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# SYSTEM OF

MEASUREMENT AND
CONVERSION
BEGASO, NIKKI ANNE P.
IMPERIAL, CHRISTINA MARIEL T.
PANILA, VINCE C.
SORIANOSOS, JULLIE FAYE D.
VILLEGAS, ZABRINA SHAYNE S.

METRIC SYSTEM
The metric system is the most widely used measurement system in the
world today. It is generally the only system of measurement used in
drug dosages. The metric system is very simple to use. It is a decimal
system based on the number 10.
In healthcare, metric measurements are based on the meter, gram,
and liter. The meter (M) is a measurement of length or distance, the
gram (g) is a measurement of weight, and the liter (L) is a
measurement of liquid volume.

MEASUREMENT OF WEIGHT
The basic unit of mass in the metric system is the gram (g).
Relationships between pharmaceutically important metric units of mass
are:

SOLUTIONS

## IF YOU GOT THIS RIGHT, MOVE ON TO FRAME

4; IF NOT REVIEW AND TRY AGAIN:

MEASUREMENT OF VOLUME
The standard unit of the volume in the metric system is the liter (L).
The following listing describes the metric units most frequently used by
pharmacists in measuring volume and understanding clinical laboratory
test values.

SOLUTION:

SOLUTION:

MEASUREMENT OF LENGTH
The meter (m) is the basic unit of length. The metric units of length
most frequently encountered by pharmacists are as follows:

APOTHECARY SYSTEM
The Apothecary system (measurements based on volume and weight) is the oldest
system of measurement. (It is based on the "average weight" of one grain of wheat
or the size of an "average weight" drop.) This system was used for many years in
prescribing and dispensing medications. Because it is the least accurate system
measurement, it has also been replaced metric system equivalents.
It is possible that a home care nurse could encounter a measurement in the
apothecary system (usually with outdated medications.) The most common of these
is "Grains V," which is the dose of one regular size aspirin tablet (325 mg). You may
also see an order for "one fluid ounce of a medication, such as Milk of Magnesia;
this is equivalent to 30 ml (milliliters). (Other apothecary terms formerly used, in
addition to grain, were scruple, minim, and dram.)

HOUSEHOLD MEASURE
EQUIVALENT

HOUSEHOLD MEASURE
Household measure is a system of measure used in homes, particularly in
kitchens, in the United States. The units of household measure for volume
include teaspoonful, tablespoonful, cup, pint, quart, and gallon. The units
of household measure for weight are pounds and ounces.
Measuring volume using the household measure is less accurate than
using other systems because the measuring utensils can vary in size.
Nevertheless, house- hold volume measure may be used in community
pharmacy practice when dispensing drugs that will be administered in the
patients home because patients may not have other measuring devices at
home. Labels instructing patients on how to take a medication often use
household measure units for this reason.

## CONVERTING HOUSEHOLD VOLUME

MEASURES
Like all systems, units of household volume measure can be converted
to larger or smaller units. The following examples will demonstrate this
type of conversion.

EXERCISES
How many 1 tsp doses are in 3 cups of liquid
medications?
How many 1 fl oz doses are in 3 pt of liquid
medication?

## CONVERTING BETWEEN HOUSEHOLD

MEASURE AND THE METRIC SYSTEM
Because of the inaccuracy of the measuring tools used in the
household measure, it is often preferable to convert all quantities into
the metric system. This may seem like additional work for some
problems, but using the metric system will serve you better than
relying on the household system, which is declining in use.
Prescriptions that are interpreted and entered into a computer as part
of the patients record will need to be converted to the metric system.
Typically, such computer programs are set up to accept measurements
using milliliters and grams.

EXERCISES
How many tbsp doses are in 480 mL?
Theophylline elixir contains 80 mg/15 mL. A dose is 2
tbsp. How many milligrams are in 1 dose of the
theophylline elixir?

CALCULATIONS

## Oral dosages including

pedia

Oral Dosages
80% of all drugs consumed are given orally. Oral
drugs are available in tablet, capsule, powder and
liquid form.

## The client frequently can take

oral medications without
assistance

## Variation in absorption as a result

of food in the GI tract and pH
variation of GI secretions

## The cost of oral medications is

usually less than when given via
routes

by certain drugs

store

## Destruction or partial inactivation

of the drugs by liver enzymes.

