Hi, my name is Jill Beavers-Kirby
and today we’re gonna be talking about some common dosage calculations.
So what are some of the routine medication administration schedules
or what are the most common times that we give the medicine?
So a couple of abbreviations that you’re gonna see routinely
throughout your career as a nurse are things like AC can be a capital A and a capital C
or a lower case a and a lower case c which means before meals, Ad lib is as directed,
BID is twice a day, PC is after meals, PRN is as needed, QID is four times a day,
stat means immediately, QAM means every morning, Q2h means every two hours,
Q4h means every four hours.
Couple of medication abbreviation times that you should not use
and you should not see is when QD which in the old days mean q day,
but now we don’t like to use that because it can cause confusion so instead of writing QD
we will see daily, you wanna use that instead of QD.
So what are some words that you have to know when you’re giving medications?
One is onset, this is the time that it takes a medication after it’s given to start taking effect.
The peak time of a medication is when the medication reaches its highest concentration
in the body the trough is it the opposite of the peak,
it’s the point of which the medication is at its lowest level of affect in the body.
You’ll want to use trough times for dosing medication such as antibiotics
such as vancomycin, you’ll want a trough time to know if you need to change the dose
of the medication so that they are getting a steady state of the medication throughout their blood system.
Another term you’ll see is duration.
This is simply how long the medication is gonna be effective in the system,
so the duration of a medication maybe as short as 30 seconds
such as adenosine or as long as 24 hours such as some chemotherapies.
And finally plateau, this is when the serum concentration of a medication
has reached its highest and maintains that same level.
So you’ll see plateaus used for things like dosing of warfarin also known as Coumadin
cuz you have to have about three doses of Coumadin in your system
before you can get a steady state or plateau in your system.
So how do we give medication?
Couple of them you probably already familiar with: oral, by mouth - pills that you can swallow,
pills that you can put under your tongue which is called sublingual,
or buccal that’s the inside of the cheek area.
Or parenteral that includes subcutaneous which is in the layer of skin, intramuscular
which is in the muscle, intravenous or epidural.
There's also some topical medications, this go directly on the skin,
the most common when you're probably see are things like topical steroids for rashes
or nitroglycerine patches for people with angina.
You can also give medications by inhalation.
You usually see this with people with respiratory issues such as people with asthma or COPD,
when they are asked to inhale a bronchodilator so that helps gets their lungs open.
And finally, mucus membranes, these includes eyes such as eye drops, ear such as ear drops,
nose such as ephedrine or something else that you squirt in your nose,
it also includes the vaginal suppositories, rectal suppositories, or for some people
who can't take anything by mouth and they have an ostomy,
you can also give medications through their ostomy site.
So as with everything, there is good and bad so what are the pros and cons
of certain routes of medication administration?
So the oral route - well, it’s easy, it’s convenient
however, it might be difficult for some people to swallow this pills or liquids,
they might taste terrible and if your patient has nausea and vomiting
or something else is going on in their GI tract they're not gonna absorb it very well.
Parenteral route is a good route that’s the IV route, the subcutaneous route, the IM route.
These are also easy, convenient, however, you're risking infection
because you're breaking the skin, can be painful for some patients.
Some people are just scared absolutely petrified of getting stuck with the needle
and in that case the parenteral probably isn't a good choice for them.
Topical routes are also painless, they are pretty easy to do, and less side effects.
However, if the skin is broken or thin, you might get a different expectation of absorption,
in other words the lotion might go all up and down the arm if the skin is real thin
and transports the lotion that way or if there's an area of broken skin, the lotion might burn
or the cream or whatever you're putting on might burn the patient.
The mucosal route is nice because it's readily absorbable
however it can cause some local irritation so it can cause the mucosal site to get red
or a little raw on a patient and they may not prefer that or if it's rectal or vaginal
it might not be easy for the patient to give for themselves.
