IV Therapy Concepts and Calculations

okay so today we're going to go over IV therapy and calculations um for the first half of chapter 25 okay so this is just a copy of your SLO so by the end of this uh lecture you will hopefully be able to calculate um an IV fluids using the pumps using the gravity and drop Factor um and the calculations for IV push you also to formulate nursing care therapy for patients receiving IV Therapy um so this mean what does that mean so you're able to use the nursing process to implement IV therapy so what do you do before what do you do during what do you do after who needs what why do they need it things like that okay all right so osity um tonicity and the movement of fluid so osmolality is a concentration of the osmotic solution um think of it like your cup of coffee okay with the awful coffee grounds okay so the osmolality is how many solutes which or coffee grounds there are in your cup of coffee okay so we're going to measure it dependent on the number of dissolved solutes in one kilogram or one liter of fluid it doesn't matter what fluid it is it can be blood it can be urine it can be CSF it can be gastric fluid you can measure the osity of anything okay so what are we measuring though is how many solutes so the solutes could be sodium it could be glucose it could be Ura okay which is found in urine so we're measuring how much how many solutions are in that um the bag of fluid or the cup of fluid um so changes in osal can cause water to move to different compartments we know that right we've all had biology when we did the Biology experiment where you had a very big or we've all cooked you had a big pot of water you add a bunch of salt you add your potatoes and all the salt goes in the potatoes right so the changes when you added the salt when you added the potatoes you Chang the osmolality so it had to become equal so that's called the osmosis the movement of water and solutes across membranes to make it equal on both sides okay tonicity is a relative concentration of IV fluids so how many Sal it's just how you um measure the IV fluids normal saline LR half normal saline those kinds of things okay it's not a precise measurement so osmosis is the movement of water from an area of low osmolality to an area of high osmolality okay hypertonic moves uh from intertial space to plasma okay so we're pulling it from wherever extra it is to the blood volume so we can get it out okay so we have lots of Edema okay we're pulling it in to push it out all right hypotonic is the um when water moves from the plasma to the interstitial space so now I have too much in the in my blood or my blood vessels and I need to move it out okay and then isotonic causes no shift so as we know your kidneys do most of the fluid um regulation okay through the Rin angens and ostero system through the aldosterone system through the ADH okay or anti-diuretic hormone that's am this is just your review okay so someone who has fluid balance someone in fluid volume deficit what causes it usually dehydration or shock or Hemorrhage or things like that okay how do you treat it if they're awake you can give them oral fluids but if they're not or if they're very severely dehydrated we use IB fluids if someone has excess fluid how do we get the fluid out we get it throughout through diuretics okay so crystalloids versus colloids um so both of these replace fluid and electrolytes um whether it's from a loss of water and electrolytes through vomiting diarrhea laxatives Burns precipitation Hemorrhage so like your minor losses vomiting your diarrhea excess suctioning your extreme um water and electrolyte losses are the precipitation burns the leading out into your abdomen things like that okay hemorrhaging excessive diuresis so my sugar is too high or I have sadh okay which is Sy syndrome of inappropriate antidiuretic hormone so I'm peeing way too much okay crystalloids so crystalloids are iy solutions with electrolytes that can um that are capable of leaving the plasma and moving to the interstitial spaces so um or in an intracellular fluid so it has all of the solutes that are in the those um Solutions are small enough to be able to move okay they're used to replace fluid and promote your output um and they become and they have isotonic hypertonic and hypotonic um and then we have what are those isotonic so like we said it expands the circulating intravascular fluid volume without causing the shift okay so it's used for hydration um and to expand um extracellular fluid so we need more in our plasma and we want it to not move we want it to stay there so we want isotonic okay we don't want it going in into the interstitial space we want it to stay in our blood vessels so that's why we use isotonic hypertonic expl expands plasma volume by pulling it from somewhere okay so isotonic just gives you what you need hypertonic pulls the excess that you have okay so think about the potato and the salt okay right so they pull all the water inside the potato because it's got all this extra on the the outside and it's trying to make it even on both sides so you have all this extra water whether it's through cellular edema um cerebral edema or peripheral edema and it's pulling it into the plasma or into the the blood vessel so that it can get out okay um so this is using water you already have it's pulling it by and that's how it expands your plasma volume um a very interesting thing is that a lot of the uh D5 um hypertonic Solutions are hypertonic but as the dextrose becomes metabolized um the solution actually becomes hypotonic uh causing the water to shift into the intracellular space and relieving the dehydration within the cells so if I had let's say I had so such bad peripheral edema or cerebral edema all the extra fluid is outside the interstitial space so I give you the D5 half normal saline which is what that is um right here I give you the D5 half normal saline so that's it's pulling the water into the plasma into the blood vessel that you have extra right so we have edema but my cells are still dehydrated so then after the dextrus is metabolized the um hypotonic solution is going to hydrate my cells okay so now we're into hypotonic so it causes water to move from the plasma I out of the plasma to the tissues and cells in the in cellular compartment so it's taking the water that you have excess water in the in the vessel and putting it either in the cell or in the tissue okay so they're not plasma expanders right they're not volume expanders they're not helping your volume because your volume's already too much so we use this for hypernia so when my sodium's super high and I want the water to move so that it can regulate or cellular dehydration okay so I want the water to go inside the cell because my cells are dehydrated and then colloids are um are solutions where the molecules or the solutes inside the uh solution are too large to pass the capillary re membrane so we call these um PL um volume expanders because they are going to stay in the plasma and then the blood vessel okay so they stay in the intravascular space and rapidly expand your plasma volume so they increase your blood volume okay they draw water um from the intracellular fluid and interstitial spaces into the plasma so remember an isoton the way this is different than isotonic okay is isotonic doesn't let anything move it all stays within the vascular and everything stays in the extra vascular in the extra in the intra it stays in the intravascular and intracellular okay this will call pull the water from everywhere else and put it in your plasma and keep it in the plasma okay so that's how they're different um an example of that is dextran 40 okay dextran 40 is an IV route U medication it's used for um uh volume expander so we use it for fluid volume replacement for hypo liic shock What is Hypo liic shock hypo low volume so I have so much uh volume loss that I'm in shock okay whether this is from dehydration Hemorrhage surgery Burns so we use that for all of those things and for the shock okay so once again it raises the osmotic blood pressure by causing fluid to move from the interstitial spaces into the intravascular um has several minute onset unknown Peak 12 24hour duration an adverse high blood pressure that's a big one right because if you're raising my osmotic pressure which is the pressure with inside the inside the vessel if you're raising that of course I'm going to have high blood pressure If you give me too much okay if the pressure in the vessel is too much my blood pressure can go up um the fluid volume overload which is a a thing we have to look for for any kind of IV Therapy okay so in this and Metabolism we have to look for fluid volume overload with everything because if we give so much too much replacement we're going to see these symptoms like tacac cardia peripheral edema distended neck veins dispena cough okay that is a sign of fluid volume overload we've given them too much and we need to back off okay and then anaphylaxis obviously you can become allergic to it um there's no specific drug- to drug interactions no food interactions um and the treatment if you have normal kidney function is to just stop stop the infusion so if you start seeing the fluid volume overload symptoms we stop the infusion and everything will as I pee it out it'll fix itself okay now if I have don't have kidneys that work properly I may need an osmotic diuretic to help okay get it out contraindications kidney injury right I have a kidney an acute kid kidney injury I shouldn't get a bunch of volume expanders because I'm not going be able to pee out what I don't need okay severe dehydration it's not going to help it's going to be it's going to make it worse we don't we don't use Dex stren for that severe heart failure if you're in heart failure you should not receive fluids especially a large amount of fluids and especially a volume expander okay so why not though if their blood pressure is low if they're dehydrated why are we not going to fix it because we're going to kill them okay so in heart failure if my heart already cannot pump what