Tablets, Capsules
and Liquids

## Tablets, Capsules and Liquids

Tablets come in different forms and drug strengths. Most tablets are
scored and thus can be readily broken when half of the drug amount is
needed.
Capsules are gelatin shells that contain powder or time-release pellets.
Sustained-release (pellet) capsules should not be crush and diluted,
because the medication will be absorbed at a much faster rate than
indicated by the manufacturer.
The liquid form can be in a suspension, syrup, elixir, or tincture. Some
liquid medications that irritate the stomach, such as potassium chloride,
are diluted. The tincture form is always diluted.
Enteric-coated (hard shell) tablets must not be crushed, because the
medication could irritate the gastric mucosa. Enteric-coated drugs pass
through the stomach into the small intestine where the drugs coating
dissolves and then absorption occurs.
Oral drugs that irritate the gastric mucosa should be taken with 5
to 8 ounces of fluids or taken with food.

Interpreting Oral
Drug Labels

## Ceftin is the brand (trade) name,

and cefuroxime axetil is the generic name.
The dose is 125 mg/5ml (oral suspension)

Drug Differentiation

Drug Differentiation
Some drugs spelling look alike or sound alike but have
different chemical drug structures and are prescribed for
different health problems. When ordering drugs make sure
the spelling of the drug is correct and be extremely careful
when administering drugs whose names look alike.
Caution: Physicians Handwriting
Example: Quinidine and Quinine
Quinidine is an antiarrythmic drug, and quinine is an
antimalarial drug. Read drug label three times before
pouring drug.

Calculations For
Tablet, Capsule And
Liquid Doses

## Example Order: dilitiazem (Cardizem) 60 mg PO, b.i.d.

Availabe: diltiazem HCl (Cardizem) 30 mg

Basic Formula
Ratio and Proportion

Fractional equation
Dimensional Analysis

EXERCISES!!!

## ORDER: doxepin HCl (sinequan) 30 mg PO, at

bedtime Available: doxepin HCl (Sinequan) 10 mg,
How many capsules should the client receive?
ORDER: Lisinopril (Zestril) 5 mg PO, daily
Available: Lisinopril (Zestril) 2.5 mg, How many
ORDER: digoxin (Lanoxin) 0.5 mg PO, daily
Available: digoxin (Lanoxin) 0.25 mg
ORDER: bethanechol CI (Urecholine) 20 mg PO,
t.i.d.

3 Capsules of Sinequan
2 Tablets of Zestril
2 Tablets of Lanoxin
Select Urecholine 10 mg bottle

## Body Weight and Body Surface

Area
To use the body weight method, convert the persons weight
in pounds to kilograms. To convert, divide pounds by 2.2 to
equal kilograms. To use the body surface area method, the
persons weight and height and a nomogram are needed.
Example:
Order: cyclophosphamide (Cytoxan) 2mg/kg PO daily. Client
weighs 143 lbs. How much does the client weigh in kg? How
many mg should the client have?
Answer: 143 lb 2.2 = 65 kg
2 mg 65 = 130 mg of cyclophosphamide daily.

EXCERCISES!!!
ORDER: valproic acid (Depakene) 8 mg/kg/day in
four divided doses. Client weighs 165 lb. How
much Depakene should be administered per dose?
ORDER: cyclophosphamide (Cytoxan) 4
mg/kg/day. Client weighs 176 lb. How much
Cytoxan should the client receive per day?

75 kg; 150 mg/dose; 600 mg/day
80 kg; 320 mg/day

## Oral Drugs for Pediatric Clients

For infants and toddlers, the oral syringe and dropper can
provide better drug delivery than a small cup.
A young child, who is cooperative is able to use a small cup or
measuring spoon. The cup or spoon may be rinsed with water
or juice to ensure that the child has received all of the drug.

## Avoid giving oral medications to a crying child or infant

because the drugs could be easily aspirated or the child could
spit out the drug.

## For the older child, some drugs are available in chewable

form. Children should be told not to chew drugs that are
enteric-coated or in time release form.

