Nclex

IV FLOW RATES

THE FOLLOWING FORMULAS NEED TO BE MEMORIZED:

Formula 1:

One Step

Total Amount of fluid (mL) X Drop factor (gtts/mL) Total Minutes (# of hours x 60 mins)

Example 1: Order: 3000 mL NS IV over 24 hrs. Drip factor of tubing: 15 gtts/mL. 3000 x 15 gtts/mL

45000

24 hr X 60 min

=

1440 = 31.25 = 31gtts/min

***Calculate drip rates to the nearest whole number*** Example 2: Calculate the drip rate in drops/minute for 50 ml of 0.9% sodium chloride containing 1 g of Ancef to be infused over a period of 30 minutes. The tubing has a drop factor of 60 drops/ml. 50 mL x 60 gtts/mL 30 min

=

3000 30

= 100

= 100 gtts/min

Formula 2: Two Step

Step 1 - Amount of fluid divided by hours to administer = ml/hr

Step 2 -

ml/hr x Drop Factor (gtts/ml)

= gtts/min

60 min

Example: 1.

IV therapy is ordered for Mr R. He is to have 2 litres of 0.9% Saline over

12 hours. The IV set delivers 20 drops per ml, calculate the rate of infusion in drops per minute.

Step 1: First calculate mL/hr by dividing the total volume by the number of hours to be infused. 2L (or 2000 mL) 12 hours

= 166.6 or 167 mL/hr

Step 2: Using formula 2 167 mL/hr x 20 gtts/mL 60 minutes

=

55.6 or 56 gtts/min

IV FLOW RATES Practice Problems: Calculate the flow rate when using an electronic pump (mL/hr): 1. Infuse 1500 cc NS over 24 hours. 2. Infuse1000 cc D5W over 15 hours. 3. Infuse 1000 cc NS over 10 hours. 4. Infuse 600 cc LR over 3 hours. 5. Infuse 2000 cc ½ NS over 24 hours. 6. Infuse Cimetidine 300 mg IVPB mixed in 100 cc NS over 45 minutes. 7. Infuse Ampicillin 500 mg IVPB mixed in 50 cc NS over 10 minutes. 8. Infuse Granisetron 20 mg IVPB mixed in 75 cc NS over 45 minutes. 9. Infuse Ampicillin 500 mg IVPB mixed in 50 cc NS over 30 minutes. 10. Infuse 30 cc of 3% NS IVPB over 15 minutes.

Answers: 1. 63 cc/hr

2. 67 cc/hr

3. 100 cc/hr

4. 200 cc/hr

5. 83 cc/hr

6. 133 cc/hr

8. 100 cc/hr

9. 100 cc/hr

10. 120 cc/hr

7. 300 cc/hr

________________________________________________________________________________________ Practice Problems Determine the infusion rate in gtts/min for the following: 1. Order: 1000 cc NS to infuse in 8 hours.

2. Order: 1000 cc NS to infuse in 6 hours.

Drip factor of administration set: 15 gtts/cc.

Drip factor of administration set: 20 gtts/cc.

3. Order: 1000 cc NS to infuse in 10 hours.

4. Order: 500 cc NS to infuse in 4 hours.

Drip factor of administration set: 15 gtts/cc.

Drip factor of administration set: 15 gtts/cc.

5. Order: 85 cc NS to infuse in 1 hour.

6. Order: 1500 cc D5W to infuse in 10 hours.

Administration set is a micro set.

Drip factor of administration set: 15 gtts/cc.

7. Order: 1000 cc NS to infuse in 8 hours.

8. Order: Famotidine 40 mg IVPB mixed in 100 cc NS to

Drip factor of administration set: 20 gtts/cc.

infuse over 30 minutes. Drip factor: 20 gtts/cc.

9. Order: Doxycycline 200 mg IVPB mixed in 100 cc NS

10. Order: Vancomycin 500 mg IVPB in 250 cc to infuse

to infuse over 30 minutes. Drip factor: 10 gtts/cc.

over 45 minutes. Drip factor: 15 gtts/cc.

Answers: 1. 31 gtts/min

2. 56 gtts/min

3. 25 gtts/min

4. 31 gtts/min

5. 85 gtts/min

6. 38 gtts/min

7. 42 gtts/min

8. 67 gtts/min

9. 33 gtts/min

10. 83 gtts/min

Heart failure can involve the heart's left side, right side or both sides. However, it usually affects the left side first. Each side is made up of two chambers: the atrium, or upper chamber; and the ventricle, or lower chamber. The atrium receives blood into the heart, and the ventricle pumps it where it needs to go. Heart failure occurs when any of these chambers lose their ability to keep up with the amount of blood flow. What is left-sided heart failure? Left-sided or left ventricular (LV) heart failure involves the heart's left ventricle (lower chamber). Oxygen-rich blood travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. Because this chamber supplies most of the heart's pumping power, it's larger than the others and essential for normal function. If the left ventricle loses its ability to contract normally (called systolic failure), the heart can't pump with enough force to push enough blood into circulation. If the ventricle loses its ability to relax normally (diastolic failure) because the muscle has become stiff, the heart can't properly fill with blood during the resting period between each beat. This is an important distinction because the drug treatments for each type of failure are different. In either case, blood coming into the left chamber from the lungs may "back up," causing fluid to leak into the lungs. (The technical term for this is pulmonary edema.) Also, as the heart's ability to pump decreases, blood flow slows down, causing fluid to build up in tissues throughout the body (edema). This excess fluid or congestion explains the term congestive heart failure, which you've probably heard before. What is right-sided heart failure? The right atrium receives the "used" blood that returns to the heart through the veins; then the right ventricle pumps it into the lungs to be replenished with oxygen. Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles.

ID injections -

Needle size

subQ Injections - Needle size im injections

gauge 5/8”

23 -25 gauge

needle size 1 – 1 ½ inch

Volume Injected: Deltoid 0.5 -- 2 mL

15 degree (skinny) – 30 degree (large) gauge

Vastus lateralis (thigh)

1 -- 4 mL

Persons with bleeding disorder 23 gauge or smaller

Electrolytes are minerals in your body that have an electric charge. They are in your blood, urine and body fluids. Maintaining the right balance of electrolytes helps your body's blood chemistry, muscle action and other processes. Sodium, calcium, potassium, chlorine, phosphate and magnesium are all electrolytes. You get them from the foods you eat and the fluids you drink. Levels of electrolytes in your body can become too low or too high. That can happen when the amount of water in your body changes. Causes include some medicines, vomiting, diarrhea, sweating or kidney problems. Problems most often occur with levels of sodium, potassium or calcium.

Fluid and Electrolyte Balance Compartments of Body and Distribution of Water by Weight The main fluid in the body is water. Total body water is 60% of body weight. The water is distributed in three main compartments separated from each other by cell membranes. The intracellular compartment is the area within the cell. The extracellular compartment consists of the interstitial area (between and around cells) and the inside of the blood vessels (plasma).

Plasma 5% Interstitial 15% Intracellular 40% Total 60 % Water Solids - 40% fat, protein, carbohydrates, minerals

Electrolyte Sodium

Potassium Calcium Magnesium Total Positive ions

ELECTROLYTE DISTRIBUTION Extracellular Intracellular Function meq/liter meq/liter fluid balance, 142 10 osmotic pressure Neuromuscular 5 100 excitability acid-base balance bones, blood 5 clotting 2 123 enzymes 154

205

Electrolyte Distribution Extracellular Intracellular meq/liter meq/liter

Electrolyte

Function

Chloride

105

2

Bicarbonate

24

8

fluid balance, osmotic pressure acid-base balance

Proteins

16

55

osmotic pressure

Phosphate

2

149

Sulfate

1

-

energy storage protein metabolism

Total Negative ions

154

205

Electrolytes are the chemicals dissolved in the body fluid. The distribution has important consequences for the ultimate balance of fluids. Sodium chloride is found mostly in extracellular fluid, while potassium and phosphate are the main ions in the intracellular fluid.

