pleaseeee help student nurse with peds math!

Hi everyone! Im hoping someone can help me...Ive been sitting here for hours and my mind is smoking!!! AHHHHH! Im doing my Peds rotation and I have to do a report on a patient and I cant figure out the math!!!!! Heres the info:
Pt is 33 months old. 36 inches, 31 lbs. (68 kg.)
One of the questions is askng to list the meds theyre taking and then calculate the patients safe dose range in 24 hours. The meds are:
Ampicillin 100 mg/kg/day 350 reg IV q6h < the 350 reg IV confused me but thats how it was written
Nysatin 100,000 u/ml to white plaque QID
How in the heck do I figure it out?
The next question asks:
Calculate the pts 24 hour fluid needs, and hourly fluid needs. Include the rate if patient is receiving IV fluids. Heres what i got to so far:
10 x 100 = 1000
10 x 50= 500
48 x 20 = 960 The answers total 2460 ml/24 hours
Then I divided 2460 by 24 and got 102.5 ml/hour.
Am i correct in that part? But what do they mean by including the rate for the IV????
If anyone can help me I think Ill cry tears of joy!! I appreciate it sooooooooooooooooooooooooooooooooooooooooooooooooo
oooooooooooooooooooooooooooooooooooooooooooooooo much!
Thank you!!!!!!!!
Nicole
__________________
Nicole

Oct 20, '02Joined: Oct '00; Posts: 10,236; Likes: 64Originally posted by nicoleinphilly
Pt is 33 months old. 36 inches, 31 lbs. (68 kg.)
One of the questions is askng to list the meds theyre taking and then calculate the patients safe dose range in 24 hours. The meds are:
Ampicillin 100 mg/kg/day 350 reg IV q6h < the 350 reg IV confused me but thats how it was written
Nysatin 100,000 u/ml to white plaque QID
How in the heck do I figure it out?
So, divide 31 by 2.2 = 14.
So, the patient gets 100mg per kilogram a day.
100 x 14 = 1400
Now, that's in 4 divided doses (q6 hours)
1400 divided by 4 = 350mg per dose.
The nystatin isn't really dose. The 100,000 u/ml is just the strength. It's a topical cream, so it's kind of hard to actually dose it.
Hope that helps!
Heather 
Oct 20, '02Joined: Oct '00; Posts: 10,236; Likes: 64Originally posted by nicoleinphilly
The next question asks:
Calculate the pts 24 hour fluid needs, and hourly fluid needs. Include the rate if patient is receiving IV fluids. Heres what i got to so far:
10 x 100 = 1000
10 x 50= 500
48 x 20 = 960 The answers total 2460 ml/24 hours
Then I divided 2460 by 24 and got 102.5 ml/hour.
Am i correct in that part? But what do they mean by including the rate for the IV????
I know nothing about peds, so I have no idea how you came up with the amount of fluid the child is supposed to get (I'm sure there's a formula you're using that I'm not familar with).
But I can tell you what they mean about the IV. Once you figure out what the child is supposed to have q24 hours, you have to subtract what you're automatically giving them in their IV (include piggybacks). The number that remain will be what they should be taking in orally.
So, using your numbers, if the child is supposed to be receiving 102.5 mL per hour, and an IV is running at 50 mL per hour (and I don't even know if this is appropriate for a child), then they should be getting the remaining 52.5 orally.
Heather 
Oct 20, '02Joined: Oct '00; Posts: 10,236; Likes: 64HEY! That was kinda fun!
(hope it helped!)
Heather 
Oct 20, '02Occupation: Nurse Clinician/Case Manager Specialty: 20 year(s) of experience in Pediatric Rehabilitation ; From: US ; Joined: Mar '01; Posts: 2,830; Likes: 67Originally posted by nicoleinphilly
Hi everyone! Im hoping someone can help me...Ive been sitting here for hours and my mind is smoking!!! AHHHHH! Im doing my Peds rotation and I have to do a report on a patient and I cant figure out the math!!!!! Heres the info:
Pt is 33 months old. 36 inches, 31 lbs. (68 kg.)
One of the questions is askng to list the meds theyre taking and then calculate the patients safe dose range in 24 hours. The meds are:
Ampicillin 100 mg/kg/day 350 reg IV q6h < the 350 reg IV confused me but thats how it was written
Nysatin 100,000 u/ml to white plaque QID
How in the heck do I figure it out?
The next question asks:
Calculate the pts 24 hour fluid needs, and hourly fluid needs. Include the rate if patient is receiving IV fluids. Heres what i got to so far:
10 x 100 = 1000
10 x 50= 500
48 x 20 = 960 The answers total 2460 ml/24 hours
Then I divided 2460 by 24 and got 102.5 ml/hour.
Am i correct in that part? But what do they mean by including the rate for the IV????
If anyone can help me I think Ill cry tears of joy!! I appreciate it sooooooooooooooooooooooooooooooooooooooooooooooooo
oooooooooooooooooooooooooooooooooooooooooooooooo much!
Thank you!!!!!!!!
Nicole
__________________
Nicole
Now, what your instructor MAY want you to do on the above is look in your drug book and get the dosages from the book for a child this size and THEN calculate the safe dose by the recommended dosages. this is actually the "safe dose"..the above figures only give you the dose actually ordered.
Your fluid needs for a child that small looks mighty high to me. I'm not sure what the formula is for calculating fluid needs..there is one, but I know your # is mighty high for IVF's on a child that's NPO at the same wt.
I don't understand the figures you have on the ivf..explain?
I'm not sure the next question is referring to what heather says or if it's asking for a drip factor. Is there a way for you to know how much fluid you're going to use for your meds (did you get a dilution ratio?)?
I need more info..give the questions..all the info, please
tracyLast edit by nurs4kids on Oct 21, '02 
Oct 20, '02Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14there is a formula for determining iv rates, Ijust cannot recall it at this time.

