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In Critical Care Nursing, often medications are ordered as IV continuous drips.

These medications are potent and the nurse must maintain constant monitoring to assess for desired effect and potential side effects. The physician may order to titrate an IV medicated drip. To titrate a drip is to increase or decrease a drip to achieve the desired effect. Such drugs may be ! "asi#, $! %opamine, &! %obutamine, '! Nipride, (! Nitroglycerin, )! *eparin, and +! Insulin. ,s an e#ample, the nurse may titrate an Insulin drip and increase the rate to bring the serum blood glucose levels do-n to the normal range. .nce this range is met, the nurse may then maintain that rate or decrease the rate to prevent hypoglycemia. /any drugs are administered IV route in the Critical Care 0nit.

Medications may be ordered in:

mg1hr2 "asi#, Cardi3em , ,minophylline units1hr2 *eparin and Insulin mcg1min2 Nitroglycerin mcg14g1min2 %opamine and %obutamine mg1min2 "idocaine

Two Formulas can be used:

5ormula /ethod % * # V 6 flo- rate 7ml1hr!

8atio 9 :roportion 7%! osage on hand 7*! Solution on hand 6 %osage prescribed 7;! < 7ml1hr -e are solving for!

/=%IC,T.NS IN />1*8 ?.
C,S= ST0%@2 /rs. Ailma Aetlung has been admitted -ith C*5 and reBuires a "asi# drip. The /% has ordered "asi# C )mg1hr. @ou receive a "asi# IV bag of $DDmg in DDml of D.EF NaCl. *o- many ml1hr -ill you infuse the drip atG Formula Method: )mg1hr $DDmg < DDml 6 flo- rate 7ml1hr!

,NSA=82 & ml1hr Ratio Proportion Method: $DDmg DDml < )mg1hr < 6 $DD#6)DD # 6 &ml1hr

/=%IC,TI.NS IN 0NITS1*8 ?.
C,S= ST0%@2 /r. %. V. Tee came into the =8 c1o shortness of breath and -as found to have a pulmonary embolism. *e -as started on a *eparin drip. The /% ordered for *eparin $(,DDDunits in (DDml of D.EF NaCl to infuse at $DD units1hr. Ahat -ill be the rate in ml1hrG Formula Method: $DD units1hr < $(,DDD units ,NSA=82 $' ml1hr Ratio Proportion Method: $(,DDD units (DD ml < $DDunits1hr 6 < $(,DDD# 6 )DD,DDD #6$'ml1hr (DDml 6 flo- rate 7ml1hr!

/=%IC,TI.NS IN /C>1/IN ?.
These medication calculations add one e#tra step. This step is to multiply by )D at the end because your order is per minute and your IV pump infuses per hour.

C,S= ST0%@2 /r. .. Hlusion came into the =8 -ith chest pain. The patient is admitted to the CC0 and placed on a Nitroglycerin IV drip to titrate for chest pain and to maintain a SI: JEDK 'D. The /% orders to start it at $Dmcg1min. @ou hang a bottle of (Dmg in $(Dml %(A. *o- many ml1hr -ill it be infusedG Formula Method: 7.rdered! 7.n *and! $Dmcg1min # $(Dml (Dmg

Ne#t2 Convert (Dmg to mcg ?.. $Dmcg1min (D,DDDmcg # $(Dml 6 D. ml1min

5inally2 /ultiply # )Dminutes ?. D. ml1min # )Dmin 6 )ml1hr Ratio Proportion Method: (Dmg $(Dml < $Dmcg1min < 6

Ne#t2 Convert (Dmg to mcg ? (D,DDDmcg $(Dml < $Dmcg1min < 6 (D,DDD# 6 (,DDD #6D. ml1min

5inally2 /ultiply # )Dmintes ? D. ml1min # )Dmin 6 )ml1hr

/=%IC,TI.NS IN /C> 1 H> 1 /IN ?

These formulas are the same e#cept that you must also multiply by the patientLs -eight in 4g. If the patientLs -eight is provided in pounds, then you must convert it to 4g by dividing by $.$.

Common medications ordered this -ay are %opamine and %obutamine. "etLs try one. %obutamine to infuse at (mcg14g1min. The drug is supplied in (DDmg in $(Dml of D.EF NaCl. The patient -eighs MD4g. Formula Method: (mcg14g1min < (DDmg $(Dml 6

Ne#t, convert (DDmg to mcg ? (mcg14g1min < (DD,DDDmcg $(Dml 6 D.DD$( ml1min 7per 4g!

Ne#t, multiply by 4g ? D.DD$(ml1min < MD4g 6 D.$ml1min "astly, multiply by )Dminutes to give your hourly rate ?. D.$ml1min < )D 6 $ml1hr 7final ans-er!

N.A, @.0 T8@ .N=N C,S= ST0%@2 @our patient in the CC0 -ho endured an /I is having decreased cardiac output. The vital signs and urine output are decreasing. The Cardiologist -ants to start the patient on %obutamine drip and orders it to start at (mcg14g1min. @ou have a bag of MDDmg1$(Dml NS. The morning -eight -as D4g. Calculate your rate 7ml1hr! for the IV pump. >. ,*=,% N.A ?. ,NSA=8 S*.0"% I=2 D.&ml1hr

! Cardi3em $(Dmg in $(Dml of D.EF NaCl to infuse at Dmg1hr $! *eparin $(,DDD units in (DDml D.EF NaCl to infuse at (Dunits1hr

&! Insulin $DD units in DDml of D.EF NaCl to infuse at 'units1hr '! "asi# $DDmg in DDml of D.EF NaCl to infuse at $mg1hr (! %opamine MDDmg in $(Dml of %(FA to infuse at Dmcg14g1min. The patient -eighs M&4g. )! %obutamine $(Dmg in $(Dml of %(FA to infuse at Dmcg14g1min. The patient -eighs )$4g. +! "idocaine > in $(Dml of %(FA to infuse at $mg1min M! Nitroglycerine (Dmg in $(Dml %(FA to infuse at Dmcg1min ,NSA=8S2 ! $! &! '! (! )! +! M! Cardi3em C Dml1hr *eparin C $&ml1hr Insulin C $ml1hr "asi# C ml1hr %opamine C (.)ml1hr %obutamine C &+.$ "idocaine C &Dml1hr Nitroglycerine C &ml1hr

I,CH T. N$'D *./=:,>=