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Medication Math for the Nursing Student

Take the test: 25 practice problems--have fun with your brain. Review the test with complete answers: Way more than you may want to know Conversion factors for Nursin !tu"ents: Copy an" make your own cheat-sheet #bbreviations for Nursin !tu"ents: $now%m an" love%m &e"&ath 'rrors an" the Nursin !tu"ent: (e afrai") be very afrai" # *ui"e to +imensional #nalysis: The one-pa e all-you-really-nee"-to-know ui"e ,ow to &inimi-e &istakes: .ou coul" save a life +imensional #nalysis !ummary: # few tips # Criti/ue of Clinical Calculations: # unifie" approach) 0th e". Recommen"e" Corrections to Clinical Calculations: # unifie" approach +imensional #nalysis for everyone else: !ome eneral e1amples here &e"&ath an" your 2+#: 3iles an" pro rams you can use

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&e"ication &ath 'rrors an" the Nursin !tu"ent

# shockin number of patients "ie every year in 4nite" !tates hospitals as the result of me"ication errors) an" many more are harme". 5ne wi"ely cite" estimate 67nstitute of &e"icine) 28889 places the toll at 00)888 to :;)888 "eaths) makin "eath by me"ication <misa"venture< reater than all hi hway acci"ents) breast cancer) or #7+!. 7f this estimate is in the ballpark) then nurses 6an" patients9 beware: &e"ication errors are the forth to si1th lea"in cause of "eath in #merica.

,ow many me"ication errors are miscalculation errors= No one really knows since by some estimates as little as one in ten errors are reporte" 62epper) 28829. 5f reporte" errors one 3+# stu"y 6Thomas) et. al.) 288>9 foun" that ?@ were "ue to <miscalculation of "osa e or infusion rate.< Combinin this estimate with the estimate for total "eaths) as many as A)888 to B);88 "eaths are cause" annually by me"ication math errors. This woul" mean that in the avera e hospital one patient "ies every year or two because someone makes a miscalculation) an" one or two patients are sub-lethally harme" each month. #s future nurses) then) there is a "istinct possibility that we will harm) or even cause the "eath of) a patient over the course of our career. 7f we believe the a"a e <first "o no harm< applies to us) then what can we possibly "o to minimi-e miscalculation errors= 7f we only aim to pass &e"ication &ath with an ;8@ or above) are we settin the bar hi h enou h= 7t mi ht be late some !atur"ay ni ht) you%re the only RN on the floor) the hospital pharmacy is close") an" it%s up to you to calculate a nee"e" "osa e. !urely ettin the ri ht answer only ;8@ of the time is not acceptable. 2erhaps the problem you nee" to solve is a little "ifferent than any you%ve seen before or recall seein in the te1tbook. ,ow confi"ent will you be that your calculation is correct= The time to buil" confi"ence is while we are stu"ents. 7 su est that as conscientious stu"ents we shoul" aim for :5@ or better. We shoul") then) carefully stu"y) learn from) an" thereby avoi" repeatin what mistakes we "o make) so that by the time we are workin in the real worl" we can be confi"ent that) if we are vi ilant enou h) we can approach >88@ proficiency. !ince <to err is human)< we will always be at risk of not achievin a oal of >88@ proficiency) but we cannot aim for less) an" knowin that we are always at risk will make us e1tremely careful. Neither effort) "esire to avoi" error) nor carefulness) however) is enou h. We nee" the ri ht tools an" techni/ues that will help us avoi" miscalculations. 7 believe that "imensional analysis is the most appropriate tool available to us. 7t is) by far) the best metho" of solvin me"ication math problems with the least chance of makin errors. #s nurses we%re not likely to ever use whatever al ebra) tri onometry) calculus) or statistics we may know an" 6even better=9 we nee" make no effort to learn these subCects) but we shoul" strive for a "eep un"erstan"in of) an" proficiency in) "imensional analysis 6+#9. The oo" news is that mastery of +# is not at all an unobtainable oal. While few coul" master a vast subCect such as al ebra in a lifetime) most stu"ents shoul" be able to master +# in a few weeks of focuse" effort. &astery woul" mean the ability to solve any problem that coul" crop up) no matter how it is presente") while avoi"in pitfalls) an" retainin proficiency in the years to come. Nee"less to say) if 7 thou ht that nursin stu"ents were masterin +#) 7 woul"n%t be writin this paper. The ba" news) then) is that most nursin stu"ents seem to have a weak un"erstan"in of +#. &ost can follow e1amples iven in the te1tbookD they can then solve all the practice problems that follow the same eneral format. 7f /ui--es or tests also follow the te1tbook e1amples) most stu"ents succee" brilliantly.

That all is not well) however) is apparent went problems "o not meet e1pectations. 5ne sophomore class stumble" ba"ly on a test apparently for this reason. They coul" all follow) if imitatively) the e1amples in the te1tbook) an" coul" therefore "o all the practice problems) but when the test presente" problems in an une1pecte" format) most faile"--only 2 stu"ents passe" the test. 7n their final semester before ra"uatin as RNs) a thir" faile" another test. This su ests a weak un"erstan"in of +#. 4nfortunately most stu"ents have almost) but not /uite) a complete un"erstan"in of +#. 7 believe this is "ue to the te1tbook use" 6Clinical Calculations: # unifie" approach) 0th e".9 almost) but not /uite) presentin a complete "escription of +#. 7t may be that there are too few nurseEmathematicians to write te1tbooks) an" so a weak foun"ation for +# is lai" for stu"ents to buil" on. &y aim in writin this paper is to provi"e nursin stu"ents with a more robust foun"ation to buil" on) an" perhaps re"uce future misa"ventures. 7 am not a mathematician) but 7 have been "oin +# for A8 years) have ma"e refinements in the techni/ue over that time) an" as a substitute teacher 7 have tau ht it to mi""le an" hi h school stu"ents. +imensional analysis is your frien". 'mbrace itD learn to love it. 7t is our best "efense a ainst "oin harm to a patient by miscalculation.

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# !tep by !tep *ui"e to +imensional #nalysis

The followin summary can be use" as a ui"e for "oin +#. !ome familiarity with +# is assume". While not all steps liste" below will be nee"e" to solve all problems) 7 have foun" that any problem that can be solve" usin +# will yiel" its answer if the followin steps are followe". 7 woul" not su est memori-in the se/uence of steps) but rather un"erstan"in an" practicin them. 4n"erstan"in is more "urable than memory. >. +etermine what you want to know. Rea" the problem an" i"entify what you%re bein aske" to fi ure out) e. . <how many milli rams are in a liter of solution.< a. Rephrase if necessary usin <per.< '1ample: .ou want to know <milli rams per liter.< b. Translate into <math terms< usin appropriate abbreviations to en" up with <m EF< as your answer unit 6#49. Write this "own) e. . <#4G m EF< 2. +etermine what you alrea"y know. a. What are you iven by the problem) if anythin = '1ample: <7n one minute) you counte" 05 "rops.<

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Rephrase if necessary. Think: <+rip rate is 05 "rops per minute.< Translate into math terms usin abbreviations) e. . <05 ttEmin<

7f a iven is in the form m Ek E"ay) rewrite as m Ek 1 "ay 7f a percenta e is iven) e. . 25@) rewrite as 25E>88 with appropriate labels

a. +etermine conversion factors that may be nee"e" an" write them in a form you can use) such as <B8 minE> hour.< .ou will nee" enou h to form a <bri" e< to your answer unit6s9.
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3actors known from memory: .ou may know that > k G 2.2 lb) so write "own <> k E2.2 lb< an"Eor <2.2 lbE> k < as conversion factors you may nee". 3actors from a conversion table: 7f the table says <to convert from lb to k multiply by 2.2)< then write "own <2.2 lbE> k <

!etup the problem usin only what you nee" to know. a. 2ick a startin factor.
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7f possible) pick from what you know a factor havin one of the units that%s also in your answer unit an" that%s in the ri ht place. 5r pick a factor that is iven) such as what the physician or"ere". Note that the startin factor will always have at least one unit not in the "esire" answer unit6s9 that will nee" to be chan e" by cancelin it out.

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a. 2ick from what you know a conversion factor that cancels out a unit in the startin factor that you "on%t want. b. $eep pickin from what you know factors that cancel out units you "on%t want until you en" up with only the units 6answer units9 you "o want. c. 7f you can%t et to what you want) try pickin a "ifferent startin factor) or checkin for a nee"e" conversion factor. ". 7f an interme"iate result must be roun"e" to a whole number) such as "ropsE"ose which can only be a"ministere" in whole "rops) setup as a separate sub-problem) solve) then use the roun"e" off answer as a new startin factor.

!olve: &ake sure all the units other than the answer units cancel out) then "o the math. a. !implify the numbers by cancellation. 7f the same number is on the top an" bottom) cancel them out. b. &ultiply all the top numbers to ether) an" then "ivi"e into that number all the bottom numbers. c. +ouble check to make sure you "i"n%t press a wron calculator key by "ivi"in the first top number by the first bottom number) alternatin until finishe") then comparin the answer to the first one. &iskeyin is a si nificant source of error) so always "ouble check. ". Roun" off the calculate" answer.
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(e realistic. 7f you roun" off ?0.?AAAAA to ?0.?A mF that implies that all measurements were of an e1treme accuracy an" that the answer is known to fall between ?0.?25 an" ?0.?A5) or ?0.?A H 8.885 mF. # more realistic answer woul" probably be ?0.? mF or ?5 mF. 7f you roun" to a whole number that implies a reater accuracy than is appropriate) write your answer to in"icate a ran e) such as ?5 H 5 mF.

a. #"" labels 6the answer unit9 to the appropriately roun"e" number to et your answer. Compare units in answer to answer units recor"e" from first step. Take a few secon"s an" ask yourself if the answer you came up with makes sense. 7f it "oesn%t) start over. This is a fairly bare outline) so refer to #ppen"i1 # for e1amples. The steps are best taught) rather than read) an" so woul" serve better as a ui"e to tutorin stu"ents than as a selfteachin ui"e. *o to top

,ow to &inimi-e &istakes

#nythin we can "o to re"uce errors by even the smallest "e ree is worth "oin . ,ow we choose to write "own a +# problem) for e1ample) can make a "ifference. !houl" we Cust keep the answer unit in min") circle it in the problem) or actually write it "own= #t best we will hit what we aim for) so we must be very clear about what we want) about the answer unit6s9 we are aimin for. Rea"in the problem with the sole) focuse" purpose of "eterminin the answer unit) then writin it "own 6least we for et or et confuse" later on9 is an e1ample of oo" techni/ue.

.ou can be sloppy an" still et the ri ht answers most of the time) but eventually you%ll blun"er because of poor techni/ue. .ou%ll triumphantly) like me) write "own <0.A mFEmin< as your answer for ettin that you were suppose" to calculate <mFEhr< an" all because you ne lecte" to write "own the answer units an" compare them with your answer. +# problems are often written in fraction form) even thou h they are factors an" shoul"n%t be confuse" with fractions. 3ractions cannot be inverte" an" remain correct) 2EA is not e/ual to AE2) while factors can be 6A tspE> tbs is e/uivalent to sayin > tbsEA tsp.

