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 3 Calculations
Clinical
Dosage

Edition
VANESSA BROTTO
KATE RAFFERTY
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

6 Infusion calculations 121 10 Mental health calculations 191

Introduction 121 Introduction 191
Types of infusion delivery 121 Types of calculations commonly used in mental health 192
Approaching infusion calculations 125 11 Critical care and high dependency dosage calculations 206
Calculating rates for infusions 126 Introduction 206
Changing from a gravity feed (dpm) to a volumetric General principles for solving calculations in units/min
pump (mL/h) 137 and units/body weight/min 206
How long until the infusion is finished 139 Infusion calculations – units per minute (microg/min or mg/min) 207
Changes to the infusion rate 140 Infusion calculations – units per body weight per minute
Calculating more complex rates for infusions 141 (microg/kg/min or mg/kg/min) 214
Infusion calculations – bolus infusion doses 218
Part 2 – Skills deepening 144 Medicine calculations – liquids and concentrations 222

7 Paediatric calculations 145 12 Oncology calculations 227

Introduction 145 Introduction 227
Dose per kilogram 145 Types of calculations commonly performed in oncology 229
Body surface area 147
Displacement values (powder volumes) when Part 3 – Skills practice 240
reconstituting powdered IV medications 151
Practice questions 241
Practical calculations 154
Basic mathematics 241
8 Aged care calculations 164 General questions 242
Introduction 164 Medication chart questions 247
Polypharmacy 164
Answers 250
Cutting and crushing tablets 166
Tablets with special coatings 169
Online resources 270
9 Midwifery calculations 182 References 271
Introduction 182 Index 273
Pain relief in labour 182 Working outs 281

Contents CLINICAL DOSAGE CALCULATIONS vii

Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

viii

ABOUT THE BOOK

Dosage calculations have often been a source of stress for pharmacology resource or medicine administration guide: other
students and practising health professionals. They are a vital relevant texts are needed for these purposes. This book only offers a
part of clinical practice and can have tragic consequences if basic overview of some of these important areas where appropriate.
performed incorrectly (i.e. if clients inadvertently receive too Clinical Dosage Calculations introduces some unique
much or too little of their medications). The response to the approaches to the medication chart for the health professional.
first and second editions of this book has been overwhelming, The revised ‘10 steps for safe use of a medication chart’ ensures an
with so many students finding dosage calculations much easier overall systematic process for calculating doses and establishing
with some choice over how they approach them. which medicines are due/available to administer to a client. The
In formal classes or in other texts, students are often not given text also incorporates specialist area chapters (midwifery, aged
a choice as to the method they use when learning how to perform care, mental health, oncology, critical care and paediatrics),
dosage calculations. As a result, many health professionals are taught which allow the reader to practise calculations commonly found
the ‘formula method’ only, and they may struggle to remember all in these areas, giving a clinical basis for their learning.
the necessary formulae, and how and when to use them. Clinical This text may be read from ‘front to back’ or the reader may
Dosage Calculations allows for variety in the calculations and covers choose to skip the general mathematics section and start from
both the formula method and the proportions method (using basic the general calculations. It would be advisable for readers to
mathematics and ratio principles to solve dosage calculations). read through the general chapters first before the specialist ones
This targets those students who struggle with formulae and who but this is not strictly required. Each chapter explains the main
might wish to try a different approach. concepts and shows worked examples. The reader can then
We have tried to ground this text in the realities of clinical engage in the activities of each chapter as an introduction to
practice by using real-life cases, examples and medicine labels. the concept before moving onto the final chapter where they
Important national concepts and initiatives such as ‘risk can test their knowledge overall. The worked solutions to the
management’ and ‘quality use of medicines’ are introduced in activities are available on the companion website and the quick
terms of their application to performing dosage calculations. This answers may now be found at the back of the book.
allows students to increase their familiarity with the whole process We hope you enjoy reading and using Clinical Dosage
of medicine administration and see the relevance of what they are Calculations in your learning, and that the different approaches
learning. However, it is beyond the scope of this text to act as a help with performing calculations.
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

