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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
The fast and easy way to pass the Nursing Calculations test
Is the maths behind the medicine making you maudlin over taking your Nursing Calculations test? You've come to the right place! Written by a nurse with countless hours of experience—and who trains other nurses every day—this plain-English, no-nonsense guide to nursing calculations and IV therapy makes it easier to come to grips with the numbers and formulas you'll encounter on the day of the exam—and in the field.
Many students and practising nurses struggle with mathematics. Luckily, this friendly guide is here to take the intimidation out of the subject, arming you with the knowledge and know-how you need to take the exam with confidence and to achieve the best score possible. From fractions, percentages, and proportions to pills, fluids, and prescriptions, Nursing Calculations & IV Therapy For Dummies UK edition offers detailed advice and instruction on everything you need to know to pass the exam with flying colours.
- Hundreds of practise questions help you learn and revise
- Clear explanations and lack of jargon make learning easy
- Observation charts and extra content are available for download upon purchase
- Combines nursing calculations and IV therapy to offer excellent value
Whether you're a student revising for the Nursing Calculations test, a newly qualified nurse looking to brush up on your maths skills, or a member of a medical staff who's been asked to take on nursing duties, this friendly and accessible guide makes maths less menacing.
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Nursing Calculations & IV Therapy For Dummies®
Published by: John Wiley & Sons, Ltd., The Atrium, Southern Gate, Chichester,www.wiley.com
This edition first published 2016
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ISBN: 978-1-119-11416-1 (pbk); ISBN 978-1-119-11440-6 (ebk); ISBN 978-1-119-11425-3 (ebk)
Nursing Calculations & IV Therapy For Dummies®
Visit www.dummies.com/cheatsheet/nursingcalculationsandivtherapyuk to view this book's cheat sheet.
Table of Contents
Cover
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part I: Getting Started with Nursing Calculations and IV Therapy
Chapter 1: Getting the Lowdown on Nursing Calculations and IV Therapy
Increasing Your Confidence in Healthcare-Related Maths
Choosing to Use Bundles
Monitoring Your Patients
Administering IV Therapy
Looking Out for the Complications of IV Therapy
Chapter 2: It’s about Units, Innit! The Metric System of Measurement
Anyone for Tens? Using the Metric System of Measurement
Mastering Conversions
Chapter 3: Making a Point: Fractions and Decimals
Getting to Grips with Fractions
Grappling with Decimals
Chapter 4: Ordering Parts with Percentages, Averages and Ratios
Peering into the World of Percentages
Appreciating the Usefulness of Averages
Reading about Ratios
Chapter 5: Making Sense of Moles and Solution Concentrates
Meeting Moles and Millimoles
Concentrating on Solution Concentrates
Chapter 6: Administering Drugs Accurately and Safely
Keeping Drug Safety in Mind
Looking at Types of Medicine Administration
Deciphering Doctors’ Instructions on Prescription Charts
Part II: Working Out Tablet and Liquid Dosages
Chapter 7: Measuring the Important Vital Signs
Monitoring the Vital Signs: Physiological Measurements
Identifying Deteriorating Patients
Finding Out about Fluid Charts
Chapter 8: Sorting Out Medication Dosages
Figuring Out the Correct Oral Dose to Administer
Calculating the Correct Liquid Dose
Titrating Drugs According to Body Weight
Chapter 9: Making Out the Make-Up of Pills
Going through the System: How Drugs Work in the Body
Looking at Patient Information Leaflets
Getting to Know some Smart Drugs
Chapter 10: Keeping Up to Scratch on Injections
Exploring the Different Types of Injections
Cleaning Injection Sites
Polishing up Your Injection Techniques
Tooling up to Inject: Equipment
Chapter 11: Comprehending Diagnostic Blood Tests: Venepuncture
Taking Blood to Test: Venepuncture
Showing Some Bottle When Taking Blood
Chapter 12: Using Advanced Formulae
Dealing with Infants
Handling Body Calculations
Making Organ and System Calculations
Looking at Additional Calculations
Chapter 13: Monitoring Patients for Adverse Reactions
Understanding Adverse Reactions
Taking a Tour of the Bodily Systems Affected
Managing Anaphylaxis Events
Reporting Adverse Reactions
Part III: Figuring Out Infusion Rates for IV Therapy
Chapter 14: Water, Water, Everywhere! Looking at IV Fluids
Considering the Legal Aspects of IV
Understanding Fluids in the Body
Tooling up for IV Drips
Chapter 15: Discussing Drips and Drops: IV Therapy
Looking at Methods of IV Therapy
Delivering Medications from Ampoules and Vials
Administering Continuous Infusions: Insulin and Heparin