blood I have and what plasma I have okay so it's already struggling with what I got if I rapidly increase that volume my heart's going to not know what to do and it's going to stop okay you can throw them into fluid volume overload like that because their heart cannot compensate and pump the plas the volume that that you rapidly give them if we give someone fluids with heart failure we have to look out for fluid volume overload we have I mean it it'll happen like that okay when we give them fluids we go low volume very slow IV okay whereas if I was dehydrated I was in shock you could give me a liter of fluid in 10 minutes or less someone with heart failure we're not doing that we're going very slow they're only getting a 250 Bolis maybe okay we go very low volume very slow Administration cuz we don't want that they'll use something else besides volume expanders to get their blood pressure up to help their dehydration okay um also hyperic disorders it's a contraindication if I already have too much volume don't give me anymore right so there's um specific guidelines for how much and how fast you can give it if it's an emergency I'm dying I'm hemorrhaging out I'm about to the only way you're going to save me is through these volume expanders and surgery you can give it to me very fast 1.2 to 2.4 grams per minute and if it's just regular dehydration where I'm awake and I just need IV um expansion you have to give it very slow at 240 millgram per minute okay and obviously whatever is in the bag if you don't use it you got to throw it away okay that's with any IV bag they are single patient only if you don't use all of it throw it away okay we don't reuse them not for other people not for that patient if you don't use it throw it away get a new bag it's all good okay so what am I going to do for this patient I'm going to monitor Vital Signs blood pressure especially right because and T cardia because I'm looking for those fluid volume overload symptoms I'm looking for that hypertension okay I'm I'm making sure that their shock symptoms are getting better right or if they're getting worse if I'm not going fast enough if I'm going too fast okay and then obviously I'm looking for that fluid volume overload Okay so IV infusions so there's different types of infusions okay there's replacement fluids there's maintenance fluids continuous fluids intermittent fluids okay replacement fluids I threw up 500 Ms of gastric fluid so you give me a 500 milliliter back okay I had surgery and I hemorrhaged or I bled a bunch you know exactly how much I lost so you give it back okay that's replacement maintenance and continuous fluids um continuous is all the time don't stop them unless it's discontinued maintenance to me they're the same they're very similar okay it's the helps the same normal levels of fluid and electrolytes when I was on the stroke floor everyone got a normal saline 125 Ms an hour until Speech Pathology had cleared them to eat because we didn't know when they were going to be able to eat again so we had to replace their fluid and their electrolytes CU they weren't allowed to eat or drink at all until this happened so these are maintenance fluids they're continuous they're Around the Clock we don't give little boluses here and there okay intermittent intermittent IV infusions are um when you administer drugs supplemental fluids every now and then it's not all the time continuous okay so these are IB piggybacks ipv or IV push and then we have our primary versus our secondary line okay so this is what a primary line Looks like this is just a normal um IV line they have uh you have your bag you have your drip chamber you have your y site it goes to the pump and then we have our clamp and then it goes to the patient okay this is a secondary line so now I need to hang I have my normal saline going but I need to hang an antibiotic for 30 minutes it needs to go for 30 minutes so it's most of the uh secondary or piggyback lines come with a little hook we want to use the hook on the primary line because we want to use gravity to help us right something higher is going to drip faster than something lower so we're going to help the little machine out by putting this higher than that okay so we connect it to that little yite and then we set the pump to to give the the B the secondary infusion so the piggyback can be concurrent which means both of them go at the same time or it can be it can stop a give all of B and then restart a it's a very smart pump okay um the biggest deal um problem is that you have to make sure these are compatible if a and b are not compatible if my push isn't compatible if something isn't compatible with what's going I'm I can't do it okay so I've had someone have um let's say I have to give them two antibiotics right this evamy is going to take 3 hours to be given and I need a 30 minute uh ANF okay they can't be hung together I would need a whole another set I would need two of these two separate poles two separate pumps two separate IV sites okay because they're not compatible now if they were compatible we can hang them up set to go concurrent then he can get both of his antibiotics at the same time and it's done okay but if these are not compatible you cannot hang them together okay you will hurt someone you it will crystallize bad things happen Okay so before you push anything through your IV site you hang anything in your secondary line you have to check compatibility before you start before you do it okay so Ivy um medication safety check every 30 minutes to 60 Minutes on the on is it flowing is it Kink is the site looking good is it red infiltrated is the flow rate going well and make sure your pumps are plugged in if the battery dies the pumps no good it stops sometimes it never comes back on be sure they're plugged in okay um and these are just different examples of IB bags they're from your book so this is a 5% dexos infusion um there's a lot there's an expiration that the ISS she's covered up it tells you how big it is so this is a um a 1,000 ml uh bag it also counts down okay so if we've here we've had a 100 two three four 5 900 and then this is the last 100 um so this is a 50 mil bag of normal sailing there's the lot the expiration somewhere 5% dextrose and half normal staline 500 mil bag we've got our numbers over here our lot and our expiration they've just blocked them out so this um there's two sites as you've noticed um this one is used to to PR um to spike your tubing and prime your tubing with this one is for a needle Port Entry we don't use it it's not safe to to make your own bags now in an emergency we do but they don't like us to keep them hung for very long because this should be a sterile procedure and done in the pharmacy and they do it under a hood it's like a very specific process they use and it's a sterile technique and if we're making it a bedside we're not doing all of those things so it's a very um it's a higher in uh instance that we might have infected this whole bag with something okay so they don't like us to use that don't touch it keep it clean other wise that's what it's for okay and this is a bag of LR it's 250 we've got our numbers we've got our lot our expiration we've also got a brand on this I don't know if you could see it the Bron all right so gravity systems and pumps so um the size in your tubing for the drip chamber for the the hole that pulls the fluid from the bag into the drip chamber the hole is not standard so however many drops equal one milliliter is different okay so manufacturers um specify the number of drops that equal a mill for particular tubing it's found on the bag just so you know when you grab your Ivy tubing it'll tell you how many drops per per Mill and how many mills per minute it can give the it can give the infusion so we call that a drop Factor so the drop factor is how many drips per Mill M okay that's a drop Factor you have to know the drop factor to find out the flow rate right so drops per minute micro drops per minute tells me how many milliliters an hour we're going to learn how to fix figure that out okay so these are just um different manufacturers different drops okay as you know most of the micro drip sets are 60 drops per Mill all right so now we're going to go into practice of how to calculate milliliters an hour drips per minute and how to go from back and forth between both um I'm just going to be for warning I had to learn a new set of math skills to teach this um drop Factor okay so we're going to learn together okay and if you still don't understand it please email me and we will try to figure something out okay all right so flow rates they're in volume time so drips per minute milliliters per hour it's volume over time okay so first example and these are from your book um we have a a liter of fluid or a th000 milliliters that needs to go continuous IV for 24 hours how many milliliters per hour are we going to be able to set the pump to so I'm going to give you three seconds if you need time please pause it okay all right so pretty simple we just divide 1,00 by 24 okay we'll get 41.6 and we're going to round that to a whole number of 42 because you can't set the pump at a at a decimal very often all right example number two this client needs to receive a tube feeding of inure for 120 milliliters um in over 90 minutes how many milliliters per hour are we going to be able to set the pum pump all right so the way I know to do it is called dimensional analysis this is ratio over ratio proportion okay so we're going to go dimensional analysis first because that makes the most sense to me so my question is asking for milliliters per hour so I to make sure my milliliters is on top and my hours on bottom so I put my 120 milliliters on top it needs to go over 90 minutes okay 90 minutes is not a whole number for an hour so I need to do my conversion for 60 minutes is one hour my minutes cross out okay and I'm left with milliliters over hours which is what my question is asking for so that makes sure that is how I am sure that I have all the information I need if everything is crossed out that I don't