Question

please, help me answers questions 1-6. thank you so much all your help.

1. Using the heparin protocol posted on Blackboard, determine the bolus dose (in units) for a 60 year old patient with a DVT weighing 120 kg. Round as specified in the protocol 2. Using the heparin protocol posted on Blackboard, determine the rate of flow (in mL/h) of the maintenance dose for the same patient weighing 120 kg. 3. Using the second page of the heparin protocol posted on Blackboard, determine the adjustment necessary when the above patient's PTT comes back at 120, when the patient is a standard risk bleed. Determine the new dose in mL/hr. Unless otherwise specified in the protocol, round to the nearest tenth 4. What is the CrCl of a 32 year old, male patient who weighs 90 kg, is 5'8" tall, and has a SC of 1.4. 5. A 32 year old, male patient who weighs 90 kg, is 5'8" tall, and has a SCr of 1.4. Round to the nearest tenth. What is the adjusted CrCl for this patient? BSA is 2.1m. 6. What is the loading dose (LD) of a drug that is dosed based on IBW at 5 mg/kg for a male patient who weighs 90 kg and is 5'7" tall.

Answer 1

Answers:

1. Heparin Bolus Dose

The patient has DVT and weighs about 120kg

As per protocol, pt <120kg 80Units/kg/Iv.

Bolus dose = 80 X 120 = 9600units.

The bolus dose for this patient is 9600Units.

2. Rate of flow of maintenance Dose of Heparin.

Heparin supplied in 25000Units in 250mL

Rate = Volume of fluid in mL X units in dose / Total no.of units in volume X time(hr).

Rate = 250 X 9600 / 25000 X 1hr

Rate = 96mL/hr.

Rate of flow of maintenance dose of heparin is 96mL/hr

3. Heparin Dose based on PTT

PTT = 120

The patient is at standard risk bleed

As per protocol, decrease 2 units/hr/kg

So the rate has been adjusted to 78Units/kg/hour

Total Loading Dose = 78X120 = 9360Units.

New Dose mL/hr = 250 X 9360 / 25000 X 1hr

New Dose mL/hr = 93.6ml/hr(rounded as 94)

New Dose = 94mL/hr.

4. Creatinine Clearance

CrCl for male =  ([140-age] × weight in kg)/(serum creatinine × 72)

= ([140-32] x 90) / 1.4 x 72

= 108 x 90 / 100.8

= 9720 / 100.8

= 96.4 mL/hr.

Creatinine Clearance for this patient is 96.4 mL/hr.

5. Adjusted creatinine clearance

Adjusted creatinine clearance = CrCl X 1.73/2.1

= 96.4 X 1.73 / 2.1

Adjusted Creatnine Clearance = 79.08mL/min.

5.Loading Dose based on IBW

IDW = 50 + (0.91 × [height in centimeters − 152.4])

IBW = 50+ (0.91 x [174 - 152.4])

IBW = 50 + (0.91 x 21.6)

= 50 + 19.65

= 69.65(rounded as 70)

IBW = 70kg

Ordered dose 5mg/kg

Loading Dose = 70 x 5 = 350mg.

Loading Dose of a patient based on IBW = 350mg.