When it comes time to "o the math) the first number can be overlooke") especially if you%re usin scratch paper with other problems on it) perhaps because it is visually "ifferent an" not in line with other values. #n error of omission is less likely usin the followin nonfraction format:

This format is more visually inte rate") more bri" e like) an" is more appropriate for workin with factors. 7t is also less confusin when "oin amounts-per-bo"y-wei ht-per"ose or "ay calculations. 7n this format) the hori-ontal bar means <"ivi"e)< an" vertical bars mean <multiply.< 5ccasionally a factor like <58 k < will nee" to be "ivi"e" rather than multiplie" which coul" cause confusion or errors when "oin the math if the "ivision si n is not notice" when written in fraction form.

!ince the first factor is normally multiplie") stu"ents mi ht stumble if "ivision is re/uire" an" "ivi"e everythin into 58) an error) instea" of multiplyin 2581581>888) then "ivi"in by 58 an" 588. When written in factor form usin bars) mistakes an" confusion are minimi-e":

This is) then) another reason to avoi" the fraction format. 2erhaps with the e1ception of conversion factors you have memori-e") it is a"visable to actually write "own) in <math terms< or factor form anythin iven to you by the problem as well as any conversion factors you ha" to look up. 5ften the har"est part of a problem is translatin fu--y 'n lish phrasin into crisp math terms you can use.

4se abbreviations that are clear an" label numbers fully. 4sin a "e ree symbol for hour instea" of <hr< is an invitation to error. 7f the "e ree symbol is written a little too bi it coul" be mistaken for a -ero resultin in an or"er of ma nitu"e error. When "oin the math) the brain is lookin for numbers an" coul" see <>8< where a <>< is meant:

#nother abbreviation to avoi" is usin &u () for micro as in micro ram 6 9. When han"written) < < can look like an <m< an" so < < looks like <m < which coul" lea" to a three or"ers of ma nitu"e error. The preferre" abbreviation) then) is <mc< for <micro< as in <mc < for <micro ram.< 7f you were "oin calculations involvin milliliter volumes of three solutions) #) () an" C) then "o not use <mF< alone without specifyin <mF of what=< .our labels) then) woul" be in the form <2A mF #< or <A mF C< an" you woul" know to only cancel out <mF (< with <mF (.< Whenever you label any number with a unit of measure) always be aware that you are "ealin with rams of something or liters of something) an" so on. 7t may therefore be helpful to label fully rather than minimally. Writin <25 mF N!< is much clearer than Cust <25 mF.< 7n some problems) failure to fully label numbers can lea" to serious confusion an" error.

Conclusions
'rrors may be unavoi"able in absolute terms) but we can minimi-e the number of errors we make. # oo" un"erstan"in of "imensional analysis is our best "efense a ainst miscalculation errors. With practice all nursin stu"ents can ac/uire a hi h level of proficiency in "oin me"ication math.

R. 'ric Fee) RN busybeeIalysion.or

References
7nstitute of &e"icine 62888) To Err Is Human: Building a Safer Health System National #ca"emy 2ress. #vailable online: http:EEwww0.nas.e"uEnews.nsfEisbnE8A8:8B;A?>= 5pen+ocument

2epper) *inette #. 628829 Errors in drug administration by nurses from 4n"erstan"in an" 2reventin +ru &isa"ventures Conference. #vailable online: http:EEwww.ashp.or EpublicEproa"Eme"errorEpep.html Thomas &RD ,o/uist CD 2hillips J. 65ct. >) 288>9 Med error reports to FDA sho a mi!ed bag" +ru TopicsD >056>:9D 2A. #vailable online: http:EEwww.f"a. ovEc"erE"ru E&e"'rrorsEmi1e".p"f *o to top

&e"&ath 2ractice 2roblems for Nursin !tu"ents

The followin problems will test your math ability without wastin your time with repetitive problems. 'ach problem is a mini-test of some important concept. 7f you miss any /uestion) review the un"erlyin concept. 7f you et them all ri ht) ask if you can take the final. *eneral &ath Which of the followin statements are True= >. 28E0; G 5E>2 2. >BE5 G A >E5 A. > ?E; G >5E; 0. 2EA H AE0 G >:E>2 5. 5E: H 2EA G > 2E: B. >8 >E5 - B AE5 G A AE5 ?. ? >E; 1 AE0 G 5 >>EA2 ;. 5E; >E>B G >8 :. A5@ G 8.A5 >8. 1iv G >0 !ee #nswers

+imensional #nalysis 2roblems 6see Conversion 3actors for Nursin !tu"ents9

>. Just as a warm up) how many secon"s are in a "ay=

2. .ou are to ive < r 5 3e!50< but the available bottle ives only the milli rams of iron sulfate per tablet 6A25 m Etab9. ,ow many milli rams is the or"er for= 6.es) this an" several of the other problems are ones 7%ve actually encountere" in my nursin practice.9

A. .ou Cust opene" a 588-mF bottle of uaifenesin an" will be ivin > tablespoon per "ose. ,ow many "oses are in the bottle= 7n other wor"s how many tablespoons are in 588 mF=

0. .ou ive your home health patient an unopene" 588-mF bottle of uaifenesin an" tell them to take 2 teaspoons 0 times a "ay as or"ere". They ask you how lon the bottle will last.

5. .our or"er is for meperi"ine 6+emerol9 A5 m ) 7&) !T#T. #vailable is a 2-mF vial containin 58 m EmF meperi"ine. 5n han" are > cc an" A cc syrin es. ,ow much shoul" you "raw up into which syrin e=

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B. .ou are sha"owin a nurse "urin a clinical who receives an or"er to a"Cust the infusion rate of a pump so that >.B m of li"ocaine are bein "elivere" per minute. ,an in is a >88 cc pi yback containin 8.0 rams li"ocaine) a 8.0@ solution. Without writin anythin "own) the nurse tries to solve the problem on a calculator. #fter the fifth "ifferent an" incorrect answer you fin" a piece of scratch paper an" offer to show her how to set up the problem. !he assures you she can always "o problems like this on tests) but a"mits that at the moment her brain "oesn%t seem to be workin . ,ow woul" you set up an" e1plain the problem to her=

?. 5n your first "ay of clinicals at a lon -term care facility you are carin for a resi"ent receivin total enteral fee"in throu h a 2'* tube. ,e is receivin B8 mF Jevity per hour as or"ere" when the pump fails an" no other pumps are available. ,is over-e1ten"e" re ular nurse han s "rip tubin ) a"Custs the "rip rate to somethin that <looks about ri ht)< an" rushes on to her ne1t "eman". .ou "eci"e to a"Cust the "rip rate accurately to ive the or"ere" amount. What "o you nee" to know to "o so=

;. .our hospice patient is on a "ouble pump. 5ne si"e is runnin N! at A8 ccEhr $K5) an" the other has a >88 cc ba containin 2 m morphine sulfate 6&!9 runnin at 5 ccEhr for pain mana ement. !he be ins to show si ns of breakthrou h pain an" her "octor or"ers 8.2 m &! !T#T. .ou woul" normally use a prefille" syrin e containin > m E> mF &! an" ive 8.2 mF 7K push) but on lookin in the narcotic cabinet you fin" none available an" the pharmacy is close". 7t occurs to you that you coul" reset the pump to "eliver 8.2 m &! in 5 minutes) then o back to 5 mFEhr. #t what rate shoul" you set the pump=

:. # te1tbook on clinical calculations inclu"es the followin conversion for househol" to metric: > teaspoon G 5 mF G 5 . #s a home health nurse you nee" to help a client make homema"e pe"iatric electrolyte solution usin the followin recipe: > F boile" water) A8 su ar) >.5 salt) 2.5 lite salt 6$Cl9) 2.5 bakin so"a. !ince only kitchen measurin cups

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an" spoons are available you nee" to convert from metric. The answer) accor"in to the te1tbook) is > /t boile" water) 2 tbsp su ar) >E0 tsp salt) >E2 tsp lite salt) an" >E2 tsp bakin so"a. What /uestionable assumption "oes the te1tbook make=

>8. 7n another te1tbook you are iven the followin e1ample: The or"er is for Chloromycetin A88 m 7K bolus via saline lock. Fabel: Chloromycetin > . +irections: Reconstitute with >8 mF sterile water for inCection to yiel" >88 m EmF. ,ow may mF of Chloromycetin shoul" be a"ministere"= '/uivalents: > G >8 mF) >888 m G > A88 m 1 > >888 m 1 >8 mF G A mF >

While the answer <A< happens to be ri ht) the set up is not. What error "i" the te1tbook make=

>>. ,ow woul" you prepare 2 F of A@ so"ium hypochlorite 6bleach9 an" water solution= .ou have only a measurin cup.

>2. 7n a home settin ) how woul" you prepare > F 6or so9 of normal saline 68.:@ NaCl9 usin water an" table salt if you have only a measurin cup an" a teaspoon= 5n han" is an unopene" > lb bo1 of salt.

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>A. .ou have an or"er to infuse >888 mF of +5W 65@ +e1trose in water9 7K over a perio" of 5 hr. No pump is available) but the tubin set packa e notes that the "rop factor is >8 ttEmF. ,ow woul" you a"Cust the "rip rate=

>0. The or"er is for meperi"ine B8 m an" atropine r >E>58) 7&. The meperi"ine on han" is >88 m EmF an" the atropine is 8.0 m EmF. The two are compatible so you plan to "raw up both in the same syrin e. ,ow much of each will you "raw up=

>5. Ta amet is or"ere" 288 m ) 7K) /Bh. #vailable is Ta amet A88 m in a 2 mF vial of a/ueous solution. .ou are to "ilute a portion of this in >88 mF N! an" infuse over 28 minutes usin a (uretrol with a "rop factor of B8 ttEmF. ,ow much Ta amet will you inCect into the (uretrol) an" what will the "rip rate be=

>B. The or"er is for amo1icillin B8 m ) po) ti" for a chil" wei hin >A lb. The pe"iatric "osa e ran e is 28-08 m Ek E"ay in three e/ual "oses. 7s the "ose safe=

>?. # chil" with severe poison ivy wei hs 25 k an" (ena"ryl po 5 m Ek E"ay is or"ere" /Bh. (ena"ryl is available as a >2.5 m E5 mF solution. What "ose shoul" be iven=

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>;. .ou are to infuse heparin 25888 4 in 258 mF N! at >8.B mFEhr. What is the concentration of heparin solution= When you clear the pump you note that B? mF have been infuse". ,ow much heparin has been iven=

>:. .our patient wei hs >0A lb) an" you are or"ere" to infuse 258 m "obutamine in 588 mF N! at >8 mc Ek Emin. ,ow many milli rams of "obutamine will infuse per hour=

28. 2henobarbital >;8 m Em2E20 hours iven every ei ht hours is or"ere" for a chil" whose (!# 6bo"y surface area9 is 8.2: m2. ,ow much will each "ose be=

2>. .ou are to ive Fi"ocaine A8 mc Ek Emin to a chil" wei hin 55 lb. The pi yback contains >28 m Fi"ocaine in >88 mF N!. #t hat rate will you set the pump=

22. Nipri"e is or"ere" an" you are to titrate to maintain the systolic bloo" pressure at >58 mm , . #vailable is Nipri"e 58 m E258 mF. The ran e is A-B mc Ek Emin. # micro"rip chamber 6B8 ttEmF9 is use" with a pump. .our patient wei hs >55 lb.