Chapter 16: Round Peg in a Square Hole: Getting Drugs and Fluids into the Body
Introducing IV Access Devices
Going for the Vein: Peripheral Cannulae
Getting Drugs into the Central System
Chapter 17: Administering Blood Components
Introducing Blood Types
Being on Top of Blood Transfusion Requirements
Tracing the Blood Transfusion Procedures
Chapter 18: Reducing Infections and Needle Injuries
Keeping the Bugs at Bay
Staying Sharp to Stay Safe
Chapter 19: Checking for IV Therapy Complications
Avoiding Problems when Administrating IV Medication
Dealing with Cannula Problems
Getting Smart with Other IV-Related Precautions
Chapter 20: Meeting Sister Morphine: The Poppy and Pain Management
Ouch! Dipping a Toe into a World of Pain
Using (Not Abusing) Morphine
Assessing Patients and Documentation
Part IV: Testing Your Calculations and IV Knowledge
Chapter 21: 101 Questions to Test Your IV Therapy Knowledge
Chapter 22: 101 Answers to the IV Therapy Questions
Part V: The Part of Tens
Chapter 23: Ten Tips for Administering IV Drugs Safely
Employing the Aseptic Non-touch Technique
Reading the Prescription
Using the Correct Equipment
Choosing the Venous Access Device (VAD) Correctly
Working Out the Maths Correctly
Titrating Correctly According to the Patient’s Body Weight
Delivering the Drug over a Set Time
Avoiding Coring of Rubber Bungs on Ampoules
Reconstituting Drugs Correctly
Priming the Lines
Chapter 24: Ten Useful Drug-Administration Formulae
Working Out the Amount of Pills to Dispense
Calculating the Millilitres to Draw up for Liquid Medications
Assessing Infusion Pump Rates
Computing IV Drip Rates – Gravity Method
Determining IV Drip Rates: Duration Request
Titrating Drugs According to Body Weight
Administering an IV Dose per Minute
Counting Out Cardiac Output
Measuring Body Surface Areas
Filling up on Infant Feeding Requirements
Chapter 25: Ten Key Points When Administering Medication
Taking Your Time
Knowing Your Abbreviations
Understanding Metric Measures and Calculations
Recognising Drugs that Look and Sound Alike
Reviewing the Patient for Drug Allergies
Being Aware of Adverse Drug Reactions and Contra-indications
Handling Sharps Carefully
Asking for Advice and Information
Observing the ‘Rights’ of Medication Administration
Remembering Your Healthcare Responsibilities
About the Author
Cheat Sheet
Connect with Dummies
End User License Agreement
Guide
Cover
Table of Contents
Begin Reading
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Introduction
This book is really two for the price of one: a book on – yes, I’m going to use the ‘c’ word – calculations (sends a chill down your spine, doesn’t it?) and another book on intravenous (IV) drug administration. As well as offering you great value, this approach is necessary, because you first need to know your maths in order to administer medications.
Don’t panic, however! This book takes you by the hand and walks you gently through the basics, before leading you on to the more advanced stuff. I’ve worked for many years in healthcare and taught thousands of individuals how to work out their drug administration calculations. I’ve also listened to their concerns about how scary giving IV drugs is, because they fear that they may get something wrong. With their assistance, I’ve formulated tricks of the trade to help them (and now you) become confident and competent in delivering IV therapy.
This book helps you get to grips with the maths competency side of your nurse training (or similar course, such as assistant practitioner, operating department practitioner and so on). You’re required to pass maths tests along the way throughout this training. Also, when you’ve qualified – or are about to qualify – you need to prove your maths ability by taking an IV calculations test, before being trained to administer IV drugs.
Even then it’s not over! After you pass the IV calculations test, you’re ready to attend the IV study training: this book also provides you with the skills to perform this clinical skill.
About This Book
Calculations and IV therapy are two huge subjects in their own right, but this book aims to provide you with what you need to know, covering the major areas in an easy-to-read format. True, you may have to read some of the sections more than once to get the point, but don’t become disheartened. Keep with it to increase your knowledge and skills.
To be honest, I wish this book had been available when I first started administering IV therapy! I’d have saved a lot of time and effort.
One convention that I do use to help you: I often abbreviate units of measurement into what you see in practice, especially in equations and exercises: for example ‘g’ for grams, ‘mg’ for milligrams and ‘ml’ (you may sometimes see ‘mL’) for millilitres.
Foolish Assumptions
Rightly or wrongly, I make the following assumptions about you:
You’re a student nurse, midwife or other practising caregiver.
