More math answers…

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Please let me know if the answers don’t add up!

TPN questions

1. You are hanging a 1 L bag of TPN which contains 40% Dextrose, 8.25% Aminosyn which is supplied in a 50/50 ratio. You are infusing it at a rate of 100 mL/hr. You put the bag up at 0900 but had to stop the feeding at 1100 to 1200 due to other procedures for your patient. The feeding continues through the day. Your shift ends at 1900 and you need to figure out your I/Os. How many mL of TPN did they get? What was their caloric intake? If the doctor had prescribed some 10% Lipids to run for 12 hrs at 40mL/hr starting at 1300, what is the total caloric intake now at the end of your shift?

2. If you hang a 1L bag of TPN which includes 8.25% protein, 30% dextrose and 20 % lipids all running at 45ml/hr and is at a 40/40/20 ratio, what is your total calories for the bag?

(hint: 40/40/20 means 40% of the bag is protein, 40% is dextrose and 20% is lipids. 40% of 1000mL is 400mL)

 

answers 1 2

Math answers cont…

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Math answers as I do them. From NS240

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It’s math week again!

Question: How many grams of Dextrose are in 100mL of water for a D5W solution?

answer

IV Push Math

Holliday-Segar

If a baby is at 9kg, what is the fluid maintenance requirement needed in a day, and what would you set the rate on the pump to be?

100mL/kg for first 10 kg  = 900mL

50mL/kg for 2^nd 20 kg = 0

20mL/kg for remainder of wt in kg = 0

Total for this example = 900mL in a day

1000mL divided by 24 hrs = 37.5 mL/hr

(A shorter way to see this: For the first 10 kg of weight, give 100 mL/kg fluid.  For 11-20 kg, give 1000 mL + 50 mL/kg for each kg over 10 kg. For a child over 20kg, give 1500mL + 20mL/kg for each kg over 20 kg)

Maintenance requirements for water of individuals is determined by their caloric expenditure.

Problem: The infant on the floor is currently producing 1 diarrheal stool q 3 h and refusing to drink. Clinical findings of dry mucous membranes, poor skin turgor, markedly decreased urine output, and tachycardia with normal BP and capillary refill suggest 10% fluid deficit. Rectal temperature is 37° C; serum Na, 136 mEq/L; K, 4 mEq/L; Cl, 104 mEq/L; and HCO₃, 20 mEq/L. The doctor has ordered fluid volume replacement for this 25kg child. What would the IVF maintenance rate be set at?

Warm-ups for TPN Calculations

Total Parental Nutrition (TPN) solutions are intravenous fluids (IVFs) that provide nutrition to clients who can’t eat normally for many different reasons. Different additives  placed in the bag are modified for the patient’s particular needs.

Dextrose & amino acids are usually the base of the fluids. They represent the carbohydrates and proteins in our normal diet. How much is in your TPN is determined by lab draws and nutrition requirements of your patient with consideration to the length of time they are on this type of therapy.

http://grey.colorado.edu/shortgut/index.php/MaxCares_TPN_Tubing

The above site provides great info on  TPN bags and tubing.

1. You have mixture of Glucose (200 g) Fat (55 g) and Protein. The mixture provides 2000 kcal, how many grams of protein are in the mixture?
2. If the daily calorie requirements for your patient is 2600 kcal, and they have a daily intake of 300 g glucose and 200 g protein, how much fat is needed to meet the requirements?
3. What is your intake of fat if you were to consume 10 g, then 20g, then 30g of fat in one day?
4. How many calories will your patient receive if you infuse 2.5 liters of 5% dextrose?
5. With 8% fats, 10% protein and 15% dextrose, how many calories are in 1 Liter?
6. What would the kcals be of a liter of 10% dextrose and 8.5% amino acids?
7. Your patient receiving TPN has a solution consisting of 500mL of 25% dextrose and 500mL of 10% amino acids. What are the total calories in the preparation?
8. Your patient received 1000mL of the following mixture every 8 hours: 50% dextrose in water 500mL and 8.5% Fre-Amine 500mL. Calculate the glucose calories per day. What are the grams of protein received per day?

