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Clinical Case Study, Chapter 5, Liquids for Injection

 

Dorothy Richardson, age 77, following a fall at home, was admitted to the hospital with fractured right hip. Ms. R. had a large open wound on her forehead, which was sutured prior to surgery. Surgery was completed successfully, total hip replacement secondary to client’s history of rheumatoid arthritis. Ms. R. also has a history of pernicious anemia and mild CHF (congestive heart failure). (Topics covered: solving injection from liquid problems)

Allergies: PCN (penicillin), sulfa, meperidine, hydromorphone 

Medication orders: 

heparin 10,000 units subcutaneous ×1 then 3,000 units subcutaneously daily
cyanocobalamin 0.5 mg subcutaneous daily
digoxin 0.125 mg IV daily
ondansetron 3 mg IV q 6 hours prn nausea
morphine 2 mg IV q 3 hours prn pain
adalimubab 40 mg subcutaneous once weekly
epinephrine 1 mg subcutaneous prn anaphylaxis
lidocaine 40 mg for injection before suturing wound

 

Calculate the doses: Do not round.

heparin. Supply: 5000 units/ 0.5 mL
cyanocobalamin. Supply: 1000 mcg/mL
digoxin. Supply: 250 mcg/mL
ondansetron. Supply: 4 mg/2 mL
morphine. Supply: 4 mg/mL
adalimubab. Supply: 80 mg/0.8 mL prefilled syringe
epinephrine. Supply: 1:1000
lidocaine. Supply: 2%

 

Critical Error:

The heparin order was transcribed: Heparin 10000 units subcutaneous. Available is 5000 units in 0.5 mL. The nurse calculated the dose as 0.1 mL. What error could happen?

 

SCIENCE
HEALTH SCIENCE
NURSING
NRS 104

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