NFORMATION SHEET
DOSAGE AND CALCULATION
Learning objectives:
Upon completion of this chapter, you will be able to:
1.
Time-allotment: 3 hours
Performance standards:
1.
2. Differentiate drug dosage forms for various routes and purposes of
administration.
Condition:
Learners must have the following:
1. Workplace location: simulate varied health care settings
2. Equipment: appropriate healthcare equipment; laptops, smart
phone;
3. Tools, accessories, and supplies: Flowcharts, Facebook app, art
materials
4. Outcomes-based teaching and learning resources: module, e-books,
peer reviewed article, course-syllabus.
(Concept note follows)
If possible, concept notes should be a teacher strategy of structuring
essential topics (OBE concept) based on learning outcome to avoid
unethical (without permission) use of learning materials from available
course references – this way we can say we own the module while
crediting sources (references- see APA guide)
(Copy paste content from reliable references for time being only! If not
available in MS word format, print required references from e-book and
attached to module)
OVERVIEW
● Basic medication dose conversion and calculation skills are essential to the
provision of safe nursing care.
● Nurses are responsible for administering the correct amount of medication by
calculating the appropriate amount of medication to give. Types of calculations
required include:
◯Solid oral medication
◯Liquid oral medication
◯Injectable medication
◯Correct dose based on the client’s weight
◯IV infusion
●Nurses can use three different methods for dosage calculation. These are ratio
and proportion, desired over have, and dimensional analysis.
● Standard conversion factors include:
◯1 mg = 1,000 mcg
◯1 g = 1,000 mg
◯1 kg = 1,000 g
◯1 oz = 30 mL
◯1 L = 1,000 mL
◯1 tsp = 5 mL
◯1 tbsp = 15 mL
◯1 tbsp = 3 tsp
◯1 kg = 2.2 lb
◯1 gr = 60 mg
●General Rounding Guidelines
◯Rounding up: If the number to the right is equal to or greater than 5, round up by
adding 1 to the number on the left.
◯Rounding down: If the number to the right is less than 5, round down by dropping
the number, leaving the number to the left as is.
◯ For dosages less than 1.0, round to the nearest hundredth.
■ For example (rounding up): 0.746 mL = 0.75 mL. The calculated dose is 0.746
mL. Look at the number in the thousandths place (6). Six is greater than 5. To round
to hundredths, add 1 to 4 in the hundredths place and drop the 6. The rounded dose
is 0.75 mL.
■ Or (rounding down): 0.743 mL = 0.74 mL. The calculated dose is 0.743 mL. Look
at the number in the thousandths place (3). Three is less than 5. To round to the
hundredth, drop the 3 and
leave the 4 as is. The rounded dose is 0.74 mL.
◯For dosages greater than 1.0, round to the nearest tenth.
■For example (rounding up): 1.38 = 1.4. The calculated dose is 1.38 mg. Look at
the number in
the hundredths place (8). Eight is greater than 5. To round to the tenth, add 1 to the
3 in the tenth place and drop the 8. The rounded dose is 1.4 mg.
■Or (rounding down): 1.34 mL = 1.3 mL. The calculated dose is 1.34 mL. Look at
the number in the hundredths place (4). Four is less than 5. To round to the tenth,
drop the 4 and leave the 3 as is. The rounded dose is 1.3 mL.
SOLID DOSAGE
Example: A nurse is preparing to administer phenytoin (Dilantin) 0.2 g PO
every 8 hr. The amount available is phenytoin 100 mg/capsule. How many
capsules should the nurse administer per dose? (Round the answer to the
nearest whole number.)
Using Ratio and Proportion
STEP 1: What is the unit of STEP 5: What is the quantity STEP 8: Reassess to
measurement to calculate? of the dose available? determine whether the
Cap 1 cap amount to give makes sense.
STEP 2: What is the dose STEP 6: Set up an equation If there are 100 mg caps and
needed? and the prescribed amount is 0.2
Dose needed = Desired. solve for X. g (200 mg), it makes sense
0.2 g to give 2 caps.
Have = Desired
STEP 3: What is the dose Quantity X The nurse should
available? Dose available = administer phenytoin 2 caps
Have. 100 mg = 200 mg PO every 8 hr.
100 mg 1cap X cap(s)
STEP 4: Should the nurse X=2
convert
the units of measurement? STEP 7: Round if necessary.
Yes (g ≠ mg)
Equivalents:
1 g = 1,000 mg (1 x 1,000)
0.2 g = 200 mg (0.2 X 1,000)
Using Desired over have
STEP 1: What is the unit of STEP 5: What is the quantity STEP 7: Round if necessary.
measurement to calculate? of the dose available?
mL 1 mL STEP 8: Reassess to
STEP 2: What is the dose determine whether the
needed? STEP 6: Set up an equation amount to administer makes
and solve for X. sense.
Dose needed = Desired.