ABOUT THE AUTHORS

Vanessa Brotto, RN, BN, BAppSci(HP), GDipAdvNurs(CritCare), Kate Rafferty, RN, DipAppSci(Nurs), GCertPaed(CritCare),
GCertHigherEd, MClinNurs, was a university academic for GCertNursAcuteCare(Periop Pract), Cert IV TAA, currently works
17 years, having led teaching teams in the Bachelor of Nursing at Peter MacCallum Cancer Centre in the operating theatres.
degree, the Postgraduate Diploma of Critical Care and the She previously held the position of Clinical Director at Cobden
Master of Nursing Practice (Nurse Practitioner) degrees. She District Health Service for eight years. Kate also has experience
has worked as a clinical nurse specialist in intensive care and teaching in the Certificate IV of Nursing, and coordinating
post-anaesthetic care units at a major metropolitan hospital several traineeships in health-affiliated areas across Victoria
in Melbourne, as well as in clinical education for many years. with South West TAFE. She has worked as a registered nurse
Vanessa has a passion for using diverse teaching methods and in cardiac intensive care in the Royal Alexandra Hospital for
making the classroom a fun and engaging learning space. Children and as a perioperative nurse at St Vincent’s and St
Vanessa won a university teaching award for her approach to Vincent’s Private Hospitals in Melbourne. She has experience in
teaching large classes and has received a number of university a coordinator’s role at St John of God in Warrnambool and as a
commendations for excellence in teaching. unit manager in aged care (high care dementia). Kate has also
worked as an educator at Deakin University. She has a strong
interest in making health education vibrant and memorable.

CLINICAL DOSAGE CALCULATIONS ix

Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

ACKNOWLEDGEMENTS
The third edition of this book would not have been possible The authors and Cengage would like to thank the following
without the support of our great team at Cengage Learning and reviewers for their incisive and helpful feedback:
our family and colleagues. The team at Cengage have been a • Penny Coogan – James Cook University
pleasure to work with – a special thank you to Michelle Aarons • Mike Shearsmith – Open Colleges School of Health
(content manager), Rhiannon Bowen (content developer), • Dr Trish Burton – Victoria University
Emily Spurr (content developer), Lauren McGregor (project • Jo-Anne Rihs – Victoria University
editor) and Julie Wicks (editor), who have been a brilliant team • Erika Silfo – Open Colleges
to work with. Thanks must also go to our external reviewers • Joachim Ferrer – University of Southern Queensland
who gave valuable feedback and advice on each of the chapters • Lisa Taffe – TAFE NSW
in order to improve the relevance of the text in Australia and • Jenny Dolzadelli – Curtin University
New Zealand. • Deborah Kugler – Holmesglen Institute
• Leanne Hunt – Western Sydney University
From Vanessa: I could not have done this without the support
of my amazing family and friends. I dedicate this work to my Cengage Learning would also like to thank Michelle Hong,
two young daughters Aniela and Amalie, who have been very Senior Pharmacist at the Peter MacCallum Cancer Centre,
supportive of their mum writing on the weekends. Melbourne, Victoria, for her help with sourcing drug label
images for this text.
From Kate: To my wonderful family and friends – thank you.
Your ongoing support, encouragement and understanding
continue to give me the energy to meet deadlines.

Vanessa Brotto and Kate Rafferty

Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

Guide to the text

As you read this text you will find a number of features in every
chapter to enhance your study of clinical dosage calculations.

FEATURES WITHIN CHAPTERS

CHAPTER 4

Using quality and risk management principles in dosage calculations CLINICAL DOSAGE CALCULATIONS 90
Find the information to correctly calculate and administer drug doses with
FIGURE 4.2 Similar medication labels – different doses of Rifadin FIGURE 4.3 Similar medication labels – different doses of Efexor
real medication charts and medication labels. (a) Rifadin 300 mg (b) Rifadin 150 mg (a) Efexor 150 mg (b) Efexor 37.5 mg
(a) (a)

Date Marevan/Coumadin INR

Warfarin select brand Result

Continue on discharge? Yes / No

Yes / No
Route Target INR Range
Prescriber to enter
individual doses
Dose mg mg mg mg mg mg mg mg mg mg mg

days Qty:
Indication Pharmacy
Prescriber

Prescriber signature Print your name Contact 1600

Initial 1

Dispense?
© Sanofi-Aventis Australia Pty Ltd

Duration:
© Pfizer

Initial 2
(b) (b)

© Pfizer
© Sanofi-Aventis Australia Pty Ltd

(Note that the medication packages used represent Australian packages at the
specified date of publication and are reproduced for educational purposes only.)

xi
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Guide to the text CLINICAL DOSAGE CALCULATIONS xii

CHAPTER 1

Worked Basic
examples demonstrate how to work out the
mathematics Clinical case
CLINICAL DOSAGE study icons8identify where
CALCULATIONS

key calculations that (i.e.

