Medical Charts

Chart 2: Child with rheumatic fever

The prescription order for the12 years old child wit rheumatic fever and weighing 36 pounds (or 16.4 kg) entails 200,000 models of Penicillin G Potassium that is injected intramuscularly. Illustration of Penicillin G Potassium may be the brand Pfizerpen like a sterile solution that may be saved under low temps for 1 week without losing potency. The 200,000 models of Pfizerpen is split into four dosages given 6 hourly. Pfizerpen ought to be given like a diluent because more powerful solutions cause irritation towards the patient. The kid can also be given 650 mg of Vancocin that is a brand for that molecule Vancomycin hydrochloride. 650 mg is selected because the dosage for that child due to age. Normally, for patients below 12 years old, and who aren’t neonates or infants, 40mg per kg of body weigh of Vancomycin is given. The 650mg Vancocin in given inside a continuous time period of one hour, intravenously through piggy-back since this is an accepted patient, and furthermore, Vancocin can be obtained being an intravenous drug. The individual can also be given Prednisone in a dosage of 5mg two times each day, taken orally. Usually, Prednisone is taken at .5mg per body kg, which value was increased through the patient&rsquos weight 16.4kg. The individual therefore requires and overall dose of 8.2 mg which if adopted a two times each day basis, the individual needed 4.1mg. However, as being a child, the dosage is defined on the greater side of 5mg since the patient can lose a lot of it throughout administration. Diazepam can also be given towards the patient at 1mg four occasions each day on the 6 hourly basis through mouth. Diazepam can be obtained as 2mg, 5 mg and 10mg however the pills are obtained. And so the 2mg tablet could be damaged to acquire 1mg of diazepam. In compliance to age the individual, 160mcg of Digoxin will be given. The purchased dosage thus remains 80mcg given orally on the two times each day basis or 12 hourly. The individual may also be placed on 500ml of 5% Dextrose in lactated ringer&rsquos solution (D5LR). D5LR is given intravenously on continuous infusion at 25 ml each hour. D5LR is really a fluid alternative therapy that stops body lack of fluids around the put in the hospital patient. The dosages for that medicine is safety dosages because extra weight from the patient is recognized as within the calculation from the dosages.

To reconstitute the 650 mg Vancocin, 13ml of sterile water for injection will be included to the 1g vial Vancomycin powder. It is because it’s needed that 20 ml of sterile water for injection be included to 1g vial of dry Vancomycin powder. Within this situation the 500mg vial can’t be used since the needed dose of 650 mg is greater than 500mg. The reconstituted option would be diluted with 130ml of diluent, thinking about that 100ml of diluent is needed to dilute 500mg of reconstituted Vancomycin. For intravenous use, the reconstituted option would be further diluted with 250ml of D5LR since the amount has ended 500mg, which requires 100ml from the diluent. Vancomycin may be the primary while D5LR may be the secondary intravenous infusion.

Chart 3: A grownup with congestive heart failure and lung edema

The next section talks about the prescription order for any 54.5 kg adult who’s receiving treatment for congestive heart failure and lung edema. The individual is given to Lasix, whose generic is furosemide. Lasix is given at 3-37mg each hour through continuous intravenous infusion to be able to get yourself a serum degree of 1-2 mg/l. This can be a safe dosage for that 54.5kg adult thinking about that the safe dose happens between .005 to .5 mg/kg/hr. If this rates are calculated with age the individual, it’s discovered that patient requires an infusion rate of two.725-27.25 mg/hour. The physician orders for any rate of three-27mg each hour which falls inside the pointed out rate, and therefore safe for that patient. Lasix may either be given intramuscularly or intravenously. Intravenous infusion is really a selected way of this patient since the patient is going through congestive heart failure and intravenous appears a quicker method of getting a systole as in comparison to intramuscular drug administration.

Slow-K is given towards the adult on at 8mEq which means milliequivalent, and it is given orally (p.o), two times each day (b.i.d). The individual requires 1 tablet from the extended release 600mg Slow-K as purchased through the patient. Nipride is offered as 164-327mcg each minute given through continuous intravenous infusion to be able to conserve a systolic bloodstream pressure (SOB) of under 140nm. Nitroglycerin is given at 20mcg each minute through intravenous infusion for 10 hrs every day. Demerol is given at 75 mg intramuscularly at each four hrs (q4h) taken when needed (p.r.n) in case of discomfort. .075 ml of Demerol is going to be needed every four hrs to be able to have the purchased dose. Codeine 30mg is given orally towards the patient at four hour interval when needed in case of discomfort. Codeine is given for mild and moderate discomfort.

To own stat Lasix order 2.7ml from the Lasix is going to be needed. This really is slightly greater compared to suggested 2ml however the physician&rsquos intention is to make sure that the serum degree of the individual is one to two mg each hour. For any stat dose, it’s far better to administer the drug intravenously than intramuscularly because the patient has the capacity to have the needed serum level inside a shorter time.

To dilute 40 mg of Lasix to some total solution of 50ml Dextrose 5%in water (D5W) 4ml of Lasix is going to be needed for titration to be able to have the 40mg. It is because the vial of Lasix includes 20mg per every 2ml. To acquire a solution of 50ml total volume 1ml much more of D5W must be included to the answer. To start titration, a dosage rate 3 mg each hour is needed which may also be presented as .003ml each hour. It is because every 1000mg of solvent is the same as 1ml from the solvent. The individual&rsquos serum level normalizes once the Lasix is infusing at 8ml each hour which implies that the individual gets a dosage of .13ml each minute. At this time around, 75 % from the dosage rate the patient receives is .0975 ml each minute which becomes the brand new infusion rate and could be documented on an order chart as 9.75mg/hr continuous IV infusion. Every day the individual receives 234mg of Lasix using the new dosage rate. Following a couple of days on IV infusion, the individual is switched to dental Lasix which the dosage is 40mg each day when calculated on 200 percent from the new dosage rate. This is often recorded as 20mg p.o. b.i.d. For Lasix pills which are packed as 40mg, the individual requires half a tablet for each dental dose daily.