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Zorluk: ZorPharmacological and Parenteral Therapies

A client weighing 198 lb198\text{ lb} is receiving a continuous intravenous (IV) heparin infusion for the treatment of a deep vein thrombosis. The client's morning activated partial thromboplastin time (aPTT) is reported as 42 seconds42\text{ seconds}. According to the facility's weight-based heparin protocol, for this aPTT result, the nurse must administer an IV push bolus of 40 units/kg40\text{ units/kg} and increase the continuous infusion rate by 2 units/kg/hr2\text{ units/kg/hr}. The continuous IV infusion is currently running at 14 units/kg/hr14\text{ units/kg/hr}. The pharmacy provides a premixed heparin bag containing 25,000 units25,000\text{ units} in 250 mL250\text{ mL} of 0.9%0.9\% sodium chloride, and a separate heparin vial containing 1,000 units/mL1,000\text{ units/mL} for the bolus dose.

After administering the required bolus, at what rate in mL/hr\text{mL/hr} should the nurse set the IV pump for the new continuous infusion? (Record your answer to the nearest tenth.)

Cevap: 14.4 mL/hr

Cevap

14.4
To find the correct continuous infusion rate, the nurse must first convert the client's weight to kilograms (198÷2.2=90 kg198 \div 2.2 = 90\text{ kg}). Next, determine the new infusion rate by adding the 2 units/kg/hr2\text{ units/kg/hr} protocol increase to the current 14 units/kg/hr14\text{ units/kg/hr} rate, resulting in 16 units/kg/hr16\text{ units/kg/hr}. Multiply this rate by the client's weight to find the total hourly dose (16×90=1440 units/hr16 \times 90 = 1440\text{ units/hr}). Finally, calculate the required volume from the continuous infusion bag (which has a concentration of 100 units/mL100\text{ units/mL}) by dividing the hourly dose by the concentration (1440÷100=14.4 mL/hr1440 \div 100 = 14.4\text{ mL/hr}).

Adım Adım Çözüm

1
Convert the client's weight from pounds to kilograms.
90 kg90\text{ kg}
Medication dosing in the protocol is weight-based in kg (198÷2.2=90198 \div 2.2 = 90).
2
Determine the new prescribed continuous infusion rate.
16 units/kg/hr16\text{ units/kg/hr}
The protocol requires adding 2 units/kg/hr2\text{ units/kg/hr} to the current rate of 14 units/kg/hr14\text{ units/kg/hr}.
3
Calculate the total units per hour required.
1440 units/hr1440\text{ units/hr}
Multiply the new rate (16 units/kg/hr16\text{ units/kg/hr}) by the client's weight (90 kg90\text{ kg}).
4
Determine the concentration of the continuous heparin bag.
100 units/mL100\text{ units/mL}
Divide the total units in the bag (25,000 units25,000\text{ units}) by the total volume (250 mL250\text{ mL}).
5
Calculate the new IV pump rate in mL/hr.
14.4 mL/hr14.4\text{ mL/hr}
Divide the hourly unit requirement (1440 units/hr1440\text{ units/hr}) by the bag concentration (100 units/mL100\text{ units/mL}).

Anahtar Kavram

Weight-Based Intravenous Medication Titration
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