You have a certain standard of mathematical ability from secondary school and a healthcare training facility.
You have a general working knowledge of basic nursing skills and an understanding of common medical terminology.
You want to help people in your care in a kind and compassionate manner to the best of your ability.
Icons Used in This Book
Throughout the book, you come across icons indicating key ideas and information.
This icon gives you handy hints as suggestions or recommendations. You probably don’t want to skip over this material, because the information is sure to be useful.
This icon represents important information you really don’t want to miss.
Here I provide practical examples to help get across the necessary point.
This icon informs you of something to be aware of: watch out!
Here you get a chance to try out your newly developed skills.
This icon relays what you can call extra information: interesting and useful, but not essential to know.
Beyond the Book
I provide a Cheat Sheet chock-full with lots of helpful information that you can refer to on a regular basis. The Cheat Sheet is at www.dummies.com/cheatsheet/nursingcalculationsandivtherapyuk.
The printed book isn’t the be-all-and-end-all these days. I’ve also put together some online bonus bits and pieces (at www.dummies.com/extras/nursingcalculationsandivtherapyuk) to help you take things further.
Where to Go from Here
You don’t have to read For Dummies books linearly; you can open this book at any section that takes your fancy. If you’re unsure where to begin, do as the song says, ‘Start at the very beginning, Doe a deer, a female deer, Ray, a drop of golden sun …’ In other words, start at Chapter 1, which gives you an overview of the whole book, highlighting the broad concepts I cover in each chapter.
Part I
Getting Started with Nursing Calculations and IV Therapy
For Dummies can help get you started with lots of subjects. Visit www.dummies.com to discover more and do more with For Dummies books.
In this part …
Use the practice-makes-perfect theory and check your understanding of working with fractions and decimals.
Become familiar with working with percentages, averages and ratios, because these skills are often used in healthcare to give a quick indication of specific quantity and when making comparisons.
Know how to use moles, millimoles and solution concentrates in order to describe the amount of substance and for electrolyte measurements: for example, ‘body sodium levels 133–146 mmol/l’.
Interpret doctors’ instructions on prescription charts and medical terminology, including the 24-hour clock, so that when administering medications you know that ‘0800 hours’ means ‘8:00 a.m.’ and ‘20:00’ hours means ‘8:00 p.m.’, to avoid any confusion.
Chapter 1
Getting the Lowdown on Nursing Calculations and IV Therapy
In This Chapter
Understanding the basic maths required for healthcare
Knowing IV therapy and its correct administration
Being clear on complications
Intravenous (IV) therapy is one of the most common clinical skills that healthcare professionals perform. It includes administering IV drugs, fluid replacement (including blood and blood products), cytotoxic therapy (chemotherapy) and parenteral nutrition (which doesn’t mean your mum and dad providing a hot meal when you pop home to get your washing done (!) but feeding ‘not via the alimentary canal’). Intravenous therapy can also take the form of administering emergency fluids and medications, such as when individuals have sustained huge blood loss, and/or to convert heart arrhythmias back to sinus rhythm.
In this chapter, I describe how this book takes you through the whole IV process – showing you how to walk before you can run. I help you get to grips with the mathematics and formulae necessary to work out the amounts of drugs or fluids to administer through the main routes, including oral, and translating doctors’ written instructions (which can be tricky at the best of times!).
This book also describes the types of IV therapy and how they can relate to patients’ blood tests obtained by venepuncture (flip to Chapter 11 for more) as well as their medical condition. I explore methods of getting the medications into the IV route as well as looking at the legal and professional aspects of IV therapy and complications associated with specific routes of administration.
Whatever your reason for entering healthcare, you share a common goal with all nurses and other healthcare professionals. You want to make your sick patients better, keep your healthy patients healthy and provide high-quality care to people, including those at their end-of-life journey.
This aim is encompassed within the culture of ‘compassionate care’ – known as the 6 Cs:
Care
Compassion
Competence
Communication
Courage
Commitment
Practices can, of course, vary among hospitals and clinical areas. Adhere to your own employer’s policies and procedures at all times and document all your actions.
Monitoring Your Patients
As a healthcare professional, you need to measure and record details of your patients’ conditions. This information relates to their vital signs, prescriptions, fluid levels and any indications of deterioration. You need to know the important methods and documents for recording these details inside out.
Visiting the realm of vital signs: Physiological measurements
When a patient’s respiratory rate and heart rate rise, you need to investigate the reason why and provide an appropriate treatment. For example, you may need to administer analgesics and/or anti-emetics if the patient is in pain or feeling sick. In other words, you need to apply nursing calculations in all aspects of the patient’s care, not just when administering medications. The physiological measurements – or vital signs (see Chapter 7) – are often abbreviated to TPR and BP (meaning temperature, pulse and respirations and blood pressure).
