Ebonee Parker, age 9, is admitted to the oncology unit for chemotherapy for acute lymphocytic leukemia. Weight is 60 pounds, height is 60 inches, BSA 1.05. (Topics covered: converting pounds to kilograms, determining a safe dose, mg/kg calculations, body surface area calculations)
Medication orders:
• asparaginase 27,000 international units in 50 mL D5W, IVPB. Infuse over 30 minutes
• prednisone 15 mg po q 8 hours
• vincristine 2 mg in 50 mL D5W, IVPB. Infuse in 15 minutes
• morphine 1.5 mg IVP q 6 hours prn pain
• dexamethasone 4 mg IVP bid
• ondansetron 4 mg IVP 30 minutes prior to chemotherapy, repeated 4 and 8 hours later
• Primary IV: D5W 50 mL/hour × 24 hours
Calculate the safe dose, determine if the ordered dose is safe, and calculate the amount needed for the correct dose (round the weight conversion to a whole number; do not round answers unless directed):
1. asparaginase. Safe dose: 25,000 international units/m2 3 times a week. Supply: 10,000 units/mL. What is the infusion rate?
2. prednisone. Safe dose: 40 mg/m2 po in divided doses, q 8 hours. Supply: oral solution 5 mg/5 mL
3. vincristine. Safe dose: 1.5–2 mg/m2 single dose. Supply: 1 mg/mL
4. morphine. Safe dose: 0.05 mg/kg/dose. Supply: 2 mg/mL
5. dexamethasone. Safe dose: 0.08 to 0.3 mg/kg/day divided q 12 hours. Available: 4 mg/mL injection
6. ondansetron. Safe dose: 0.15 mg/kg IVP. Supply: 2 mg/mL
7. What is the total amount of the primary infusion in 24 hours?
The nurse does not calculate the safe dose (range) and accepts the medication orders as written. What error could happen?