A mother calls a nurse to say that she lost the measuring cup that comes with the cough syrup botle. How many teaspoons should the nurse recommend for the child if the dose is 10 mL?

To find the answer, we need to convert the units of the medication order and the infusion rate to the same units. We can use the following conversions:

1 mcg = 0.001 mg 1 kg = 1000 g 1 min = 60 s 1 h = 3600 s

The medication order is 140 mcg/kg/min, which means the patient needs 140 mcg of medication per kilogram of body weight per minute. The patient weighs 60 kg, so we multiply 140 mcg by 60 kg to get the total amount of medication per minute:

140 mcg/kg/min x 60 kg = 8400 mcg/min

We then convert this to milligrams by dividing by 1000:

8400 mcg/min / 1000 = 8.4 mg/min

The infusion rate is 10 mL/h, which means the patient receives 10 mL of fluid per hour. We convert this to minutes by dividing by 60:

10 mL/h / 60 = 0.167 mL/min

We can now find the concentration of the medication in the fluid by dividing the amount of medication per minute by the amount of fluid per minute:

8.4 mg/min / 0.167 mL/min = 50.3 mg/mL

This means that for every milliliter of fluid, there are 50.3 milligrams of medication. To find how many milligrams of medication are in one hour, we multiply the concentration by the infusion rate:

50.3 mg/mL x 10 mL/h = 503 mg/h

This is the total amount of medication that the patient receives in one hour. To find how many milligrams are in one dose, we divide this by the number of doses per hour, which is one:

503 mg/h / 1 dose/h = 503 mg/dose

This is the final answer, but we need to round it to the nearest tenth, as per the instructions: 503 mg/dose ≈ 67.2 mg/dose

The correct technique for preparing this insulin order is to follow these steps¹²:

- Perform hand hygiene and put on gloves.
- Mix NPH (cloudy) insulin by gently rotating the vial between the palms of your hands. Do not shake the vial.
- Clean the tops of both vials with alcohol swabs and let them dry.
- Draw up the amount of air equal to the dose of NPH insulin into a syringe. Inject the air into the NPH vial without touching the needle to the solution. Withdraw the needle and syringe without drawing up any insulin. This will create positive pressure in the NPH vial and make it easier to draw up later.
- Draw up the amount of air equal to the dose of regular (clear) insulin into the same syringe. Inject the air into the regular vial and invert the vial. Make sure the needle tip is below the fluid level and draw up slightly more than the dose of regular insulin. Tap the syringe gently to remove any air bubbles and push out any excess insulin to get the exact dose. Withdraw the needle and syringe from the regular vial.
- Reinsert the needle and syringe into the NPH vial without touching the needle to the solution. Invert the vial and draw up slightly more than the dose of NPH insulin. Tap the syringe gently to remove any air bubbles and push out any excess insulin to get the exact dose. Withdraw the needle and syringe from the NPH vial.
- Check that you have the correct doses of both insulins in one syringe. The total volume should be equal to the sum of both doses.
- Administer the dose within 5 to 10 minutes after drawing up because regular insulin binds to NPH and this decreases its action.