need and I'm left with what the question is asking I've got it correct correct I've got it set up the right way okay and you see it's got to be the right setup too my Mill have to be on top my hour has to be on bottom so if I multiply across 120 * 60 and then I divide that by 90 I get 80 Ms an hour okay so ratio over proportion so I have my question my my answer right I have my 20 20 I'm sorry 120 milliliters over 90 minutes I need it for it to be 60 minutes okay so the same thing on top has to be on top they have to equal each other okay it's not like over here where they have be opposite these have to be on the same side so milliliters milliliters minutes minutes so I know my milliliters I know my minutes that's how that's my order okay now I don't know how many milliliters need to be in 1 hour or 60 minutes so I cross multiply so 120 * 60 is 7200 and I cross multiply over here so 90x = 7,200 then I divide by 90 to find x and x equals 80 so 80 mes an hour same there's a multiple ways and I'm sure there's a whole another way to do this okay if you still don't understand it please let me know all right so D5W has been infusing for 30 MS uh an hour IV for eight hours how many milliliters have been infused all right so I did it it the easy way I just multipli 30 * 80 and it gets 240 you set it up in the dimensional analysis way my question is asking in milliliters so I want to make sure I my Mill milliliters on top that means that's all I want everything else has to cross out so if 30 milliliters happens in one hour how many will eight Out hours because my hours will cross out and one goes on the bottom because we don't have anything under eight hours so you multiply across and it's two 40 and then you divide by 1 is still 240 so using my um ratio and proportions my milliliters have to equal so I have 30 milliliters equals x amount of milliliters because I don't know how many that's what my question's asking 1 hour and I have my 8 hours I plugged it all in correct right and then I cross multiply and divide so 30 * 8 is 240 all right so now we have uh normal saine 500 M IV at 125 an hour how long will this take all right so 500 milliliters we're looking for hours how many hours will this how long will this take in hours so I want to make sure my hours are on top I have my 1 hour over 200 125 milliliters okay my only other milliliters is this 500 over 1 1 I multiply across multiply across and then divide and that equals 4 so 500 / 125 I just divided the two and then I set it up like this to show you or you can just say 125 plus 125 plus 125 plus keep going until you figured out how many equaled 500 the other way to do this is the ratio and proportion so once again I have to make sure that everything on top and everything on bottom matches so I have my 500 Mill and my 125 millit I have my x amount of hours cuz we don't know how many and my 1 hour I cross multiply so I have 125x because we don't know what x is equals 500 and now I divide my 125 and that equals four all right the order reads for 125 milliliters of 5% dextrose and water IV for one hour what is the flow rate and micro drops once again I'm giving you a couple seconds please pause to figure this out yourself okay all right so this is 125 milliliters in one hour or 60 minutes we because we want drops for minute that just took out a whole step for us so let's just go ahead and convert it CU we know 1 hour is 60 minutes now we have micro drops per minute that's what we want right so I have my micro drops on top my minutes on bottom and my milliliters can cross out micro drops we know from the conversion earlier there are 60 micro drops in every milliliter so that's where I got this conversion from 60 micro drops are in every milliliter okay so I plugged it in my milliliters cancel out I'm left with micro drips over a minute so 125 time 60 divided by 60 is 125 so 125 Ms an hour is 125 drops per minute micro drops per minute sorry all right so now we have this new way of uh this new one okay it's called Factor converter that's what the FC stands for Factor converter so the factor converter equals 60 divided by your um drip factor okay it is always 60 on top and then drop Factor on bottom okay and that will give you your Factor converter then you have to decide if you're going to multiply or divide okay this is how they want you to remember it so if you want to if you want drops or micro drops you divide D and D if I want milliliters I multiply so I find my Factor converter and then I do whatever the question's asking okay so my Factor converter 60 divided by my drop factor which is 60 okay that equals one this one's easier so it's it's it's different but we'll get harder okay so then we take our milliliters and we're asking for drops so we're going to divide okay we take our milliliters and we divide by our Factor converter and that's how we got our drops per minute this seems kind of weird right now but when we get um a little further it'll make more sense okay all right so how many milliliters of D5 W will Infuse IV in 10 hours at a rate of 13 drops per minute if the drop factor is 15 drops per Mill once again pause if you need to all right so the dimensional analysis way I plug in all my numbers I want to know hours okay so I've somehow got to get that up top let's figure it out so I want my 10 hours on top so I have 13 drops I'm sorry we don't want to know hours we want to know milliliters my bad so 13 drops per minute 60 Minutes 1 hour 10 hours over number one 1 M over 15 so I put in all my numbers that I have and I make sure they're opposites from the conversions and then I make sure I'm left with what I'm asked for okay so my drops cancel out here my minutes cancel out here my hours cancel out here and I'm left with my milliliters which is what the question's asking for so that's how I know I got this right okay I've used all the numbers I've plugged them in appropriately I'm left with my milliliters on top that means I'm going to get my questions going to be in milliliters okay so if I multiply 13 * 16 * 10 I get 7,800 divided by 1 * 1 * 1 * 15 is 15 you get 520 milliliters this sound's a little longer right okay so we took our 10 hours but we don't know how many milliliters so that's what we're trying to figure out how many milliliters in 10 hours because we had to convert our so we had to convert our drops permanent to our milliliters per hour and then we had to figure it out time 10 hours okay so Factor converter so once again Factor con um converter 60 on top our drop Factor on bottom so our drop factor is 15 so we divide 60 by 15 and we get four okay all right now the question is asking what for milliliters so milliliters I multiply 4 times our 13 drops to get our 52 Ms an hour I know crazy you already got milliliters per hour okay so now we have milliliters per hour and we want to know how many milliliters per hour how many milliliters will have will they be given in 10 hours you could just multiply by 10 or you can do the ratio over proportion way and do 1550 milliliters is equal I'm sorry that's supposed to be an equal sign is equal to x amount of milliliters 1 hour over 10 hours you cross multiply you get x = 5 52 * 10 x = 520 get a little crazy there huh okay please let me know if you have any questions there are lots of examples in your book please use them to your advantage okay all right so an infusion of 5% dextrus and water is infusing at 20 dra I'm sorry 20 drops per minute 500 milliliters of the solution was originally in the bag and the client has received 200 milliliters okay if the drop factor is 15 drops per milliliter how many hours will it take for the remaining solution in the bag to to infuse okay so this is going to be broken down dimensional analysis so first you have to find out how many milliliters are left in the bag 500 minus um 200 is 300 okay so now we know how many milliliters we have to infuse we want to know how long it's going to take so we're looking for hours so we're going to put our hours on top our 1 hour over six is over 60 minutes because we know we have 1 hour equals 60 minutes and we have a minute up here so then we do our one minute over 20 drops so that our minutes can cross out we're going to put in our drop factor of 15 drops per ml so our drops can factor out and then we're going to putting our remaining solution our 300 Ms so our milliliters can cross out and I'm only left with this hour over here okay multiply across multiply across divide 3.75 hours all right now let's do it the factor converter way so once again we have to figure this out at the beginning for later so Factor converter is 60 over our drop Factor our drop factor is 15 it equals 4 we're looking for milliliters so we want to multiply so 4 * 20 because that's our how many drops per minute equals 80 Ms an hour okay so now we have our 80 Ms equals our 300 Ms 80 Ms over one hour how many hours is the 300 Ms going to take you cross multiply you and then you divide so we get 80x = 300 and then you divide by the 80 and you get 3.75 I kind of like this this is a lot simpler all right and then our last one is an IV push which is what you've been doing since the beginning okay so if I order for 2 milligrams I be push to be given once Ami available is morphine 4 milligrams per milliliter how many milliliters am I going to give we're going to figure it out half a mill all right you know how to do this one I don't need to explain it right okay so I put my milliliters on top because that's what my question's asking for the only other Mill have that is attached to this milliliter you can't separate them ever is this four milligrams I put my milligram on top so my milligrams can cross out I multiply across multiply across divide it's a half or my desired over half desired over half time one5 all right and that is IV calculations that was only a couple examples from your book I very much pushed that you need to do all the examples in your book so that you keep can get the practice there is going to be a practice set on your um on campus to do as well if you have any questions please put them in the discussion board please email me