如何对待和处分违纪的学生Title培训课件

SafetyrelatedtoAdministrationmethodsUNRS314JanBazner-ChandlerCPNP,CNS,MSN,RNPediatricdosagescalculatedbyweightMostdrugbooksuseweightinkilograms,patientsareoftenweighedinpounds:Toconvertpoundstokilograms2.2lb=1kg.2.2x=weightinlbDividepoundsby2.2togetweightinkgCalculationIfachildweighs88lbs,whatistheweightinkg?88lb:xkg88dividedby2.2=40kgIfachildweights6lbswhatistheweightinkg?6lbdividedby2.2=2.72kgSafeMedicationDoseCalculatedailydoseordered(Physicianorders)Calculatethelowandhighparametersofsaferange(fromdrugbook)Comparethepatient’sdailydosetothesaferangetoseeifitfallswithinthesafezoneCalculationAchildis2yearsandweighs36lbsisreceivingAmoxicillin215mgpotidforabilateralotitismedia(earinfection).Patientweightinkg=16.36kgDavisdrugguide:PO(children)<40kg:6.7to13.3mg/kgq8hours.16.36x6.7=109.6mgq8hours16.36x13.3=217.5mgq8hoursSaferange:110to218mgofAmoxicillinQ8hoursIsthedosesafe?Howmuchmedicationdoyougive?Amoxicillinsuspensioncomes250mgper5ml.250mg/5ml=215mg/xmlGive4.3ccpoevery8hoursSafeDoseRangesReadthemedicationrangescarefullySomearethedoserangefor24hoursSomearethedoserangeforq8hoursSomearethedoserangeforq12hoursFluidControlCrucialinthepediatricpopulationUnitsoftenhavepoliciesthatchildrenundercertainageswithIVfluids/IVmedicationbeplacedonaninfusionpump.KeyconceptsFluidoverloadmustbeavoidedTimeoverwhichamedicationshouldbeadministerediscriticalinformationMinimaldilution(endconcentrationofmedication)isimportantformedicationssuchasaminoglycosides.CollectingtherapeuticbloodlevelsFluidoverloadKnowwhattheIVrateis.HourlyrecordingofIVfluidintakeDon’ttryandcatchuponfluidsCalculatefluidsusedtoadministerIVmedicationsintothehourlyfluidcalculations.IVBuretrolIVBuretrolAburetrolorvolutrolisaninlinereceptaclebetweentheclient’sIVcathetersetandthebagoffluids.Capacityis100to120mLRationale:thenursecanfilltheburetroltoacertainlevelandiftheIVpumpmalfunctions,onlythevolumeintheburetrolwillflowtotheclient.TheInfusionPumpTheml/hourthedoctorordersissetonthepumpastheinfusionrate.Theamountoffluidintheburetrolorvolutrolistheamounttobeinfused.Thiswillneedtobesetevery2hoursoraccordingtohospitalpolicy.IVfluidcalculationsThemaintenancedoseforadministrationofIVfluidsisbasedonthefollowingformula:100mloffluidforthe1st10kgofweight50mloffluidforthe2nd10kgofweight20mloffluidforandadditionalkgYouneedtomemorizethisPracticeproblemJoseweighs16poundsWeightinkg=7.27kgUsingtheformulaprovidedhowmanymlsoffluidwouldheneedin24hours.PracticeproblemKyishaisa10yearoldadmittedtotheunitinsicklecellcrisis.Sheweighs36kg.Whatwouldhermaintenancedoseoffluidsbe?Sheisdehydratedsotheyphysicianordersthefluidstobedoublemaintenance.Whatwouldher24hourfluidneedsbe?IVbolusA6yearoldwithdehydrationisadmittedtoyourunit.ThereferringhospitalhasanadultIVset-up.(dripfactorof15gtt/ml)Thephysicianorderistoinfuse90mLofnormalsalineover1hour.AtwhatratewillyousettheIVrate?90mlx15gtts/mldividedby60minutesDripratewillbe____gtts/minuteSafeadministrationofIVmedicationsVancomycin:anti-infectiveFortreatmentofpotentiallylife-threateninginfectionswhenlesstoxicanti-invectivesarecontraindicated.MRSA:MethicillinresistantstaphaureusUsewithcautioninpatientswithrenalimpairmentVancomycinIV(children):10mg/kgq6hoursor20mg/kgq12hours.IV(neonates)1weekto1month:15mg/kginitially(loadingdose)then10mg/kgq8hours.IV(neonates)lessthan1week:15mg/kginitiallythen10mg/kgq12hours.NursingimplicationsAssessforinfectionatbeginning,duringandendoftherapy.(wbc,fever,lethargy,wound,lungsounds)Obtainanyculturesorderedbeforeadministrationofthemedication.Vancomycinisirritatingtotissueandcausesnecrosisandseverepainwithextravasation.Evaluate8thcranialnervefunctionbyaudiometryandserumVancomycinlevelsthroughoutcourseoftherapy.Monitorurine:cloudyorpinkurinemaybesignsofnephrotoxicity.IntermittentinfusionDiluteeach500mgvialwith10mlofsterilewater.Dilutefurtherwith100to200mlofIVsolution(D5W)Infuseover60minutes:Donotadministerrapidlyorasabolustominimizeriskofthrombophlebitis,hypotension,orrednecksyndrome.Thrombophlebitiscanbeminimizedbyusingdilutesolutionsof2.5to5mg/ml.NeonatedosageWeight:3.25kg/5daysoldHowmuchVancomycinforloadingdosage?HowmuchVancomycinformaintenancedosage?Howmuchfluidwouldyouneedtodilutemedicationintoadministersafely?Calculations3.25x15mg=48.75mgVancomycincomesin500mgvial500mgdilutedwith10ccsterilewater500mg/10cc=48.75/XmlYouwilldrawup.97mlHowmuchfluiddoyouhavetofurtherdilutemedicationin:(2.5to5mg/ml)?Diluteinapproximately20mlandruninover60minutes.Whatabouttheflush?Ifyouputthemedicationandthe20ccintheburetrolhowfastwillyouhavetosettheIVpumptogetthemedicationintothepatientin60minutes?Hint:youwillneed20mlofadditionalfluidtoflushthemedicationthroughtheIVline.THEPHYSICIANORDERWILLNEVERSTATETOFLUSHTHELINE–YOUMUSTDOTHISWITHEACHIVMEDICATIONPracticeIVmedicationsJoseisa15yearoldtoreceive750mgofAncef(Cefazolin)pre-operativelyforanORIForthopedicprocedure.Thepharmacysendsyou1gramofpowderedAncef.Thedirectionaretodilutethepowderwith10mlofsterilewater.Youconcentrationisnow1gramin10mlofsterilewater.Howmanyml’swillyouneedtodrawuptoequal750mg?Ancefcontinued750mgofAncefin7.5ml.Addthe7.5mlofmedicationto50mlofIVfluidandinfuseover30minutes.HowfastdoyouneedtosetyourIVat(rememberthe20mlflush)tohavethemedicationinfusedover30minutes?PracticeproblemJohnisreceivingCefuroxime350mgIV.Themedicationcomesfromthepharmacy350mgofCefuroximein3.5mloffluid.Themedicationistobefurtherdilutedwithfluidtoequal20ml