6 3 100 5 600 youwewilladd need toasaccurately
two zeros, this is the number real-life scenarios are used throughout
How many frusemide tablets in total does the client need if
administer medications.of zeros found in 100)
6 3 1000 5 6000 (i.e. we add three zeros, as this is the number
the worked examples and activities.
they go away on holiday for six days?
of zeros found in 1000) From the previous question we know the client needs 2 3 2 5 4
frusemide tablets each day.
WORKED EXAMPLE 1.3 Day 1

Day 2
MULTIPLICATION
A client needs to take two antibiotic capsules three times per Day 3
day. They also need to take two frusemide tablets twice per day. Day 4
How many antibiotic capsules does the client need to take
each day? Day 5

Day 6
4 3 6 5 24 tablets needed in total
Four tablets By six
2 3 3 5 6 capsules in a day each day days
Two Three times
capsules per day

How many frusemide tablets does the client need to take ACTIVITY 1.3
each day?
Multiply the following.
1 How many tablets are there in total?

2 3 2 5 4 tablets in a day
Two Twice
tablets per day

>>
 the same sequence: you perform the calculations in brackets Using Formula 2, how do we calculate this using th
first, then you do any exponentials, then division, followed by sequence or order of operations?
multiplication, and then lastly the addition and subtraction. Brackets There are none to calculate here
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202 Exponentials Calculate the height in metres2 firs
FORMULA 1 – BEDMAS 1.8 m 3 1.8 m 5 3.24 m2
Brackets ( ) Division Then do the division component
CHAPTER 4 Exponentials a2 91 kg
BMI (m2) 5 or 91 4 3.24 5 28.09
Reinforce your knowledge of safety tips and procedures
Using quality and risk management principles in dosage calculations CLINICAL DOSAGE CALCULATIONS 94
Formula boxes highlight important mathematical
Division 4
Multiplication 3
3.24 m2
Multiplication There are none to calculate here
with overallSafety
ensure anthe boxes. concepts.
Let’s take this three-step process further in order to incorporates the three-step process and ensures the health
systematic process for calculating doses professional is checking the prescription, the client, the Addition 1 Addition There are none to calculate here
and establishing which medicines are due/available to give situation, the dosage and the follow-up care/documentation. Subtraction 2
to a client. The ‘10 steps for safe use of a medication chart’
Subtraction There are none to calculate here

SAFETY FORMULA 2 – CALCULATING BMI

FORMULA 3 – CREATININE CLEARANCE
10 STEPS FOR SAFE USE OF A MEDICATION CHART
Note where the logic check is performed in Step 6. Step 6 Think about this dose – is it logical (e.g. you would not weight in kilograms (kg)
Step 1 Scan medication chart to ensure the prescription(s) meet expect to give more than a couple of tablets or a few mL BMI (m ) 5 2
(140 2 age) 3 weight (kg)
out of a bottle)? height in metres 2 (m2) CrCl (mL/min) 5
legal requirements and are able to be used. 0.814 3 serum creatinine (microm
Step 2 Check which medicines are due/available to administer Step 7 Convert all measurements to the same units then perform
now. dosage calculations using either the formula or the
Step 3 Check for any interactions or contraindications. If proportions method. This ensures the correct amount of
medicines have a risk of serious adverse effects then
ensure you are able to monitor/manage these safely.
medicine is given.
Step 8 Administer the medicine following the ‘7 rights’, ensuring Test your understanding of concepts and practise
the client understands and consents to this.
calculations with the activities.
Step 4 Check that the dosage and route are appropriate for the
client’s condition. Step 9 Sign/document the medicine as administered on the
Step 5 Assess the client to see if the medicine(s) are suitable for appropriate charts.
them at this time. Ensure no allergies or contraindications Step 10 Assess the client for any adverse effects.
to this medicine.
ACTIVITY 4.1
Refer to the prescriptions below with their corresponding medication labels. Perform a logic check for the following (i.e. estimate how much
medication you expect to give).
1 Digoxin