Oct 20, '02Occupation: rn Joined: Feb '02; Posts: 693; Likes: 2Great link for pharmocology that someone, and I can't remember who!, posted the other day. Here is the paediatric one, detailing IV fluids:
http://www.accd.edu/sac/nursing/math/peds3.html
So for a 14kg kid, it would need 1200ml TOTAL in fluids per day.
This equates to 50 mls/hour. As Heather explains, if the child is having no oral input, then your IV rate would be 50mls/hr. If taking oral fluids, then you would decrease IV rate accordingly.
I agree Heather, that was fun
PS I am assuming the web site information is OK.Last edit by aus nurse on Oct 21, '02 
Oct 21, '02Occupation: PCU/TELE Joined: Jun '02; Posts: 489; Likes: 13You do have to go to the drug book for the safe dose range. Most peds drugs are a range, so you have to figure the low dose for therapeutic effect and the high dose for safe dose range. Figure both the 24 hour dose AND the maximum per dose; i.e. the max in 24 hours may be 500 mg but the safe per dose amount is 125 mg. Watch this, our instructors liked to trip us up. you have to know the minimum dose (therapeutic) and the maximum dose (safe dose) both are equally important. After you have figured you dosage range THEN check the dose ordered is it safe and is it therapeutic. Remember, peds math is the same as adult math, math is math, in peds you have to figure the dose per kg which is an extra step but the safe dose and the therapeutic dose math is the same for peds or adults.

Oct 21, '02Joined: Oct '00; Posts: 10,236; Likes: 64Hope it all looked better to you today nicole! Sometimes you look at something for so long you'll never see it correctly!
Good luck!
Heather 
Oct 21, '02Occupation: registered nurse Joined: Nov '01; Posts: 1,083; Likes: 14heres another maintenance iv rate formula for you
80cc /kg/per day divide by 24 to get hourly rate 
Oct 21, '02Occupation: Nurse Clinician/Case Manager Specialty: 20 year(s) of experience in Pediatric Rehabilitation ; From: US ; Joined: Mar '01; Posts: 2,830; Likes: 67Mark,
I couldn't remember the IV formula either...but your rate sounds much more realistic. As for the formula, it also is determined by the child's current hydration status. Many times, they will run them at 1.5 rate if dehydrated or having high output from drains/drainage.
Connie is exactly correct in reference to safe and therapeutic. I had an error above..that is NOT the 24h SAFE dose on the amp, it is the 24h ordered dosage.
ahh, guys..that wasn't fun..
fun is trying to figure out something like Unasyn dosage once the vial has been reconstituted..our rx has us spoiled on that one now..they just send up a sticker telling us how much h20 to add to the vial and how much to withdraw for the ordered dose. 
Oct 22, '02Occupation: telemetry nurse Joined: Aug '02; Posts: 59WHEWWWWWWWWWWWW!!!!!! YOU GUYS ARE THE BESTTTTTTTT! I am now finished the report and there is no way in hell in could've been done without all your help! Thank you so much for really caring, you have no idea how much it means to me!
love,
Nicole
xoxoxoxoxox 
Nov 6, '02Occupation: CICU/PICU Specialty: 15 year(s) of experience in Cardiothoracic nursing ; From: PT ; Joined: Oct '01; Posts: 27The formula:
750ml x body area

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