pediatric drug calculation.NEED HELP PLEASE!

jnkrek2006 · Jan 22, 2012

hi allnurses,
so have a few questions regarding peds drug calc.the highlighted red are the questions i don't quite understand.
-----doctors order: cefotaxime 600 mg iv q6h
patient weight = 19 kg.
safe dose range is 50‑200 mg/kg/24 hours
the drug should be diluted to 20mg/ml and infused over 1 hour.
the vial on hand contains 1000 mg/5cc

a. what is the safe dose range? (10 points)

low: ___950_____ high: ____3800____
__237.5_____/ dose __950____/dose

b. is the order a safe dose? (2 pts.) __yes__

c. if safe, what is the fractional dose? (5 pts.) __3ml__

d. what is the dilution required? (2 pts.) _minimum 27ml__--why and how 27 ml?_ because 600mg ordered divided at 20mg/ml gives you a total of 30 ml subtract your 3ml of the medication and you get 27 ml of dilulant

e. what is the time required to administer the drug? (2 pts.) _1hr___

f. what is the amount of flush required? (2 pts.) _depends on the tubing being used___

g. what is the rate of the iv pump (ml/hr) for the hour? (2 pts.) ___30ml/hr____

-----penny weighs 30 kg. she will receive two 240cc, by mouth, feeds on your shift. she will get one antibiotic, which requires 30cc of dilution and 20cc of flush during your shift. it will run for 60 minutes.

a. what are penny's fluid requirements for (10 pts)

24 hours 1000+500+200= 1700___

for 8 hours? _567____

b. what is her po intake for your shift? (2 pts.) _240+240= 480 ml____

c. how much iv fluid will she need for medication administration on your shift? (2 pts.) _50ml___ -so we just add 20cc of flush plus 30cc of dilution,correct? ,,,,,,yes

d. what iv flow rate, on the pump, (ml/hour) will be needed to achieve maintenance when the antibiotic is not running? (5 pts.) __567-480-50= 37/7= 5.29_ i dont quite understand this question,is this always the case? i dont understand this one either, i thought it should be placed at kvo or sl but i dont know about this one!

-----anthony weighs 36kg. he usually takes two 120cc cups of juice, by mouth, during your shift. he has no iv meds scheduled for your shift.
a. what are the fluid requirements for 2/3 maintenance for: (10 pts.)

24 hours? __1201.2ml________________

8 hours? _400.37ml_____ how did they come up with this answer?i dont know how it becomes 400.37 ( not sure cause i am getting 400.4 flat out!
b. what is anthony's po intake for your shift? (2 pts.) _240ml__

c. what iv flow rate, for the pump, (ml/hour) will be needed to achieve 2/3 maintenance fluids? (5 pts.) __160.37/8 = 20.05ml__ i have no clue where 160.37 came from. i dont understand how they got this number! myself

----doctor's order: nafcillin 750 mg. iv q6h

rose weighs 19.4 kg.
safe dose is 150‑200 mg/kg/24 hours
drug should be diluted to 20mg/ml and infused over 1 hour
vial on hand contains 500mg/2cc

a. what is the safe dose for rose? (10 pts.)

low: _2910 mg_______ high: __3880 mg______
__727.5 mg______ __970 mg______

b. is the ordered dose safe? (2 pts.) _yes__

c. what is the fractional dose? (5 pts.) _3ml__

d. what is the dilution required in the volutrol? (2 pts.) _24.5ml____im getting 57mg/ml from giving 3cc at 20mg/cc=60mg-3ml=57_

e. what is the time required to administer the drug? (2 pts.) _1hr___

f. what is the amount of flush required? (2 pts.) _20ml (volutrol tubing)___

g. what is the rate of the iv pump (ml/hr) for the hour? (5 pts.) __27.5m?/hr____

i answered then beside the ones in question, keep in mind i may be wrong but some of theirs i have no idea on

nursingstudent_88 · Jan 23, 2012

thanks!=) it could be that the answers they gave us are wrong

KelRN215, BSN, RN · Jan 23, 2012

Scenario #1

D. Your problem tells you that you must dilute the medication to a maximum concentration of 20 mg/mL. Your dose is 600 mg. 600mg/20 mg/mL = 30 mL. Your medication volume prior to dilution is 3 mL, therefore you need to mix it with 27 mL to make a final concentration of 20 mg/mL.

You are correct that the amount of flush you need depends on the tubing. Your volume is only 30 mL, so in my institution this would come from pharmacy (pharmacy would do the diluting) in a 30 mL syringe and would be run on a syringe pump. Medfusion tubing only holds something like 1.5 mL so a 3-5 mL flush is more than enough.

Scenario #2.

A. The formula for pediatric fluid maintenance is 4 cc/kg/hr for the first 10 kg, 2 cc/kg/hr for the next 10 kg and 1 cc/kg/hr thereafter. Therefore, fluid maintenance for a 30 kg child is 70 cc/hr. Her 24 hr fluid requirement is 1680 mL and her 8 hr is 560 mL.

You are correct for both B & C.

D. Her maintenance fluid rate is 70 mL/hr and this will always be her maintenance rate. She took in a total of 530 mL in your shift, only 30 mL below her maintenance. There is no reason to think you would hook her up to IVF to make up this 30 mL.

Scenario #3

Use the above mentioned fluid maintenance formula. Fluid maintenance for a 36 kg child is 76 mL/hr = 1824 mL/day.

2/3 of this is 1216 mL. You are pretty close so I'm assuming the formula you learned for fluid maintenance is perhaps slightly different.

8 hours is 1/3 of 24 hours. All you need to do here is divide the above answer by 3 and you have your 2/3 fluid maintenance for 8 hours.

He took in 240 cc of PO fluids. You need to remember this. They took this into consideration when figuring out how much fluid you need to make up. In the real world, no one runs fluids at 20 cc/hr to make up maintenance fluids unless it's an infant. For a child of this size, just give him more to drink.

Scenario #4.

Again, your problem tells you that your drug must be diluted to a concentration of 20 mg/mL. Your ordered dose is 750 mg so your volume must be at least 37.5 mL. The current concentration is 250 mg/mL so yes, you need to give 3 mL of the drug. You need to mix it in at least 34.5 mL to make the final volume 37.5 mL. If you are giving it over 1 hr, it would be 37.5 mL/hr.