do the mandatory quiz it'll help all right good luck and goodbye okay so because we didn't explain what how to do desire over have I'm going to do just a little addition on the end of this to help explain it so that y'all can understand it okay so we're going to the same problems but we're going to do the desired over halfway okay so a client must receive a tube feeding eventure of 12 milliters in 90 minutes calculate the milliliters per hour so for um um desire of for have the uh equation is not for um the drop and for a lot of the things it's it's volume over time okay so when we do it we have to first figure out my computer's being really slow and I'm really sorry it's probably GNA close please don't do it please don't do it so first we have to decide um to find out how many hours because that's what the questions asking for okay so how many hours is 90 minutes so you divide 90 minutes by 60 minutes because we know that's 1 hour right and it's 1.5 hours okay so then we take our volume over our time so our 120 milliliters over our 1 and 1 half hours and you get 80 Ms an hour it's very straightforward okay all right so we're going to do another one so now we have a D5W that's been infusing at 30 MS an hour for 8 hours how many milliliters have infused it's pretty simple so you could literally count it 30 eight times or you could multiply 30 milliliters times 8 8 hours it's 240 okay it's pretty simple all right so now we have an order for uh normal saline 500 milliliters at 125 an hour how many how long will this take so once again um we're looking for how long will this take we're looking for hours okay so volume over time okay volume over time so 500 milliliters Divi um sorry it's not this is desired to over have our desired is 500 milliliters we have 125 milliliters times our 1 hour you just divide it and it's 4 hours okay or you could say 125 + 125 is is you know 250 Plus plus 125 + 125 or just you can figure it out that way too all right so now we're going to get into a little bit different okay I messed up on this but that's okay my computer's being very slow so the order is for 125 milliliters of 5% dextrose and water uh Ivy in 1 hour what is the flow rate in micro drops per minute so we're looking for micro drops per minute okay so our order is 125 an hour right in 1 hour and our um flow rate is micro drops per minute so first we figure out micro drops so there are 60 micro drops per 1 ml okay and there's one you know one hour is 60 minutes so our volume over our time times our drop factor which is the 60 I know I put drops and that's where I said I messed up it's supposed to be micro drops per ml okay it doesn't change anything it's the same thing 125 divided by 60 is 2.08 3 repeating keep that number it's ugly and fat and nasty I know keep it in your calculator do not round okay do not put 0083 in the calculator keep it the three repeating multiply by the drop factor and you get 125 micro drops per minute okay I know I use different three different I'm so sorry three different labels my computer was messing up this morning and I didn't even catch that sorry about that all right so now we have um how many milliliters of D5W will Infuse IV uh in 10 hours at a rate of 13 drops per minute if the drop factor is 15 drops per milliliter okay so this one's a little different but not too different okay we still have a desired over a have like a h desire um or an order okay so I have an order of 13 drops per minute I have um I have a factor drop factor of 15 drops per Mill so 13 divided 15 times our volume okay and we get 086 repeating remember keep it big ugly nasty that will give us our milliliter per minute okay when we multiply this big ugly number by 60 minutes because 60 minutes are in an hour right you get 52 milliliters an hour now okay now I want to know how much we'll Infuse in 10 hours so if it's 52 milliliters an hour I just multiply 52 * 10 and I get 520 okay so this one's like a little mix between desired of or have and our volume okay so so we have our desired which is our order our have which is the 15 drops which I think of my have as my rule or my what I have literally in my hand and what's on that pump the pump says 15 mil you know that's the drop factor I got to have that to use in my formula okay so 13 drops per 15 um divid by 15 times our volume okay do you see where where it's coming from okay so we have we've crossed out these drops we have milliliters we still have a minute up here so it's per minute we have to we have to make it per hour because I mean I guess you could divide 10 by 60 and figure out with or 10 * 60 and multiply this number by that big number if you want to it probably it still give you 520 but it makes more sense to do 6 Mill per minute time 60 minutes to get me 52 Ms per hour okay all right okay so now we have a little bit more complicated an infusion of 5% DW uh dexos and water is infusing at a rate of 20 drops per minute um it was a 500 mL bag and now they've received 200 milliliters of the 500ml bag um the drop factor is 15 drops per milliliter how many hours will you get the remaining okay so I rewrote this question because that's where I first I always start with rewriting my questions okay so my order is for um 5% who cares at 20 drops per minute okay that's my order um my rule is my drop Factor my 15 drops per millit so my order over my have my desired over my have that's what it is okay um the question is asking for remaining 300 milliters in hours where did I get 300 from I subtracted 500 from 200 is 300 so it's asking how long in hours will it take to infuse this 300 milliliters so first we have to figure out we don't have any hours to even go on we don't have a milliliters per hour to go on so we got to find out a milliliter per hour and then we can multi we can figure out after that so okay remember our desired is 20 drops because that's our order we our rule or what we have is our 15 drops times our milliliters okay so 20 divid 15 is um 1.3 milliliters per minute times 60 minutes because 60 milliliters minutes are in an hour okay is 80 Ms an hour so now we have a fat um a rate in milliliters per hour it wants to know the question's asking for hours so we can easily figure this out we have our 300 divided by 80 because we know that's these are hours right it's 3.75 so when you're looking for the time you can divide like that um you when you have the volume and you're looking for the time you divide right when we did this one back here we had opposites so we multiplied okay you have to think through the problem you have to think okay is this is this a multiplication or does this a division like do if multiplying it's going to get me my time or will divide and get me my time so all right so we're going to do one more this one's an extra one we didn't do this one for everyone else we're only going to do it for you because I wanted you to have one more practice for this drops per minute because this is kind of what we're learning okay so um you an to order for a th000 milliters of D5W it's always D5W why do they use that one so much IV over8 hours the drop factor is 10 drops per Mill milliliters okay calculate the initial flow rate in drops per minute so order a th000 MLS per over eight hours our have or our our rule drop factor is 10 drops per Mill our question is drops per minute okay so when you you see questions like this rewrite them it helps okay so we have our volume over time times our drop Factor the rule is okay when you're doing this time the time needs to be in whatever increment it's asking for or you're not going to get the right answer I could do this divided by 8 but then I'd also have to figure it out by 60 later okay so I think this is my opinion you can do what you want okay I want this already done that way I don't have to think about it later okay so eight hours how many I have to change this eight hours to my minutes for my time because that's what the question's asking okay so 8 hours time 60 minutes sorry I didn't label it is 480 minutes okay so now I have a new order is 1,00 o over 480 minutes I have a rule and I want to know my drops per minute so my volume is 1,000 milliliters because that's the only volume I got right my time is 480 minutes and then I multiply by my drop Factor 10 drops per ml okay so if you think I know you don't like dimensional analysis but it it helps my brain at least to think like this okay if I cross these milliliters out I'm left with drops per minute okay because they're it's basically dimensional analysis um you're left with drops per minute so 1,000 divided 480 is 2.08 3 ugly number leave it big leave it ugly you multiply by 10 and you get 20.83% to round do you round to the tenths do you round to the hundreds do you round to the whole number okay so that's why I put a couple options up here um but this will give you the drops per minute all right there is a lot of practice online if you need help please ask someone ask your instructors ask your clinical instructors someone can help you okay um Sigma Kai should have uh uh I think it's s maai or no the uh Honor Society for nursing it's the that's who tutors they tutors on Monday if you need help with math they can help you okay um you can contact Miss Woodruff which is in level three she might can help you with finding out when they're going to offer tutoring for for that um if you need any help though please do not suffer in silence if you suffer in silence you're not going to know how to do these there's plenty of practice online there's there's the website there's quizzes and there's extra practice sheets I suggest you practice practice practice okay um if you need anything else though put in the discussion board and have a great day By the end of the class, the student will be able to: 1. Calculate the rate of administration for intravenous (IV) fluids using infusion pumps. 2. Calculate the rate of administration for IV fluids using gravity and a drop factor. 3. Calculate doses and administration time for medication given IV push. 4. Formulate nursing care for a patient receiving IV therapy