The inhalation route is really good for patient like I said with respiratory problems,
with breathing problems cuz that way they can breathe in the medicine
the medicine goes in pretty quickly and it starts to affect them pretty quickly
however because you're inhaling it, it might cause systemic side effects
for example a lot of the bronchodilators can cause your heart rate to increase
which kinda makes people a little nervous and jittery for about the first ten minutes
after they take this medication.
Some patients don’t like that and it's very uncomfortable for them.
So how do we measure our medicine? How do we measure what we're giving the patient?
Well, the most common, the most accurate system is the metric system,
this is most widely used and this is pretty common in hospitals, doctor’s offices, clinics,
everywhere you go.
So there's those things like grams, liters, milliliters, milligrams,
and these are all very specific measurements.
Old system of measurement is called the apothecary system.
These were things like a dram which I still don’t know what that means
cuz I've never seen it used but it’s a very old system, it was non-standardized.
We don’t use it to measure out medications today.
However, we do still slip in household measurements.
You will see some medications written as give one teaspoon or give one tablespoon or drink
the entire gallon, and we’ll mix this with the metric system so it does get a little confusing at times,
but just to kinda keep it at the back of your mind that one teaspoon equals five milliliters,
a tablespoon equals 15 milliliters and so on, and that's -- you just kinda have to remember that.
So speaking of conversions, here are some of the common conversions -
as I said, a tablespoon is 15 milliliters, a kilogram equals 2.2 pounds.
Some medications are gonna be based on x amount of drug per kilogram,
they don’t say x amount of drug for pound, so you have to know how to convert pounds and kilograms.
So a thousand milligrams is a gram, 500 milligrams is 0.5 grams, a thousand milliliters is a liter, and so on.
So the most common formula that you're gonna use to figure out drug calculation
is called ratio and proportion. It's kind of a reminder back to high school math.
So for example, on the screen we have 5:10 = 1:2, so that is saying five is to ten as one is to two.
If you remember, the first and last number of that equation are called the extremes,
the middle numbers are called the mean, so you multiply the means time the extremes,
take them up with your answer.
For example: 250 milligrams of the drug is in 5 ml's of a solution.
You need to give the patient a 100 milligrams, so how many ml's do we need to give?
So we know that there's 250 milligrams in 5 mls, we need to give 100 milligrams is to x ml -
we don’t know what the x is, so we multiply our means by our extremes and we get 250x equals 100 times 5,
do the math, x ends up being at 2 mls of the drug.
So if you just kinda think about that, you know that the 2 mls is less than 5 mls
and there's 250 milligrams in 5 mls and you need to give less than that so 2
is kind of is the right answer and you've just done kind of a little immediate self-check in your brain.
So what are the rights of medication administration?
Anytime you give a patient a medication, any and every single time you give a patient a medication,
you need to ask yourself these five rights:
Do I have the right medicine? Do I have the right dose? Do I have the right patient?
And do I have the right route? And am I giving it at the right time?
Every single time you give a patient a medicine, you should go through this five rights.
If one of these is incorrect and you still give the medication it's considered a medication error,
so every single time you give a medicine, ask this little five rights in your head every single time.
So what are the elements of a medication order?
A medication order has to be very specific in order for you to give it as the nurse.
One it has to have a patient's name; two, it has to have the patient date and time that the order is written.
It has to have the name of the medication on it, has to have the dose.
If it doesn't have all those, you can't take it as a medication order.
You have to have the route of the administration, the time and frequency
that you're going to give it and the signature of the prescriber.
So for example, Joe Smith, take one 350 mg Tylenol tablet every six hours
as needed by mouth signed by Jane Doe.
If it doesn’t have all of those elements, it's not a complete medication order
and you can't give it.
You can't just make up one of the elements and think you can give the medication.
You need to contact the prescriber and say, how often do you want the patient to have this?
How did you want the patient to get this? Did you want them to take it by mouth or as a suppository?
All of these elements have to be there.
You as a nurse cannot make these decisions independently.
Thank you. This has been Jill Beavers-Kirby discussing dosage calculations.