What is the concentration of the solution in mc EmF=

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,ow many mc Emin) lower an" upper ran e) coul" be a"ministere"=

Within what ran e will the pump rate be set=

What is the titration factor in mc E tt=

The patient%s systolic (2 is currently >?8 mm , while receivin the low ran e "ose. 7f you increase the ttEmin by 5 tt) how many mc Emin will the patient be receivin =

#fter > hr) the systolic bloo" pressure is >28 mm , ) so you "ecrease the ttEmin by B tt. ,ow many mc Emin is the patient now receivin =

2A. ,ow woul" you prepare 588 mF of a >:A5 bleach solution from a >:>8 bleach solution usin water=

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20. +r. $issoff) wishin to test your perspicacity) or"ers >.: milliscruples of &orphine 7K for each stone of bo"y wei ht to be a"ministere" over a A88-minute perio". #vailable is > ill of &orphine 6&!9 solution havin a concentration of 8.0 pennywei hts of &orphine "issolve" in >888 "rachms of solution. The patient wei hs ?: kilo rams. #t what rate shoul" you set the pump= .our "ru ui"e says that 8.; to >8 m of morphine can be iven per hour. 7s the or"ere" "ose safe= 6.es) all the units of measure are real) if sel"om use") but the point is you "on%t even have to know what the units are) Cust how to et from what you are iven to what you want to know. !ee the lon list of Conversion factors for clues) then use the (ack button on your browser to return.9

25. .ou have come "own with a ba" case of the eebies) but fortunately your ran"mother has a sure cure. !he ives you an eye"ropper bottle labele": Take > "rop per >5 lb of bo"y wei ht per "ose four times a "ay until the eebies are one. Contains r ; heebie bark per "r >88 solvent. B8 "ropsG> tsp. .ou wei h >2; lb) an" the 0-o- bottle is half-full. .ou test the eye"ropper an" fin" there are actually B0 "rops in a teaspoon. .ou are oin on a three-week trip an" are "eeply concerne" that you mi ht run out of ranny%s eebie tonic. +o you nee" to see her before leavin to et a refill=

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#bbreviations for Nursin !tu"ents

4nits of &easure c G cup cc G cubic centimeters cm G centimeters "r G "rams "ss G 2 teaspoons fl G flui" ft G foot G rams al G allon l G lass r G rains t G "rop tt G "rops in G inches k G kilo rams F G liters lb G poun" m G meters mc G micro rams m'/ G milli/uivalents m G milli rams mF G milliliters mm G millimeters o- G ounce pt G pint /t G /uart tbsp G tablespoons tsp G teaspoons 4 G unit 5ther #bbreviations a G before 6ante9 #(* G arterial bloo" as #(T G antibiotic therapy ac G before meals 6ante cibum9 #+ G ri ht ear 6auricula "e1ter9 #+, G anti"iuretic hormone a" lib G as "esire" #+# G #merican +iabetes #ss. am G before noon 6ante meri"ian9 #&# G a ainst me"ical a"vice a/ G water #! G left ear 6auricula sinister9 #4 G both ears 6auriculi utro9

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bi" G twice a "ay 68:88) >?889 (2 G bloo" pressure (4N G bloo" urine nitro en c G with cap G capsule C#+ G coronary artery "isease C#T G computeri-e" a1ial tomo raphy C(C G complete blo" count C3 G cystic fibrosis C,3 G con estive heart failure CN! G central nervous system C5 G car"iac output C52+ G chronic obstructive pulmonary "isease C2$ G creatinine phosphokinase C!3 G cerebrospinal flui" CK# G cerebrovascular acci"ent CK2 G central venous pressure 'C G enteric coate" 'C* G electrocar"io ram ''* G electroencephalo ram eli1 G eli1ir e1t G e1tract *3R lomerulofiltration rate *T G astrostomy h G hour hct G hematocrit h b G hemo lobin hs G hour of sleep) be"time 62>889 7+ G intra"ermal 7C2 G intracranial pressure 7& G intramuscular 7K G intravenous 7K2 G intravenous pushEpyelo ram 7K2( G intravenous pi yback $K5 G keep vein open &7 G myocar"ial infarction N* G naso astric NJ G nasoCeCunal N25 G nothin by mouth N! G normal saline 5+ G ri ht eye 6oculus "e1ter9 oint G ointment 5TC G over the counter 5! G left eye 6oculus sinister9 54 G both eyes 6oculo utro9 p G after 6post9 pc G after meals 6post cibum9 per G by pm G after noon 6post meri"ian9 po G by mouth 6per os9 pr G per rectal prn G whenever necessary 2T G prothrombin time 2TT G partial prothrombin time / G every />h G every > hour

18
/2h G every 2 hours /Ah G every A hours /0h G every 0 hours 68:88) >A88) >?88)...85889 /Bh G every B hours 62088) 8B88) >288) >;889 /;h G every ; hours 68B88) >088) 22889 /" G every "ay 68:889 /h G every hour /i" G four times a "ay 68:88) >A88) >?88) 2>889 /o" G every other "ay /s G /uantity sufficient R(C G re" bloo" count R5& G ran e of motion s G without sc G subcutaneous sl G sublin ual sol G solution s/ G subcutaneous !R G sustaine" release ss G one half !E! G si ns an" symptoms stat G imme"iately supp G suppository susp G suspension syr G syrup tab G tablet ti" G three times a "ay 68:88) >A88) >?889 T5 G telephone or"er tr G tincture un G ointment 4T7 G urinary tract infection K5 G verbal or"er K! G vital si ns W(C G white bloo" count WNF G within normal limits

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Conversion 3actors for Nursin !tu"ents

!hort list
> cup 6c9 G ; ounces 6o-9 > "ram 6"r9 G B8 rains 6 r9 > "ram 6fl "r9 G B8 minims > allon 6 al9 G 0 /uarts 6/t9 > lass G ; ounces 6o-9 > rain 6 r9 G B0.; milli rams 6m 9 > ram 6 9 G >5.0A rains 6 r9 > inch 6in9 G 2.50 centimeters 6cm9 > kilo ram 6k 9 G 2.2 poun"s 6lb9 > liter 6F9 G >.85? /uarts 6/t9

19
> milliliter 6mF9 G >B.2A minims > minim G > "rop 6 t9 > ounce 6o-9 G 2 tablespoons 6tbsp9 > ounce 6o-9 G ; "rams 6"r9 > ounce 6fl o-9 G 2:.5? milliliters 6mF9 > pint 6pt9 G >B ounces 6o-9 > poun" 6lb9 G >B ounces 6o-9 > /uart 6/t9 G 8.:0B liters 6F9 > /uart 6/t9 G 2 pints 6pt9 > tablespoon 6tbsp9 G A teaspoons 6tsp9 > teacup G B ounces 6o-9 > teaspoon 6tsp9 G 0.:A mF

Fon list
> cental G 05)A5: rams 6 9 > centimeter 6cm9 G >8 millimeters 6mm9 > cubic centimeter 6cc9 G > milliliter 6mF9 > cup 6c9 G ; ounces 6o-9 > "rachm G A.55 milliliter 6mF9 > "ram 6"r9 G B8 rains 6 r9 > "ram 6fl "r9 G B8 minims > allon 6 al9 G 0 /uarts 6/t9 > ill G 0 ounces 6o-9 > lass G ; ounces 6o-9 > rain 6 r9 G B0.; milli rams 6m 9 > ram 6 9 G >)888 milli rams 6m 9 > ram 6 9 G >)888)888 micro rams 6mc 9 > ram 6 9 G >5.0A rains 6 r9 > han" G 0 inches 6in9 > inch 6in9 G 2.50 centimeters 6cm9 > kilo ram 6k 9 G >)888 rams 6 9 > kilo ram 6k 9 G 2.2 poun"s 6lb9 > liter 6F9 G >888 milliliters 6mF9 > liter 6F9 G >.85? /uarts 6/t9 > meter 6m9 G >)888 millimeters 6mm9 > meter 6m9 G >88 centimeters 6cm9 > milli ram 6m 9 G >)888 micro rams 6mc 9 > milliliter 6mF9 G > cubic centimeter 6cc9 > milliliter 6mF9 G >5 "rops 6 t9 > milliliter 6mF9 G >B.2A minims > minim G > "rop 6 t9 > ounce 6fl o-9 G 2 tablespoons 6tbsp9 > ounce 6o-9 G 28 pennywei hts 6"wt9 > ounce 6o-9 G 20 scruples > ounce 6o-9 G A>.> rams 6 9 > ounce 6o-9 G 0;8 rains 6 r9 > ounce 6o-9 G ; "rams 6"r9 > ounce) flui" 6fl o-9 G 2:.5? milliliters 6mF9 > palm G A inches 6in9 > pennywei ht 6"wt9 G 20 rains 6 r9 > pint 6pt9 G >B ounces 6o-9 > pint 6pt9 G 0 ills > poun" 6lb9 G >B ounces 6o-9 > poun" 6lb9 G A58 scruples

20
> /uart 6/t9 G 8.:0B liters 6F9 > /uart 6/t9 G 2 pints 6pt9 > scruple G 28 rains 6 r9 > stone G 8.>0 centals > tablespoon 6tbsp9 G A teaspoons 6tsp9 > teacup G B ounces 6o-9 > teaspoon 6tsp9 G B8 "rops 6 tt9 > teaspoon 6tsp9 G 0.:A mF

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#ppen"i1 #

3un with +imensional #nalysis

+imensional analysis 6also known as the factor-label metho"9 is by far the most useful math trick you%ll ever learn. &aybe you%ve learne" some al ebra) but "o you ever use it= 'ver foresee usin it= 3or most people the answer is <not after the final e1am.< 3or a fraction of the effort nee"e" to learn al ebra) you too can learn <"imensional analysis.< 3irst off) however) let%s et ri" of the bi wor"s. What this is all about is Cust conversion--convertin one thin to another. This is somethin you will have occasion to "o in real life. This is seriously useful stuff. This trick is about applie" math) not about numbers in the abstract. We%re talkin about measurable stuff you can count or measure. #nythin you measure will have a number with some sort of <unit of measure< attache". # unit coul" be miles) allons) miles per secon") peas per po") or pi--a slices per person. 3irst a little test of basic math: Which of the followin statements are True= >. 28E0; G 5E>2 2. >BE5 G A >E5 A. > ?E; G >5E; 0. 2EA H AE0 G >:E>2 5. 5E: H 2EA G > 2E:

