Tips for Calculating IV Medicanon Infusion Rates
Information Required to Cakulate IV Infusion Rates to
Deliver Specific Medication Doses
• Dose to be infused {eg, mg/kg/min, mg/min, mg/h)
• Concentration of IV solution (eg, dopamine 400 mg in
D5W 250 mL - 1.6 mg/mL; nitroglycerin 50 mg in D5W
250 mL • 200 mcg/mL)
• Patient's weight
Calculate the IV infusion rate in milliliten per hour for a 70-kg patient requiring dobutamine 5 mcg/kg/mio using a dobutamine admixture of 500 mg in DsW250mL.
• Dose to be infused: 5 mcg/kg/min
• Dobutamine concentration: 500 mg/250 mL = 2 mg/mL or
2000mcglmL
• Patient weight: 70 kg
Calculation:
5 mcg/kg/min ><>
350 mcg/min ><>
21,000 mcg/h + 2000 mcg/mL ~ 10.5 mUh
Calculate the IV infu1ion rate in milliliten per hour for a 70-kg patient requiring nitroglycerin 50 mcg/m in using a nitroglycerin admixture of 50 mg in D5
W.250mL.
• Dose to be infused: 50 mcg/min
• Nitroglycerin concentration: 50 mg/250 mL = 0.2 mglmL or 200 mcg/mL
• Patient weight: 70 kg
Calculation:
50 mcg/min x 60 min/h ~ 3000 mcg/h
3000 mcg/h + 200 mcg/mL = 15 ml./h
Calculate the IV infusion rate in millilitel'll per hour for a 70-kg patient requiring heparin 18 units/ kg/h using a heparin admixture of 25 ,OOO unit• in D5W 500mL.
• Maintenance infusion: 18 units/kg/h
• Heparin concentration: 25,000 units/500 mL = 50 units/mL
• Patient weight 70 kg
Calculation:
Infusion rate: Heparin 18 units/kg/h x 70 kg= 1260 units/h +
50 units/mL =25.2 mUh
Q21
Diagnosing Moral Distress
In sdecting a topic for a graduate school assignment, Karen chose idiopathic pulmonary fibrosis, inspired by a patient, Adeline, she cared for in the medical intensive care unit {I CU), in room 576. Adeline was 66 years old and on high flow nasal cannula oxygen when Karen first met her and learned that she was a retired nurse. They chatted briefly about Adeline's career and her family while the patient awaited transfer to the operating room {OR) for a lung biopsy. Following the procedure, Adeline was intubated and sedated and Karen, rounding with the pulmonary team a few days later, was told that the biopsy showed a rare and very aggressive form of the disease. Over the subsequent week, Adeline's hypoxia worsened, and she was unable to undergo spontaneous breathing trials or sedation interruption without her oxygen saturation dropping to the low 80s. In a family conference, Adeline's sons presented the team with an advanced directive, which stated that in the event of a poor prognosis, Adeline did not desire life-sustaining measures such as mechanical ventilation. After much discussion, the family elected to remove Adeline from the ventilator. Because she had a chance to know Addine, even very briefly, and to relate to her, Karen feels distressed observing her adult children as they grieve their loss. •This doesn't seem right" she thinks, •it's just so sad." After tearfully describing the situation to a colleague who is kind and gives her a hug, Karen decides she wants to learn more about this disease process.
A month later, Karen is working nights and is again assigned to room 576. The patient, Gabriel, is a 72 year old with multiple medical problems who was admitted that day with sepsis, requiring mechanical ventilation and vasopressors despite adequate fluid resuscitation. The nurse from dayshift reports that she placed a urinary catheter, but no urine is draining from it. "But" she tells Karen •I know it's in, right? He's a man, after all!" After the dayshift nurse leaves, Karen finds that one of the antibiotics prescribed STAT and documented as administered is still hanging on the IV pole. Furthermore, the catheter remains without any urine. When she moves the collection bag to a lower position in an effort to prompt drainage, the sedated man twitches, as if uncomfortable. Karen removes the catheter and a stream of blood and urine are released. Based on the patient's history, she theorizes that an enlarged prostate impeded passage of the catheter into the bladder, and the balloon was actually inflated in the urethra, causing trauma. Karen feels angry at the treatment her patient received and consults the charge nurse for guidance. The charge nurse points out that the nurse on the prior shift had a really tough day and asks that Karen not mention what happened. She advises •you know what's it like to have a bad day, don't you? You don't want her to get in trouble for that and leave and then we're short staffed!" Karen feels distressed and does not know where to go for support. She is certain that the patient was harmed by the dayshift nurse's negligence and she feels obligated to protect him and other patients from further harm, but she is compelled to remain silent based on the guidance she was given by the charge nurse.
How is the distre11 Karen experienced in these two situations different?
How does identifying the form of distresa help Karen?