Reference no: EM133221204

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.

1. heparin. Supply: 5000 units/ 0.5 mL
2. cyanocobalamin. Supply: 1000 mcg/mL
3. digoxin. Supply: 250 mcg/mL
4. ondansetron. Supply: 4 mg/2 mL
5. morphine. Supply: 4 mg/mL
6. adalimubab. Supply: 80 mg/0.8 mL prefilled syringe
7. epinephrine. Supply: 1:1000
8. 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?