Year 20 19 Date and month

PRESCRIBER MUST ENTER administration times
Date Medicine (print generic name) Tick if
1/3 digoxin slow

Continue on discharge? Yes / No

Yes / No
release

Route Dose Frequency and NOW enter times

0800

Date:
days Qty:
PO 0.25 mg mane
Indication Pharmacy
ATRIAL FIBRILLATION

Dispense?
Duration:
Prescriber signature Print your name Contact
#171

PRESCRIPTION ONLY MEDICINE

KEEP OUT OF REACH OF CHILDREN

DIGOXIN
250 micrograms

Digoxin tablets
Each tablet contains DIGOXIN 250 micrograms
100 TABLETS

>>
Using quality and risk management principles in dosage calculations CLINICAL DOSAGE CALCULATIONS 95
CHAPTER 4

Guide to the text CLINICAL DOSAGE CALCULATIONS xiii

Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Guide to the text CLINICAL DOSAGE CALCULATIONS xiv

Refer to the useful formulae printed on the inside covers

to help with your revision. END OF BOOK FEATURES
USEFUL FORMULAE
At the end of the book you will find:
FORMULA 1: BEDMAS FORMULA 8: %w/w

• Practice questions to test your skills

Brackets ( ) weight in medicine (grams)
%w/w 5 3 100
Exponentials a2 weight of solution (grams)
Division 4
Multiplication 3 FORMULA 9: CONCENTRATION
Addition 1 amount (units)
Subtraction 2

FORMULA 2: CALCULATING BMI (M2)

Concentration (units/mL) 5
volume (mL)

FORMULA 10: DROPS PER MINUTE (WHEN TIME IS KNOWN IN MINUTES)

• Answers to a selection of questions from the text
weight in kilograms (kg) total volume of fluid to be infused (mL) 3 number of drops per mL

• Key online resources for a selection of chapters

BMI (m2) 5 Rate (dpm) 5
height in metres2 (m2) time (minutes)
FORMULA 3: CREATINE CLEARANCE FORMULA 11: DROPS PER MINUTE (WHEN TIME IS KNOWN IN HOURS)
(140 – age) 3 weight (kg) total volume of fluid to be infused (mL) 3 number of drops per mL

• An index to help you locate key terms and concepts.

CrCl (mL/min) 5 Rate (dpm) 5
0.814 3 serum creatinine (micromol/L) time (hours) 3 60
FORMULA 4: DOSE PER KILOGRAM: TABLETS AND LIQUIDS FORMULA 12: mL/h (WHEN TIME IS KNOWN IN HOURS)
Dose to be given 5 recommended dose (mg/kg) total volume of fluid to be infused (mL)
3 weight (kg) Rate (mL/h) 5
time (in hours)
FORMULA 5: DOSAGE CALCULATION FORMULA 13: mL/h (WHEN TIME IS IN MINUTES)
strength required total volume of fluid to be infused (mL) 3 60
Dose 5 3 volume Rate (mL/h) 5
stock strength time (minutes)
FORMULA 6: %w/v

%w/v 5
weight in medicine (grams)
volume of solution (mL)
3 100
FORMULA 14: CALCULATING ‘NEW VOLUME TO BE INFUSED’ (VTBI) FOR EXISTING INFUSIONS
New volume to be infused (mL) 5 total fluid (mL) 2 what has already PRACTICE QUESTIONS
been administered (mL)
FORMULA 7: %v/v FORMULA 15: HOW LONG UNTIL INFUSION FINISHES
volume in medicine (mL) total fluid to be administered from now (mL)
%v/v 5 3 100 Time until finished (hours) 5
volume of solution (mL) rate (mL/h)
Note: Formulae continued on inside of back cover.