When administering medications to patients, you need to look at the whole picture and understand that the prescription chart isn’t something to follow blindly. For example, you don’t administer anti-hypertensive medication to a patient who’s hypotensive, or give a drug when you’ve just found out that the patient previously suffered an allergic reaction to it (for details about adverse reactions, check out Chapter 13). You use your noggin (brain) to work out that you need to discuss this issue with the doctor.
Interpreting the prescription chart
Before administering medications, you need to be familiar with the abbreviations on the prescription chart. In the community (anything out of the hospital setting), this chart is often called the Medication Administration Records and Requests document (or MARRs sheet).
Whatever the specific document you use, understanding the instructions is vital.
Another factor when reading the prescription chart is whether the medication has been prescribed using the correct non-proprietary name (that is, the chemical or generic name) or the proprietary name (the brand or trade name). To avoid confusion, drugs should be prescribed using the approved generic name. For example, salbutamol (albuterol) is the drug’s non-proprietary name, whereas its proprietary name is Ventolin.
Generally speaking, don’t use too many abbreviations, apart from the approved ones, because different clinical areas sometimes use different abbreviations. For example, DOA can mean ‘dead on arrival’ in an emergency unit but ‘date of admission’ in a ward unit. Unsurprisingly, patients object to being declared dead when they’ve just arrived for a 15-minute cataract procedure!
Chapter 6 looks at interpreting instructions.
Finding out about the fluid chart
The fluid chart is an important document, which when completed correctly establishes the patient’s fluid balance. The fluid balance (see Chapter 7) relates to the difference between the amount of fluid taken into the body and the amount excreted or lost.
Accurately monitoring a patient’s fluid balance is crucial to a patient’s well-being, because the body works within narrow parameters and is always striving for homeostasis (balance). In other words, any water loss needs to be replaced in order for the body’s water volume to remain constant.
Completing a fluid chart is simply about recording the amount of all drinks, IV fluids and so on going into the patient’s body. You then add up all the fluid that has left the body, taking this amount away from the input amount. The result is the fluid balance.
When the intake is greater than the output amount, a positive balance is recorded, but if the intake amount is less than output the fluid balance is recorded as negative. The balance is usually viewed over a couple of days, because sometimes the body is playing ‘catch-up’.
Sometimes, when you’re rushed off your feet, you can tally up these figures inaccurately. As a result, the patient may be prescribed more or less fluids wrongly, which can have an adverse effect on the person’s well-being.
Reading the NEWS chart
Many healthcare settings use the National Early Warning Score (NEWS) observation chart as a ‘surveillance’ system to identify and monitor patients deteriorating. The reason is simple: picking up these signs saves lives.
Research shows that 80 per cent of NHS patients across the UK experiencing a cardiac arrest had physiological abnormalities present 12–24 hours prior to the cardiac arrest.
The NEWS charts are colour-coded in order to demonstrate the severity of the patient’s condition – a high NEWS score indicates a severe illness. No point knowing how many pills to give your sick patient if you don’t observe the poor soul deteriorating! Chapter 7 shows you how to use these charts.
Administering IV Therapy
Intravenous therapy is medics’ chosen route when they need to deliver fluids and medications as quickly as possible to the patient. IV therapy is also used in order to give substances that can’t be administered by any other route. For example, unless you’re a vampire, a blood transfusion is administered via the IV route as opposed to the oral route (sink your teeth into Chapter 17 for more details).
Getting under the skin of the IV route
Doctors use a variety of methods of administering drugs via the IV route. The most common types of IV administration include the following:
Peripheral IVs:
The tip of these devices sits in the vein, usually in the hand or arm. These short-term devices are used to deliver IV drugs or fluids (flip to
Chapter 16
for details).
IV bolus push:
When a specific dose of a medication is given via a bolus through a peripheral or central device (see
Chapter 15
).
Central lines:
These devices are placed in the chest, neck, groin, leg, arm or scalp. The catheter is sited in the veins of the central venous system, such as the superior vena cava or inferior vena cava (
Chapter 16
has all about central lines).
Infusion pumps, syringe drivers and patient controlled analgesia (PCA) pumps:
These electronic devices are set to infuse fluids or medications via an automatic pump intermittently or continuously. Syringe drivers generally administer smaller controlled doses of medication over a prescribed duration. PCAs give patients control over their analgesic administration, because they can self-administer their medication. (Check out
Chapter 14
for more on these devices.)
