“ Be a doer not a

me too-er.”
Dr. Greg House
All liquids taken by the
patient
Oralfluids
Water, milk, juice, soft
drinks, coffee, tea, cream,
soup, sherry, wine
Water taken with
medications
Ice chips –
approximately ½ their
volume
Foods that become liquid
at room temperature
Ice cream, sherbert, custard,
gelatin, pudding, popsicle
soup, & broth, ice water, frozen
yogurt
A full cup of ice is equal to 1/2
cup of water (120cc).
Note: do not measure foods
that are pureed; these are
solid food prepared in a
different form
Tube feedings
Remember to include the
30-60 ml. water rinse at
the end of intermittent/
continuous feedings
Parenteral fluids
IVF, blood & its
components

Total
Parenteral Nutrition
(TPN)
 A patient has recorded the following on a
sheet of paper at the bedside:
 Breakfast: eggs, toast, one cup of coffee
(coffee cups at this hospital contains 6
ounces); small orange juice (4 ounces)
      
 Lunch: sandwich, apple, glass of tea
(glasses at this hospital contains 8 ounces)
 Dinner: chicken, broccoli, rice, 2 glasses
of tea
 Between meals: 4 glasses of water
 1000 mL of D5 W infusing IV at 30
mL/hour
 Calculate the Intake for a 12 hour shift:
Note you need to covert ounces to mls.
Dextrose in Other Name Concentration
H2O Solution

Dextrose 5 % D5W Isotonic

in water

Dextrose 10 D10W Hypertonic

% in water
Saline solution Other Name Concentration

0.45 % NaCl ½ NS Hypotonic

(Half NS)
0.9 NaCl NS Isotonic

3-5% Sodium 3-5 % NS Hypertonic

Chloride
3-5% NaCl
Dextrose in Other Name Concentration
Saline Solution
Dextrose 5% D5 0.9% NaCl Hypertonic
in .9 NaCl
D5 0.9% NS