okay so today we're going to go over IV therapy and calculations um for the first half of chapter 25 okay so this is just a copy of your SLO so by the end of this uh lecture you will hopefully be able to calculate um an IV fluids using the pumps using the gravity and drop Factor um and the calculations for IV push you also to formulate nursing care therapy for patients receiving IV Therapy um so this mean what does that mean so you're able to use the nursing process to implement IV therapy so what do you do before what do you do during what do you do after who needs what why do they need it things like that okay all right so osity um tonicity and the movement of fluid so osmolality is a concentration of the osmotic solution um think of it like your cup of coffee okay with the awful coffee grounds okay so the osmolality is how many solutes which or coffee grounds there are in your cup of coffee okay so we're going to measure it dependent on the number of dissolved solutes in one kilogram or one liter of fluid it doesn't matter what fluid it is it can be blood it can be urine it can be CSF it can be gastric fluid you can measure the osity of anything okay so what are we measuring though is how many solutes so the solutes could be sodium it could be glucose it could be Ura okay which is found in urine so we're measuring how much how many solutions are in that um the bag of fluid or the cup of fluid um so changes in osal can cause water to move to different compartments we know that right we've all had biology when we did the Biology experiment where you had a very big or we've all cooked you had a big pot of water you add a bunch of salt you add your potatoes and all the salt goes in the potatoes right so the changes when you added the salt when you added the potatoes you Chang the osmolality so it had to become equal so that's called the osmosis the movement of water and solutes across membranes to make it equal on both sides okay tonicity is a relative concentration of IV fluids so how many Sal it's just how you um measure the IV fluids normal saline LR half normal saline those kinds of things okay it's not a precise measurement so osmosis is the movement of water from an area of low osmolality to an area of high osmolality okay hypertonic moves uh from intertial space to plasma okay so we're pulling it from wherever extra it is to the blood volume so we can get it out okay so we have lots of Edema okay we're pulling it in to push it out all right hypotonic is the um when water moves from the plasma to the interstitial space so now I have too much in the in my blood or my blood vessels and I need to move it out okay and then isotonic causes no shift so as we know your kidneys do most of the fluid um regulation okay through the Rin angens and ostero system through the aldosterone system through the ADH okay or anti-diuretic hormone that's am this is just your review okay so someone who has fluid balance someone in fluid volume deficit what causes it usually dehydration or shock or Hemorrhage or things like that okay how do you treat it if they're awake you can give them oral fluids but if they're not or if they're very severely dehydrated we use IB fluids if someone has excess fluid how do we get the fluid out we get it throughout through diuretics okay so crystalloids versus colloids um so both of these replace fluid and electrolytes um whether it's from a loss of water and electrolytes through vomiting diarrhea laxatives Burns precipitation Hemorrhage so like your minor losses vomiting your diarrhea excess suctioning your extreme um water and electrolyte losses are the precipitation burns the leading out into your abdomen things like that okay hemorrhaging excessive diuresis so my sugar is too high or I have sadh okay which is Sy syndrome of inappropriate antidiuretic hormone so I'm peeing way too much okay crystalloids so crystalloids are iy solutions with electrolytes that can um that are capable of leaving the plasma and moving to the interstitial spaces so um or in an intracellular fluid so it has all of the solutes that are in the those um Solutions are small enough to be able to move okay they're used to replace fluid and promote your output um and they become and they have isotonic hypertonic and hypotonic um and then we have what are those isotonic so like we said it expands the circulating intravascular fluid volume without causing the shift okay so it's used for hydration um and to expand um extracellular fluid so we need more in our plasma and we want it to not move we want it to stay there so we want isotonic okay we don't want it going in into the interstitial space we want it to stay in our blood vessels so that's why we use isotonic hypertonic expl expands plasma volume by pulling it from somewhere okay so isotonic just gives you what you need hypertonic pulls the excess that you have okay so think about the potato and the salt okay right so they pull all the water inside the potato because it's got all this extra on the the outside and it's trying to make it even on both sides so you have all this extra water whether it's through cellular edema um cerebral edema or peripheral edema and it's pulling it into the plasma or into the the blood vessel so that it can get out okay um so this is using water you already have it's pulling it by and that's how it expands your plasma volume um a very interesting thing is that a lot of the uh D5 um hypertonic Solutions are hypertonic but as the dextrose becomes metabolized um the solution actually becomes hypotonic uh causing the water to shift into the intracellular space and relieving the dehydration within the cells so if I had let's say I had so such bad peripheral edema or cerebral edema all the extra fluid is outside the interstitial space so I give you the D5 half normal saline which is what that is um right here I give you the D5 half normal saline so that's it's pulling the water into the plasma into the blood vessel that you have extra right so we have edema but my cells are still dehydrated so then after the dextrus is metabolized the um hypotonic solution is going to hydrate my cells okay so now we're into hypotonic so it causes water to move from the plasma I out of the plasma to the tissues and cells in the in cellular compartment so it's taking the water that you have excess water in the in the vessel and putting it either in the cell or in the tissue okay so they're not plasma expanders right they're not volume expanders they're not helping your volume because your volume's already too much so we use this for hypernia so when my sodium's super high and I want the water to move so that it can regulate or cellular dehydration okay so I want the water to go inside the cell because my cells are dehydrated and then colloids are um are solutions where the molecules or the solutes inside the uh solution are too large to pass the capillary re membrane so we call these um PL um volume expanders because they are going to stay in the plasma and then the blood vessel okay so they stay in the intravascular space and rapidly expand your plasma volume so they increase your blood volume okay they draw water um from the intracellular fluid and interstitial spaces into the plasma so remember an isoton the way this is different than isotonic okay is isotonic doesn't let anything move it all stays within the vascular and everything stays in the extra vascular in the extra in the intra it stays in the intravascular and intracellular okay this will call pull the water from everywhere else and put it in your plasma and keep it in the plasma okay so that's how they're different um an example of that is dextran 40 okay dextran 40 is an IV route U medication it's used for um uh volume expander so we use it for fluid volume replacement for hypo liic shock What is Hypo liic shock hypo low volume so I have so much uh volume loss that I'm in shock okay whether this is from dehydration Hemorrhage surgery Burns so we use that for all of those things and for the shock okay so once again it raises the osmotic blood pressure by causing fluid to move from the interstitial spaces into the intravascular um has several minute onset unknown Peak 12 24hour duration an adverse high blood pressure that's a big one right because if you're raising my osmotic pressure which is the pressure with inside the inside the vessel if you're raising that of course I'm going to have high blood pressure If you give me too much okay if the pressure in the vessel is too much my blood pressure can go up um the fluid volume overload which is a a thing we have to look for for any kind of IV Therapy okay so in this and Metabolism we have to look for fluid volume overload with everything because if we give so much too much replacement we're going to see these symptoms like tacac cardia peripheral edema distended neck veins dispena cough okay that is a sign of fluid volume overload we've given them too much and we need to back off okay and then anaphylaxis obviously you can become allergic to it um there's no specific drug- to drug interactions no food interactions um and the treatment if you have normal kidney function is to just stop stop the infusion so if you start seeing the fluid volume overload symptoms we stop the infusion and everything will as I pee it out it'll fix itself okay now if I have don't have kidneys that work properly I may need an osmotic diuretic to help okay get it out contraindications kidney injury right I have a kidney an acute kid kidney injury I shouldn't get a bunch of volume expanders because I'm not going be able to pee out what I don't need okay severe dehydration it's not going to help it's going to be it's going to make it worse we don't we don't use Dex stren for that severe heart failure if you're in heart failure you should not receive fluids especially a large amount of fluids and especially a volume expander okay so why not though if their blood pressure is low if they're dehydrated why are we not going to fix it because we're going to kill them okay so in heart failure if my heart already cannot pump what blood I have and what plasma I have okay so it's already struggling with