Volumetric pumps:
These devices administer medications such as sodium chloride 0.9% via an administration set to a peripheral device sited in, for example, the patient’s arm. Depending on the infusate, the administration set delivers 20 drops per millilitre for clear fluids and 15 drops per millilitre for blood and thickened fluids. A microdrip system infuses smaller amounts of fluids per hour. (Pop to
Chapter 14
for more on volumetric pumps.)
Continuous and intermittent infusions:
Continuous infusions deliver medications or fluids at a constant rate, whereas intermittent infusions deliver medications or fluids at specific times and at designated intervals (see
Chapter 15
).
Appreciating the advantages of IV administration
The IV route has many advantages over other routes of drug administration. You can:
Achieve a rapid response of the medication if a patient is having a cardiac arrest
Provide a constant therapeutic effect, such as via continuous infusion
Still give medication if the patient is nil by mouth (NBM)
Still administer the medication if the patient is unable to undergo an intramuscular injection, due to being a haemophiliac
Give medications that may not be absorbed via the oral route
Administer medication to unconscious patients
Correct fluids and electrolyte imbalances promptly
Looking Out for the Complications of IV Therapy
Make no mistake about it, despite all the advantages of IV therapy that I lay out in the preceding section, the process isn’t without its complications. Here are some potential complications that you may face and how to deal with them.
Understanding the disadvantages of IV administration
The IV route has the following disadvantages as a means of fluid and drug administration:
Side effects to the drug usually more immediate and severe
Risk of embolism
Risk of microbial contamination/infection
Risk of infiltration
Risk of extravasation
Risk of phlebitis
Increased risk of fluid overload
Risk of speed shock
Problems with compatibility/stability of medicines
Chapters 18 and 19 give more information around these topics.
Preventing infection
One of the major risks of using the IV route is, of course, infection. Hand-washing with liquid soap and water is the single most important means of preventing the spread of infection. Washing with liquid soap and water is often referred as the gold standard of infection control.
Using the aseptic non-touch technique (ANTT) is the evidence-based method of administering IV medications. It ensures that asepsis is achieved on the key parts of the equipment that come into direct or indirect contact with the liquid infusion during preparation and administration of the medication. When preparing medications for patients, the healthcare professional identifies all the key parts and then protects them at all times using the non-touch technique.
Here’s the ten-step overview of the ANTT in relation to IV therapy:
Gather together all the equipment.
Clean the
aseptic field
– the area you working from (injection tray and so on).
Clean your hands and put on an apron and non-sterile gloves.
Prepare the medicines and equipment, protecting key parts at all times using the non-touch technique.
Go to the patient and prepare the access device, after gaining the patient’s consent.
Administer medicines – protecting key parts at all times.
Dispose of any sharps immediately.
Remove gloves and apron.
Wash hands.
Document your actions.
Chapter 18 looks at the infection control aspects of IV therapy.
Dealing with pain on IV injection
Before administering IV medications through a peripheral line, you need to undertake an inspection of the site.
If the patient doesn’t complain of pain during the cannula flush (which isn’t a hand at poker, but when you clean out the line – see Chapter 14), but does so on the administration of the drug, this pain may be due to the following reasons:
Hypertonicity:
Where medicines have a higher osmolarity than plasma, which can cause fluids to pass out of blood cells, resulting in cell
lysis
(breaking down of the cell).
Rapid administration:
Inappropriate rapid infusion or insufficient dilution of irritant medications can cause damage to the blood vessels, resulting in pain.
Here’s a list of drugs that are known to cause pain on injection:
Dextrose solutions above 10 per cent dilutions
Erythromycin
Phenytoin
Potassium infusions
Sodium bicarbonate 8.4 per cent
Tetracycline
Vancomycin
Chapter 16 looks at access devices and pain. For more on pain management in general and morphine in particular, move gingerly to Chapter 20.
Chapter 2
It’s about Units, Innit! The Metric System of Measurement
In This Chapter
Calculating decimals
Converting metric units
When using maths in healthcare, you need a good understanding of the basic principles of the metric system of measurement. Sometimes you’re required to work with small units of the whole (the difference between administering a thousandth and a tenth of a unit of medicine can be, quite literally, fatal).
For example, if you take the gram (g) unit of measurement as the whole, but require one-thousandth () of this unit, you have the milligram (mg). The ‘milli’ part is known as a prefix in the metric system; prefixes are used to denote multiples and sub-multiples of its units.
In this chapter, I walk you through all the important parts of the metric system as it relates to healthcare, including working with decimals and converting from one unit to another.