Example:

## Order: Ceflacor (Ceclor) 50 mg q.i.d. Child weighs 15 lb

or 6.7 kg ( 15 2.2 = 6.8) Childs drug dosage: 20-40
mg/kg/day in three divided doses
Available: Ceclor 125 mg per 5 mL
Basic Formula
Ratio and Proportion
Fractional equation
Dimensional Analysis

Area
Example:

## Order: methotrexate (Mexate) 50 mg weekly. Childs height is 54

inches and weight is 90 lb (41 kg)
Childs drug dosage: 25-75 mg/m2/week
Childs height and weight intersect at 1.3 m2 (BSA)
Is the prescribed dose safe? __

## Multiply the BSA, 1.3 m2 by the minimum and maximum doses.

25 mg x 1.3 m2 = 32.5 mg
75 mg x 1.3 m2 = 97.5 mg
Dosage is considered safe within the parameters according to the
childs BSA

Dosage
To
calculate the pediatric dosage from the adult dosage,

## determine the childs height and weight. Where they intersect

on the nomogram is the BSA in square meters. The formula for
calculation is the following:

## Example: Order: erythromycin (E-mycin 125 mg PO q.i.d.

Childs height is 42 inches and weight is 60 lb. Childs height
and weight intersect at 0.9 m2 . The Adult dosage is 1000 mg/
day
Drug dosage: 520 mg 4 times a day = 130 mg/dose
Dosage is within safe range

EXERCISES!!!!

## 1.) ORDER: dicloxacillin sodium 100 mg q6h. Child

weighs 55 lb (___kg). Childs drug dosage range:
<40 kg, 12.5-25 mg/kg/day
AVAILABLE: dicloxacilline 62.5 mg per 5 ml
Is the prescribed dose safe?____ How many
milliliters should be given for each dose?____
2.) ORDER: amoxicillin (Amoxil) 200 mg PO q8h.
Child weighs 26 lb (12 kg); Childs drug dosage: 2040 mg/kg/day in three divided doses.
AVAILABLE: amoxicillin (Amoxil) 250 mg/5mL
Is the prescribed dose safe?___ How many milliliters
should be given every 8 hours?____

3.)
ORDER: amoxicillin and clavulanate potassium
(Augmentin) 100 mg PO q8h. Child weighs 28 lb. ;
Childs drug dosage: 20-40 mg/kg/day,
AVAILABLE: amoxicillin and clavulanate potassium
(Augmentin) 125mg/5mL
a. Is the prescribed drug dose within safe drug
parameters?
b. How many milliliters should the child receive per
dose?
4.) ORDER: vinblastine (Velsar) ; Childs BSA is
1.2 ; Childs drug dosage: 2.5 mg/ ; How many

1. a. Child weighs 25 kg (55 lb 2.2 = 25 kg)
b. Drug parameters:
12.5 mg x 25 kg = 312.5 mg/day
25 mg x 25 kg = 625 mg/day
Dosage order: 100 mg x 4 times a day (q6h) = 400
mg/day
Dosage is within safe drug parameters

2. Drug Parameters:
20 mg x 12 kg = 240 mg/day
40 mg x 12 kg = 480 mg/day
Dosage order: 200 x 3 (q8h) = 600 mg/day
Dosage is not within safe drug parameters.
Dose exceeds the drug parameters. Health
care provider must be contacted.

Drug parameters ( 28 lb 2.2 = 12.7 kg )
3.
20 mg x 12.7 kg = 254 mg/day
40 mg x 12.7 kg = 508 mg/day
Dosage order: 100 mg x 3 (q8h) = 300 mg/day
Dosage is within safe drug parameters
4. Drug Dosage: 2.5 mg x 1.2

Calculations:
Injectable Including
Pediatrics
BY ZABRINA SHAYNE S. VILLEGAS

## Medication Formulas Volume /

Injection

Strength Required
Stock Strength

Volume

Volume
Required

## Medication Formulas Volume /

Injection
Volume Medication Example:
CALCULATE THE VOLUME TO BE DRAWN UP IF A PATIENT
REQUIRES 1 mg OF BUMETANIDE, AND EACH STOCK
AMPOULE
CONTAINS 2mg/4ml
Volume Formula Calculation
Strength Required
Stock Strength