21

B. >8 >E5 - B AE5 G A AE5 ?. ? >E; 1 AE0 G 5 >>EA2 ;. 5E; >E>B G >8 :. A5@ G 8.A5 >8. 1iv G >0

#ll are true e1cept L0) which shoul" be >?E>2. 7f you misse" any) review: >. Re"ucin to lowest terms 2. Chan in an improper fraction to a mi1e" number A. Chan in a mi1e" number to an improper fraction 0. 3in"in a common "enominator 5. #""ition of fractions B. !ubtraction of fractions ?. &ultiplication of fractions ;. +ivision of fractions :. 2ercent >8. Roman numerals 6Click back button to o back to test if you are takin it9

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25 '1amples 6To take as a test first) click &e"-math 2ractice problems9

>. Ho many se#onds are in a day$ 5kay) so this is not a me"-math problem) but as an intro"uction to "imensional analysis 6+#9) it works fine. 7f you%re up to spee" in +#) skip this answer. 5therwise) what "o you "o= 3irst) as with all +# problems) "on%t panic. 7f you have no i"ea what the answer is or how to come up with an answer) that%s fine because you%re not oin to solve T,' problem. What you are oin to "o is break the problem "own into several small problems that you can solve) an" here%s how. a. #sk yourself) <What units of measure "o 7 want to know or have in the answer=< 7n this problem you want to know <secon"s in a "ay.< #fter you fi ure out what units you want to know) translate the 'n lish into &ath. &ath is a sort of shorthan" lan ua e for writin about numbers of thin s. 7f you can rephrase what you want to know usin the wor" <per)< then that%s a step in the ri ht "irection) so rephrase <secon"s in a "ay< to <secon"s per "ay.< 7n math terms) what you want to know is:

b. #sk) <What "o 7 know=< What "o you know about how <secon"s< or <"ays< relate to other units of time measure= .ou know that there are B8 secon"s in a minute. .ou also know that in > minute there are B8 secon"s. These are two ways of sayin the same thin . .ou know that there are 20 hours in a "ay 6an" in one "ay there are 20 hours9. 7f you coul" now connect <hours< an" <minutes< to ether you woul" have a sort of bri" e that woul" connect <secon"s< to <"ays< 6secon"s to minutes to hours to "ays9. The connection you nee") of course) is that there are B8 minutes in an hour 6an" in one hour there are B8 minutes9. When you have this kin" of connection between units) then you know enou h to solve the problem--but first translate what you know into math terms that you can use when solvin the problem. 7f in "oubt) write it out:

#ll of these statements) or conversion factors) are true or e/uivalent 6B8 secon"s G > minute9. #ll you nee" to "o now is pick from these statements the ones that you actually nee" for this problem) so.... c. #sk) <3rom all the factors 7 know) what "o 7 nee" to know=<

23

Remember that you want to know:

!o pick from the thin s you know a factor that has secon"s on top or "ay6s9 on the bottom. .ou coul" pick either of the followin two factors as your <startin factor:<

Write "own your startin factor 6say you pick B8 secon"s per > minute9:

Now the trick is to pick from the other thin s you know another factor that will cancel out the unit you "on%t want. .ou start with <secon"s< on top. .ou want <secon"s< on top in your answer) so for et about the secon"s--they%re okay. The problem is you have <minutes< on the bottom but you want <"ays.< .ou nee" to et ri" of the minutes. .ou cancel minutes out by pickin a factor that has minutes on top. With minutes on top an" bottom) the minutes will cancel out. !o you nee" to pick B8 minutes per > hour as the ne1t factor because it has minutes on top:

.ou now have secon"s per hour) since the minutes have cancelle" out) but you want secon"s per "ay) so you nee" to pick a factor that cancels out hours:

". !olve it. When you have cancelle" out the units you "on%t want an" are left only with the units you "o want) then you know it%s time to multiply all the top numbers to ether) an" "ivi"e by all the bottom numbers.

7n this case you Cust nee" to multiple B81B8120 to et the answer: There are ;B)088 secon"s in a "ay. ,ere%s how this problem mi ht look if it were written on a chalkboar":

24

Remember that you "on%t nee" to worry about the actual numbers until the very en". Just focus on the units. 2lu in conversion factors that cancel out the units you "on%t want until you en" up with the units you "o want. 5nly then "o you nee" to worry about "oin the arithmetic. 7f you set up the bri" e so the units work out) then) unless you push the wron button on your calculator) you W7FF et the ri ht answer every time.

2. %ou are to gi&e 'gr ( FeS)*' but the a&ailable bottle gi&es only the milligrams of iron sulfate per tablet +,-( mg.tab)" Ho many milligrams is the order for$ To et from rains to milli rams you%ll nee" a conversion factor like > r G B0.; m . 5 r 1 B0.; m G A20 m ) so you "eci"e that%s close enou h an" ive > tab. > r Roun"in to B8 m E> r) as is often "one) ives A88 m as your answer) which mi ht cause you to "oubt if you will be ivin the or"ere" "ose.

A. %ou /ust opened a (00 m1 bottle of guaifenesin and ill be gi&ing 2 tablespoon per dose" Ho many doses are in the bottle$ In other ords ho many tablespoons are in (00 m1$ 588 mF 1 > tsp 1 > tbs G AA tbs 0.:A mF A tsp Roun"in to 5 mF ives you the same answer) so roun"in to 5 mF is reasonable.

0. %ou gi&e your home health patient an unopened (00 m1 bottle of guaifenesin and tell them to ta3e - teaspoons * times a day as ordered" They as3 you ho long the bottle ill last"

25

.ou coul" ive an answer in hours or weeks) but you fi ure <"ays< is the better choice for an answer unit. .our set up:

588 mF 1 > tsp 1 > "ose 1 > "ay G >2.5 "ays) 5 mF 2 tsp 0 "oses so you tell them the bottle will last >2 "ays.

5. %our order is for meperidine +Demerol) ,( mg4 IM4 STAT" A&ailable is a - m1 &ial #ontaining (0 mg.m1 meperidine" )n hand are 2 ## and , ## syringes" Ho mu#h should you dra up into hi#h syringe$ .our answer will be in mF 6cc9) the number of milliliters that will contain A5 m meperi"ine. .ou know from the label that there is 58 m meperi"ine in > mF of meperi"ine solution. .ou reali-e you will ive less than > mF. .our set up: A5 m mep. 1 > mF mep. sol G 8.? mF mep. sol 58 m mep. or) since you know that you want <mF on top< in your answer) you coul" start with > mFE58 m : > mF 1 A5 m G 8.? mF 58 m 7f you "on%t actually write "own full labels) at least be thinkin <mF of what=< <m of what=<

B. %ou are shado ing a nurse during a #lini#al ho re#ei&es an order to ad/ust the infusion rate of a pump so that 2"5 mg of lido#aine are being deli&ered per minute" Hanging is a 200 ## piggyba#3 #ontaining 0"* grams lido#aine4 a 0"*6 solution" 7ithout riting anything do n4 the nurse tries to sol&e the problem on a #al#ulator" After the fifth different and in#orre#t ans er you find a pie#e of s#rat#h paper and offer to sho her ho to set up the problem" She assures you she #an al ays do problems li3e this on tests4 but admits that at the moment her brain doesn8t seem to be or3ing" Ho ould you set up and e!plain the problem to her$ We want to know mFEhr) which has <time< on the bottom so startin with >.B m Emin shoul" work. We now Cust have to chan e minutes to hours) an" et from m to mF.

26

>.B m F. 1 B8 min 1 >88 mF F. sol G 20.8 mF F. sol > min > hr 088 m F. hr Checkin to make sure all the units of measure) e1cept for mF an" hr) cancel out) now is the time for the calculator. Crunchin the numbers twice 6first 1 1 1 ) then 1 1 1 9 an" ettin 20.8 each time) we can now set the pump with confi"ence. ?. )n your first day of #lini#als at a long9term #are fa#ility you are #aring for a resident re#ei&ing total enteral feeding through a :E; tube" He is re#ei&ing 50 m1 <e&ity per hour as ordered hen the pump fails and no other pumps are a&ailable" His o&er9e!tended regular nurse hangs drip tubing4 ad/usts the drip rate to something that 'loo3s about right4' and rushes on to her ne!t demand" %ou de#ide to ad/ust the drip rate a##urately to gi&e the ordered amount" 7hat do you need to 3no to do so$ .ou look in the trash for the tubin packa e) but "on%t see it. .ou recall seein tubin in the supply room an" o there lookin for the same tubin as what was hun . The reason is "rop si-e varies from >8 to B8 "rops per mF. The manufacture woul" have calibrate" their "rip chamber an" put the number of "ropsEmF on the packa e) an" it is the "rop factor 6"ropsEmF9 that you nee" to know. .ou finally fin" the tubin use" an" the packa e says >2 "ropsEmF. .our answer will be in "ropsEmin) so: B8 mF 1 >2 "rops 1 > hr G >2 "rops > hr > mF B8 min min or A "rops every >5 secon"s which is easier to count. 7t turns out that <about ri ht< was about twice the or"ere" rate. ;. %our hospi#e patient is on a double pump" )ne side is running =S at ,0 ##.hr >?)4 and the other has a 200 ## bag #ontaining - mg morphine sulfate +MS) running at ( ##.hr for pain management" She begins to sho signs of brea3through pain and her do#tor orders 0"- mg MS STAT" %ou ould normally use a prefilled syringe #ontaining 2 mg.2 m1 MS and gi&e 0"m1 I? push4 but on loo3ing in the nar#oti# #abinet you find none a&ailable and the pharma#y is #losed" It o##urs to you that you #ould reset the pump to deli&er 0"- mg MS in ( minutes4 then go ba#3 to ( m1.hr" At hat rate should you set the pump$ # ain you want mFEhr) so start with mF on top: >88 mF &! sol 1 8.2 m &! 1 B8 min G >28 mF &! sol 2.8 m &! 5 min > hr hr Now that you know the rate) you nee" the volume to be infuse": >88 mF &! sol 1 8.2 m &! G >8 mF &! sol 2.8 m &!

