During a shift in the intensive care unit, the nurse assumes care for a patient in cardiog… — NCLEX-RN

During a shift in the intensive care unit, the nurse assumes care for a patient in cardiogenic shock whose current weight is $80\text{ kg}$ . The patient has a central venous catheter infusing dobutamine at a rate of $24\text{ mL/hr}$ . The IV bag is labeled as containing $500\text{ mg}$ of dobutamine mixed in $250\text{ mL}$ of normal saline. Following a hemodynamic assessment, the critical care prescriber instructs the nurse to increase the dobutamine dosage by $2.5\text{ mcg/kg/min}$ . Calculate the new rate at which the nurse should program the infusion pump. Record your answer in $\text{mL/hr}$ as a whole number.

Cevap: 30 mL/hr

Cevap

To find the new infusion rate, first determine the concentration of the medication:

500\text{ mg}

250\text{ mL}

is equivalent to

2\text{ mg/mL}

2000\text{ mcg/mL}

. The provider ordered an increase of

2.5\text{ mcg/kg/min}

. For an

80\text{ kg}

patient, this amounts to an additional

200\text{ mcg/min}

(

2.5 \times 80

), which converts to an extra

12,000\text{ mcg/hr}

(

200 \times 60

). By dividing this hourly dose increase by the concentration (

12,000 \div 2000

), you find the pump needs to deliver an additional

6\text{ mL/hr}

. Adding this to the baseline rate of

24\text{ mL/hr}

yields the new programmed setting of

30\text{ mL/hr}

Adım Adım Çözüm

Convert the total medication mass from milligrams to micrograms and calculate the concentration per mL.

500\text{ mg} \times 1000\text{ mcg/mg} = 500,000\text{ mcg}

. Then,

500,000\text{ mcg} \div 250\text{ mL} = 2000\text{ mcg/mL}

Standardizing the concentration unit to micrograms is necessary because the ordered dosage change is measured in micrograms.

Calculate the total microgram increase required per minute based on the patient's weight.

2.5\text{ mcg/kg/min} \times 80\text{ kg} = 200\text{ mcg/min}

Weight-based dosing must be multiplied by the patient's actual weight in kilograms to determine the total required dose per minute.

Convert the microgram increase per minute to a microgram increase per hour.

200\text{ mcg/min} \times 60\text{ min/hr} = 12,000\text{ mcg/hr}

Intravenous infusion pumps are programmed in hours, so the rate per minute must be multiplied by 60 minutes.

Determine the additional fluid volume per hour needed for the increase, and add it to the current baseline rate.

12,000\text{ mcg/hr} \div 2000\text{ mcg/mL} = 6\text{ mL/hr}

increase. New rate:

24\text{ mL/hr} + 6\text{ mL/hr} = 30\text{ mL/hr}

Adding the calculated additional volume rate to the baseline rate yields the final programmed setting on the infusion pump.

Anahtar Kavram

Weight-Based Intravenous Medication Titration

Soru

Cevap

Adım Adım Çözüm

Anahtar Kavram

Sık Yapılan Hatalar

Konular

Bu konudan daha fazla soru