Volume

Volume To Be

## Medication Formulas Volume /

Injection
Volume Medication Example:

1mg
2mg

4ml

2 ml

## Medication Formulas Volume /

Injection
Volume Medication Example:
AN INFANT REQUIRES 2000 units OF CALCIPARINE. IF STOCK
AMPOULES CONTAIN 20000 units in 1 ml. HOW MUCH
SHOULD
YOU DRAW UP?
Volume Formula Calculation
Strength Required
Stock Strength

Volume

Volume To Be

## Medication Formulas Volume /

Injection
Volume Medication Example:

2000 units
20000 units

1ml

.1 ml

## Medication Formulas Volume /

Injection
Volume Medication Example:
IF AN ADULT PATIENT WAS ORDERED 85mg OF CORTISONE,
AND EACH STOCK AMPOULE WAS 5 ml AND CONTAINED
100mg
OF CORTISONE, FIND THE VOLUME REQUIRED?
Volume Formula Calculation
Strength Required

Volume

Stock Strength
85mg
100mg

5ml

4.25 ml

Volume To Be

## Medication Formulas Volume /

Injection
Volume Medication Example:

85mg
100mg

5ml

4.25 ml

## Medication Formulas Volume /

Injection
Volume Medication Example:

## A PATIENT ORDERED 70mg OF PETHIDINE, FIND THE

VOLUME REQUIRED IF THE STOCK SOLUTION CONTAINS
OF PETHIDINE PER 200ml?
Volume Formula Calculation
Strength Required

Volume

Stock Strength
Conversion Required
g to mg 10g x 1000 = 10000mg

10g

Volume To Be

## Medication Formulas Volume /

Injection
Volume Medication Example:
Conversion Required
g to mg 10g x 1000 = 10000mg

70 mg
10000 mg

200ml

1.4 ml

Volume Quiz

Strength Required
Stock Strength

Volume

1.

## A patient experiencing pain is ordered 25mg of Toradol

(Ketorolac Trometamol). The Toradol comes in 30mg/1ml. How
many mls do you draw up?

2.

## A 2 year old child is ordered Painstop (120mg

Paracetamol/Codeine Phosphate 5mg/5ml). The child is ordered
5ml Painstop every 6 8 Hours. How many mls do you

3.

A patient has returned from theatre with Nausea. The PRN order
is for Ondansetron IMI. The order is for 6mg, the Ondansetron
comes in 4mg/2ml. How many mls do you draw up?

1. A patient experiencing pain is ordered 25mg of Toradol (Ketorolac
Trometamol). The Toradol comes in 30mg/1ml. How many mls do you draw
up?
25mg
X

1ml

0.8ml

30mg
2. A 2 year old child is ordered Painstop (120mg Paracetamol/Codeine
Phosphate 5mg/5ml). The child is ordered 5ml Painstop every 6 8 Hours.
How many mls do you administer?
5ml

3. A patient has returned from theatre with Nausea. The PRN order is for
Ondansetron IMI. The order is for 6mg, the Ondansetron comes in
4mg/2ml. How many mls do you draw up?
6mg
4mg

2ml

3ml

MORE?

## Pethidine 60 mg is ordered. Stock ampoules

contain 100 mg in 2 ml. What volume of drug
should be drawn up?

## Papaveretum 15 mg is ordered. Ampoules are

available in 20 mg/ml. What volume of drug
should be drawn up?

## An injection of morphine 8 mg. is ordered. An

ampoule is available containing 10 mg/ml. What
volume of drug should be drawn up?

## Pethidine 80 mg is to be given I.M. Stock

ampoules contain 100 mg in 2 ml. What volume of
drug should be drawn up?

## A patient is to receive an injection of gentamicin

60 mg. The ampoule contains 80 mg in 2ml. What
volume of drug should be drawn up?

## How much morphine solution should be drawn up

for a 7.5 mg dose if a stock ampoule contains 15
mg in 1ml?

## Heparin is available at a strength of 5000 units

per 5ml. What volume is needed to give 800
units?

## A patient is to be given 40mg of hydrocortisone.

Stock ampoules contain 50mg in 2ml. What
volume of drug should be drawn up?

