Getting Started

Pharmacy calculations are very important for prescribing, especially in regards to renal function and pediatric dosing. This assignment will focus on calculating renal function and medication doses for pediatric patients. Review the information below and then follow the subsequent instructions.

Upon successful completion of the course material, you will be able to:

• Successfully calculate dosing for renal functions

Background Information

Renal function

Renal function can be calculated different ways but the most common ways are using the Cockcroft-Gault and CKD-EPI equations (see below). If adjustments to dosing are required due to decreased renal function, it is important to know which equation should be used. This can be found in a drug reference or the package insert for a particular medication. In general, if renal cutoffs are expressed as mL/min the Cockcroft-Gault equation should be used but if renal cutoffs are expressed in mL/min/1.73m2 then the CKD-EPI equation should be used. Different equations are necessary to calculate renal function in the pediatric population.

The Cockcroft-Gault equation is as follows:

• CrCl = [(140-age) (ideal body weight)]/[(72) (SCr)] x 0.85 (if female)
  • age is expressed in years
  • weight is expressed in kg [ideal body weight (IBW) should be used except for obese patients, in which case adjusted body weight is typically used]
  • SCr is serum creatinine expressed in mg/dL
  • IBW (male) = 50kg + 2.3 kg for each inch of height over 5 feet
  • IBW (female) = 45.5kg + 2.3 kg for each inch of height over 5 feet
  • Adjusted body weight = IBW + [0.4 x (actual body weight – IBW)]

The CKD-EPI equation is as follows:

• eGFR = 141 x min(SCr/κ, 1)α x max(SCr /κ, 1)-1.209 x 0.993Age x 1.018 [if female] x 1.159 [if Black]
  • eGFR (estimated glomerular filtration rate) = mL/min/1.73 m2
  • SCr is serum creatinine expressed in mg/dL
  • κ = 0.7 (females) or 0.9 (males)
  • α = -0.329 (females) or -0.411 (males)
  • min = indicates the minimum of SCr/κ or 1
  • max = indicates the maximum of SCr/κ or 1
  • age = years

Pediatric Dosing

In general, medication dosing for pediatric patients is based on weight. This makes it particularly important to be able to calculate doses appropriately. The most basic calculation is dose (ie. mg/kg) times weight (in kg).

Example

• Cefdinir (Omnicef®) for acute otitis media is 14 mg/kg/day in 1-2 divided doses
  • What would the recommended dose be for a 22 lb patient?
  • First, lbs must be converted to kg.
    • 22 lb x (1 kg/2.2 lb) = 10 kg
  • Now, the dose can be calculated.
    • 14 mg/kg x 10 kg = 140 mg
  • Based on the dosing recommendation above, this could be given 2 different ways:
    • 140 mg once daily
    • 70 mg two times daily

For liquids or suspensions, medication doses are often given as the volume to be given to the patient. One must be aware of the available concentrations for a particular medication.

Example

• Cefdinir (Omnicef®) is available in the following concentrations:
  • 125 mg/5 mL
  • 250 mg/5 mL
• Using the example above, how many mL would be needed for 140 mg daily?
  • [140 mg / 125 mg] x 5 mL = 5.6 mL
  • [140 mg / 250 mg] x 5 mL = 2.8 mL
  • Often, we have to round to the nearest 0.5 mL to make it easier to administer using an oral syringe. Rounding the first option to 5.5 mL would give the patient 137.5 mg (5.5 mL x 125 mg/ 5 mL)

Instructions

1. Print out the Calculations Quiz.
2. Complete each question by hand and show your work.
3. Scan the completed quiz and submit via the Assignment.

This assignment is worth 50 Points

Access the Assignment submission page

Purpose

This week’s graded topics relate to the following Course Outcomes (COs).

• CO 1: Examine the sources of evidence that contribute to professional nursing practice. (PO 7)
• CO 2: Apply research principles to the interpretation of the content of published research studies. (PO 4 & 8)
• CO 4: Evaluate published nursing research for credibility and significance related to evidence-based practice. (PO 4 & 8)
• CO 5: Recognize the role of research findings in evidence-based practice. (PO 7 & 8)

Discussion

Application and implications for practice come from the interpretation of meaning from research findings. Communicating and using research evidence is an expectation of a BSN graduate.