This chapter has been designed to give you an additional Fractions and decimals
opportunity to practise skills you have gained from other
Simplify the following fractions:
chapters. More practice questions can be found on the website
http://www.cengage brain.com. 8 23 2 7
ANSWERS 21
24
5 28
6
5 35
5
3
22
5

Basic mathematics 22
25
5 29 6 5
3
36
3
4
2
5
1000 6 12 5
Basic arithmetic 13 23 1 9
1 21613185 11 83 3 16 5 23 5 30 5 37 4 5
39 18 2 11
2 49 1 25 5 12 72 3 9 5 4 1 2 3 2
3 296 1 91 1 104 1 1 5 13 1599 3 8 5 24 12 5 31 3 5 38 4 5
8 6 23 11 5
4 217 1 896 5 CHAPTER14 1:4852 3 45 5
BASIC ACTIVITY 1.3 22 ACTIVITY 1.6 17 5 ACTIVITY 1.8
6 8 9
25 4 d
5 12 1 356 1 22 1 33MATHEMATICS
5 15 9889 3 72 5 1 30 tablets 5
30 1 3 132 3 5 39
3 8
4
12
5 12
5 23 9 1 3
6 521 2 86 5 16
ACTIVITY 1.133 4 3 5 2 72 caplets 27 24 8 3 7 8 13 3 10
26 33 3 40 e
7 156 2 69 5 17 84 4 6 5
1 5 tablets 3 4 mL 5 10 5 8 12
5 1 22 4 4 5 16
5 2 5 2 7
8 4589 2 2351 5 18 375 4 5 5
2 5 caplets 4 25 mL 19 24 12 1 5 15
2 f
9 4892 2 68 5 3 7 mL19 1827 4 29 5 27 5 8 134 3 5 1 27
ACTIVITY 1.4 8 3 5 3 9 3 11
10 86 2 21 5 20 3906
4 3 tablets and 4 42 5 24 3 fractions to decimals: 6
Convert the following 6
1 30 days 2 a
4 capsules; 2 10 days 43 22 1 13 12
41 5ACTIVITY 1.742 5 4 743
7 medicines 3 5 doses 50 25 3 50 5 3
b
in total 4 10 hours 33 1 12
1 5 14
5 7.5 mL 5 2 hours 4 2 241 c 12
47 60
ACTIVITY 1.2 ACTIVITY 1.5 2 ACTIVITY 1.9
1 3 tablets 16 63
1 45.67 4 d
67 1 a 72
2 1 caplet 2 30.08 3 10
3 0.6 mL 2 32
3 26.23 3 e
4 3 capsules 130 65 b 64
4 9.04 mL/minute 4 5 6
5 194.5 mL 8 4 12
4 f
61 c 36
5 8
7 10
g
25

ANSWERS
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

Guide to the online resources

FOR THE INSTRUCTOR

Cengage is pleased to provide you with a selection of resources that

will help you prepare your lectures and assessments. These teaching tools
are accessible via http://login.cengage.com .

MEDICATION CHARTS COGNERO TEST BANK

Additional real medication charts from Australia and New A bank of questions has been developed in conjunction
Zealand are available for use in your teaching. with the text for creating quizzes, tests and exams for your
students. Create multiple test versions in an instant and
deliver tests from your LMS, your classroom, or wherever you
want using Cognero. Cognero test generator is a flexible
SOLUTIONS MANUAL
online system that allows you to import, edit and manipulate
The solutions manual includes a full set of worked
content from the text’s test bank or elsewhere, including your
solutions for each chapter activity.
own favourite test questions.

POWERPOINT PRESENTATIONS ARTWORK FROM THE TEXT

Use the chapter-by-chapter PowerPoint presentations to Add the digital files of graphs, pictures and flowcharts
enhance your lecture presentations and to reinforce the key into your course management system, use them in
principles of your subject, or for student handouts. student handouts or copy them into lecture presentations.

xv
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Guide to the online r e s o u r ce s CLINICAL DOSAGE CALCULATIONS xvi

FOR THE STUDENT

GOT IT
Have you got it?
DOSAGE CALCULATIONS
Got it! Dosage Calculations is an online revision platform that enables
you to practise and check your understanding of the key concepts.
Ranging from basic arithmetic to more complex calculations of medications, this digital study
tool is fun and easy to use.
Log in at login.cengagebrain.com using the code on the card inside the front cover to
access Got it! Dosage Calculations.
Got it! Dosage Calculations includes
• revision
• practice tests
• real medication labels
• videos that step you through key concepts
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