## 60 mg of phenobarbitone is required. Available

stock contains 125 mg in 5 ml. What volume of
drug should be drawn up?

## A stock bottle of heparin contains 25,000 units in

1 ml. What volume of drug will be required to give
15,000 units?

IV FLUIDS
INCLUDING PEDIA
BY JULLIE FAYE SORIANOSOS

## Intravenous (IV) fluid therapy is used to administer fluids

that contain water, dextrose, vitamins, electrolytes, and
drugs.
Today an increasing number of drugs are administered
by the IV route for direct absorption and fast action. Some
drugs are given by IV push. Many drugs administered IV
irritate the veins, so these drugs are dilluted in 50 to 100
ml of fluid. Other drugs are delivered in a large volume of
fluid over a specific period, such as 4 to 8 hours.

## Two methods are used to administer IV fluids and drugs:

continuous IV infusion and intermittent IV infusion.
Continuous IV infusion replaces fluid loss, maintain fluid
balance, and serves as a vehicle for drug administration.
Intermittent IV infusion is used primarily to give IV drugs.

## Nurses have an important role in the preparation and administration of IV solutions IV

drugs. The nursing functions and responsibilities during drug preparation include the
following:
Knowing IV sets and their drop factors
Calculating IV flow rates
Mixing and diluting drugs in IV fluids
Gathering equipment
Knowing the drugs and the expected and untoward reactions
Nursing responsibilities continue with assessment of the client for the effectiveness and
untoward effects of the therapy and assessmentof the IV site.

CONTINUOUS INTRAVENOUS

## When IV solutions are required, the healthcare

provider orders the type of amount of IV solution
in liters over a 24-hour period or in milliliters per
hour. The nurse calculates the IV flow rate
according to the drop factor, the amount of fluids
to be administered, and the time period.

Intravenous Sets
Various IV infusion sets are marketed by Abbott, Cutter, McGaw, and Travenol.
Drop factor the number of drops per milliliter

## - normally printed on the packaging cover of the IV set.

Macrodrop set A set that delivers large drops per milliliter (10 20 gtt/ml)
Microdrop (minidrip) set A set that delivers small drops per milliliter (60
gtt/ml)

Manufacturer
Macrodrip Sets

Drops (gtt/ml)

Abbott

15

Cutter

20

McGaw

15

Travenol

10

Microdrip Sets

Travenol

60

Minidrip Sets

60

## In most instances, the nurse has the choice of using

either the macrodrip or microdrip set. If the IV rate is to
infuse at 100 ml/hr or more, the macrodrip is usually
used. If the infusion rate is less than (<) 100 ml/hr or the
client is a child, the microdrop set is preferred. Slow drip
rates of <100 ml/hr make macrodrip adjustment difficult.

## At times, IV fluids are given a slow rate to keep vein

open (KVO), also called to keep open (TKO). The reasons
for ordering KVO include a suspected or potential
emergency situation for rapid administration of fluid and
drugs and the need for an open line to give IV drugs at
specified hours. For KVO, a microdrop set (60 gtt/ml) and
a 250-ml bag may be used. KVO is usually regulated to
deliver 10 ml/hr.

CALCULATING INTRAVENOUS
FLOW RATE
Three different methods may be used to
calculate IV flow rate (drops per minute
or gtt/min). The nurse should select one
method, memorize it, and consistently
use it to calculate IV flow rate.

Method I: Three-Step
1. Amount of Solution
------------------------ = milliliters/hour (ml/h)
2. Milliliters per hour
------------------------ = milliliters/minute
(ml/min)
60 minutes
3. Milliliters per minute x drops per
milliliter of IV set = drops/minute (gtt/min)

## Method II: Two-step

1. Amount of fluid
------------------------- = milliliters/hour (ml/hr)
2. Milliliters per hour x Drops per milliliter (IV set)
------------------------------------------------------------- = drops/minute
(gtt/min)
60 minutes
If the milliliters per hour is known, then use Step 2 to
determine the drops per minute.

## Method III: One-Step

1. Amount of fluid x
Drops per milliliter (IV set)
--------------------------------------------------------- =
drops/minute (gtt/min)
minutes per hour (60)

PUMPS IN ML/HR:
Formula:

## Example: the order is to infuse 1 liter of 0.9% Normal Saline in 8 hours.

Example: The order is to infuse Gentamicin 100 mg in 100 mL of 0.9% Normal Saline over 30 minutes.

