** Medication exercises ** NICU Phase II

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1 ** Medication exercises ** NICU Phase II A) Baby A has had a bowel resection six hours ago. She weighs 3 kg. Postop, she is quite agitated and she is on a fentanyl drip at 2 micrograms/kg/hr (#1). She becomes more agitated and desaturates frequently. The doctor orders you to increase the fentanyl drip to 4 micrograms/kg/hr (#2). The concentration of fentanyl ordered by the doctor is 50 mcg/ml. i. Calculate your infusion rates for #1 and #2 ii. Do you believe that 50 mcg/ml is an acceptable concentration for this patient? iii. How would you prepare your drip? B) What problem would occur if your baby weighed only 780g? What should be done about this problem? C) How do you prepare your drip dilution in question B) if you want to prepare a 20 ml syringe? D) Baby D is 2.850kg. The doctor orders a dopamine drip to improve her urinary output. The dosage ordered is 5 micrograms/kg/min. The concentration of the dopamine in the bag is 3200mcg/ml. 1) Choose a concentration and determine the rate. 2) Which concentration seems most appropriate? 1

2 E) You need to start a dopamine drip on baby E in order to maintain a good blood pressure. The medical order reads: Start dopamine at 5 micrograms/kg/min based on a weight of 1.2 kg. The concentration of the dopamine in the bag is 3200mcg/ml. 1) Which concentration will you choose to make? 2) Which solution will you take to dilute it with? 3) How would you dilute the dilution to prepare a 30 ml syringe? 4) What will the rate be? F) You are taking care of baby F who just arrived from the O.R. for a PDA ligation. He is intubated. His HR is 196 beats/min and he is very stiff, the physician prescribed a fentanyl drip at 2mcg/kg/hr and the baby s weight is 1.37 kg. Prepare the drip and start it. 15 minutes after you start your fentanyl drip, you notice that your baby is very agitated and his HR is still beats/min. The physician orders a fentanyl bolus of 2mcg/kg and subsequently increase your drip to 3mcg/kg/hr. 1)How will you give your bolus? 2)What volume will you give and how fast should you give it? 3)How you will set your pump? 48 hours after the O.R., your baby s condition improves. The physician decides to wean the fentanyl. He asks you to decrease your fentanyl to 1 mcg/kg/hr. What would your infusion rate be? G) Baby G needs a drip of midazolam to be started at 1mcg/kg/min. He weighs 2

3 2.230kg. The concentration of midazolam in the vial is 5 mg/ml. 1) Calculate your rate and 2) Prepare the drip dilution to have 20 ml in your syringe. H) Epinephrine is the most important drug used in resuscitation. What is the dosage and the route of administration preferred? What does 1: on the epinephrine vial mean? You need to start an epinephrine drip at 0.1 micrograms/kg/min. Baby H weighs 1.21kg. 1) Which concentration will you choose? 2) What will the rate be? 3) How would you prepare the dilution to have a 30 ml syringe total? I) Baby I, 1 month old, is in room air and has an abdominal wound infection. He is in pain and the physician orders a bolus of morphine. Baby weighs kg. 1)What is the minimal dose the physician is suppose to start with? The concentration of the morphine in the vial is 10mg/ml. 2)How will you prepare your dilution to have a bolus? The baby is now really in pain, so the physician orders a morphine drip of 10mcg/kg/hr. What would your infusion rate be if the concentration of the drip is ordered as 100 mcg/ml? 3

4 The 2 nurses preparing the above drip made a huge error and ran the drip at 4.3ml/hr. The baby becomes apneic. What would you do in this situation? What emergency medication would you expect to be prescribed? J) You need to start an insulin drip for baby J at 0.1 unit/kg/hr and the ordered concentration is 0.04 units/ml. Baby weighs 750g. 1)What would be the rate of infusion? 2) The vial concentration is 100 unit/ml. Are there any precautions you need to take when you prepare your drip of insulin? Prepare your dilution to make a 50 ml syringe. K) A cardiac echo just revealed a ductus dependant systemic blood flow lesion on baby K. You need to start a PgE drip now. The doctor orders PgE at 0.01 micrograms/kg/min. You have on hand an ampoule of Prostin in the fridge with a concentration of 500 micrograms/ml. BB weighs 4 kg. #1 - Which infusion concentration do you and the team choose? #2 - What would your infusion rate be? #3 - How do you prepare your drip dilution if you want to prepare a 20 ml syringe? Could you infuse your PgE with your maintenance solution? The baby's saturation is in the low 50's. The doctor asks you to increase the dose of PgE to micrograms/kg/min. At what rate would you run the PgE at? 4

5 What are the most significant side effects of PgE? Prepared by Martine Chagnon, July 2012 Revised by Karine Huppé / Elissa Remmer, Oct

** Medication exercises ** NICU Phase II

** Medication exercises ** NICU Phase II ** Medication exercises ** NICU Phase II A) Baby A has had a bowel resection six hours ago. She weighs 3 kg. Post-op, she is quite agitated and she is on a fentanyl drip at 2 micrograms/kg/hr (#1). She

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