9. A 250mL solution of 2% fat, 5.5% protein, and 25% dextrose will give ___ calories?

10. How many mL of 20% dextrose solution or 5% protein are required to get 50kcals of energy?

11. What is the protein-calorie percentage of a 500 mL solution of 10% dextrose and 20% protein?

12. What is the protein in a solution , whose protein-calorie percentage is 20% and which contains 400 g of dextrose?

Do these quickly!

Don’t read these simple math equivalents yet!! Set your timer to 4 minutes and do these quickly! Ready, set, go!

__ g =	1 oz
__ mL =	1 pt
__ mg =	1 gr
__ Tbsp =	1 oz
__ mL =	1 tsp
__ mL =	1 fl. Oz
__ lb =	1 kg
__ tsp =	1 Tbsp
__ Tbsp =	3 tsp
__ tsp =	5 mL
__ fl oz =	30 ml
__ kg =	2.2 lb
__ oz =	2 Tbsp
__ gr =	60 mg
__ oz =	30 g
__ pt =	500 mL the answers are in the problems.

Units

Unit Calculations

• When charting never use ‘U’, always write out ‘Units’.

1A.  The doctor orders heparin of 800 units/hr.  The solution available is 40,000 units in 1000/mL of D5W. (40,000U/1000mL of D5W). Calculate the flow rate.

1B.  What are the heparin units infusing when an IV bag of 1000 mL D5W containing 40,000 units has been ordered, and you notice it is infusing at 30 mL and hour?

1 C.  Is the amount infusing an hour within normal limits?

2.  Laura was told to give 2500 units of heparin to her patient in an IV solution. After checking the doctor’s order she went to get the medication and found she needed to prepare her syringe with the correct amount first. The vial said 5000 units/ml for IV or SC use. In large letters it says 10 mL, multiple dose vial. How many mLs does she need to pull in order to give 2500 units to the IV solution running at 40 mL/hr? The drop rate is 60gtt/min.

3. Brandi is preparing a solution for her patient. She has a multiple dose vial labeled 5,000,000 units. The directions say “add 3.2 mL diluent to make 1,000,000 units per mL”. After she prepares this correctly, and we know she will, she gives her patient 1.7 mL of this solution. How many units did she give?

answers

Okay, I lied.

Really, didn’t mean to. Did you see the movie with Bob Hope  the other night on saying the truth for one day?

Its just I’m doing a little math everyday now until our test. So – Maybe a little math.

These math problems are on the volume of diluent and the flow rate for the infusion. (round mL to tenth if over 1)

1. An IV of an antibiotic of 750 mg in 3 mL was ordered by the doctor to be diluted to a total of 25 mL of NS to infuse over 40 minutes.
What is the volume of diluent  __________ mL
What is the flow rate ___________ mL/hr
2. 1.5 grams/2mL of an antibiotic is to be diluted to a total of 40 mL of NS and administered over 40 minutes.
What is the volume of diluent  __________ mL
What is the flow rate ___________ mL/hr
3. Over 35 minutes, a dosage of 20 mg in 2 mL has been ordered and must be diluted to 30 mL.
What is the volume of diluent  __________ mL
What is the flow rate ___________ mL/hr
4. 500,000 U of an antibiotic preparation with a volume of 4 mL is ordered by the doctor. It must be diluted to 50 ML D5 ½ NS to infuse in 1 hr.
What is the volume of diluent  __________ mL
What is the flow rate ___________ mL/hr
5. 200 mg in 4 mL is to be diluted to 50 mL and administered over 70 minutes.
What is the volume of diluent  __________ mL
What is the flow rate ___________ mL/hr
6. A dosage of 25 mg in 5 mL is ordered diluted to 40 mL and needs to be administered in 50 min.
What is the volume of diluent  __________ mL
What is the flow rate ___________ mL/hr

Answers

TPN Math Problems

Practice TPN

Answers – work shown. I didn’t halve the D5/1/2 NS, problem # 5. The answer is:

CHO/Dex        4/1          5/100               62.5/1hr            24/1 day        =          30,000/100 =          300

All the rest of the problems are correct.

