need help with math problem

Nursing Students Student Assist

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Hello,

I have a question about a math question that we just had. the question is....

your client presents in the clinic complaining of fluttering in her chest. she is placed on a cardiac monitor which shows a new onset atrial fibrillation. she has history of COPD and CHF. home medications are digoxin and lasix everyday.

vitals: HR 110-120, RR 22, B/P 100/60

weight: 100 Kg.

she is admitted to the inpatient monitored unit and started on a Cardizem drip. the pharmacy sends you a 50mL bag of 0.25 NS with 250 mg of cardizem added. your order states to start the infusion at 0.5 mg/kg/min.

using nursing judement, would you hang this infusion? why?

my question is...wouldn't you need to check the patients digoxin level before giving this medication? I know that Cardizem will lower the patients BP even lower and can also increase digoxin serum levels.

I'm totally confused....our question had that the pharmacy sends you a 50mL bag of 0.25 NS with 250 mg of Cardizem added. I feel like they are trying to trick us, which is nothing unusal. What really bothers me is that we haven't been taught this, so it's really hard to know what to do with the problem. I've looked in the drug books and in our text books and they say to start the infusion at 0.25mg/kg; may repeat in 15 min with a dose of 0.35 mg/kg. may follow with continuous infusion at 10mg/hr (range 5-15mg/hr) for up to 24hrs.

I didn't understand why she put in the problem 5/mg/hr. most of the time you would see it as 5mg/hr, but this just seems different to me. could it mean that it would be increased in increments of 5 mg???

so would I take the 0.25mg/kg = 25mg divide by 250 x 50mL = 5mL/hr???

I so sorry to keep bothering you with this crazy problem, but it will drive me crazy until I either figure it out or someone can explain it to me how it should be done.

Thanks!!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

My IV drug book says that the 25mg of Cardizem comes as a solution of 50mL and that it needs to be added to an IV solution and further diluted.

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Specializes in Utilization Management.

I can only tell you how we do it.

Our Cardizem comes in a bottle of 125 mg in a 25 ml bottle. We draw that up and mix it into a 100 ml bag of either D5W or NS 0.9%.

Total = 125 ml in the bag to 125 mg of the med. The concentration is then 1mg of medicine to 1 ml of fluid.

We can run up to 20 mg (or ml, it's the same amount either way), per hour, with up to a 20 mg bolus.

Usually, we give a 10 mg bolus and then run the drip at 5-10 ml/hr.

I concur with Daytonite; the dilution is too strong and I would not hang the med.

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just had another thought about this question. I don't think the order is complete. therefore, you would call the doctor to clarify the order. the order that the teacher has given us doesnt have a range to go by. Could this be correct?

this would also be true for the 2nd question two, right?

This is one of those crazy problems that causes you not to sleep at night because you lay in bed at night trying to figure the problem out!

Thanks again

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Specializes in Utilization Management.

The question was:

using nursing judgement, would you hang this infusion? why?

Based on my experience as a nurse, I would not hang it. The dilution seems wrong to me. I would call the pharmacy and/or the doctor about this medication and get it clarified.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

thanks, angie. i was going by what i was seeing in my copy of 2007 intravenous medications, 23rd edition, by betty l. gahart and adrienne r. nazareno. i am not familiar with the practical application of this drug at all. wouldn't they use the drug as an emergency stopgap, but eventually defibrillate to covert back to a sinus rhythm?

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Specializes in Critical Care.
thanks, angie. i was going by what i was seeing in my copy of 2007 intravenous medications, 23rd edition, by betty l. gahart and adrienne r. nazareno. i am not familiar with the practical application of this drug at all. wouldn't they use the drug as an emergency stopgap, but eventually defibrillate to covert back to a sinus rhythm?

depends on the patient. i've seen them use cardizem to get the rate under control for a couple days (iv continuous followed by po extended release) while anticoagulating, then proceeding with electrical or chemical cardioversion or even ablation.

other times, i've seen the cardizem kick the patient back into sr on it's own.

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ok...i get the part about the dilution and not to hang the med, but what about where it says....if the md order stated to start the infusion at 5/mg/hr. at what rate would this be? does this mean that the order would be increased by 5 mg increments per hour? for example, my drug book says that the dosage starts out at 0.25mg/kg; may repeat in 15 min with a dose of 0.35mg/kg?

i'm so sorry to keep asking these questions over and over, but i really want to understand what she is asking. i understand if she had put 5mg/hr, but by her putting 5/mg/hr kind of changes the problem.

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Specializes in Critical Care.
ok...i get the part about the dilution and not to hang the med, but what about where it says....if the md order stated to start the infusion at 5/mg/hr. at what rate would this be? does this mean that the order would be increased by 5 mg increments per hour? for example, my drug book says that the dosage starts out at 0.25mg/kg; may repeat in 15 min with a dose of 0.35mg/kg?

i'm so sorry to keep asking these questions over and over, but i really want to understand what she is asking. i understand if she had put 5mg/hr, but by her putting 5/mg/hr kind of changes the problem.

the use of a slash between 5 and mg is likely a typo and not part of your problem.

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one of my classmates had emailed her about it, and she replied back and said it was right. ?? I have never seen it written that way.

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Specializes in Critical Care.
one of my classmates had emailed her about it, and she replied back and said it was right. ?? I have never seen it written that way.

Your instructor also gave you ".25 NS" which is fictitious. Is there another instructor you can talk to?

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I was just looking that up too, I didn't see it anywhere! I think she just want to see if we know what to do in this situation. The whole order is messed up!

do you think that the 5/mg/hr is fictitious too? I've never seen it written out like this.

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