Vancomycin HCl 0.3g IV intermittent infusion, for a child with ...

[lb_gilbert]

Vancomycin HCl 0.3g IV intermittent infusion, for a child with methicillin resistant Staphylo-coccus aureus infection (MRSA). Child's weight: 30 kg SDR: Infants and children.40 mg per kg per day in divided doses q 6-8 hr not to exceed 5 mg per mL concentration. Available from pharmacy: An IV piggyback solution of 60 mL containing 300 mg of Vancomy-cin with directions to infuse over 30 minutes.

a. SDR for this patient:DA:

b. Evaluation:

c. Is the pharmacy-supplied dilution safe for 0.3 g drug according to the label directions? DA:

d. Flow rate on pump in mL per hr based on pharmacy directions.Estimate: DA:

e. Evaluation:

Question 2

Ordered: Hydrocortisone, IV push, 50 mg bolus dose, for an adolescent with adrenal insuffi-ciency. Patient weight is 45 kg. SDR: 1-2 mg per kg IV bolus: Dilute each 250 mg or fraction thereof with 2 mL bacteriostatic SW and give over 3 minutes.
 
  a. SDR for this patient:
  b. Evaluation: Safe to administer or hold and contact prescriber promptly?
  c. Amount to withdraw from the vial:Estimate:DA:Evaluation:Total mL for IV bolus (prepared dose plus diluent added):
 d. mL per minute to administer:
  DA:
  e. Draw an arrow indicating the volume administered at end of first minute and second minute.

[mammy1697]

Answer to Question 1

a. 40 x 30 = 1200 total mg per day  6 = 200 mg per dose or  4 = 300 mg per dose

b. Safe. The label says that 500 mg must be prepared in 100 mL solution. 300 mg can be pre-pared in 60 mL solution.

c. Flow rate on pump in mL per hr: estimate: 120 mL per hr would deliver 60 mL in hour.

d. DA verification:

e. Tip: Pharmacies usually prepare these piggyback solutions, however, it is good for the nurse to understand why first and second dilutions are often necessary and how they are han-dled. The first dilution is to just to get the powder mixed with sufficient diluent so that only the amount of drug needed can be withdrawn: When a second dilution is required as with this drug, the purpose is to make the solution a safe concentration to administer. Once you have the correct dose in solution, the flow rate is based on the order and the mL available.

Answer to Question 2

a. SDR: 45-90 mg
b. Evaluation: Safe to administer
c. Estimate: of 2 mL; less than 0.5 mL

Estimate support Answer. Equation is balanced.
d. Total mL for IV bolus: 2.4 mL  0.4 mL medication = 2 mL diluent
e. 0.8 mL per minute
DA: