Question

Case Study 2 COPD/Emphysema

A patient is admitted to the hospital with dyspnea and COPD exacerbation. The orders from the physician include:

• Stat ABGs, chest x-ray, complete blood count, and electrolytes
• IV D5W/½ NS 1000 mL/8 hr
• Aminophylline IV loading dose of 5.6 mg/kg over 30 minutes followed by 0.5 mg/kg/hr continuous IV
• O₂at 2 L/min per nasal cannula
• Albuterol respiratory treatments every 4h
• Chest physiotherapy every 4h
• Erythromycin 800 mg IV every 6h
• Bed rest
• Accurate intake/output
• High-calorie, protein-rich diet in six small meals daily
• Encourage PO fluids to 3 L/day

Identify the orders that require calculations.

Set up and solve each problem using dimensional analysis.

• Calculate mL/hr to set the IV pump.
• Calculate mL/hr to set the IV pump for the loading dose of aminophylline for a patient weighing 140 lb. Aminophylline supply: 100 mg/100 mL D5W.
• Calculate mL/hr to set the IV pump for the continuous dose of aminophylline for a patient weighing 140 lb. Aminophylline supply: 1 g/250 mL D5W.
• Calculate mL/hr to set the IV pump to infuse erythromycin 800 mg. Erythromycin supply: 1-g vial to be reconstituted with 20 mL sterile water and further diluted in 250 mL NS to infuse over 1 hr.
• Calculate the PO fluids in mL/shift.

1. Answer dosage calculation
2. Create a nursing care plan
3. Create as many nursing diagnoses as you can
4. Create a skill template list

Answer 1

Calculating ml/hr to set IV pump:-

IVF D5W/1/2 NS 1000ml/ 8 hrs

= Total volume to be infused÷ time of infusion

=1000÷8

=125ml/hr

Calculate ml/hr to set IV pump for the loading dose of aminophylline for a patient weight 140 In. Aminophylline supply 100mg/100ml D5W

First 30 minutes

Aminophylline 5.6mg/kg

140Ib=63.50kg

The total dosage to be administered in 30 minutes

= 5.6×63.5÷2(as we are calculating the dosage for 30 minutes)

=355.6÷2

=177.8mg

This should be diluted with equal D5W

So, 177.8mg in 177.8 ml D5W

=177.8mg over 30 minutes

= 355.6ml for first 30 minutes.

Calculate ml/hr to set the IV pump for the continuous dose of aminophylline for a patient weighting 140 In. Aminophylline supply 1gm/250ml D5W.

0.5/kg/hr continues infusion

=0.5×63.5

=31.75mg/hr

So we have to diluted 1gm in 250 ml D5W

31.75mg/hr to be diluted= what we need (mg)÷ total dosage available× total volume in ml

= 31.75÷1000×250= 0.03175×250

=7.9375ml/hr

Calculate ml/hr to set the IV pump to infuse erythromycin 800mg. Erythromycin supply 1g vial to be reconstituted with 20 ml sterile water and further diluted in 250ml NS to infuse in ml/shift

1gm in 20ml and to be diluted in 250 NS

So, to find out how much to be infused in 1 hr

Total ml to be infused

= What we need ÷ total dosage× total volume in ml

=800÷ 1000+270(250ml NS+ 20ML)

=0.8× 270=216ml/dose

Thus erythromycin to be administered in every hourly

Therefore, 216ml/hr to be infused in a

Calculate the PO fluid in ml/shift

3l/day to be taken

So one shift is 6 hrs

In an hour

=3÷24= 0.125 l/hr= 125ml/hr

In a shift

125× 6= 750 ml/shift