## Shortcut Method for Calculating Drops per Minute

This method is helpful when an institution uses the same macrodrop set
throughout. For example, St. Lukes' uses the Travenol brand of
macrodrip infusion tubing which delivers 10 ggt/mL.
Step 1: Calculate the drop factor constant (division factor) for the IV
administration set. Divide 60 by drop factor calibration.
Example: Calculate the drop factor constant for the following infusion
sets.
Microdrip: 60 gtt/mL
Macrodrip: 20 gtt/mL
15 gtt/mL
10 gtt/mL

Some IV drugs are prescribed to be administered
three to six times a day in a small volume of IV fluid
(50 to 100 ml of D5W or NSS 0.9% sodium chloride).
The drug solution is usually infused over a period of 15
minutes to 1 hour. Separate tubing for IV drugs, the
secondary IV line set, is inserted into a port (rubber
stopper) of the Iv connector on the continuous, or
primary IV line set. This type of administration is called
intermittent IV therapy.

## Secondary Intravenous Sets without IV Pumps

Two IV sets available to administer IV drugs are
(1) the calibrated cylinder (chamber) with tubing such
as Buretrol, Volutrol, and Soluset
(2) the secondary IV set, which is similar to a regular IV
set except the tubig is shorter
The secondary IV line set is used mostly to infuse small
volumes 50, 100, 250 ml and for children's IV solution.
The chamber of the Buretrol, Volutrol, and Soluset holds
150 ml of solution. Medication is injected into the
chamber and then diluted with solution. These methods of
administering IV drugs are referred to as IV piggyback
(IVPB).

Drugs for IV infusion are diluted before infusion. Clinical agencies frequently have their own
protocols for dilutions; the pharmacist and the drug circular are also resources for infusion
guidelines. Guidelines and protocols help to prevent drug and fluid incompatibility.
The current trend IV medication administration is the use of premixed IV drugs in 50- to 500-ml
bags. Those premixed IV medications can be prepared by the manufacturer or by the hospital
pharmacy. The problems of contamination and drug errors are decreased with the use of premixed
IV medication. Each IV drug bag has separate tubing to prevent admixture. Cost is higher but risk is
lower with the use of premixed IV drug bags. Because not all medication can be premixed in the
solution, nurses will continue to prepare some drugs for IV administration.
Note: When using a calibrated cylinder such as Buretrol, add 15 ml of IV solution to flush the drug
out of the IV line after the drug infusion is completed. The flush volume is added to the client's
intake.

## When continuous IV fluid is to be discontinued and

intermittent drug therapy is to begin, an adapter is attached
to the IV catheter or needle where the IV tubing can be
inserted as needed to continue drug therapy. The use of
adapters increases the client's mobility by not having an IV
line tagging along and is cost-effective because less IV
tubing, solution, and equipment are needed.

## DIRECT INTRAVENOUS INJECTIONS

Medications that are given by the IV injection route are calculated in the
same manner as medications for intramuscular (IM) injection. This route is
often referred to as IV push. Clinically, it is the preferred route for clients
with poor muscle mass or decreased circulation or for a drug that is poorly
absorbed from the tissues. Medications administered by this route have a
rapid onset of action, and calculation errors can have serious, even fatal,
consequences. Drug information inserts mut be read carefully, and attention
must be given to the amount of drug that can be given per minute. If the
drug is pushed into the bloodstream at a faster rate than specified in the
drug literature, adverse reactions to the medication are likely to occur.

ELECTRONIC INTRAVENOUS
REGULATORS
Pumps are electronic intravenous (IV) regulators used in hospitals and some community settings. The electronic
IV regulators are set to deliver a prescribed rate of IV solution. If the flow rate is obstructed, an alarm sounds.
IV pumps deliver IV solution against resistance. The flow rate is set in milliliters per hour. Pumps do not
recognize infiltration. The alarm does not sound until the pump has exerted its maximum pressure to overcome
resistance.
IV pumps are recommended for use with all central lines, such as femoral and subclavian sites, and peripheral
lines. Ongoing nursing assessment is essential when using electronic IV regulators.
There are two types of flow control for electronic IV regulators: volumetric and nonvolumetric regulators. A
volumetric regulator delivers a specific volume of fluid at a specific rate, in milliliters per hour. A nonvolumetric
regulator is designed to infuse a drop rate in drops per minute. To determine wheter the machine is volumetric
or nonvolumetric, check to see whether the panel display is calibrated for ml/hr or gtt/min.