27

Just to "ouble check) how many minutes will it take for the pump to "eliver >8 mF at >28 mFEhr= B8 min 1 > hr 1 >8 mF G 5 min > hr >28 mF

:. A te!tboo3 on #lini#al #al#ulations in#ludes the follo ing #on&ersion for household to metri#: 2 teaspoon @ ( m1 @ ( g" As a home health nurse you need to help a #lient ma3e homemade pediatri# ele#trolyte solution using the follo ing re#ipe: 2 1 boiled ater4 ,0 g sugar4 2"( g salt4 -"( g lite salt +>Al)4 -"( g ba3ing soda" Sin#e only 3it#hen measuring #ups and spoons are a&ailable you need to #on&ert from metri#" The ans er4 a##ording to the te!tboo34 is 2 Bt boiled ater4 - tbsp sugar4 2.* tsp salt4 2.- tsp lite salt4 and 2.- tsp ba3ing soda" 7hat Buestionable assumption does the te!tboo3 ma3e$ While > tsp G 5 mF is a vali" conversion factor) > tsp G 5 is vali" only when measurin water. <Teaspoon< is a measure of flui" volume an" not wei ht. !ince water has a "ensity of > 6> E> cc9) > tsp of water woul" wei h 5 rams. The "ensity of salt) however) is 2.2 Ecc 6su ar >.B) $Cl 2.8) Na,C5A 2.29) so a teaspoon woul" wei ht over twice as much) ri ht= (ut wait) these "ensities are for the soli" substances. 7n pow"ere" form they woul" wei h less. # teaspoon of salt 6"ensity >.A Ecc9 woul" wei h B.5 rams. The "ensity of ranulate" su ar is 8.? Ecc) $Cl is >.8 Ecc) an" bakin so"a is 8.; Ecc) so a teaspoon of each woul" actually wei h between A.5 Ecc an" B.5 Ecc. #ssumin 5 Etsp for each seems a bit rou h. To "o the conversions ri ht) factor in the "ensity: !u ar: A8 !alt: >.25 1 > cc 1 > mF 1 > tsp 1 > tbsp G 2.: tbsp 6not 2.8 tbsp9 8.? > cc 5 mF A tsp 1 > mF 1 > tsp G 8.2 tsp 6close to >E0 tsp9 >.A 5 mF 1 > mF 1 > tsp G 8.BA tsp 6closer to 2EA than >E29 8.; 5 mF

(akin so"a: 2.5

$Cl) with "ensity >) remains at >E2 tsp. +oes takin the "ensity into account really matter= Reali-in that "ensity is somethin to take into account matters) an" until you look up the "ensities an" factor them in you woul"n%t know if it matters or not.

>8. In another te!tboo3 you are gi&en the follo ing e!ample: )rder: Ahloromy#etin ,00 mg 2? bolus &ia saline lo#3" 1abel: Ahloromy#etin 2 g" Dire#tions: Ce#onstitute ith 20 m1 sterile ater for in/e#tion to yield 200 mg.m1" Ho may m1 of Ahloromy#etin should be administered$ EBui&alents: 2 g @ 20 m14 2000 mg @ 2 g

28

,00 mg ! 2 g ! 20 m1 @ , m1 2000 mg 2 g 7hile the ans er ',' happens to be right4 the set up is not" 7hat error did the te!tboo3 ma3e$ The set up is in error "ue to a failure to fully label units. The >8 mF is <>8 mF sterile water.< .ou have to ask) <>8 mF of what=< .our answer unit) what you want to know) is <mF Chloromycetin sol< an" not Cust <mF.< .ou can%t use <mF water< an" en" up with <mF Chlor. sol.< When you a"" >8 mF water to reconstitute you will en" up with somewhat more than >8 mF Chlor. solution. !ince you want <mF Chlor. sol< in your answer) pick a factor that has <mF Chlor. sol< in it an" in the ri ht place. .ou are iven <>88 m EmF< which shoul" be more completely written as <>88 m Chlor.EmF Chlor. sol< an" <>8 mFE < shoul" be <>8 mF waterE> Chlor.< which is /uite an unnecessary bit of information for solvin this problem) thou h the te1t incorrectly uses it. A88 m Chlor. 1 > Chlor. 1 >8 mF water G A mF water 6notM9 >888 m Chlor. > Chlor. The correct set up shoul" be: A88 m Chlor. 1 > mF Chlor. sol G A mF Chlor. sol >88 m Chlor.

>>. Ho ould you prepare - 1 of ,6 sodium hypo#hlorite +blea#h) and ater solution$ %ou ha&e only a measuring #up" 2 F sol 1 >888 mF 1 A mF bleach 1 > o- 1 > cup G >E0 cup bleach >F >88 mF sol A8 mF ; o(ut how much water= The solution is :?@ water) ri ht= 2 F sol 1 >888 mF 1 :? mF water 1 > o- 1 > cup G ;.> cups water >F >88 mF sol A8 mF ; o-

>2. In a home setting4 ho ould you prepare 2 1 +or so) of normal saline +0"D6 =aAl) using ater and table salt if you ha&e only a measuring #up and a teaspoon$ )n hand is an unopened 2 lb bo! of salt" The key is to clearly un"erstan" what 8.:@ means. !alt is measure" by wei ht) so 8.:@ means 8.: parts salt by wei ht to >88 parts salt solution 6not water9 by wei ht. 7f you knew the "ensity of ranulate" salt you coul" convert from a "esire" wei ht of salt to a volume of

29

salt. !ince you can only measure volume 6usin cup an" tsp9) you will somehow have to "etermine the "ensity of salt. .ou coul" look up the "ensity) or what if you poure" the bo1 of salt 6>B o-9 into your measurin cup= +oin so you fin" that you have a bit over >2 flui" ounces of salt. Recallin that "ensity is wei htEvolume) you fi ure the "ensity of salt at >B o-E>2.A fl o- or >.A o-Efl o-. What you want to know is the number of teaspoons per /uart. The set up follows: >2.A fl o- salt 1 8.: o- salt 1 A2 o- 1 2 tbsp 1 A tsp G > >EA tsp salt >B o- salt >88 o- salt sol > /t > fl o- > tbsp /t salt sol To make one /uart you woul" first put the salt into a measurin cup then fill to the > /uart mark.

>A. %ou ha&e an order to infuse 2000 m1 of D(7 +(6 De!trose in ater) I? o&er a period of ( hr" =o pump is a&ailable4 but the tubing set pa#3age notes that the drop fa#tor is 20 gtt.m1" Ho ould you ad/ust the drip rate$ 3irst) what "o you want to know= The flow rate in ttEmin) which are the answer units. What "o you know= .ou%re iven that there are >8 ttEmF an" that the infusion rate is >888 mFE5 hr. !ince you want tt on top an" >8 ttEmF has tt in the ri ht place) >8 ttEmF makes a perfectly oo" startin factor--from there you Cust nee" to et from mF to min. The set up then: >8 tt 1 >888 mF 1 > hr G AA tt > mF 5 hr B8 min min .ou woul"n%t want to count a full minute) so "ivi"e by A an" count for 28 secon"s. >0. The order is for meperidine 50 mg and atropine gr 2.2(04 IM" The meperidine on hand is 200 mg.m1 and the atropine is 0"* mg.m1" The t o are #ompatible so you plan to dra up both in the same syringe" Ho mu#h of ea#h ill you dra up$ 3or both you want to know mF) your answer unit. B8 m 1 > mF G 8.B mF meperi"ine >88 m > r 1 B0.; m 1 > mF G >.> mF atropine >58 > r 8.0 m >5. Tagamet is ordered -00 mg4 I?4 B5h" A&ailable is Tagamet ,00 mg in a - m1 &ial of aBueous solution" %ou are to dilute a portion of this in 200 m1 =S and infuse o&er -0 minutes using a Buretrol ith a drop fa#tor of 50 gtt.m1" Ho mu#h Tagamet ill you in/e#t into the Buretrol4 and hat ill the drip rate be$

30

.ou want to know m of Ta amet) an" ttEmin. 288 m T. 1 2 mF T. sol G >.A mF T. >88 mF N! A88 m T. >88 mF N! The "rip rate woul" be: B8 tt 1 >8>.A mF T. sol G A80 tt T. sol > mF 28 min min Can you count 5 ttEsec= Not likely) so what "o you "o= What if you a""e" a secon"ary set with a "rop factor of >2 ttEmF= >2 tt 1 >8>.A mF T. sol G B8 tt T. sol > mF 28 min min

>B. The order is for amo!i#illin 50 mg4 po4 tid for a #hild eighing 2, lb" The pediatri# dosage range is -09*0 mg.3g.day in three eBual doses" Is the dose safe$ .ou want to know m Ek E"ay for this chil". What you know is that you will ive B8 m per >A lb bo"y wei ht per "ose or B8 m E>A lbE"ose) which true but is unusable in this form) so you rewrite it as B8 m E>A lb 1 > "ose. ,ow can you "o that= Consi"er "ivi"in >E0 by 2. ,alf of one /uarter is one ei hth) but how to fi ure that: >G>1>G > G > 0 0 2 012 ; 2 +ivi"in by 2 is the same as invertin 2 to et >E2 an" multiplyin . #cceleration) to ive another e1ample) is measure" in feet per secon" per secon" or ftEsecEsec) which is e/ual to ftEsec 1 sec or ftEsec2.

B8 m 1 2.2 lb 1 A "ose G A8.5 m G A8.5 m Ek E"ay--a safe "ose. >A lb 1 > "ose > k > "ay k 1 "ay Whenever you have 1 per y per -) rearran e in the form 1EyN- an" everythin will stay strai ht. >?. A #hild ith se&ere poison i&y eighs -( 3g and Benadryl po ( mg.3g.day is ordered B5h" Benadryl is a&ailable as a 2-"( mg.( m1 solution" 7hat dose should be gi&en$ .ou want to know mFE"ose. !ince you want mF on top) start with:

31

5 mF 1 5 m 1 > "ay 1 25 k G >2.5 mF >2.5 m k 1 "ay 0 "oses "ose >;. .ou are to infuse heparin 25888 4 in 258 mF N! at >8.B mFEhr. What is the concentration of heparin solution= When you clear the pump you note that B? mF have been infuse". ,ow much heparin has been iven= .ou want to know 4nitsEmF) so nothin tricky here: 25888 4 G >88 4EmF 258 mF B? mF sol 1 >88 4 G B?88 4 mF sol >;? mF sol 1 28 4 G ?0);88 4 mF sol >:. %our patient eighs 2*, lb4 and you are ordered to infuse -(0 mg dobutamine in (00 m1 =S at 20 m#g.3g.min" Ho many milligrams of dobutamine ill infuse per hour$ .ou want to know m Ehr) which has time on the bottom. #fter convertin to >8 mc Ek 1 min you note that time is also on the bottom) so this shoul" work as a startin factor: >8 mc 1 B8 min 1 > m 1 >k 1 >0A lb G A: m k 1 min > hr >888 mc 2.2 lb hr

28. :henobarbital 2E0 mg.m-.-* hours gi&en e&ery eight hours is ordered for a #hild hose BSA +body surfa#e area) is 0"-D m-" Ho mu#h ill ea#h dose be$ .ou want to know m E"ose) so you coul" start with > "ayEA "oses or >;8 m Em 2E"ay: > "ay 1 >;8 m 1 8.2: m2 G >?.0 m A "oses m2 1 "ay "ose 2>. %ou are to gi&e 1ido#aine ,0 m#g.3g.min to a #hild eighing (( lb" The piggyba#3 #ontains 2-0 mg 1ido#aine in 200 m1 =S" At hat rate ill you set the pump$ .ou want to know mFEhr. !tartin with the patient%s wei ht usually works out: 55 lb 1 > k 1 A8 mc 1 > m 1 >88 mF 1 B8 min G A?.5 mF 2.2 lb k 1 min >888 mc >28 m > hr hr

32

22. =ipride is ordered and you are to titrate to maintain the systoli# blood pressure at 2(0 mm Hg" A&ailable is =ipride (0 mg.-(0 m1" The range is ,95 m#g.3g.min" A mi#rodrip #hamber +50 gtt.m1) is used ith a pump" %our patient eighs 2,( lb" Titration problems are Cust lon er) not more "ifficult) so rela1 an" focus on what you want to know.

