problem you need are 125ml/hr and 24 hrs the 1000ml bag is useless info...clutter really, to distract you from what the problem is asking," How much fluid would your pt get in 24hrs if the pump were infusing at 125ml/hr? This is not a Dr order in this instance it is simply a math problem.
This is not a Dr order in this instance it is simply a math problem.
leslie :-D
11,191 Posts
sorry suzanne, but i've gotten many orders to run a liter only, w/o any f/u.
furthermore, just by virtue of having 1000 or 3000cc's as a choice, it shows this question was trying to confuse the reader.
and to me, when it says give 1000ml's, it is common sense to give only 1000, and f/u w/md.
leslie