D5NS

Dextrose 5% D5 0.45% Hypertonic

in .45% NaCl NaCl

D5 0.45% NS

D5 1/2 NS
Multiple Other Name Concentration
Electrolyte
Solutions
Lactated LR Isotonic
Ringers
Solution
Dextrose 5% D5LR Hypertonic
in Lactated
Ringers
Solution
Isotonic Solution –
extracellular volume
replacement; FVD
secondary to excessive
vomiting
Intravenous medications
IV medications that are
prepared with solutions
(ex. NSS)
Ex. Tobramycin sulfate 80
mg. in 50 ml.
Catheter or tube irrigants
Fluid used to irrigate urinary
catheters, NGT,
intestinal tubes
Urinary output
After each voiding, pour the
urine in a measuring
container,
Observe the amount &
and record it & the time of
voiding on the bedside I &
O form
Retention catheter – note &
record the amount of urine
at the end of the shift then
empty the drainage bag.
If the client is incontinent of
urine or is extremely
diaphoretic, estimate and
record these outputs
“Incontinent X 3” or
“Drawsheet soaked in 12
inches diameter.”
Weigh diapers or incontinent
pads that are dry, then
subtracting this weight from
the weight of soiled items.
1 gram = 1 ml. of urine
If the urine is frequently
soiled with feces, record
the number of voiding
instead.
Vomitus & liquid feces
Time & type of fluid must
be specified
Diaphoresis
Record “Perspiring
profusely.” or
Perspiration ++++
Check agency policy on
this
Tube drainage
Gastric, intestinal
drainage
Wound drainage & draining
fistulas
Recorded by counting the type
& number of dressings; linen
saturated with drainage
Measuring the exact amount of
drainage collected in a
vacuum drainage system
( Hemovac, Jackson Pratt
drain )
Amount of input &
output must be measured
in 24 hrs.
Recorded in I & O sheet
Input & Output must be
recorded at the end of
every nursing shift
Nursing procedure
obtaining an accurate data
base
evaluating client’s
hydration status
Following a surgical
procedure
Febrile clients
Clients with fluid
restrictions
Clientunder diuretics/IVF
therapy
Chronic CP/Renal Illness
Unstable Client
The patient recorded the following amounts
voided on the sheet of paper: 400 cc at 7:00
am; 100cc at 10:00 am; 200cc at 12 noon; 150
cc at 2:00 pm; 400cc at 6:00 pm. The nurse
emptied 300cc from a JP tube. The patient
vomited 100cc at 4:00 pm What is the total
output for the 12 hour shift?
Laboratory Studies
Serum/Urinary electrolyte
levels
Hematocrit (Hct)
Creatinine
Blood Urea Nitrogen
(BUN)
Urine Specific Gravity
5 % weight gain – moderate
FVE
Eyes
Sunken, dry conjunctivae,
Decreased tearing - FVD
Periorbital edema,
papilledema – FVE
Throat & Mouth
Dry mucous membrane,
Dry cracked lips, decreased
salivation - FVD
CV System
Flat neck veins, slow
venous filling – FVD
Distended neck veins -
FVE
Increase PR, weak pulse,
low BP – FVD
Bounding pulse, 3rd heart
sound, hypertension -
FVE
Respiratory System
Crackles, increase RR – FVE
GI System
Sunken abdomen – FVD
Distended abdomen – 3rd
space syndrome
Renal system
Oliguria/Anuria – FVD
Edema (dependent areas-
sacrum, back, legs -
FVE
Skin
Decreased body
temperature, dry frosted
skin, cold clammy skin,
inelastic skin turgor - FVD
single most important
indicator of fluid status
Must be done:
1. Same time each day
2. Same scale after the
client voids
3. Client must wear same
clothes
4. If bed scale is used, must
have same number of
sheaths
If client is under fluid
restrictions, allowed to
take 30 ml. of water
Allow half of the allotted
oral fluids between 7
am - 3 pm.
Why ?
Client is most active at that
time
Received 2 meals
Take most of their oral
medications
Urine is liquid waste product
of the body secreted by the
kidneys by a process of
filtration from blood and
excreted through the urethra.
Change in urine volume
– significant indicator of
fluid alterations or
kidney disease
Plasticreceptacles
Urinals
bedpans
Urimeter can hold 100-
200 ml. of urine, after
measuring can be drain
into a receptacle or urine
bag for disposal
To measure urine volume,
use separate plastic
graduated measuring
receptacle
Normal Urine Output
 30 cc./hr.
1500 ml./day
Hourly urine output
< 30 ml. for more than 2
hrs. is a cause for
concern
< 0.5 ml/kg./hr. for 2
consecutive hrs
Daily urine output of 2000-
2500 ml. daily-
Must be reported to the
physician
Oliguria– small volume of urine
Urine output =
100-500 ml./24 hr
Anuria – absence of urine
output
Output < 50 ml./24 hr.
To determine whether the
fluid output is
proportional to intake or
there is a change in the
client’s fluid status
The nurse compares the total 24 hr.
fluid output measurement with the
total fluid intake measurement
Compares both to previous
measurements
Urinary output = Amount
of fluids ingested
Urine output = 1500-2ooo
ml. in 24 hrs.
or 40 – 80 ml. in 1 hr.
 Route Gain Route Loss (ml.)
(ml.)
H2O 1000 Skin 500
(food)
H2O 300 Lungs 300
(oxidation)
H2O 1200 Feces 150
(liquid)
Kidneys 1500
Total 2500 = 2500
Nursing Responsibilities:
1. No room for error in
calculating dosages
2. Check math work with
another nurse
3. Work problems
systemically & carefully
on paper
4. Recheck calculations
5. Is the answer
reasonable?
Metric Apothecary
60 mgs 1 gr.
1000 mgs 15 gr.
4 grams. 1 dram
30 grams. 1 oz.
.45 kg 1 lb.
1 kg. 2.2 lbs.
Formula when Preparing Solid or liquid forms

Dose Ordered X Amount on hand = Amount

Dose on hand to administer
Dose ordered – amount of
medication prescribed
Dose on hand is the weight
or volume available in
units supplied by the
pharmacy
Amount to administer –
the actual amount of
medication the nurse
will administer;
expressed in the same unit
as the amount on hand
Formula :
Volume/Time x drop factor = drop
rate
Volume/cc/hr = Time
The order reads : 1000 ml D5W to run for
8 hrs. Drop factor is 10.IV correctly set
at 21 gtt./min. After 4 hrs. 500 ml. would
be infused. However after 4 hrs. You find
600 ml. remaining. You must compute a
new flow rate for 600 ml. to run for
remaining 4 hrs.
If you are going to catch up the lost
100 ml. in 1 hr. can be very
dangerous.
Do not do it!
The flow rate must be recalculated if
the IV is off schedule.
Pediatric dosage refers to
the determination of the
correct amount,
frequency & the total # of
doses of a medication to
be administered to a
child or infant.
Young’s Rule – 2 yr. old
or older
Up to 12 years old
Fried’s Rule – for infants
less than 2 yrs. old
Clark’s Rule – uses
child’s wt. to determine
proper dosage
Estimating Body Surface
Area – uses a nomogram
 employs weight in
determining the dose

C.D. = Weight in lbs. X Adult dose

150
What is the dose of a drug for a 45 lb.
child if the average adult dose of the
medication is 15 mg ?

Child’s dose = 45 x 15 = 4.5 mg.

150
 infants up to 2 years old
C.D. = Age in months x Adult dose
150
What is the dose for a 9 month old infant If
the average adult dose
is 35 mg?

Child’s dose = 9 x 35 = 2.1 mg

150
for children 2 years & older

C.D = Age (yr) x Adult dose

Age (yr) + 12
The adult dose of the drug is 7 grains.
What is the dose of a 3 yr. old child?

Child’s dose = 3 x 7 gr. = 1.4 gr

3 + 12
 finding the surface area in
square meters (m2)

C.D. = BSA of Child (m2) x Adult dose

1.73 (m2)
Average Adult B.S.A = 1.73 m2
ac – before meals
ad lib – freely, as desired
bid – twice a day
c – with
cap – capsule
dil – dilute, dissolve
 elix – elixir
 g, gm, Gm – gram
 gr – grain
 gtt – drop
 h – an hour
 hs – at bedtime (hour of sleep)
 IM – intramuscular
 IV – intravenous
 kg or Kg – kilogram
 L,l– liter
 mcg – microgram
 mg – milligram
 OD – right eye
 OS – left eye
 OU – both eyes
 pc – after meals
 po, PO – by mouth
 prn – when needed
 q – every
 qAM – every morning
 qh – every hour
 qhs – every night at bedtime
 qid – 4 times a day
 qod – every other day
 Rx – take
 s – without
 Sc, sc, SQ – subcutaneous
 Sig or S – label
 stat – at once
 sup or supp – suppository
 tid – three times a day
60/M with obstructive jaundice
due to a pancreatic head mass.
Prothrombin time is deranged.
Patient will be needing
Vitamin K.
I forgot what preparation of
Vitamin K to give?
Is it Oral or Parenteral?
Which is better?
Equipment:
Syringes – consists of barrel,
plunger & tip
Tuberculin syringe ( 1 ml.) – for
small doses of epinephrine,
intradermal skin tests & subQ meds
Measured in ml. long lines
represent .1 ml.; shorter lines .
05 ml. & shortest lines .01 ml.
3 ml. Syringe – most frequently
used; for most IM injections;
calibrated in ml. or cc.
 Insulin syringe – calibrated in units;
U 100 syringe holds 100 units/ 1 ml.;
U 50 units/.05 ml.
 Needles – hub, shaft & beveled tip
Lumen – opening at the
needles beveled end
Gauge – size of the diameter of
the inside of the needle’s shaft;
the smaller the gauge the larger
the diameter of the needle
 Needle length – selected based
on the depth of the tissue into
which the medication is to be
injected
 Intradermal injections – 3/8 - 5/8
inch
 IM – 1-1 ½ inch
 SubQ – 5/8 – ½ inch
Needles should never be
recapped to avoid needle stick
injuries