what I got if I rapidly increase that volume my heart's going to not know what to do and it's going to stop okay you can throw them into fluid volume overload like that because their heart cannot compensate and pump the plas the volume that that you rapidly give them if we give someone fluids with heart failure we have to look out for fluid volume overload we have I mean it it'll happen like that okay when we give them fluids we go low volume very slow IV okay whereas if I was dehydrated I was in shock you could give me a liter of fluid in 10 minutes or less someone with heart failure we're not doing that we're going very slow they're only getting a 250 Bolis maybe okay we go very low volume very slow Administration cuz we don't want that they'll use something else besides volume expanders to get their blood pressure up to help their dehydration okay um also hyperic disorders it's a contraindication if I already have too much volume don't give me anymore right so there's um specific guidelines for how much and how fast you can give it if it's an emergency I'm dying I'm hemorrhaging out I'm about to the only way you're going to save me is through these volume expanders and surgery you can give it to me very fast 1.2 to 2.4 grams per minute and if it's just regular dehydration where I'm awake and I just need IV um expansion you have to give it very slow at 240 millgram per minute okay and obviously whatever is in the bag if you don't use it you got to throw it away okay that's with any IV bag they are single patient only if you don't use all of it throw it away okay we don't reuse them not for other people not for that patient if you don't use it throw it away get a new bag it's all good okay so what am I going to do for this patient I'm going to monitor Vital Signs blood pressure especially right because and T cardia because I'm looking for those fluid volume overload symptoms I'm looking for that hypertension okay I'm I'm making sure that their shock symptoms are getting better right or if they're getting worse if I'm not going fast enough if I'm going too fast okay and then obviously I'm looking for that fluid volume overload Okay so IV infusions so there's different types of infusions okay there's replacement fluids there's maintenance fluids continuous fluids intermittent fluids okay replacement fluids I threw up 500 Ms of gastric fluid so you give me a 500 milliliter back okay I had surgery and I hemorrhaged or I bled a bunch you know exactly how much I lost so you give it back okay that's replacement maintenance and continuous fluids um continuous is all the time don't stop them unless it's discontinued maintenance to me they're the same they're very similar okay it's the helps the same normal levels of fluid and electrolytes when I was on the stroke floor everyone got a normal saline 125 Ms an hour until Speech Pathology had cleared them to eat because we didn't know when they were going to be able to eat again so we had to replace their fluid and their electrolytes CU they weren't allowed to eat or drink at all until this happened so these are maintenance fluids they're continuous they're Around the Clock we don't give little boluses here and there okay intermittent intermittent IV infusions are um when you administer drugs supplemental fluids every now and then it's not all the time continuous okay so these are IB piggybacks ipv or IV push and then we have our primary versus our secondary line okay so this is what a primary line Looks like this is just a normal um IV line they have uh you have your bag you have your drip chamber you have your y site it goes to the pump and then we have our clamp and then it goes to the patient okay this is a secondary line so now I need to hang I have my normal saline going but I need to hang an antibiotic for 30 minutes it needs to go for 30 minutes so it's most of the uh secondary or piggyback lines come with a little hook we want to use the hook on the primary line because we want to use gravity to help us right something higher is going to drip faster than something lower so we're going to help the little machine out by putting this higher than that okay so we connect it to that little yite and then we set the pump to to give the the B the secondary infusion so the piggyback can be concurrent which means both of them go at the same time or it can be it can stop a give all of B and then restart a it's a very smart pump okay um the biggest deal um problem is that you have to make sure these are compatible if a and b are not compatible if my push isn't compatible if something isn't compatible with what's going I'm I can't do it okay so I've had someone have um let's say I have to give them two antibiotics right this evamy is going to take 3 hours to be given and I need a 30 minute uh ANF okay they can't be hung together I would need a whole another set I would need two of these two separate poles two separate pumps two separate IV sites okay because they're not compatible now if they were compatible we can hang them up set to go concurrent then he can get both of his antibiotics at the same time and it's done okay but if these are not compatible you cannot hang them together okay you will hurt someone you it will crystallize bad things happen Okay so before you push anything through your IV site you hang anything in your secondary line you have to check compatibility before you start before you do it okay so Ivy um medication safety check every 30 minutes to 60 Minutes on the on is it flowing is it Kink is the site looking good is it red infiltrated is the flow rate going well and make sure your pumps are plugged in if the battery dies the pumps no good it stops sometimes it never comes back on be sure they're plugged in okay um and these are just different examples of IB bags they're from your book so this is a 5% dexos infusion um there's a lot there's an expiration that the ISS she's covered up it tells you how big it is so this is a um a 1,000 ml uh bag it also counts down okay so if we've here we've had a 100 two three four 5 900 and then this is the last 100 um so this is a 50 mil bag of normal sailing there's the lot the expiration somewhere 5% dextrose and half normal staline 500 mil bag we've got our numbers over here our lot and our expiration they've just blocked them out so this um there's two sites as you've noticed um this one is used to to PR um to spike your tubing and prime your tubing with this one is for a needle Port Entry we don't use it it's not safe to to make your own bags now in an emergency we do but they don't like us to keep them hung for very long because this should be a sterile procedure and done in the pharmacy and they do it under a hood it's like a very specific process they use and it's a sterile technique and if we're making it a bedside we're not doing all of those things so it's a very um it's a higher in uh instance that we might have infected this whole bag with something okay so they don't like us to use that don't touch it keep it clean other wise that's what it's for okay and this is a bag of LR it's 250 we've got our numbers we've got our lot our expiration we've also got a brand on this I don't know if you could see it the Bron all right so gravity systems and pumps so um the size in your tubing for the drip chamber for the the hole that pulls the fluid from the bag into the drip chamber the hole is not standard so however many drops equal one milliliter is different okay so manufacturers um specify the number of drops that equal a mill for particular tubing it's found on the bag just so you know when you grab your Ivy tubing it'll tell you how many drops per per Mill and how many mills per minute it can give the it can give the infusion so we call that a drop Factor so the drop factor is how many drips per Mill M okay that's a drop Factor you have to know the drop factor to find out the flow rate right so drops per minute micro drops per minute tells me how many milliliters an hour we're going to learn how to fix figure that out okay so these are just um different manufacturers different drops okay as you know most of the micro drip sets are 60 drops per Mill all right so now we're going to go into practice of how to calculate milliliters an hour drips per minute and how to go from back and forth between both um I'm just going to be for warning I had to learn a new set of math skills to teach this um drop Factor okay so we're going to learn together okay and if you still don't understand it please email me and we will try to figure something out okay all right so flow rates they're in volume time so drips per minute milliliters per hour it's volume over time okay so first example and these are from your book um we have a a liter of fluid or a th000 milliliters that needs to go continuous IV for 24 hours how many milliliters per hour are we going to be able to set the pump to so I'm going to give you three seconds if you need time please pause it okay all right so pretty simple we just divide 1,00 by 24 okay we'll get 41.6 and we're going to round that to a whole number of 42 because you can't set the pump at a at a decimal very often all right example number two this client needs to receive a tube feeding of inure for 120 milliliters um in over 90 minutes how many milliliters per hour are we going to be able to set the pum pump all right so the way I know to do it is called dimensional analysis this is ratio over ratio proportion okay so we're going to go dimensional analysis first because that makes the most sense to me so my question is asking for milliliters per hour so I to make sure my milliliters is on top and my hours on bottom so I put my 120 milliliters on top it needs to go over 90 minutes okay 90 minutes is not a whole number for an hour so I need to do my conversion for 60 minutes is one hour my minutes cross out okay and I'm left with milliliters over hours which is what my question is asking for so that makes sure that is how I am sure that I have all the information I need if everything is crossed out that I don't need and I'm left with what the question is asking I've got it correct