8,000 units Desired x Quantity=X If there are 10,000 units/mL
STEP 3: What is the dose Have and the prescribed amount is
available? Dose available = 200 mg x 1 cap=X cap (s) 8,000 units, it makes sense
Have. 100 mg to
10,000 units administer 0.8 mL.
2=X
STEP 4: Should the nurse The nurse should administer
convert STEP 7: Round if necessary. heparin injection 0.8 mL
the units of measurement? subcutaneously every 8 hr.
No
Using Dimensional analysis
STEP 1: What is the
unit of measurement
to calculate?
mL
STEP 2: What quantity
of the dose is
available?
1 mL
STEP 3: What is the
dose
available?
Dose available =
Have.
10,000 units
STEP 4: What is the
dose needed?
Dose needed =
Desired.
8,000 units
LIQUID DOSAGE
Example: A nurse is preparing to administer erythromycin estolate 0.25 g PO every 6 hr. The
amount available is erythromycin estolate oral suspension 250 mg/mL. How many mL should
the nurse administer per dose? (Round the answer to the nearest whole number.)
Using Ratio and Proportion
STEP 1: What is the unit of STEP 5: What is the quantity STEP 8: Reassess to
measurement to calculate? of determine
Ml the dose available? whether the amount to give
1 mL makes sense.
STEP 2: What is the dose If there are 250 mg/mL and
needed? STEP 6: Set up an equation the prescribed amount is
Dose needed = Desired. and 0.25 g (250 mg), it makes
0.25 g solve for X. sense
STEP 3: What is the dose Quantity to administer 1 mL. The
available? Dose available = have nurse
Have. X should administer
250 mg desired erythromycin estolate oral
= suspension 1 mL PO
STEP 4: Should the nurse 1ml every 6 hr.
convert 250 mg
the units of measurement? X ml
yes (g ≠ mg) 250 mg
Equivalents: =
1 g = 1,000 mg (1 x 1,000) X=1
0.25 g = 250 mg (0.25 x
1,000) STEP 7: Round if necessary.
Using Desired over have
STEP 1: What is the unit of STEP 5: What is the quantity STEP 8: Reassess to
measurement to calculate? of determine
mL the dose available? whether the amount to give
STEP 2: What is the dose 1 mL makes sense.
needed? STEP 6: Set up an equation If there are 250 mg/mL and
Dose needed = Desired. 0.25 and the prescribed amount is
g solve for X. 0.25 g (250 mg), it makes
STEP 3: What is the dose have sense
available? Dose available = desired x Quantity to administer 1 mL. The
Have. X nurse
250 mg = should administer
STEP 4: Should the nurse 250 mg erythromycin
convert the units of 250 mg x 1ml estolate oral suspension 1
measurement? X ml mL PO
yes (g ≠ mg) Equivalents: = every 6 hr.
1 g = 1,000 mg (1 x 1,000) 1=X
0.25 g = 250 mg (0.25 x STEP 7: Round if necessary.
1,000)
Using Dimensional analysis
STEP 1: What is the
unit of
measurement to
calculate?
mL
STEP 2: What
quantity of the dose
is available?
1 mL
STEP 3: What is the
dose
available? Dose
available = Have.
250 mg
STEP 4: What is the
dose needed?
Dose needed =
Desired.
0.25 g
INJECTABLE DOSAGE
Sites for Injections:
Common sites for Sub-Q injections are the upper arms, abdomen, back,
and thighs.
Reference: Clinical Drug Therapy-Rationales for Nursing Practice 9 th ed.-A.
Abrams, et. Al., (Lippincott, 2007) [Link]
Sites for IM injections are the deltoid, dorsogluteal, ventrogluteal,
and vastus lateralis muscles. These sites must be selected by first identifying
anatomic landmarks.
Anatomic landmarks and intramuscular (IM) injection sites: (A) ventrogluteal
muscle, (B) deltoid muscle, (C) vastus lateralis and rectus femoris muscle,
and (D) dorsogluteal muscle.
Common sites for IV injections are the veins on the back of the hands and on
the forearms.
Veins of the hand and forearm that may be used to administer intravenous fluids and
medications.
INJECTABLE DOSAGE
Example: A nurse is preparing to administer heparin 8,000 units
subcutaneously every 8 hr. The amount available is heparin injection 10,000
units/mL. How many mL should the nurse administer per dose? (Round the
answer to the nearest tenth.)
Using Ratio and Proportion
STEP 1: What is the STEP 7: Round if
unit of necessary.
measurement to
STEP 8: Reassess to
calculate? mL
determine whether
STEP 2: What is the the amount to
dose needed? Dose administer makes
needed = Desired. sense. If there are
8,000 units 10,000 units/mL and
the prescribed
STEP 3: What is the
amount is 8,000
dose available?
units, it makes sense
Dose available =
to administer 0.8 mL.
Have. 10,000 units
The nurse should
STEP 4: Should the administer heparin
nurse convert the injection 0.8 mL
units of subcutaneously every
measurement? No 8 hr.