• Select and describe one of the conclusions from the required article from the Week 6 assignment that you found interesting and applicable to practice. Describe how you would apply the evidence to improve nursing practice. Explain your answer.
• Discuss ways you would disseminate research-based evidence; how would you share with your peers? Include your thoughts on why it is important for you to be involved in communicating and applying nursing research evidence.

Grading

To view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

Search

The required source is listed below:

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Friese, S. (2019). Qualitative data analysis with ATLAS. Ti. SAGE Publications Limited.

Salmona, M., & Kaczynski, D. (2016, July). Don’t blame the software: Using qualitative data analysis software successfully in doctoral research. In Forum Qualitative Sozialforschung/Forum: Qualitative Social Research 17(3). Retrieved from http://www.qualitative-research.net/index.php/fqs/article/view/2505/4008#g61

Submit the third milestone of your final project.

Project on – Venice Family Clinic

Item budget proposal –  Electronic Health Record (EHR) Systems

Prompt: After reviewing your proposal outline, your boss has strongly recommended that you identify options for implementing your capital proposal. Wanting to submit a successful proposal and earn a $2,500 bonus, you plan to do just that. Previously, you created a departmental budget that considered the costs and revenue associated with your capital budget item. For Milestone Three, you’ll go one step further and research the options for implementing your capital budget item(s). This research will culminate in a short paper identifying the capital item(s) you are proposing, describing:

I. Impacts and Justification 

1. Short-Term Impact: What short-term impact will this request have on the overall financial statements used for decision making and on financial
   planning?
2. Long-Term Impact: What long-term impact will this request have on the overall financial statements used for decision making and on financial
   planning?
3. Cost-Benefit: What is the percentage increase in financial need? How does this balance with the potential value added by your requests? What is
   the cost-benefit of these requests?
4. Strategic Planning: Provide an explanation for each budget request in your proposal, taking into consideration strategic plans. How do your
   budget requests show strategic planning and forethought?
5. Conflicts: Describe the strategic impact and any potential ways in which your recommendations might conflict with the overall strategic vision.

When discussing the benefits, indicate whether your proposal will affect each of the key healthcare operating indicators and why the proposal will or will not have that affect.

Requirements of submission: Your paper must be submitted as a two- to three-page document with double spacing, 12-point Times New Roman font, one-inch margins, using APA for citations.

For additional details, please refer to the Milestone 3 guidelines and rubric.

PLEASE FOLLOW ALLL INSTRUCTIONS WITHIN RUBRIC!

Excel Budget attached below with milestone 2. Please read before moving forward to milestone 3

Improving the quality of health care delivery and patient safety continues to be a political concern and has been at the heart of reform issues for many years. The American Nurses Association (ANA) and the Institute of Medicine (IOM) have increased awareness of health care quality and safety issues, as well as advocated for health care reform. The documents featured at the ANA and IOM websites listed in this week’s Learning Resources focus on many of the current issues surrounding quality and safety in the health care industry.

To prepare:

• Review this week’s Learning Resources, focusing on the Six Aims for Improvement presented in the landmark report “Crossing the Quality Chasm: The IOM Health Care Quality Initiative.”
• Consider these six aims with regard to your current organization, or one with which you are familiar. In what areas have you seen improvement? What areas still present challenges? As a nurse leader, how can you contribute to improving the organization’s achievement of these aims?
• Select one specific quality or safety issue that is presenting a challenge in the organization. Consider at least one quality improvement strategy that could be used to address the issue, as well as which of the six aims for improvement would then be addressed.
• Reflect on your professional practice and your experiences with inter-professional collaboration to improve quality and safety. How has inter-professional collaboration contributed to your organization’s efforts to realize the IOM’s six aims for improving health care? Where has inter-professional collaboration been lacking?

Post a description of the quality or safety issue you selected and a brief summary of the impact that this issue has on health care delivery. Describe at least one quality improvement strategy used to address this issue. Then explain which of the six “aims for improvement” are addressed by the strategy. Finally, explain how inter-professional collaboration helps improve quality in this area.

Read a selection of your colleagues’ responses.