PART
1
FUNDAMENTAL SKILLS
1 BASIC MATHEMATICS..................................................................................2
2 UNITS OF MEASUREMENT........................................................................43
3 MEDICATION CHARTS.................................................................................61
4 USING QUALITY AND RISK MANAGEMENT PRINCIPLES
IN DOSAGE CALCULATIONS......................................................................87
5 GENERAL DOSAGE CALCULATIONS.........................................................98
6 INFUSION CALCULATIONS....................................................................... 121
1
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

1
2

CHAPTER BASIC MATHEMATICS

DOSAGE CALCULATIONS

Introduction Addition (1)

Addition is the sum or combining of numbers together. It uses
Basic mathematics is a vital skill for health professionals who
the addition symbol ‘1’ and can be seen in Figure 1.1 showing
are administering medicines to clients. In order to learn and
that one tablet plus two tablets adds up to three tablets. Words
master dosage calculations, the clinician must be able to apply
that indicate addition include ‘add’, ‘plus’, ‘combine’ and
mathematical principles concerning arithmetic, fractions,
‘sum’. Addition is the opposite of subtraction.
ratios and percentages.
Later chapters in this text discuss the approaches to solving FIGURE 1.1 Addition: 1 tablet 1 2 tablets 5 3 tablets
dosage calculations using either a formula or a proportions 1 1 2 5 3
method. Both of these require a good understanding and ability
to apply mathematical principles.
This chapter introduces the relevant mathematics to support
both the proportions and the formulae methods for calculation
that will be introduced in Chapter 5.

Basic arithmetic
‘Basic arithmetic’ is a term used to describe the general
mathematics used by most people in society on a daily basis. It
incorporates addition, subtraction, multiplication and division
of whole numbers.
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

WORKED EXAMPLE 1.1 How many medicines in total does the client need to take
(i.e. total including all tablets and capsules)?
ADDITION Now we look at ALL the tablets and capsules together
A client asks you how many medicines they need to swallow and add them all up:
to take all their morning medicines. They have the following frusemide (1 tablet) 1
medicines to take:
digoxin (2 tablets) 12
• 500 mg paracetamol (2 capsules)
• 40 mg frusemide (1 tablet) aspirin (1 tablet) 11
• 62.5 microg digoxin (2 tablets) amoxycillin (1 capsule) 11
• 100 mg aspirin (1 tablet) paracetamol (2 capsules) 12
• 500 mg amoxycillin (1 capsule) 7 in total
How many tablets does the client need to take?
First we look at which medicines are in tablet form from
the list above: ACTIVITY 1.1
frusemide (1 tablet) 1
Add up the following.
digoxin (2 tablets) 12 1 How many tablets are there?
aspirin (1 tablet) 11
4 tablets in total
1
How many capsules does the client need to take?
First we look at which medicines are in capsule form from
the list above:
2 How many caplets are there?
amoxycillin (1 capsule) 1
paracetamol (2 capsules) 12
3 capsules in total 1 1

>>

Basic mathematics CLINICAL DOSAGE CALCULATIONS 3

CHAPTER 1
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202 CHAPTER 1

Basic mathematics CLINICAL DOSAGE CALCULATIONS 4

<< 3 How many millilitres (mL) of saline are there in total in these syringes?

5mL
1

5mL
1

4
4 How many tablets are there? How many capsules are there? 5 How many mL of liquid are there in total?
How many in total?

1
30 mL 30 mL
25 mL 25 mL
20 mL 20 mL
1
15 mL 15 mL

10 mL 10 mL
7.5 mL 7.5 mL
5 mL 5 mL
2.5 mL 2.5 mL
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

Subtraction (2) First we look at what we have in total (i.e. 25 tablets in this bottle).
Subtraction is the removal or ‘taking away’ of one number from
another. It uses the symbol ‘–’ and can be seen in Figure 1.2 showing
that if there were four tablets and three were subtracted, then 5
there would only be one tablet left. In dosage calculations it is
important to ensure that the smaller number is subtracted from 25 tablets in Now we remove Which leaves 24
the bigger number. Words that indicate subtraction include the bottle 1 tablet tablets in the bottle
‘subtract’, ‘minus’, ‘take away’ and ‘remove’. Subtraction is the How many tablets are left in the bottle if the second client
opposite of addition. requires two tablets?
FIGURE 1.2 Subtraction: 4 tablets – 3 tablets = 1 tablet After the first client took 1 tablet, we only have 24 tablets left in
this bottle.
4 2 3 5 1