What are high blood pressure and preeclampsia? Blood pressure is a measure of how hard your blood pushes against the walls of your arteries. If the force is too hard, you have high blood pressure (also called hypertension). When high blood pressure starts after 20 weeks of pregnancy, it may be a sign of a very serious problem called preeclampsia. Blood pressure is shown as two numbers. The top number (systolic) is the pressure when the heart pumps blood. The bottom number (diastolic) is the pressure when the heart relaxes and fills with blood. Blood pressure is high if the top number is more than 140 millimeters of mercury (mm Hg), or if the bottom number is more than 90 mm Hg. For example, blood pressure of 150/85 (say "150 over 85") or 140/95 is high. Or both numbers can be high, such as 150/95. A woman may have high blood pressure before she gets pregnant. Or her blood pressure may start to go up during pregnancy. High blood pressure and preeclampsia are related, but they have some differences.

High blood pressure Normally, a woman’s blood pressure drops during her second trimester. Then it returns to normal by the end of the pregnancy. But in some women, blood pressure goes up very high in the second or third trimester. This is sometimes called pregnancyinduced hypertension. It needs treatment, but it usually goes away after the baby is born. Very high blood pressure keeps your baby from getting enough blood and oxygen. This could limit your baby’s growth or cause the placenta to pull away too soon from the uterus. High blood pressure also could lead to stillbirth.

Preeclampsia Preeclampsia is a pregnancy-related problem. The symptoms of preeclampsia include new high blood pressure after 20 weeks of pregnancy along with other problems, such as protein in your urine. Preeclampsia usually goes away after you give birth. In rare cases, blood pressure can stay high for up to 6 weeks after the birth. Preeclampsia can be deadly for the mother and baby. It can keep the baby from getting enough blood and oxygen. It also can harm the mother’s liver, kidneys, and brain. Women with very bad preeclampsia can have dangerous seizures. This is called eclampsia.

What causes preeclampsia and high blood pressure during pregnancy? •

Preeclampsia seems to start because the placenta doesn't grow the usual network of blood vessels

deep in the wall of the uterus. This leads to poor blood flow in the placenta.

What are the symptoms? High blood pressure usually doesn't cause symptoms. But very high blood pressure sometimes causes headaches and shortness of breath or changes in vision. Mild preeclampsia usually doesn't cause symptoms, either. But preeclampsia can cause rapid weight gain and sudden swelling of the hands and face. Severe preeclampsia causes symptoms of organ trouble, such as a very bad headache and trouble seeing and breathing. It also can cause belly pain and decreased urination.

How are high blood pressure and preeclampsia diagnosed? High blood pressure and preeclampsia are usually found during a prenatal visit. A sudden increase in blood pressure often is the first sign of a problem. You also will have a urine test to look for protein, another sign of preeclampsia. If you have high blood pressure, tell your doctor right away if you have a headache or belly pain. These signs of preeclampsia can occur before protein shows up in your urine.

How are they treated? You may be able to keep your blood pressure under control with a balanced diet and mild exercise. In some cases, you may also need to take medicine. You probably will get medicine if your bottom blood pressure number is 105 or higher. The only cure for preeclampsia is having the baby. You may get medicines to lower your blood pressure and to prevent seizures. You also may get medicine to help your baby’s lungs get ready for birth. Your doctor will try to deliver your baby when the baby has grown enough to be ready for birth. But sometimes a baby has to be delivered early to protect the health of the mother or the baby. If this happens, your baby will get special care for premature babies.

Do preeclampsia and high blood pressure lead to long-term high blood pressure? If you have high blood pressure during pregnancy but had normal blood pressure before pregnancy, your pressure is likely to go back to normal after you have the baby. But if you had high blood pressure before pregnancy, you probably will still have it after you give birth. Experts don't think preeclampsia causes high blood pressure later in life. But women who get preeclampsia may have a higher-than-normal chance of getting high blood pressure after pregnancy or later in life.1