What is the concentration of the solution in mc EmF=

,ere you want mc EmF) so: 58 m 1 >888 mc G 288 mc EmF 258 mF > m

,ow many mc Emin) lower an" upper ran e) coul" be a"ministere"=

A mc 1 > k 1 >A5 lb G >;0 mc low ran e k 1 min 2.2 lb min !ince the hi h ran e is twice the low) Cust multiple by 2 to et AB; mc Emin.

Within what ran e will the pump rate be set=

What%s the low an" hi h rate the pump coul" be set at in mFEhr= >;0 mc 1 B8 min 1 > mF G 55 mF low ran e) > min > hr 288 mc hr

which is also 55 ttEmin: 55 mF 1 > hr 1 B8 tt G 55 tt > hr B8 min > mF min .ou coul" plu in AB; for >;0 an" recalculate) or a ain Cust "ouble 55 to et >>8 mFEhr for the upper ran e.

What is the titration factor in mc E tt for the low ran e=

+on%t know what a titration factor is= 7t "on%t matter %cause you know you want mc E tt: >;0 mc 1 > min G A.A mc > min 55 tt tt

The patient%s systolic (2 is currently >?8 mm , while receivin the low ran e "ose. 7f you increase the ttEmin by 5 tt) how many mc Emin will the patient be receivin =

33

.ou want mc Emin an" from the above) oin from 55 to B8 ttEmin: A.A mc 1 B8 tt G >:; mc > tt > min min

#fter > hr) the systolic bloo" pressure is >28 mm , ) so you "ecrease the ttEmin by B tt. ,ow many mc Emin is the patient now receivin =

.ou a ain want mc Emin an" are oin from B8 to 50 ttEmin: A.A mc 1 50 tt G >?; mc > tt > min min 2A. Ho ould you prepare (00 m1 of a 2:,( blea#h solution from a 2:20 blea#h solution using ater$ .ou want to know how much concentrate" bleach solution 6mF c.b.9 you nee" to make the weaker solution 6mF w.b.9. >8 mF c.b. 1 > mF b. 1 588 mF w.b. G >0A mF c.b. > mF b. A5 mF w. b. To the >0A mF of concentrate" bleach solution you woul" a"" enou h water to make 588 mF >:A5 solution. 7f you fully label all amounts) you shoul" avoi" confusion.

20. Dr" >issoff4 ishing to test your perspi#a#ity4 orders 2"D millis#ruples of Morphine I? for ea#h stone of body eight to be administered o&er a ,009minute period" A&ailable is 2 gill of Morphine +MS) solution ha&ing a #on#entration of 0"* penny eights of Morphine dissol&ed in 2000 dra#hms of solution" The patient eighs FD 3ilograms" At hat rate should you set the pump$ %our drug guide says that 0"E to 20 mg of morphine #an be gi&en per hour" Is the ordered dose safe$ +%es4 all the units of measure are real4 if seldom used4 but the point is you don8t e&en ha&e to 3no hat the units are4 /ust ho to get from hat you are gi&en to hat you ant to 3no " See the long list of Aon&ersion fa#tors for #lues4 then use the Ba#3 button on your bro ser to return")

(reakin the problem "own stepwise: #s always) start by askin what "o you want to know= 7f you%ve worke" with 7K pumps you know they are pro ramme" in mFEhr) so your answer will have to be in these units of measure.

34

What "o you know= 3rom the problem you know the patient wei hs ?: k ) an" that you are to infuse 8.88>: scruples per stone per A88 minutes 6it helps to rephrase the problem usin the wor" <per<9. .ou are also tol" that there are 8.0 pennywei hts &! per >888 "rachms an" that you have a whole ill of this solution however much a ill is. .ou also know that since you nee" <hours< in your answer you will nee" to et from minutes 6A88 minutes9 to hours at some point. #n" everyone knows that in > hour there are B8 minutes an" in B8 min. there is > hr. 6or in math terms you know B8 minE> hr) an" > hrEB8 min9. The rest of what you nee" to know will have to be looke" up. +oin so you fin" that there are 0 ounces per ill) 28 rains per scruple) 20 rains per pennywei ht) an" A.55 milliliters per "rachm. Fookin up <stone< you fin" that there are 8.>0 centals per stone) which forces you to lookup <cental< where you fin" that there are 05.AB kilo rams per cental. A. !etup: What factor shoul" you start with= !ince you know that the patient%s wei ht is a "eterminin factor) you coul" start with it. 5r) since you know your answer has to be in mFEhr) you know <hours< has to be on the bottom) so B8 minE> hr woul" be a lo ical startin factor 6you woul" then Cust have to et from <min< to <mF<9. 5r) since you want <mF< on top) A.55 mFE"rachm woul" also be a lo ical startin factor. 7f you recall the Commutative Faw of &ultiplication) you reali-e you et the same answer no matter what or"er you multiply 6or "ivi"e9 your terms in) but you "eci"e to pick ?: k as your startin factor.
?: k 1 > cental 1 > stone 05.AB k 1 8.88>: scruples 1 B8 min 1 28 rains 1 > pennywei ht 1 >888 "rachms 1 A.55 mF G = mF > scruple 20 rains 8.0 pennywts > "rachm hr

8.>0 centals > stone 1 A88 min > hr

+oes everythin cancel out e1cept for <hr< an" <mF<= (in o) punch the numbers in 6correctly9 an" you ot it: A5 mFEhr. +oes the answer make sense= The flow rate is within usual limits) but is the "ose safe= *o back to step >: you%ll nee" to know m Ehr) your answer unit) an" you%ll nee" a conversion factor to et from rains to milli rams. !ince you nee" <hr< on the bottom) start with A5 mFEhr. A5 mF 1 > "rachm 1 8.0 pennywei hts 1 20 rains 1 B0.; m G B.> m > hr A.55 mF >888 "rachms > pennywei ht > rain hr The "ose is safe) but on the hi h si"e) so you%ll be monitorin your patient closely. 5h) an" since you have > ill 60 ounces9 or about >28 mF of morphine solution) are you oin to have enou h= *o fi ure. 25. %ou ha&e #ome do n ith a bad #ase of the geebies4 but fortunately your grandmother has a sure #ure" She gi&es you an eyedropper bottle labeled: Ta3e 2 drop per 2( lb of body eight per dose four times a day until the geebies are gone" Aontains gr E heebie bar3 per dr 200 sol&ent" 50 drops@2 tsp" %ou eigh 2-E lb4 and the *9oG bottle is half9full" %ou test the eyedropper and find there are a#tually 5* drops in a teaspoon" %ou are going on a three9 ee3 trip and are deeply #on#erned

35

that you might run out of granny8s geebie toni#" Do you need to see her before lea&ing to get a refill$ Now this one is a bit har" if you haven%t been payin close attention. 3irst) what "o you want to know= .ou want to know how lon the bottle will last. .ou coul" fi ure out "aysEbottle or weeksEbottle an" see if the bottle will last lon er than A weeks or 2> "ays. !o you write "own <#nswer units G "aysEbottle< What "o you know to start off with that you mi ht nee" to know= .ou write "own the followin :

.ou reali-e that if a 0-o- bottle is half-full) then there is 2 o- of tonic in it) but you coul" fi ure it out "imensionally if you wante" to:

.ou woul" then en" up with <"aysEhalf-bottle< in your answer) but it%s easier to Cust o with 2 o-Ebottle. What shoul" you use as a startin factor= .ou pick >2; lb because it%s somethin you%re iven an" startin with wei ht usually works. .ou set the problem up:

,ouston) we have a problem. .ou en"e" up with units reverse" from what you wante". .ou fi ure" out how much of the bottle you woul" use in one "ay. What to "o= .ou coul" hit the >E1 button on your calculator if it ha" one) or invert the answer by "ivi"in > by 8.800) or start over with >2; lb on the bottom. What= Can you "o that= !ure you can. .ou coul" even put >2; lb on the en" an" on the bottom) or put it in the mi""le somewhere. .ou "eci"e to start over) this time pickin a startin factor that alrea"y has <"ay< or <bottle< in the ri ht place.

36

!o) it looks like you%ll have enou h. #t some point you nee" to know how many "rops per "ose you will nee" to take) so you fi ure it out:

#s a practical matter) you can%t take ;.5AA "rops per "oseD you have to roun" off. #t this point you reali-e that when you calculate" 22.5 "aysEbottle) you were not fi urin on : "ropsE"ose. .ou "eci"e to recalculate to see if roun"in up to : makes a si nificant "ifference.

.ou note a small "ifference) but conclu"e that you have Cust enou h eebie tonic. Conclu"in that you have enou h) however) an" havin enou h may not be the same thin . The story continues: %ou lea&e on your trip and on the 2Dth day you run out of geebie /ui#e" %ou didn8t spill any4 and no one too3 any" %ou sit in a stunned stupor trying to figure out here you ent rong in your #al#ulations" .ou finally reali-e there mi ht not have been 2.8 o- of tonic in the bottle to be in with. # measurement like <half a bottle< shoul" not inspire reat certainty. .ou wish you ha" measure" the amount an" foun" that the bottle containe" 2.8 H 8.85 o- of tonic) but what you were iven) more or less) was that you ha" 2 H 8.5 o- of tonic. There coul" be anythin from >.5 to 2.5 o- in the bottle. Recalculatin usin the low an" hi h values) you fin" you ha" enou h tonic to last somewhere between >B an" 2B "ays. 7f you ha" fi ure" out the correct answer of 2> H 5 "ays the first time) you woul" have reali-e" you ha" only sli htly less than a 58E58 chance of runnin out) an" woul" have one to see *ranny for a refill.

*o to top

!ummary

+on%t panic. (reak T,' 2R5(F'& "own into small ones you C#N solve. 3i ure out what answer unit6s9 you want to en" up with. This is usually easy. Write "own) in math terms) everythin you know that relates to the problem. .ou may nee" to rea" the problem several times) rephrasin parts of it) so you can

37

translate everythin into math terms. .ou may nee" to look up a few conversion factors) but that%s inconvenient) not "ifficult.

