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Maria Santiago is a 3-year-old child (weight = 12 kg) admitted to your community hospital for antibiotics and supportive care to treat a diagnosis of community-acquired pneumonia. Her admission orders include:

  • Albuterol 0.083% solution, 3 mL via nebulizer Q4H PRN shortness of breath

  • Cetirizine 5 mg (5 mL) PO daily

  • Acetaminophen 160 mg (5 mL) PO Q6H PRN fever greater than 100.4oF

  • D5-0.45NaCl with 10 mEq of KCl per liter IV at 45mL/hour

You receive the following additional order for Maria:

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Name

Santiago, Maria

MRN

19740358

Allergies/Intolerances

NKDA

Room

952

ORDERS

Date

Time

 

[today]

[20 min ago]

Ceftriaxone 75mg/kg/day divided Q12H

(CPOE defaults: in 50 mL D5W, over 30 minutes)

       
   

Electronically signed by: Laura Jennings, MD

Review the parenteral product ordered above and complete the following worksheet. You will then need to prepare a dispensing label and compound the product. In addition to standard sterile compounding supplies (eg, gloves, needles, alcohol pads), you have the following available:

  • Syringes—1 mL, 3 mL, 5 mL, 10 mL, and 20 mL

  • Sodium chloride 0.9% bags – 50 mL, 100 mL, 250 mL, 500 mL, and 1000 mL

  • Dextrose 5% bags—50 mL, 100 mL, 250 mL, 500 mL, and 1000 mL

  • Ceftriaxone vials—500 mg

  • Sterile water for injection vials – 10 mL

1) Dose Check

  • Reference(s):

  • Reference Dose:

  • Ordered Dose:

  • Conclusion:

2) Calculations

  • Amount of Drug Required to Prepare One Dose per Order (mg):

  • Volume of Diluent Required to Reconstitute and Resulting Concentration of Drug Vial:

  • Powder Volume of Drug Vial:

  • Volume of Reconstituted Drug Required to Prepare Product per Order:

  • Total Volume of Prepared Product:

  • Final Concentration of Prepared Product (mg/mL):

  • Infusion Rate (mL/hr):

3) Beyond-Use Date (BUD)

  1. Stability:

    • Reference:

    • Reference Storage Conditions:

    • Reference Compatibility and Stability:

  2. Sterility: NOTE: This CSP can be classified as “low-risk” according to USP <797>.

    • Reference:

    • Room Temperature Sterility Limit:

    • Refrigerated Sterility Limit:

  3. Conclusion:

    • BUD (Interval) and Storage Conditions:

    • BUD (Specific Date/Time):

4) Y-Site Compatibility

You refresh your order queue to find another order for Maria—IV vancomycin for suspected CA-MRSA pneumonia. As you review the new order you anticipate questions from the nurse regarding infusion compatibility. The product is ordered to be prepared in D5W and will result in a final concentration of vancomycin of ~3.5 mg/mL. It will be infused over 60 minutes.

How would you advise a nurse regarding the administration of the vancomycin and ceftriaxone at a common Y-site?

  • Ordered Products/Infusions (Drugs, Concentrations, and Solutions):

  • Reference:

  • Reference Products (Drugs, Concentrations, and Solutions):

  • Reference Compatibility:

  • Conclusion:

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