Scoop technique
Formula when Preparing Solid or liquid
forms

Dose Ordered X Amount on hand = Amount

Dose on hand to administer
Example: The physician orders 15 mgs
of diazepam (Valium). The nurse has
Valium tablets that contain 5mg/tablet.

D/S x Q
15 mgs/5 mgs x 1 tab = 3 tablets
The physician orders 40 mgs of
furosemide (Lasix). The nurse has an
ampule of furosemide labeled Lasix
20 mg/ml.
D/S x Q
40 mg/20 mg x 1 ml. = 2 ml.
Formula :

Volume/Time x drop factor = drop

rate
Volume/cc/hr = Time
Pediatricdosage refers to the
determination of the correct
amount, frequency & the total
# of doses of a medication to
be administered to a child or
infant.
 Young’s Rule – 2 yr. old or older

 Up to 12 years old

 Clark’s
Rule – uses child’s wt. to
determine proper dosage
Provide fluid & electrolyte
maintenance, restoration &
replacement
Administer medications &
nutritional feedings
Administer blood & blood
products
Administer chemotherapeutic
drugs
Administer PCA
KVO for quick access
Isotonic– exerts the same
osmotic pressure as that of
plasma
Normal saline 0.9%
Lactated Ringers
Blood components (Albumin
5%, Plasma)
5% dextrose in water (D5W)
Hypotonic – exerts less osmotic
pressure than that of blood
plasma; forces water movement
into cells to reestablish cellular
equilibrium; cells expand or
swell
Half-strength normal saline
(0.45%)
One-third sodium chloride
(0.3%)
Hypertonic – exerts higher
osmotic pressure than that of
plasma; draws water out of the
cells into the extra cellular
compartment to restore
equilibrium; cells shrink
Dextrose 5% in normal saline
0.9%
Dextrose 5% in half-strength
normal saline
Dextrose 10% in water
Dextrose 20% in water
Saline 3% & 5%
Hyperalimentation
solutions
Dextrose 5% in lactated
Ringer’s
Albumin 25%
Large –Volume Infusions –
safest, easiest; medications are
diluted in large volumes 500
ml. or 1000 ml. (Vitamins &
KCl)
Intravenous bolus “Push” –
introducing a concentrated
dose of medication
directly into the systemic
circulation; most dangerous
method for administering
medications; before
administering a bolus the
nurse confirms placement of
the IV line.
Volume-Controlled Infusions –
fluid within a secondary fluid
container separate from the
primary fluid bag.2nd container
connects directly to the
primary IV line.
Piggyback – a small IV bag or
bottle connected to short tubing
lines that connects to the upper y-
port of a primary infusion line.
small bag or bottle is set higher than
the primary infusion bag or bottle
Tandem – small IV bag or
bottle connected to a short
tubing line to the lower y-port
of a primary infusion line.
Placed at the same height as
the primary infusion bag or
bottle
Tandem & mainline infuse
simultaneously
Volume-Control
Administration (Volutrol,
Buretrol, Pediatrol, Solu-set)
small containers (50-150 ml.)
that attach just below the
primary infusion bag or bottle.
Miniinfusion pumps – battery
operated that allows
medications to be given in very
small amounts of fluid 95-60
ml.) within controlled infusion
times using standard syringes.
 Intermittent Venous Access
(Heparin lock or Saline lock) –
an IV catheter with a small
chamber covered by a rubber
diaphragm.
access must be flushed with a
solution to keep it patent.