.ou now nee" to pick a startin factor. 7f possible pick one that alrea"y has one of the units you want in the ri ht place. 5therwise start with somethin you are iven that is not a conversion factor. 2lu in conversion factors that allow you to cancel out any units you "on%t want until you are left with only the units you "o want 6your answer units9. 7f you can%t solve the problem) pick a "ifferent startin factor an" start over. +o the math an" solve it. Now "ouble-check your calculations. #sk yourself if the answer seems ri ht or reasonable. 7f not) recheck everythin .

*o to top

#ppen"i1 (
*o to top

# Criti/ue of Clinical Calculations: # unifie" approach) 0th e".

The steps for "oin "imensional analysis are iven in the te1tbook as: >. +etermine the startin factor an" answer unit. 2. 3ormulate a conversion e/uation. A. !olve the conversion e/uation. +eterminin the answer unit or units is crucialD they are not always obvious an" can be challen in to "etermine. 3or some problems) rea"in the problem correctly is the only challen e. !tu"ents nee" to be able to translate sometimes convolute" 'n lish "escriptions of a problem into clear) properly labele" factors they can later use to solve the problem. This skill is not emphasi-e" in the te1tbook. 7f the answer unit is always iven in the e1amples use") then this is because the e1amples have been contrive" to be more simple an" consistent than actual problems ten" to be. 7n some real-worl" problems no startin factor is iven) or several possible startin factors are iven with no way to "eci"e) initially) which to use. 7t is preferable) in such cases) to "etermine everythin you know that mi ht be relevant to solvin the problem) then "eci"e)

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after the answer unit is "etermine") which of the factors you know woul" make an appropriate startin factor. #ll e1amples use" throu hout the te1t use only numbers havin a sin le unit attache" for startin factors. #pparently <> hour< is an acceptable startin unit) but <258 mFEhour< is not. This is not correct as startin factors are often in the form of <somethin per somethin .< 7n"ee") some problems cannot be solve" if they have a sin le unit startin factor 6see e1ample A in #ppen"i1 #9. While many conversion factors are appro1imations) an" fraction of a percent errors are unimportant in me"ication math) >8 percent errors are a bit worrisome. '/uatin > rain with B8 milli rams when the actual e/uivalency is closer to B0.; m ) is /uestionable) as is e/uatin liters an" /uarts) or > mF to >5 minims 6actually > mF G >B.2A minims9. 7t is possible to solve a problem an" come up with answers that "iffer by as much as >8@ "epen"in on which appro1imate conversion factors you "eci"e to use. 7f H 5@ errors are acceptable) then) as an asi"e) any answer to a test /uestion that is within 5@ of the correct answer shoul" be counte" as correct. 7t is o""ly inconsistent to insist on carryin out calculations to two "ecimals) roun"in to the nearest tenth) when far reater errors can be intro"uce" by usin loose appro1imations. When) in chapter B) a problem involvin amountEbo"y wei hE"ay comes up) the solution is presente" in an unortho"o1 way. The problem 6p. 0:9 ives 25 m Ek E20 hr. When "oin "imensional analysis it is essential that all the units iven shoul" be use" an" accounte" for. 7 norin a iven unit) then pullin it out of thin air at the en" is poor techni/ue) yet this is what the te1tbook "oes. The solution is iven as:

The problem is that the correct answer units shoul" be how many mF shoul" be a"ministere" per "ay) or <mFE"ay.< 5mittin the <per "ay< part "oesn%t alter the fact that that is what you want to know--not per hour) not per "ose) but per "ay. There is actually a simple rule that applies here. 3or e1ample) when acceleration is measure" in feet per secon" per secon") it is not written as ftEsecEsec) but as ftEsec2 because ftEsecEsec is e/ual to ftEsec 1 sec. !o if you%re iven m Ek E"ay) the preferre" way to "eal with such a <triple "ecker< is to rewrite it as m Ek 1 "ay. 7n this form it can be use") all un"esire" units cancel) an" you en" up with the "esire" answer with the ri ht units attache":

7f the problem calle" for <mFE"ose< iven 0 "oses per "ay) then the solution is strai htforwar":

39

7f <"ay< were omitte") however) this problem woul" become more "ifficult to solve. The te1tbook metho" is to calculate <mF)< then "ivi"e by 0 to et <mFE"ose.< !tu"ents must remember to perform this final <critically important< step which woul" not e1ist if better techni/ue were use". #s the te1t acknowle" es) <it is easy to for et to "ivi"e the total "aily "ose into the prescribe" number of "oses) thus reatly increasin the risk of a"ministerin an over"osa e 6sic9.< 2roblems of this sort are common) an" it is unfortunate that the authors ne lect to show stu"ents how to lo ically "eal with them. The risk of confusin some stu"ents by intro"ucin a new rule can har"ly be worth the risk of error intro"uce" by teachin a flawe" techni/ue. 7n Chapter >8) pa e >;0) an e1ample is shown) as a mo"el for stu"ents to follow) to "etermine how many mc Emin must be a"ministere" to a 2>5 lb patient at A mc Ek Emin:

7n this e1ample) at least) minutes are not omitte" then a""e" at the en") an" the techni/ue is not even erroneous) but merely confusin to many stu"ents an" visually awkwar". # stu"ent mi ht try to lo ically e1ten" this techni/ue to "etermine mFEhr:

The stu"ent who notices that the answer "oesn%t make sense mi ht won"er what went wron . Woul" they reali-e that when <mc < was cancelle" that <A >Emin< was left re/uirin the use of B8 minE> hr instea" of > hrEB8 min= Tryin to e1plain how to work aroun" the poor techni/ue employe" by this e1ample only "i s a "eeper hole. The better response to stu"ent confusion woul" be to have them put a bi O mark over this section of the te1tbook an" show them a sensible way to set it up:

#nother case of flawe" techni/ue arises in Chapter >8. !tu"ents are iven problems that re/uire convertin from mFEhr to ttEmin) an" are shown conversion e/uations like the followin :

40

The problem) a ain) is that the correct answer unit is < ttEmin< an" not < tt< as it appears. The correct answer is Cust pulle" out of nowhere an" "eclare" to be <AA ttEmin.< The initial startin factor of <> min< is spurious. 7t is not a iven) an" it means absolutely nothin to say that you know <> min< or <> hour< or <> cabba e.< 7f such meanin less startin factors are simply omitte" from such e1amples) the problems are perfectly setup to yiel" the correct answers with the correct answer units. 7t seems that the pseu"o-startin factor is use" to avoi" havin a startin factor with more than one unit attache". #s mentione") however) there is no such re/uirement when "oin "imension analysis. 7n the above e1ample <:8 mFE> hr< woul" make a lo ical an" perfectly oo" startin factor. !tu"ents shoul" be tol" to Cust i nore the nonsensical <> min< an" <> hour< startin factors. 7f you were to intro"uce <> hour< as a startin factor in e1ample A in #ppen"i1 #) you woul" be committin mathematical suici"e as the problem woul" be ren"ere" unsolvable once <hour< is cancelle" out. ,ere%s an actual e1ample from chapter >8: Calculation of 7K 3low Rate When Total 7nfusion Time is !pecifie" 5r"er: >888 mF of +5W 65@ +e1trose in water9 7K to infuse over a perio" of 5 hr +rop 3actor: >8 ttEmF !tartin 3actor #nswer 4nit > min tt 6"rops9

'/uivalents: >888 mF G 5 hr) >8 tt G > mF) B8 min G > hr Conversion '/uation: > min 1 > hr 1 >888 mF 1 >8 tt G AA.A G AA tt B8 min 5 hr > mF 3low Rate: AA ttEmin

3or review) let%s o over this problem. >. There are two errors relatin to the startin factor. 5ne is proce"ural--there is no lo ical way to pick a startin factor as the first step. The other is that <> min< is a meanin less factor. 7 can meanin fully say that 7 know there are >8 "rops per mF) but it means nothin to say that 7 know <> min< in the conte1t of this problem.

41

2. The answer unit is wron . 7 want to know a rate of flow in "rops per some unit of time. Just < tt< "oesn%t cut it. A. 3actors are e1presse" as e/ualities. 7t shoul" rea" <somethin per somethin < an" not <somethin e/uals somethin < which lea"s to absur" statements like <25 m G > k < 0. (y intro"ucin a spurious startin factor the setup is in error) as is the resultant answer. The number is correct) but the answer unit is not. 5. The final statement) that the flow rate is AA ttEmin) is the only part of the e1ample that is correct) but it is lo ically "isconnecte" from everythin that prece"es it. !o) let%s see) the te1t mana es to state an incorrect answer unit) then intro"uces a spurious startin factor) which makes the setup wron ) which yiel"s AA tt for an answer) which is also wron . (ut throu h some sort of mental sli ht-of-min") they finally come up with the correct answer) which they simply "eclare to be AA ttEmin. 7s there a better way to "o this problem= 3irst ask) what "o 7 want to know= The flow rate in ttEmin) which is my answer unit) not Cust tt 6"rops9. What "o 7 know= 7%m iven that there are >8 ttEmF an" that the infusion rate is >888 mFE5 hr. !ince 7 want tt on top an" >8 ttEmF has tt in the ri ht place) >8 ttEmF makes a perfectly oo" startin factor--7 Cust nee" to et from mF to min. &y set up then: >8 tt 1 >888 mF 1 > hr G AA tt > mF 5 hr B8 min min Just omittin the <> min< from the te1tbook%s setup woul" also work. #s to what the authors mi ht be thinkin ) the only clue to their reasonin was iven in the followin para raph that prece"e" this e1ample: <7n calculatin the flow rate for drops per minute) one minute becomes the labele" value that must be converte" to an e/uivalent value: number of "rops. )ne minute) therefore) is the startin factor an" drops is the answer unit an" these) as in all "imensional analysis conversions) form an e/uivalent relationship.<

5n pa e : is the followin table: Table >-2 Conversion '/uation

42

This table reveals how the authors think about "imensional analysis. They see the startin factor as somethin ivenD there can be only one startin factorD it has only one unit associate" with it) an" it forms a special <e/uivalent relationship< with the answer unit) which) bein e/uivalent) must also have only a sin le unit associate" with it. 7n between are conversion factors that are fun"amentally "ifferent from the startin factor. #ll of these assumptions are incorrect as enerali-ations about "imensional analysis. The only e/uivalent relationship is between what is on the left si"e of the e/ual si n an" what is on the ri ht si"e. 5ne coul" speak of an e/uivalent relationship between the <numerator< an" <"enominator< of a conversion factor 62.2 lbE> k means 2.2 lb G > k 9) but otherwise there is no necessary <e/uivalent relationship< implie". There is a particular type of +# problem) the simple conversion problem) that "oes involve oin from one unit of measure to another e/uivalent measure 6such as convertin from feet to meters9. 7n this subtype of problem you have only one lo ical startin factor) which can be sai" to be e/uivalent to your answer 6>8 inches 1 2.50 cmE> inch G 25.0 cm9) but such problems shoul" not be taken as a mo"el for all +# problems) which appears to be what has happene". (y the Commutative Faw of &ultiplication) it "oesn%t matter what or"er the factors on the left si"e are multiplie" in. Therefore any factor coul" be first) an" thus be the startin factor) althou h usually only one or two factors /ualify to be thou ht of as lo ical startin factors. (oth startin factors an" answer units are often in the form of somethin per somethin . .ou coul" start with milesEhour an" en" up with secon"s in your answer) for e1ample) without any e/uivalence between startin factor an" answer unit. 7t appears that such fun"amental misun"erstan"in s un"erlie the errors in the te1tbook. 2roblems that "o not conform to their notions are torture" into compliance by intro"ucin spurious startin factors an" usin obviously incorrect answer units. 7 "on%t think it is oin too far to su est that the poor techni/ue e1hibite" by the te1tbook makes it "ifficult for stu"ents to master me"-math. 7n"ee") those who "o must "o so in spite of the te1tbook an" not because of it. *o to top