Practice TPN with answers –
Beatty’s Answers.

Do the Math

If the outlet of the pelvis is WNL, will a NB with a Biparital of 10.5 be a SVBD?

The marked variability of a FHR BL at 139 is ________to ______.

If you have 2 accelerations of less than 15 bpm for at least 15 seconds, is it considered to be a reactive trace?

If your patient/mom is on MgSo4 with a lab level of 10, what is your concern?

An doctor orders the patient to receive 2 mU per minute. What do you set the IV infusion rate at?

Answers

Math – APGAR

APGAR = Appearance, Pulse, Grimace, Activity, Respiration – for my spanish speaking friends (Apariencia, Pulso, Gesticulación, Actividad, Respiración) – or as figured by my friend Kendra CHaRRM (color, heart rate, respiratory rate, reflex irritability, muscle tone).

The apgar score was created by a Doctor Virginia Apgar, an anesthesiologist, to assess the health of the newborns immediately after being born.  Using the APGAR Score sheet (mine here), figure the score of this newborn.

A newborn was assessment was noted: Acrocyanosis, good cry but only grimacing when applying stimulation to infant. Some muscle tone is noted with an apical heart rate of 101. What is the score?

Answer 

GPTAL – Math

We know GPTAL means:

• G – gravida or # of pregnancies
• T – term or # of deliveries after 37 weeks
• P – preterm or # of deliveries after 20 weeks but before 38 weeks
• A – abortion or # of deliveries before 20 weeks, either spontaneous or induced
• L – living or # of living children

A prenatal woman states having 3 young children at home. She says her daughter was born right on time, but her sons were both a month early. Sadly, she lost a baby in her second month. What is her GTPAL?

Answer

Saturday Math

So can you come up with the EDC for:

                        4 February 2010     answer

                        30 April 2010           answer

Math Review

If you had the math questions from the workshop on Jan 28th, but need the answers – go to Resources/Semester 2 and you will find them!

Adjustments to Questions/Answers

#2 – If you use the conversion of 1 g = gr 15  or the conversion of 60 mg = gr 1, your answer can come out differently.

#27 – My answer is 40.9 mL/hr as we have learned to go to the tenths. But with pumps we may be rounding. I suggest for our test, go to the tenths place.

#30 – The answer I came up with is 47 gtt/min.

#31c – I used 20% lipids.

IV Math

1. The doctor’s order is for an intravenous infusion of one liter of 5% Dextrose with Lactated Ringers (D5LR) to infuse at 125 ml/hr. How many hours will it take for the IV bag to infuse?

Since we are talking about infusion I would automatically start thinking what I am looking for is Hrs.

Hrs |

So I know my first conversion factor must have hrs as the numerator, and I like to start usually with what the doctor wants or what is on hand.

Answer

2. The physician’s new order is to infuse 1000 ml 5% Dextrose and 0.45 Normal Saline (D5 1/2 NS) with 40 mEq KCL, over 10 hours.  (a) what will the rate be using an infusion pump?  (b) How many milliliters will the patient receive in one day?

Here I think “rate” is always ml/hr. I’m also thinking infusion which is again Hrs. So I would start with Hrs or look for the mL/hr.  Remember from the answer above, infusions are total volume divided by mL/hr.

answer

3. You are to infuse an antibiotic via IVPB. The order is for Cefazolin one-gram q 8 hrs. The medication book recommends the the infusion time of 30 minutes. The drug is supplied in 50 ml of NS. The tubing drip factor is 15 gtt/mL. (a) what will the drip rate be for the infusion?  (b) What will the rate be using an infusion pump?