24 tablets in Client two needs 2 Which leaves 22

the bottle tablets – so remove 2 more tablets in the bottle

WORKED EXAMPLE 1.2 How many tablets are left in the bottle if the third client requires
four tablets?
SUBTRACTION After the first client took 1 tablet and then the second client
took 2 tablets, we only have 22 tablets left in this bottle.
A Registered Nurse needs to administer ‘Coloxyl and Senna’
tablets to three clients. The nurse then needs to calculate how
many tablets will be left in the bottle to see if more need to be 5
ordered from the pharmacy department. There are 25 tablets in
the bottle at the start of the day.
22 tablets in Client three needs 4 Which leaves 18
The first client is ordered one ‘Coloxyl and Senna’ tablet. the bottle tablets – so remove 4 more tablets in the bottle
How many tablets will be left in the bottle?

Basic mathematics CLINICAL DOSAGE CALCULATIONS 5

CHAPTER 1
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202 CHAPTER 1

Basic mathematics CLINICAL DOSAGE CALCULATIONS 6

ACTIVITY 1.2
Calculate the following.
1 How many tablets are there if two are removed?

2 How many caplets are there if three are subtracted?

3 How many millilitres of saline is left in this syringe if 1.4 mL is subtracted?

5mL
1

4 >>
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202

<< 4 How many capsules are left if you ‘take away’ five of them? Multiplication (3)
In basic terms, multiplication is a short-cut way to add up
numbers. It is the way we calculate the total combination of
a group of numbers. It uses the symbol ‘3’ and can be seen in
Figure 1.3 showing that if there were two medicine cups that
each contained three tablets, then we could multiply three by
5 How many mL of paracetamol liquid is left in a 200 mL bottle two to find we have a total of six tablets. Words that indicate
if you remove 5.5 mL? multiplication include ‘multiply’, ‘times’ and ‘by’ (i.e. two by
three equals six). Multiplication is the opposite of division.
FIGURE 1.3 Multiplication: 3 tablets 3 2 lots 5 6 tablets or 3 3 2 5 6 tablets
3 3 2 5 6

i.e. This is the Multiplied Together they

first lot of 3 by 2 make a total of 6

Multiplying by 1, 10, 100, 1000

Multiplying a number by 1 does not change anything as the
number remains the same; however, when you multiply a
number by 10 you need to add a zero after the number. For
example:
6 3 1 5 6    (i.e. it does not change)
6 3 10 5 60  (i.e. the 6 remains but we add a zero making the
© Sanofi-Aventis Australia Pty Ltd
answer 60)

Basic mathematics CLINICAL DOSAGE CALCULATIONS 7

CHAPTER 1
Copyright 2020 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202 CHAPTER 1

Basic mathematics CLINICAL DOSAGE CALCULATIONS 8

6 3 100 5 600  (i.e. we add two zeros, as this is the number

of zeros found in 100) How many frusemide tablets in total does the client need if
6 3 1000 5 6000 (i.e. we add three zeros, as this is the number they go away on holiday for six days?
of zeros found in 1000) From the previous question we know the client needs 2 3 2 5 4
frusemide tablets each day.
WORKED EXAMPLE 1.3 Day 1

Day 2
MULTIPLICATION
A client needs to take two antibiotic capsules three times per Day 3
day. They also need to take two frusemide tablets twice per day. Day 4
How many antibiotic capsules does the client need to take
each day? Day 5

Day 6
4 3 6 5 24 tablets needed in total
Four tablets By six
2 3 3 5 6 capsules in a day each day days
Two Three times
capsules per day

How many frusemide tablets does the client need to take ACTIVITY 1.3
each day?
Multiply the following.
1 How many tablets are there in total?

2 3 2 5 4 tablets in a day
Two Twice
tablets per day

>>
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