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1、如何对待和处分违纪的学生如何对待和处分违纪的学生TitlePediatric dosages calculated by weightnMost drug books use weight in kilograms,patients are often weighed in pounds:nTo convert pounds to kilograms 2.2 lb=1 kg.n2.2 x=weight in lbnDivide pounds by 2.2 to get weight in kgFluid ControlnCrucial in the pediatric populationnU
2、nits often have policies that children under certain ages with IV fluids/IV medication be placed on an infusion pump.Key conceptsnFluid overload must be avoidednTime over which a medication should be administered is critical informationnMinimal dilution(end concentration of medication)is important f
3、or medications such as aminoglycosides.nCollecting therapeutic blood levelsFluid overloadnKnow what the IV rate is.nHourly recording of IV fluid intakenDont try and catch up on fluidsnCalculate fluids used to administer IV medications into the hourly fluid calculations.IV BuretrolIV BuretrolnA buret
4、rol or volutrol is an inline receptacle between the clients IV catheter set and the bag of fluids.nCapacity is 100 to 120 mLnRationale:the nurse can fill the buretrol to a certain level and if the IV pump malfunctions,only the volume in the buretrol will flow to the client.The Infusion PumpnThe ml/h
5、our the doctor orders is set on the pump as the infusion rate.nThe amount of fluid in the buretrol or volutrol is the amount to be infused.nThis will need to be set every 2 hours or according to hospital policy.IV fluid calculationsnThe maintenance dose for administration of IV fluids is based on th
6、e following formula:q100 ml of fluid for the 1st 10 kg of weightq50 ml of fluid for the 2nd 10 kg of weightq20 ml of fluid for and additional kgqYou need to memorize thisPractice problemnJose weighs 16 poundsnWeight in kg=7.27 kgnUsing the formula provided how many mls of fluid would he need in 24 h
7、ours.Practice problemnKyisha is a 10 year old admitted to the unit in sickle cell crisis.She weighs 36 kg.What would her maintenance dose of fluids be?nShe is dehydrated so they physician orders the fluids to be double maintenance.What would her 24 hour fluid needs be?IV bolusnA 6 year old with dehy
8、dration is admitted to your unit.The referring hospital has an adult IV set-up.(drip factor of 15 gtt/ml)The physician order is to infuse 90 mL of normal saline over 1 hour.At what rate will you set the IV rate?q90 ml x 15 gtts/ml divided by 60 minutesqDrip rate will be _ gtts/minuteSafe administrat
9、ion of IV medicationsnVancomycin:anti-infectivenFor treatment of potentially life-threatening infections when less toxic anti-invectives are contraindicated.nMRSA:Methicillin resistant staph aureusnUse with caution in patients with renal impairmentVancomycinnIV(children):10 mg/kg q 6 hours or 20 mg/
10、kg q 12 hours.nIV(neonates)1 week to 1 month:15 mg/kg initially(loading dose)then 10 mg/kg q 8 hours.nIV(neonates)less than 1 week:15 mg/kg initially then 10 mg/kg q 12 hours.Nursing implicationsnAssess for infection at beginning,during and end of therapy.(wbc,fever,lethargy,wound,lung sounds)nObtai
11、n any cultures ordered before administration of the medication.nVancomycin is irritating to tissue and causes necrosis and severe pain with extravasation.nEvaluate 8th cranial nerve function by audiometry and serum Vancomycin levels throughout course of therapy.nMonitor urine:cloudy or pink urine ma
12、y be signs of nephrotoxicity.Intermittent infusionnDilute each 500 mg vial with 10 ml of sterile water.nDilute further with 100 to 200 ml of IV solution(D5W)nInfuse over 60 minutes:Do not administer rapidly or as a bolus to minimize risk of thrombophlebitis,hypotension,or red neck syndrome.nThrombop
13、hlebitis can be minimized by using dilute solutions of 2.5 to 5 mg/ml.Neonate dosagenWeight:3.25 kg/5 days oldnHow much Vancomycin for loading dosage?nHow much Vancomycin for maintenance dosage?nHow much fluid would you need to dilute medication in to administer safely?Calculationsn3.25 x 15 mg=48.7
14、5 mgnVancomycin comes in 500 mg vialn500 mg diluted with 10 cc sterile watern500mg/10 cc=48.75/X mlnYou will draw up.97 mlnHow much fluid do you have to further dilute medication in:(2.5 to 5 mg/ml)?nDilute in approximately 20 ml and run in over 60 minutes.What about the flush?nIf you put the medica
15、tion and the 20 cc in the buretrol how fast will you have to set the IV pump to get the medication into the patient in 60 minutes?nHint:you will need 20 ml of additional fluid to flush the medication through the IV line.nTHE PHYSICIAN ORDER WILL NEVER STATE TO FLUSH THE LINE YOU MUST DO THIS WITH EA
16、CH IV MEDICATIONPractice IV medicationsnJose is a 15 year old to receive 750 mg of Ancef(Cefazolin)pre-operatively for an ORIF orthopedic procedure.The pharmacy sends you 1 gram of powdered Ancef.The direction are to dilute the powder with 10 ml of sterile water.You concentration is now 1 gram in 10
17、 ml of sterile water.How many mls will you need to draw up to equal 750 mg?Ancef continuedn750 mg of Ancef in 7.5 ml.Add the 7.5 ml of medication to 50 ml of IV fluid and infuse over 30 minutes.How fast do you need to set your IV at(remember the 20 ml flush)to have the medication infused over 30 min
18、utes?Practice problemnJohn is receiving Cefuroxime 350 mg IV.The medication comes from the pharmacy 350 mg of Cefuroxime in 3.5 ml of fluid.The medication is to be further diluted with fluid to equal 20 ml in the buretrol.The medication is to infuse over 30 minutes.Keeping in mind that you will have
19、 a 20 ml flush.(total fluid to infuse over 30 minutes is 40 ml)n20 ml of medication+20 ml rinse=40 mlPractice problemnYou are to administer 100 mg of Ampicillin q 12 hours to a neonate with sepsis.(weight 3.45 kg).The range for ampicillin is:qInfants 7 days and 2000 grams:50 mg to 100 mg/kg/day divi
20、ded into doses q 12 hours.qIs the dose a safe dose?nThe ampicillin comes as a powder 125 mg to be diluted with 1 ml of sterile water.qHow much ampicillin would you draw up from the vial to equal 100 mg?Remember the Basicsn1 teaspoon=5 mln1 tablespoon=15 mln1 ounce=30 mln1 grain=60 mgnmcg to mg to grams