To round OFF or Not To round OFF

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Specializes in Wound Care, LTC, Sub-Acute, Vents.

i am taking my very last class-peds. i have no problem doing the calculations but i am tired of my instructor changing her mind whether we round off or not when doing the calculations. please let me know how you guys do it in the real world. thank you!!

the problem she gave us today (we can't use a calculator):

child weighs 15.8 lbs

dr. orders: gentamicin 18 mg iv q8h in 10ml d5½ ns

reference: 2.5 mg/kg/dose q8h

stock: if safe: 40 mg/ml. give?

okay i know i need to convert 15.8 lbs to kilogram, which is 7.18 kg

7.18 kg x 2.5 mg = 17.95 mg/dose. now, is the original order 18 mg safe even though i got 17.95 mg? mind you, my instructor said anything that is above the recommended dose is not safe.

okay here is my second problem. if i had rounded off the 7.18 kg to 7.2 kg instead, i would get this

7.2 kg x 2.5 mg = 18 mg. and this would make the md order safe. then

i would give [18 mg/40 mg x 1 ml] = 0.45 ml

so what do you think? do i round off or not? and if the dr's order is alittle bit over the recommended dose, is it still safe or not? like what i said, a couple of students had already asked her to clarify yet she keeps giving different answers.

thanks for reading my post!

angel

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No rounding off til the very end...

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Specializes in Wound Care, LTC, Sub-Acute, Vents.
no rounding off til the very end...

so, is my original problem safe or unsafe?

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Specializes in ED.
No rounding off til the very end...

I agree EXCEPT... I always round kg to one decimal at the beginning of the problem. That was the only calculation we were taught to round before the end. So, I would say that it is a safe dose.

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Still in school myself but I had the same question as you in regards to when to round and not to because at times it does make the dose then "unsafe"

I was told to round weights to the tenths position and then dose accordingly. And if you look at your example problem, the pts weight in pounds is also to the tenths position, so I'd round my kgs to the tenths too.

RE: being just a tad over the safe level, our teacher instructs in the school setting it is what it is. If the safe level is say 45mg and you come up with the correct answer of 45.1 then the answer to is it safe would be NO. BUT in the real world she said you might under certain circumstances.

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I'm also in school and we have problems like this often. Our instruc. tells us to round off everytimes EXCEPT in peds cases. Her theory is that because children are so small and are so sensitive to drugs, you need to be precise in measuring doses. So I would say that your dose is not safe.

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Specializes in DOU.

We were taught to round EVERYTHING (including weight) to the hundreths.

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Specializes in Wound Care, LTC, Sub-Acute, Vents.

thank you for the response guys but i am still confused .

anyone working here in pediatrics floor that can help me?

thank you!

angel

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I'm also in school and we have problems like this often. Our instruc. tells us to round off everytimes EXCEPT in peds cases. Her theory is that because children are so small and are so sensitive to drugs, you need to be precise in measuring doses. So I would say that your dose is not safe.

I pulled out my notes and my instructor said exactly as yours, round to the tenth in everyone BUT peds for the same reasons you were given.

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thank you for the response guys but i am still confused .

anyone working here in pediatrics floor that can help me?

thank you!

angel

maybe if you put this in the pediatrics specialty forum someone will give you the info you (and now i) am looking for

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Specializes in Wound Care, LTC, Sub-Acute, Vents.

thanks for all the replies guys. ok, today we asked our instructor again, do we round off or not. this time she said no rounding off.

she went over the problem i posted here today and she

said when converting from lbs. to kg., just use the first decimal without rounding it off.

so for my original problem: 15.8 lbs. = 7.1 kg.

7.1 kg. x 2.5 mg = 17.75 mg, which would make the dr's order unsafe.

she sweared on this because she said she used to "write" for boards.

i still wonder how true this is but at least she told us what she wanted and that is enough for me now because i just want to get the right answers for my final.

angel :cheers:

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Specializes in NICU, PICU, educator.

She needs to just tell you what she wants you to do. In our hospital we DO NOT round anything, we use actual weights and doses since our pumps can go 3 places past the decimal point.

If we use rounded weights then it can be out of our guidelines we use for meds and therefore would need an attendings signature to give the med.

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