The Nursing Process and Client Teaching: Assessment - begins with the patients history (allergies, use of alternative

medicine, socioeconomic status, life style, family history and past medical history) - physical examination(mental state, sensory impairment, including other systems.. etc) - patients knowledge and understanding about the drug therapy he is about to receive Nursing Diagnosis - samples are found in the book page 17-18 ( NANDA 2005-2006) - based on the clients foreseeable actual problems according to the priority. - Should be individualized and minimize psychological aspects because you are not a psychologist. If you choose a nursing diagnosis based on these it should be the last priority. - As a nurse a detailed scientific explanation and pathologic changes in the body should be focused to.

Planning and Implementation - should be measurable, objective, concise, realistic for the patient, attainable for the nurses with a time frame. - Allow the patient to express the behavior or change - Make schedules or plot for the patient medications. - Practice the things you have learned in skills lab. Evaluation - this is to determine whether the outcome is effective or not at all. - This should be the basis if the treatment should continue or be stop. - Then go back to the assessment process for better outcome. Client Teaching - health teachings regarding to administration of the drug ( dose, route, time, etc), functions/actions of the drugs and its side effects/ adverse effects on the body.

- It should also involve the cost effectiveness/benefits by choosing the generic names and rational drug use. - Price of the drug should be also emphasized based on the socio economic status patient - Importance of the compliance to the treatment Medications and Calculations: - you should be able to know the skills in basic arithmetic, and or basic algebra. - In practice calculator is a must for fast and accurate calculations but as a student learn to compute without it for a while. a. Know the Principles of Drug Administration (10 Rs) b. Know how to interpret the order of the Prescriber/MDs/DMDs. c. Know the Basic Common Abbreviations on Medication Orders. - usually on the chart abbreviations is discouraged and complete name/word should be placed.

- But there are universally accepted abbreviations on medication orders and please get familiar with it.

Systems of Measurement with Conversion Be familiar with the values and units Metric System: both liquid and solids - liters, meters, grams Apothecary System: - use of Roman Numerals - grains V ( 5 grains) - smallest is the minims = 1 gtt of water - 1 ml = 15-16 minims Household System: - teaspoon, tablespoon, cups Units: - Insulin (U-100 insulin means that 1 ml of insulin solution contains 100 units of insulin) - Heparin

- Other antibiotics like Penicillin G or Nystatin - Written as Units not (U)

International Units: - measures biologicals such as vitamins, enzymed, and hormones. - Written as (IU) Milliequivalents: (mEq) - Electrolytes (Potassium Chloride 20 mEq solution) Methods of Calculation a. Basic Formula D = Desired Dose or Order H or S = On-hand dose or Stock Dose V = Vehicle (tabs, capsules, syrup etc.) A = Amount needed for the client

D/H x V = A

Example: Order: Penicillin 0.5g PO BID Stock : Penicillin 250mg capsules Answer: convert grams to milligrams
D/H x V = A = 500mg/ 250 mg x 1 capsule

= 2 capsules BID

b. Ratio and Proportion

H:V : : D:X

D = Desired Dose or Order H or S = On-hand dose or Stock Dose V = Vehicle (tabs, capsules, syrup etc.) X = Amount needed for the client :: = as or equal to means = V x D extremes = H x X example: Order: Penicillin 100mg PO QID Stock: Penicillin 250mg/5ml suspension.

Answer: 250 mg : 5ml : : 100mg : x(ml) 250mg x ?(ml) =500mg X = 2 ml

c. Fractional Equation - H/V =D/X proportion) (same principle in ratio and

d. Dimensional Analysis (factor labeling or label factor method) V = V (vehicle) x C(H) x D (desired) H (on hand) x C(D) x 1 ( drug order)

C = conversion factor Samples: 1 g = 1000 mg 1000mg = 15 gr 1g = 15 gr 1 gr = 60 mg D = Dosage desired V = drug label factor e. Body Weight - convert pounds(lbs) to kilograms (kg): lbs (divide) 2.2 = Kg - determine the drug dose per BW : Drug dose (mg/kg/day) x Kg(BW) = Clients mg/day

f. Body Surface Area with Nomogram Scale Most accurate way to calculate the infants childrens drug dose. - uses the height and weight intersect to come up with square meters. Drug dose x BSA in m2 = X mg BSA = wt in kg x height in cm 3600 ( with square root) if metric system only

BSA = wt in lbs x height in inches ( with square root) 3131 if household system only

Calculation for Oral Dosages: One step calculations Order: 50 mg of Meclizine P.O STAT Stock: 25mg Meclizine tabs S = D tabs (1 tab = 25mg)

50 mg = ? tabs 50 mg x 1 tab/25mg = 2 tabs Dosage by BW = same as above Calculating by BSA = same as above Calculations of Injectables Fluids 1 cc = 1ml syringes prepackaged cartridge tuberculin syringes Insulin syringes

Calculations of Intravenous Fluids Common Intravenous Fluids:

0.45% NaCl injection USP or NS, 0.45% NS 0.9% NaCl USP or 0.9 NS 5% Dextrose in 0.22% NaCl inj. USP or 5 D/0.22 NS 5% dextrose inj. USP or 5% D/W D/5/W Lactated Ringers Inj. USP or LR, RL, RLS Lactated Ringers and 5% dextrose Inj or 5%D/LR D5/LRS Flow rate: measures gtts/min , ml/min, mm/min You can check this at the DRIP CHAMBER

Roll valve CLAMP or CLIP = adjust the FLOW RATE Drop factor: Its based on manufacturers preference on the type of tubing size used. 10gtts = 1ml 15gtts = 1ml 20gtts = 1ml 60ugtts (microdrops) = 1ml

Infusion pumps = if electronic capable Volume Controlled set or drip chamber Drop factor x ml/min = drops/min Total infusion time = Total drops to be (hours/min) Infused Flow Rate(drops/min) x 60

Order: 50 ml D6WIV in 4 hours DF: 60ugtts/min 50ml/ 240min x 60 = 300/24 = 12.5 ugtts/min mcg /kg/hr to ml/hr Kg x { mcg / kg(hr) } x { ml/mg }x {mg/mcg } = ml/hr

Sample: Order: 0.3mg/kg/hr Solution: 250mg ml D5W W/400 mg Dopamine BW: 80kg 80kg x 0.3mg/kg/hr x 250ml/400mg = 15 ml/hr mcg/kg/min to gtts/min kg x { mcg/kg/min} x{ mg/mcg x ml/mg} x{ gtt/ml } = gtts/min DF = gtt/ml gtt/min to ml/hr gtt/min x ml/gtt x min/hr = ml/hr DF = gtt/min

ml/hr to gtt/min ml/hr x hr/min x gtt/ml = gtt/min IV Rate: ml/min Pediatric Drug Calculations a. by BW b. by BSA c. by from Adult Dosage d. by calculations for injections

Frieds Rule: Safe dose for Infant Age of the infant (months) X Adult Dose Adult age (months) Youngs Rule: Age of child in years X Adult dose Age of child + 12 years

Clarks Rule: Childs weight (lbs) X Adult Dose Adult weight (lbs)