A nurse is preparing to administer 1 L of 0.9% sodium chloride solution to a client over 6 hours. The intravenous (IV) fluid has a drop factor of 15 gt/mL. What will be the gt/min flow rate?

This instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.

The other options are not appropriate instructions because:

a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.

b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.

c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.

To find the volume of fluid that will be left at 10:00 am, you need to calculate the following:

- The time elapsed in minutes from 8:45 am to 10:00 am using the formula: Time elapsed (min) = End time (min) - Start time (min)
- The volume of fluid infused in milliliters (mL) during the time elapsed using the formula: Volume infused (mL) = Flow rate (mL/min) x Time elapsed (min)
- The volume of fluid left in milliliters (mL) at 10:00 am using the formula: Volume left (mL) = Initial volume (mL) - Volume infused (mL)

First, use the formula for time elapsed to find how many minutes have passed from 8:45 am to 10:00 am:

Time elapsed (min) = End time (min) - Start time (min)

Since the end time is 10:00 am and the start time is 8:45 am, plug in these values into the formula:

Time elapsed (min) = 600 min - 525 min

Simplify and solve for the time elapsed:

Time elapsed (min) = 75 min

Next, use the formula for volume infused to find the amount of fluid infused in milliliters during the time elapsed:

Volume infused (mL) = Flow rate (mL/min) x Time elapsed (min)

Since the flow rate is 2 mL/min and the time elapsed is 75 min, plug in these values into the formula:

Volume infused (mL) = 2 mL/min x 75 min

Simplify and solve for the volume infused:

Volume infused (mL) = 150 mL

Then, use the formula for volume left to find the amount of fluid left in milliliters at 10:00 am:

Volume left (mL) = Initial volume (mL) - Volume infused (mL)

Since the initial volume is 1500 mL and the volume infused is 150 mL, plug in these values into the formula:

Volume left (mL) = 1500 mL - 150 mL

Simplify and solve for the volume left:

Volume left (mL) = 1350 mL

Therefore, the volume of fluid that will be left at 10:00 am is **1350 mL**.