correct I've got it set up the right way okay and you see it's got to be the right setup too my Mill have to be on top my hour has to be on bottom so if I multiply across 120 * 60 and then I divide that by 90 I get 80 Ms an hour okay so ratio over proportion so I have my question my my answer right I have my 20 20 I'm sorry 120 milliliters over 90 minutes I need it for it to be 60 minutes okay so the same thing on top has to be on top they have to equal each other okay it's not like over here where they have be opposite these have to be on the same side so milliliters milliliters minutes minutes so I know my milliliters I know my minutes that's how that's my order okay now I don't know how many milliliters need to be in 1 hour or 60 minutes so I cross multiply so 120 * 60 is 7200 and I cross multiply over here so 90x = 7,200 then I divide by 90 to find x and x equals 80 so 80 mes an hour same there's a multiple ways and I'm sure there's a whole another way to do this okay if you still don't understand it please let me know all right so D5W has been infusing for 30 MS uh an hour IV for eight hours how many milliliters have been infused all right so I did it it the easy way I just multipli 30 * 80 and it gets 240 you set it up in the dimensional analysis way my question is asking in milliliters so I want to make sure I my Mill milliliters on top that means that's all I want everything else has to cross out so if 30 milliliters happens in one hour how many will eight Out hours because my hours will cross out and one goes on the bottom because we don't have anything under eight hours so you multiply across and it's two 40 and then you divide by 1 is still 240 so using my um ratio and proportions my milliliters have to equal so I have 30 milliliters equals x amount of milliliters because I don't know how many that's what my question's asking 1 hour and I have my 8 hours I plugged it all in correct right and then I cross multiply and divide so 30 * 8 is 240 all right so now we have uh normal saine 500 M IV at 125 an hour how long will this take all right so 500 milliliters we're looking for hours how many hours will this how long will this take in hours so I want to make sure my hours are on top I have my 1 hour over 200 125 milliliters okay my only other milliliters is this 500 over 1 1 I multiply across multiply across and then divide and that equals 4 so 500 / 125 I just divided the two and then I set it up like this to show you or you can just say 125 plus 125 plus 125 plus keep going until you figured out how many equaled 500 the other way to do this is the ratio and proportion so once again I have to make sure that everything on top and everything on bottom matches so I have my 500 Mill and my 125 millit I have my x amount of hours cuz we don't know how many and my 1 hour I cross multiply so I have 125x because we don't know what x is equals 500 and now I divide my 125 and that equals four all right the order reads for 125 milliliters of 5% dextrose and water IV for one hour what is the flow rate and micro drops once again I'm giving you a couple seconds please pause to figure this out yourself okay all right so this is 125 milliliters in one hour or 60 minutes we because we want drops for minute that just took out a whole step for us so let's just go ahead and convert it CU we know 1 hour is 60 minutes now we have micro drops per minute that's what we want right so I have my micro drops on top my minutes on bottom and my milliliters can cross out micro drops we know from the conversion earlier there are 60 micro drops in every milliliter so that's where I got this conversion from 60 micro drops are in every milliliter okay so I plugged it in my milliliters cancel out I'm left with micro drips over a minute so 125 time 60 divided by 60 is 125 so 125 Ms an hour is 125 drops per minute micro drops per minute sorry all right so now we have this new way of uh this new one okay it's called Factor converter that's what the FC stands for Factor converter so the factor converter equals 60 divided by your um drip factor okay it is always 60 on top and then drop Factor on bottom okay and that will give you your Factor converter then you have to decide if you're going to multiply or divide okay this is how they want you to remember it so if you want to if you want drops or micro drops you divide D and D if I want milliliters I multiply so I find my Factor converter and then I do whatever the question's asking okay so my Factor converter 60 divided by my drop factor which is 60 okay that equals one this one's easier so it's it's it's different but we'll get harder okay so then we take our milliliters and we're asking for drops so we're going to divide okay we take our milliliters and we divide by our Factor converter and that's how we got our drops per minute this seems kind of weird right now but when we get um a little further it'll make more sense okay all right so how many milliliters of D5 W will Infuse IV in 10 hours at a rate of 13 drops per minute if the drop factor is 15 drops per Mill once again pause if you need to all right so the dimensional analysis way I plug in all my numbers I want to know hours okay so I've somehow got to get that up top let's figure it out so I want my 10 hours on top so I have 13 drops I'm sorry we don't want to know hours we want to know milliliters my bad so 13 drops per minute 60 Minutes 1 hour 10 hours over number one 1 M over 15 so I put in all my numbers that I have and I make sure they're opposites from the conversions and then I make sure I'm left with what I'm asked for okay so my drops cancel out here my minutes cancel out here my hours cancel out here and I'm left with my milliliters which is what the question's asking for so that's how I know I got this right okay I've used all the numbers I've plugged them in appropriately I'm left with my milliliters on top that means I'm going to get my questions going to be in milliliters okay so if I multiply 13 * 16 * 10 I get 7,800 divided by 1 * 1 * 1 * 15 is 15 you get 520 milliliters this sound's a little longer right okay so we took our 10 hours but we don't know how many milliliters so that's what we're trying to figure out how many milliliters in 10 hours because we had to convert our so we had to convert our drops permanent to our milliliters per hour and then we had to figure it out time 10 hours okay so Factor converter so once again Factor con um converter 60 on top our drop Factor on bottom so our drop factor is 15 so we divide 60 by 15 and we get four okay all right now the question is asking what for milliliters so milliliters I multiply 4 times our 13 drops to get our 52 Ms an hour I know crazy you already got milliliters per hour okay so now we have milliliters per hour and we want to know how many milliliters per hour how many milliliters will have will they be given in 10 hours you could just multiply by 10 or you can do the ratio over proportion way and do 1550 milliliters is equal I'm sorry that's supposed to be an equal sign is equal to x amount of milliliters 1 hour over 10 hours you cross multiply you get x = 5 52 * 10 x = 520 get a little crazy there huh okay please let me know if you have any questions there are lots of examples in your book please use them to your advantage okay all right so an infusion of 5% dextrus and water is infusing at 20 dra I'm sorry 20 drops per minute 500 milliliters of the solution was originally in the bag and the client has received 200 milliliters okay if the drop factor is 15 drops per milliliter how many hours will it take for the remaining solution in the bag to to infuse okay so this is going to be broken down dimensional analysis so first you have to find out how many milliliters are left in the bag 500 minus um 200 is 300 okay so now we know how many milliliters we have to infuse we want to know how long it's going to take so we're looking for hours so we're going to put our hours on top our 1 hour over six is over 60 minutes because we know we have 1 hour equals 60 minutes and we have a minute up here so then we do our one minute over 20 drops so that our minutes can cross out we're going to put in our drop factor of 15 drops per ml so our drops can factor out and then we're going to putting our remaining solution our 300 Ms so our milliliters can cross out and I'm only left with this hour over here okay multiply across multiply across divide 3.75 hours all right now let's do it the factor converter way so once again we have to figure this out at the beginning for later so Factor converter is 60 over our drop Factor our drop factor is 15 it equals 4 we're looking for milliliters so we want to multiply so 4 * 20 because that's our how many drops per minute equals 80 Ms an hour okay so now we have our 80 Ms equals our 300 Ms 80 Ms over one hour how many hours is the 300 Ms going to take you cross multiply you and then you divide so we get 80x = 300 and then you divide by the 80 and you get 3.75 I kind of like this this is a lot simpler all right and then our last one is an IV push which is what you've been doing since the beginning okay so if I order for 2 milligrams I be push to be given once Ami available is morphine 4 milligrams per milliliter how many milliliters am I going to give we're going to figure it out half a mill all right you know how to do this one I don't need to explain it right okay so I put my milliliters on top because that's what my question's asking for the only other Mill have that is attached to this milliliter you can't separate them ever is this four milligrams I put my milligram on top so my milligrams can cross out I multiply across multiply across divide it's a half or my desired over half desired over half time one5 all right and that is IV calculations that was only a couple examples from your book I very much pushed that you need to do all the examples in your book so that you keep can get the practice there is going to be a practice set on your um on campus to do as well if you have any questions please put them in the discussion board please email me do the mandatory quiz it'll help all right good luck and goodbye okay so