Using Desired Over Have
STEP 1: What is the unit of STEP 7: Round if necessary.
measurement to calculate?
STEP 8: Reassess to
mL
determine whether the
STEP 2: What is the dose amount to administer makes
needed? Dose needed = sense. If there are 10,000
Desired. 8,000 units units/mL and the prescribed
amount is 8,000 units, it
STEP 3: What is the dose
makes sense to administer
available? Dose available =
0.8 mL. The nurse should
Have. 10,000 units
administer heparin injection
STEP 4: Should the nurse 0.8 mL subcutaneously every
convert the units of 8 hr.
measurement? No
Using Dimensional Analysis
STEP 1: What is the
unit of
measurement to
calculate? mL STEP
2: What quantity of
the dose is
available? 1 mL
STEP 3: What is the
dose available?
Dose available =
Have. 10,000 units
STEP 4: What is the
dose needed? Dose
needed = Desired.
8,000 units
Dosages by Weight
Example: A nurse is preparing to administer cefixime (Suprax) 8 mg/kg/day
PO divided in equal doses every 12 hr to a toddler who weighs 22 lb. The
amount available is cefixime suspension 100 mg/5 mL. How many mL should
the nurse administer per dose? (Round the answer to the nearest whole
number.)
Using Ratio and Proportion
Using Desired Over Have
Using Dimensional Analysis
IV Flow Rates
● Nurses calculate IV flow rates for large-volume continuous IV infusions and
intermittent IV bolus infusions using electronic infusion pumps (mL/hr) and manual
IV tubing (gtt/min).
● IV infusions using electronic infusion pumps
◯ Infusion pumps control an accurate rate of fluid infusion. Infusion pumps are able
to deliver a specified amount of fluid during a specified amount of time.
For example, an infusion pump can deliver 150 mL in 1 hr or 50 mL in 15 min.
Example: A nurse is preparing to administer dextrose 5% in water (D5W) 500 mL IV
to infuse over 4 hr. The nurse should set the IV infusion pump to deliver how many
mL/hr? (Round the answer to the nearest whole number.)
Using Ratio and Proportion, Desired Over Have, and Dimensional
Analysis
Example: A nurse is preparing to administer cefotaxime (Claforan) 1 g intermittent
IV bolus. Available is cefotaxime 1 g in 100 mL of 0.9% sodium chloride (0.9% NaCl)
to infuse over 45 min. The nurse should set the IV infusion pump to deliver how
many mL/hr? (Round the answer to the nearest whole number.)
Using Ratio and Proportion, Desired Over Have, and Dimensional
Analysis
Application Exercises
Instructions: Drug computation: Solve the following problems using Ratio and
Proportion, Desired Over Have, and Dimensional Analysis. Show your
solutions. Write your answer in a separate sheet.
1. A nurse is preparing to administer cefotaxime (Claforan) 1 g by
intermittent IV bolus. The amount available is cefotaxime 1 g in dextrose 5%
in water (D5W) 100 mL to infuse over 45 min. The drop factor shown on the
package of IV tubing is 10 gtt/mL. The nurse should set the manual IV
infusion to deliver how many gtt/min? (Round the answer to the nearest
whole number.)
2. A nurse is preparing to administer clindamycin (Cleocin) 200 mg by
intermittent IV bolus. The amount available is clindamycin injection 200 mg
in 100 mL 0.9% sodium chloride (0.9% NaCl) to infuse over 30 min. The
nurse should set the IV pump to deliver how many mL/hr? (Round the answer
to the nearest whole number.)
3. A nurse is preparing to administer furosemide (Lasix) 80 mg PO daily. The
amount available is furosemide oral solution 40 mg/5 mL. How many mL
should the nurse administer? (Round the answer to the nearest whole
number.)
4. A nurse is preparing to administer dextrose 5% in water (D5W) 750 mL IV
to infuse over 6 hr. The nurse should set the IV pump to deliver how many
mL/hr? (Round the answer to the nearest whole number.)
5. A nurse is preparing to administer haloperidol (Haldol) 2 mg PO every 12
hr. The amount available is haloperidol 1 mg/tablet. How many tablets
should the nurse administer? (Round the answer to the nearest whole
number.)
6. A nurse is preparing to administer amoxicillin (Amoxil) 20 mg/kg/day PO
divided in equal doses every 12 hr to a preschool child who weighs 44 lb. The
amount available is amoxicillin suspension 250 mg/5 mL. How many mL
should the nurse administer per dose? (Round the answer to the nearest
whole number.)
7. A nurse is preparing to administer heparin 15,000 units subcutaneously
every 12 hr. The amount available is heparin injection 20,000 units/mL. How
many mL should the nurse administer per dose? (Round the answer to the
nearest tenth.)
8. A nurse is preparing to administer acetaminophen (Tylenol) 650 mg PO
every 6 hr PRN for pain. The amount available is acetaminophen liquid 500
mg/5 mL. How many mL should the nurse administer per dose? (Round the
answer to the nearest tenth.)