I really don't know how to begin to approach this problem.
A 6-year-old patient underwent an outpatient tonsillectomy and adenoidectomy The surgeon ordered 1,000 cc D5W, dispensed at a rate of 600 cc every 8 hours, to maintain hydration levels. A pharmacist calculated the infusion rate for the IV drip to be administered. He used a calculator and checked his calculations twice. He then listed the infusion rate on the electronic medical chart as 200 mL/hr.
The nurse who started the infusion obtained a bag of D5W, which contains 1,000 cc of fluid, and administered the IV solution to the child. Like other nurses in her unit, she relied on the accuracy of the pharmacist since he had a reputation for correctness. Therefore, she did not check his calculations even though her job duties include verifying dosages. Once the first 1,000 cc bag of D5W was empty, she hung a second bag to infuse.
The child began vomiting frequently, which is not unusual in the recovery for this surgery. The child was given medicine to ease the vomiting. Forty minutes later the child exhibited seizure-like activity, which is unusual in the recovery from this type of surgery. This behavior increased over the course of the day, during which a third 1,000 cc bag of D5W was hung to dispense.
The pediatrician on call noticed the patient was experiencing hyponatremia and water intoxication due to the high IV infusion rate and lack of sodium chloride in the infused medicine. In fact, the child's sodium level was 107 mEq/L, whereas the normal range is 136-145 mEq/L. Despite treatment, the child did not survive.
Assuming all three bags were completely administered, how much D5W did the child actually receive compared to the amount ordered? Assuming the surgeon's orders were correct, what should the IV rate have been in cc/hour? How long should the IV have continued to administer the 1,000 cc ordered by the surgeon? By what percent was the child's sodium level beneath the normal range?
This is actually for a math class and not a medical class. I know nothing about medicine and am struggling with how to begin. Obviously this patient was not given the correct dose, but how can I prove this?
How would i put this into a paragraph form??
One confusion that could arise is to use cc vs ml
http://thecompounder.com/2015/04/13/cc-vs-ml-whats-the-difference/
the ordered rate was 600 cc/8 hours
= 75 cc/hour
The pharmacist erroneously calculated this to be
200 ml/hr or 200 cc/hr
To approach this problem, let's break it down step by step. First, the surgeon ordered 1,000 cc of D5W to be dispensed at a rate of 600 cc every 8 hours to maintain hydration levels. The pharmacist then calculated the infusion rate for the IV drip and listed it as 200 mL/hr on the electronic medical chart.
To determine how much D5W the child actually received compared to the amount ordered, we need to calculate the total amount infused. Since three bags of D5W were hung and assuming they were all completely administered, the total amount would be 3,000 cc (1,000 cc per bag x 3 bags).
Next, let's determine what the IV rate should have been in cc/hour. The surgeon ordered a rate of 600 cc every 8 hours, so we can calculate the hourly rate by dividing 600 cc by 8 hours. This gives us 75 cc/hr. Therefore, the IV rate should have been 75 cc/hr to match the surgeon's orders.
To find out how long the IV should have continued to administer the 1,000 cc ordered by the surgeon, we can divide the total amount of D5W ordered (1,000 cc) by the IV rate of 75 cc/hr. This gives us approximately 13.33 hours. Therefore, the IV should have continued for approximately 13.33 hours to administer the 1,000 cc ordered by the surgeon.
Finally, to calculate how much the child's sodium level was beneath the normal range as a percentage, we subtract the child's sodium level of 107 mEq/L from the lower limit of the normal range (136 mEq/L) and divide it by the normal range difference. The normal range difference is the upper limit (145 mEq/L) minus the lower limit (136 mEq/L).
Doing the calculations, we get: (136 mEq/L - 107 mEq/L) / (145 mEq/L - 136 mEq/L) * 100% = 63.16%
So, the child's sodium level was 63.16% beneath the normal range.
To summarize in paragraph form:
Based on the given information, the child actually received a total of 3,000 cc of D5W, which is three times the amount ordered. The correct IV rate should have been 75 cc/hr instead of the listed rate of 200 mL/hr. The IV should have continued for approximately 13.33 hours to administer the 1,000 cc ordered by the surgeon. Additionally, the child's sodium level was 63.16% beneath the normal range, suggesting a significant abnormality caused by the incorrect dosage and lack of sodium chloride in the administered medicine. Through these calculations, it is clear that the child did not receive the correct dose as ordered by the surgeon.