43

Recommen"e" Corrections to Clinical Calculations: # unifie" approach 60th e".9

Chapter > can be a useful supplement for stu"ents to rea") but a more complete presentation of "imensional analysis shoul" be iven without closely followin the material in this chapter. 2a e >: # *oo le search shows that only this te1tbook an" a few nursin sites associate <label factor< with "imensional analysis 6+#9. Fikewise <unit conversion< is not a synonym for +#. The only synonym commonly use" is <factor-label metho".< While this point is nit-picky) 7 woul" e1pect the authors to use the same terminolo y as everyone else by the 0th e"ition. 2a e 2: #t the bottom) <!tep 7: +eterminin the !tartin 3actor an" #nswer 4nit)< shoul" rea") <!tep 7: +eterminin the #nswer 4nit.< +eterminin the startin factor shoul" come after !tep 77) since the startin factor is not always iven) there can be more than one possible startin factor) an" the best startin factor to use may be one of the factors "etermine" in !tep 77. 2ickin a startin factor from what you are iven or know is the first step of !tep 777--settin upEsolvin the conversion e/uation. 2a e 0: 7n the bo1 is the statement: <When the conversion e/uation is solve") it will be seen that the startin factor an" the labele" answer have forme" an e/uivalent relationship.< The belief that this is true lea"s to serious error an" confusion in Chapter >8. 7f true) the collorilary woul" be that if the startin factor has one unit of measure associate" with it) then the answer unit can have only one unit of measure associate" with it an" &i#e &ersa. 2a e ?: 'mphasi-e that several of the e/uivalents in the table are fairly rou h appro1imations. *ive the actual e/uivalents--some stu"ents will want to know. #lso) if the value of an e/uivalent can be 5@ off) then) to be consistent) any test answer that is within H5@ of the correct value shoul" be counte" correct. 7n some 6unlikely9 cases answers coul" be as much as >8@ off when several appro1imate e/uivalents are use" to compoun" the error. 2a e 0:: 7n the e1ample at the bottom of the pa e you are iven 25 m Ek E20-hr 6or "ay9. The thir" unit iven shoul" not be "roppe". There is a way to "eal with problems of this type 625 m Ek E"ay G 25 m Ek -"ay9 that can be consistently applie" to all problems of this type. Triple unit factors are common an" the "ifficulty they pose shoul" be "ealt with hea" on. #ll the various ad ho# attempts to et aroun" these problems result in en"less trouble in the lon run. 7n this e1ample the answer unit is iven as <mF)< whereas the correct answer unit is <mFE"ay.< The problem shoul" be setup as:

44

Whatever initial "ifficulty this techni/ue may present for stu"ents not alrea"y familiar with it) it is still the techni/ue of choice an" will save a lot of rief later on. !ome of the techni/ues contrive" to "eal with these problems work on some problems) but not others. The techni/ue use" above has the virtue of workin with all problems involvin triple unit factors. 2a e 58: 7n the two e1amples on this pa e the #nswer 4nit is incorrectly iven as <cap< whereas <capE"ose< is what is really "esire". 7n the first e1ample) you are iven 58 m Ek E"ay an" 0 "osesE"ay) but not knowin what to "o with <m Ek E"ay< the problem is broken into two problems. The <"ay< is initially i nore") then brou ht back in the secon" part of the problem) thus pavin the way for confusion an" error. The lo ically consistent one-step setup woul" be:

3or the secon" e1ample the setup shoul" be:

7n the bo1 at the bottom on the pa e are several warnin s 6<critically important)< <easy to for et<9 that "o not apply when the problems are "one in a sin le step. 2a e >85: #voi" the two-step techni/ue) an" i nore the two e1amples at the bottom of the pa e. Work out as above. 2a e >5:: Cross out the secon" para raph: <7n calculatin the flow rate for drops per minute) one minute becomes the labele" value that must be converte" to an e/uivalent value: number of "rops. )ne minute) therefore) is the startin factor an" drops is the answer unit an" these) as in all "imensional analysis conversions) form an e/uivalent relationship.< 2a e >B8: 7 nore e1amples. 5mit the spurious <> min< !tartin 3actors. Note that #nswer 4nits are also wron 6shoul" be < ttEmin)< not Cust < tt<9. #ll that nee"s to be "one is to cross out the <> min< at the be innin of each e1ample an" a"" <Emin< to < tt< 6to et the correct answer unit9.

45

2a es >B0) >B5) an" >BB: 7 nore these e1amples as above. 2a es >??) >?;: # ain) i nore the spurious !tartin 3actors an" use the correct #nswer 4nits for the last two e1amples on pa e >??) an" e1amples 2 an" A on pa e >?;. 2a es >;0) >;5: 7 nore e1amples. #nother ad ho# variation in techni/ue is intro"uce" without comment in step > of the first e1ample. !tu"ents will et into trouble if they try to e1ten" this e1ample to other problems. #lso) what if the "esire" answer units were <mc Ehr=< Woul" stu"ents have trouble cancelin out <min< with <min< apparently on top= 2uttin <mc Emin< on top invites confusion. # better setup for step > woul" be:

3or step 2:

3or steps A an" 0) Cust omit the <> min.< an" <> tt< 2a e >;:) >:8: Cross out the meanin less !tartin 3actors in e1amples >) A) 0) 5) an" B. 7n e1ample 2) chan e <mc Emin< over <k < to <mc < over <k 1 min.< 2a e >:B: 7n '1ample a.) the setup is in error "ue to a failure to fully label units. The >8 mF is <>8 mF water.< .ou have to ask) <>8 mF of what=< .our answer unit is <mF Chloromycetin sol< an" not Cust <mF.< .ou can%t use <mF water< an" en" up with <mF Chlor. sol.< When you a"" >8 mF water to reconstitute you will en" up with somewhat more than >8 mF Chlor. solution. !ince you want <mF Chlor. sol< in your answer) pick a factor that has <mF Chlor. sol< in it an" in the ri ht place. .ou are iven <>88 m EmF< which shoul" be more completely written as <>88 m Chlor.EmF Chlor. sol< an" <>8 mFE < shoul" be <>8 mF waterE> Chlor.< which is /uite an unnecessary bit of information for solvin this problem) thou h the te1t incorrectly uses it 6an" by luck ets away with it9. The correct setup shoul" be:

2a e 285: 5mit spurious !tartin 3actors from e1ample. 2a e 228) 22>: The first e1ample asks) <,ow many mF shoul" the chil" receive per "ose=< The answer unit) therefore) shoul" be <mFE"ose< an" not <mF.< .ou are iven >5 mc Ek E"ose) so solve as shown above for e1amples on pa es 0: an" 58--likewise with the secon" e1ample on pa e 22>.

46

2a e 225: # ain) e1ample ives 58)888 4Ek E"ay an" 0 "osesE"ay) so a one-step setup woul" be:

That%s about it. The other :B@ of the te1t is okay. *o to top

Te1tbook *ui"e to +imensional #nalysis

6as compile" from various pa es throu hout the te1tbook9

+etermine the startin factorN an" answer unit. 7nitially) it is essential to "etermine e1actly what information is sou ht: the known /uantitycalle" the startin factor) an" the "esire" unit to which the startin factor will be converte") the answer unit. When the conversion e/uation is solve") it will be seen that the startin factor an" the labele" answer have forme" an e/uivalent relationship. 7n calculatin the flow rate for drops per minute +or m1 per hour) one minute 6or one hour9 becomes the labele" value that must be converte" to an e/uivalent value: number of "rops 6or mF9. )ne minute) therefore) is the startin factor an" drops is the answer unit an" these) as in all "imensional analysis conversions) form an e/uivalent relationship. 3ormulate a conversion e/uation consistin of a se/uence of labele" factors) in which successive units can be cancelle" until the "esire" answer unit is reache". 7f a iven is in the form m Ek E"ay) i nore the thir" unit) "o the conversion) then remember to factor the omitte" unit back in. 7f in the form mc Ek Emin) chan e to mc Emin over k if mc Emin is the answer unit. 7f a percenta e is iven) e. . 25@) rewrite as 25E>88 with appropriate labels. +etermine conversion factors that may be nee"e". .ou will nee" enou h to form a <bri" e< to your answer unit6s9. 4se only conversion factors that have a >:> relationship 7t is "esirable that conversion factors be arran e" in a se/uence so that i"entical units are place" "ia onally.

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7n settin up the conversion factors) it is helpful to write the "enominator first) as this contains the unit of the prece"in numerator an" facilitates cancellation of successive units. !olve the conversion e/uation by use of cancellation an" simple arithmetic. Cancel units first Re"uce numbers to lowest terms. &ultiplyE"ivi"e to solve the e/uation. Re"uce answer to lowest terms) convert to "ecimal) an"Eor roun" off. Take a few secon"s an" ask yourself if the answer you came up with makes sense. 7f it "oesn%t) start over. N The te1t in re" represents weak or erroneous techni/ue. 'rrors of omission are not in"icate".

Conclusions
This may be a case of a book bein the worst te1tbook on "imensional analysis available-with the e1ception of all the others. 7%ve hear" that it is much better than its pre"ecessor. !everal me"ication math te1tbook titles are currently available) but not havin reviewe" them) 7 can%t assume any "o a better Cob) but 7 think other titles shoul" be looke" into. There are errors of omission where stu"ents are not iven a complete enou h un"erstan"in of "imensional analysis to "o all problems that coul" crop up. There are errors of commission where stu"ents are tau ht flawe" or even erroneous techni/ue. Throu hout the te1tbook) overly simplifie" e1amples are use" that fail to show the ran e of problems that stu"ents may encounter. # wi"er ran e of problems) however) woul" have illustrate" the shortcomin s of the techni/ues as tau ht) an" may have been omitte" for that reason. 5verall) however) 7 woul" say that this book is /uite useable provi"e" its shortcomin s an" flaws are amen"e". # better roun"e") more robust presentation of "imensional analysis is "efinitely nee"e". !tu"ents shoul" not only "o well solvin test problems) but come away feelin confi"ent in their ability to han"le any problems that may come their way in the future.