Drip rate? Well, we know that means gtts/min right?

answer

4. The order is for Erythromycin 750 mg in 250 mL of 5% D5W to infuse over 1.5 hours. The tubing drop factor is 15.  (a. ) what will the drip rate be for the infusion?  (b) What will the rate be using an infusion pump?

This one gets tricky. Drip rate again means gtts/min we are looking for, but you think where is the gtt conversion?  When it says factor, know it means per min or hr. If we are talking drops it will be per min, so use the 15gtts/min.

answer

5. The physician’s order is to infuse a continuous IV of 1 liter or 1000 mL of NS with 20 mEq of KCL at 75 mL/Hr. (a) How many mL will the patient receive per day?  (b) If the infusion was started at 1:30 pm, at what exact time will the bag be totally infused?

This one is fun. I think the question (a) is a little off. You figure it will get infused before a full 24 hrs is complete. So then figure out how many hours it will take. For (b) I changed my hours to military or 2400 hrs, and added the total time. Make sure you have changed the part of an hour into minutes by multiplying the .33 of an hour by 60 to get you true minutes.

answer

OB Math

This morning I feel like another math session before I begin my day. Then a little run, and  off to the Getty with my DH and DDs. These math problems are from a prior class.

This practice not only keeps my math limber, it has made me utilize my iPod touch’s calculator. When the need comes to use this on the floor – I’ll be ready! So those of you who also are new to it (Vicki,) try using it  🙂

1.      You are to administer MgS04 (magnesium sulfate) IVPB at 1Gm. per hour. You are to add 20gm of MgS04 to 500mL D5LR. You have a 10mL vial of 50% MgS04 on hand. (50% MgS04 = 50gm/100mL)   answer

a. How much will you add?

b. At what rate will you infuse the IVPB?

2.      You are to start Pitocin IV at 1 mU/min. and you have added 10U of Pitocin to 1000mL D5LR. At what rate (mL/hr) will you START the infusion?   answer

3.      The patient has been diagnosed with DVT and is to receive Heparin. She is to receive 800U per hour. The IV bag is labeled: Heparin 40,000U/1000mL of D5W.    answer

a. Calculate the flow rate to deliver the ordered dosage using the in­fusion pump.

b. While making nursing rounds, you notice that the patient’s IV pump is infusion at 30mL/hr. Calculate how many units of Heparin is infusing per hour.

4.      The order is for Gentamycin 80mg IVPB in 100mL q 8 hours and to run over 30 minutes.   answer

a. Calculate the infusion rate.

b. Calculate the drip rate in gtts/min.(tubing delivers 15gtts/mL)

5.      During resuscitation the doctor orders Narcan 0.l mg/kg to be given to the newborn. You have an ampule of Narcan labeled 0.4mg/mL. The infant weights 2430 gm. How much medication will you give?  answer

6.       The doctor ordered Ancef 2gm IVPB in 50mL D5W to infuse over 30min.  Calculate the infusion rate in mL/hr.   answer

– my iPod touch turns off too fast!

Math Practice

To see the answer to the question, just hover your mouse over the ANSWER

1. Doctor orders carbamazepine 19 mg/kg/day to be divided into 2 doses. Your patient weighs 55 lbs. You have Carbamazepine of 50 mg on hand. How many mg of carbamazepine do you administer for each dose?

2. Doctor orders ceftibuten 270 mg PO. The nurse has 90 mg/5 mL suspension of ceftibuten available. How many mL of ceftibuten suspension does the nurse administer?

3. You need to know how many gtts/min are infusing by IV. The order was for LR at 85 mL/hr. The tubing factor is 20 gtts/mL.

4.  You need to infuse an IV of 1 L of D5NS over 6 hrs. The drip rate is 16 gtts/min. How many mL an hour do you administer the UV fluids?

5. The med chart says to give azithromycin 2 g PO once a day. You have  unscored tablets of 500 mg each. How many tablets do you give the patient?

These questions were modified from Taylor’s.