PATIENT-CONTROLLED ANALGESIA
Patient-controlled analgesia (PCA) is another method used to administer drugs IV. The objective of PCA
is to provide a uniform serum concentration os drug/s, thus avoiding drug peaks and valleys. This
method is designed to meet the needs of clients who require at least 24 to 48 hours of regular IM
narcotic injections.
Several reasons for the use of PCA include:
(1) effective pain control without the client feeling over-sedated
(2) considerable reduction in the amount of narcotic used (approximately one half that of IM delivery)
(3) client's feelings of having greater control over their pain.
There are choices available in the delivery of PCA. The pump is programmed to administer the
prescribed medication (1) at client demand, (2) continuously, and (3) continuously and supplemented by
client demand.

INTRAVENOUS FLUIDS
BY JULLIE FAYE SORIANOSOS

## Intravenous (IV) fluid therapy is used to administer fluids that contain

water, dextrose, vitamins, electrolytes, and drugs.
Today an increasing number of drugs are administered by the IV route for
direct absorption and fast action.

## Two methods are used to administer IV fluids and

drugs: continuous IV infusion and intermittent IV
infusion.
Continuous IV infusion replaces fluid loss, maintain
fluid balance, and serves as a vehicle for drug
Intermittent IV infusion is used primarily to give IV
drugs.

## Nurses have an important role in the preparation and administration of IV solutions

IV drugs. The nursing functions and responsibilities during drug preparation
include the following:
Knowing IV sets and their drop factors
Calculating IV flow rates
Mixing and diluting drugs in IV fluids
Gathering equipment
Knowing the drugs and the expected and untoward reactions
Nursing responsibilities continue with assessment of the client for the
effectiveness and untoward effects of the therapy and assessmentof the IV site.

INTRAVENOUS SETS
Various IV infusion sets are marketed by Abbott, Cutter, McGaw, and
Travenol.
Drop factor the number of drops per milliliter
- normally printed on the packaging cover of the IV set.
Macrodrop set A set that delivers large drops per milliliter (10
20 gtt/ml)
Microdrop (minidrip) set A set that delivers small drops per
milliliter (60 gtt/ml)

Manufacturer

MacrodripSets

Drops (gtt/ml)

Abbott

15

Cutter

20

McGaw

15

Travenol

10

MicrodripSets

Travenol

60

MinidripSets

60

## In most instances, the nurse has the choice of using

either the macrodrip or microdrip set. If the IV rate is to
infuse at 100 ml/hr or more, the macrodrip is usually
used. If the infusion rate is less than (<) 100 ml/hr or the
client is a child, the microdrop set is preferred. Slow drip
rates of <100 ml/hr make macrodrip adjustment difficult.

## At times, IV fluids are given a slow rate to keep vein

open (KVO), also called to keep open (TKO). The reasons
for ordering KVO include a suspected or potential
emergency situation for rapid administration of fluid and
drugs and the need for an open line to give IV drugs at
specified hours. For KVO, a microdrop set (60 gtt/ml) and
a 250-ml bag may be used. KVO is usually regulated to
deliver 10 ml/hr.

CALCULATING INTRAVENOUS
FLOW RATE
Three different methods may be used
to calculate IV flow rate (drops per
minute or gtt/min). The nurse should
select one method, memorize it, and
consistently use it to calculate IV flow
rate.

## Method II: Two-step

1. Amount of fluid
------------------------- = milliliters/hour (ml/hr)
2. Milliliters per hour x Drops per milliliter (IV set)
------------------------------------------------------------- = drops/minute
(gtt/min)
60 minutes
If the milliliters per hour is known, then use Step 2 to
determine the drops per minute.