because we didn't explain what how to do desire over have I'm going to do just a little addition on the end of this to help explain it so that y'all can understand it okay so we're going to the same problems but we're going to do the desired over halfway okay so a client must receive a tube feeding eventure of 12 milliters in 90 minutes calculate the milliliters per hour so for um um desire of for have the uh equation is not for um the drop and for a lot of the things it's it's volume over time okay so when we do it we have to first figure out my computer's being really slow and I'm really sorry it's probably GNA close please don't do it please don't do it so first we have to decide um to find out how many hours because that's what the questions asking for okay so how many hours is 90 minutes so you divide 90 minutes by 60 minutes because we know that's 1 hour right and it's 1.5 hours okay so then we take our volume over our time so our 120 milliliters over our 1 and 1 half hours and you get 80 Ms an hour it's very straightforward okay all right so we're going to do another one so now we have a D5W that's been infusing at 30 MS an hour for 8 hours how many milliliters have infused it's pretty simple so you could literally count it 30 eight times or you could multiply 30 milliliters times 8 8 hours it's 240 okay it's pretty simple all right so now we have an order for uh normal saline 500 milliliters at 125 an hour how many how long will this take so once again um we're looking for how long will this take we're looking for hours okay so volume over time okay volume over time so 500 milliliters Divi um sorry it's not this is desired to over have our desired is 500 milliliters we have 125 milliliters times our 1 hour you just divide it and it's 4 hours okay or you could say 125 + 125 is is you know 250 Plus plus 125 + 125 or just you can figure it out that way too all right so now we're going to get into a little bit different okay I messed up on this but that's okay my computer's being very slow so the order is for 125 milliliters of 5% dextrose and water uh Ivy in 1 hour what is the flow rate in micro drops per minute so we're looking for micro drops per minute okay so our order is 125 an hour right in 1 hour and our um flow rate is micro drops per minute so first we figure out micro drops so there are 60 micro drops per 1 ml okay and there's one you know one hour is 60 minutes so our volume over our time times our drop factor which is the 60 I know I put drops and that's where I said I messed up it's supposed to be micro drops per ml okay it doesn't change anything it's the same thing 125 divided by 60 is 2.08 3 repeating keep that number it's ugly and fat and nasty I know keep it in your calculator do not round okay do not put 0083 in the calculator keep it the three repeating multiply by the drop factor and you get 125 micro drops per minute okay I know I use different three different I'm so sorry three different labels my computer was messing up this morning and I didn't even catch that sorry about that all right so now we have um how many milliliters of D5W will Infuse IV uh in 10 hours at a rate of 13 drops per minute if the drop factor is 15 drops per milliliter okay so this one's a little different but not too different okay we still have a desired over a have like a h desire um or an order okay so I have an order of 13 drops per minute I have um I have a factor drop factor of 15 drops per Mill so 13 divided 15 times our volume okay and we get 086 repeating remember keep it big ugly nasty that will give us our milliliter per minute okay when we multiply this big ugly number by 60 minutes because 60 minutes are in an hour right you get 52 milliliters an hour now okay now I want to know how much we'll Infuse in 10 hours so if it's 52 milliliters an hour I just multiply 52 * 10 and I get 520 okay so this one's like a little mix between desired of or have and our volume okay so so we have our desired which is our order our have which is the 15 drops which I think of my have as my rule or my what I have literally in my hand and what's on that pump the pump says 15 mil you know that's the drop factor I got to have that to use in my formula okay so 13 drops per 15 um divid by 15 times our volume okay do you see where where it's coming from okay so we have we've crossed out these drops we have milliliters we still have a minute up here so it's per minute we have to we have to make it per hour because I mean I guess you could divide 10 by 60 and figure out with or 10 * 60 and multiply this number by that big number if you want to it probably it still give you 520 but it makes more sense to do 6 Mill per minute time 60 minutes to get me 52 Ms per hour okay all right okay so now we have a little bit more complicated an infusion of 5% DW uh dexos and water is infusing at a rate of 20 drops per minute um it was a 500 mL bag and now they've received 200 milliliters of the 500ml bag um the drop factor is 15 drops per milliliter how many hours will you get the remaining okay so I rewrote this question because that's where I first I always start with rewriting my questions okay so my order is for um 5% who cares at 20 drops per minute okay that's my order um my rule is my drop Factor my 15 drops per millit so my order over my have my desired over my have that's what it is okay um the question is asking for remaining 300 milliters in hours where did I get 300 from I subtracted 500 from 200 is 300 so it's asking how long in hours will it take to infuse this 300 milliliters so first we have to figure out we don't have any hours to even go on we don't have a milliliters per hour to go on so we got to find out a milliliter per hour and then we can multi we can figure out after that so okay remember our desired is 20 drops because that's our order we our rule or what we have is our 15 drops times our milliliters okay so 20 divid 15 is um 1.3 milliliters per minute times 60 minutes because 60 milliliters minutes are in an hour okay is 80 Ms an hour so now we have a fat um a rate in milliliters per hour it wants to know the question's asking for hours so we can easily figure this out we have our 300 divided by 80 because we know that's these are hours right it's 3.75 so when you're looking for the time you can divide like that um you when you have the volume and you're looking for the time you divide right when we did this one back here we had opposites so we multiplied okay you have to think through the problem you have to think okay is this is this a multiplication or does this a division like do if multiplying it's going to get me my time or will divide and get me my time so all right so we're going to do one more this one's an extra one we didn't do this one for everyone else we're only going to do it for you because I wanted you to have one more practice for this drops per minute because this is kind of what we're learning okay so um you an to order for a th000 milliters of D5W it's always D5W why do they use that one so much IV over8 hours the drop factor is 10 drops per Mill milliliters okay calculate the initial flow rate in drops per minute so order a th000 MLS per over eight hours our have or our our rule drop factor is 10 drops per Mill our question is drops per minute okay so when you you see questions like this rewrite them it helps okay so we have our volume over time times our drop Factor the rule is okay when you're doing this time the time needs to be in whatever increment it's asking for or you're not going to get the right answer I could do this divided by 8 but then I'd also have to figure it out by 60 later okay so I think this is my opinion you can do what you want okay I want this already done that way I don't have to think about it later okay so eight hours how many I have to change this eight hours to my minutes for my time because that's what the question's asking okay so 8 hours time 60 minutes sorry I didn't label it is 480 minutes okay so now I have a new order is 1,00 o over 480 minutes I have a rule and I want to know my drops per minute so my volume is 1,000 milliliters because that's the only volume I got right my time is 480 minutes and then I multiply by my drop Factor 10 drops per ml okay so if you think I know you don't like dimensional analysis but it it helps my brain at least to think like this okay if I cross these milliliters out I'm left with drops per minute okay because they're it's basically dimensional analysis um you're left with drops per minute so 1,000 divided 480 is 2.08 3 ugly number leave it big leave it ugly you multiply by 10 and you get 20.83% to round do you round to the tenths do you round to the hundreds do you round to the whole number okay so that's why I put a couple options up here um but this will give you the drops per minute all right there is a lot of practice online if you need help please ask someone ask your instructors ask your clinical instructors someone can help you okay um Sigma Kai should have uh uh I think it's s maai or no the uh Honor Society for nursing it's the that's who tutors they tutors on Monday if you need help with math they can help you okay um you can contact Miss Woodruff which is in level three she might can help you with finding out when they're going to offer tutoring for for that um if you need any help though please do not suffer in silence if you suffer in silence you're not going to know how to do these there's plenty of practice online there's there's the website there's quizzes and there's extra practice sheets I suggest you practice practice practice okay um if you need anything else though put in the discussion board and have a great day By the end of the class, the student will be able to:
1. Calculate the rate of administration for intravenous 
(IV) fluids using infusion pumps.
2. Calculate the rate of administration for IV fluids 
using gravity and a drop factor.
3. Calculate doses and administration time for 
medication given IV push.
4. Formulate nursing care for a patient receiving IV 
therapy

Transcript for:IV Therapy Concepts and Calculations

Transcript for:
IV Therapy Concepts and Calculations