## Method III: One-Step

1. Amount of fluid x Drops per
milliliter (IV set)
--------------------------------------------------------- = drops/minute (gtt/min)
per hour (60)

PUMPS IN ML/HR:
Formula:

## Example: the order is to infuse 1 liter of 0.9% Normal Saline in 8 hours.

Example: The order is to infuse Gentamicin 100 mg in 100 mL of 0.9% Normal Saline over 30 minutes.

## Shortcut Method for Calculating Drops per Minute

This method is helpful when an institution uses the same macrodrop set
throughout. For example, St. Lukes' uses the Travenol brand of
macrodrip infusion tubing which delivers 10 ggt/mL.
Step 1: Calculate the drop factor constant (division factor) for the IV
administration set. Divide 60 by drop factor calibration.
Example: Calculate the drop factor constant for the following infusion
sets.
Microdrip: 60 gtt/mL
Macrodrip: 20 gtt/mL
15 gtt/mL
10 gtt/mL

## Medications that are given by the IV injection route are calculated

in the same manner as medications for intramuscular (IM) injection.
This route is often referred to as IV push. Clinically, it is the preferred
route for clients with poor muscle mass or decreased circulation or for
a drug that is poorly absorbed from the tissues. Medications
administered by this route have a rapid onset of action, and
calculation errors can have serious, even fatal, consequences. Drug
information inserts mut be read carefully, and attention must be given
to the amount of drug that can be given per minute. If the drug is
pushed into the bloodstream at a faster rate than specified in the drug
literature, adverse reactions to the medication are likely to occur.

INTERPRETATION
OF MEDICATION
ORDER
BY VINCE C. PANILA

## ABBREVIATIONS THAT WE MIGHT ENCOUNTER

a.c. before meals
alt. h. alternate hours
am in the morning; before noon
aq. water
bid twice a day
c with
cap., caps. capsule
dil. dilute
dist. distilled
DS double strength
EC enteric coated
ext. external,
fld fluid
gtt drop
hr hour
IM intramuscular
IV intravenous
IVP IV push
IVPB IV piggyback

kg kilogram
L liter
lb pound
liq. liquid
mcg microgram
mEq milliequivalent
mg milligram
mL milliliter
oz ounce
p.c. after meals
PO by mouth
pm afternoon, evening
prn as needed, according to necessity
q each, every

MEDICATION ORDER
A medication order is the written record of a physicians order to the
pharmacist to dispense a drug to a patient who is in a hospital or other
healthcare facility. Medication orders are handwritten on a large
preprinted form known as the physicians order sheet or physicians
order record. The physicians order sheet is located at the front of the
patients hospital or facility medical record. For facilities with an
electronic patient record, medication orders are typed into the
computer on a designated screen that serves as a physicians order
sheet.

VERBAL ORDER
When a patient has been admitted to the hospital, the patients
physician can give a verbal drug order over the telephone to a licensed
nurse, who then writes the order on the physicians order sheet, marks
it as a verbal order (V.O.), and then signs her name and the initials of
her license. The order is then sent to the pharmacy. The physician must
come to the facility to personally sign the order within a specific
amount of time. Verbal orders are also known as telephone orders.

STANDING ORDERS
Standing orders are a group of specific orders that are preprinted on a
facilitys physicians order sheet. They often pertain to a protocol of
treatment related to a specific disease or surgical procedure. They
contain standard common orders that are the same for any patient who
has that specific disease or is scheduled for that surgical procedure. For
example, a patient admitted for bowel surgery would have
preoperative standing orders for a clear liquid diet and enemas, for an
antibiotic drug to kill bacteria in the bowel, and for no food (NPO) after
midnight before the surgery. Some parts of the preoperative standing
orders are often completed at home by the patient prior to admission
to the facility.

## AUTOMATIC STOP ORDERS

Automatic stop orders are a type of medication order that originates
not with the physician but with the hospital pharmacy. Medication
orders for certain types of drugs (e.g., controlled substances) are only
valid for a certain number of days while the patient is in the hospital.
(The exact number of days is determined by the hospitals Pharmacy
Committee.) After that time, the pharmacy automatically stops sending
the drug to the patients nursing unit, and the attending physician must
write an entirely new order if the patient is to continue to receive that
drug.