Effective Pain Management in Terminal Cancer: Calculating Hydromorphone Dosage

When a patient is battling terminal cancer, their comfort and pain management become paramount. The prescription of hydromorphone, commonly known as Dilaudid, at a dosage of 0.015 mg per kilogram (kg), is a critical component of their care plan. But how does the nurse accurately determine the required dosage, especially when the patient’s weight is in pounds? To add to the complexity, the available hydromorphone is labeled as 4 mg per milliliter (mL). In this article, we will walk you through the calculation to determine the number of milliliters the nurse should administer to ensure effective pain management in this challenging medical scenario.

Understanding Terminal Cancer and Pain Management

Terminal cancer, a condition marked by the advanced stage of the disease with no curative treatment available, can lead to severe pain and discomfort. Pain management becomes a primary concern for both patients and healthcare providers. Hydromorphone, a potent opioid, is often prescribed to alleviate pain and improve the quality of life for terminally ill patients.

The Role of Hydromorphone in Pain Relief

Hydromorphone, sold under the brand name Dilaudid, is a powerful opioid analgesic. It functions by binding to opioid receptors in the brain and spinal cord, ultimately reducing the perception of pain. It is commonly used to treat moderate to severe pain and is especially valuable in cases where other pain relief options may be less effective.

Calculating the Dosage for Hydromorphone

In this scenario, the physician has prescribed hydromorphone at a dosage of 0.015 mg/kg. However, the patient’s weight is given in pounds. To calculate the correct dosage, you need to convert the patient’s weight to kilograms and then determine the amount of hydromorphone to administer.

  1. Convert Weight to Kilograms: The patient’s weight is 150 pounds. To convert it to kilograms, divide by 2.2 (since 1 kg is approximately 2.2 pounds).

    Weight in kilograms = 150 pounds / 2.2 ≈ 68.18 kg

  2. Calculate the Dosage: To determine the dosage, multiply the patient’s weight in kilograms by the prescribed dosage of 0.015 mg/kg.

    Dosage = 0.015 mg/kg * 68.18 kg ≈ 1.0227 mg

The calculated dosage is approximately 1.0227 mg.

Determining the Milliliters to Administer

The available hydromorphone is in a concentration of 4 mg per milliliter (4 mg/mL). To find out how many milliliters should be administered, divide the dosage (in milligrams) by the concentration (in milligrams per milliliter).

1.0227 mg / 4 mg/mL ≈ 0.2557 mL

Rounded to a practical value, the nurse should administer approximately 0.26 mL of hydromorphone to the patient for effective pain management.

Nurse’s Responsibilities in Medication Administration

Accurate dosage calculation is just one part of the nurse’s role in pain management. Here are several other critical responsibilities that nurses must fulfill:

  1. Patient Assessment: Conduct a comprehensive assessment of the patient, including their pain level, medical history, and any allergies to medications. Ensure that hydromorphone is a suitable choice for pain management.
  2. Informed Consent: Educate the patient or their caregiver about the purpose of the medication, potential side effects, and expected outcomes. Obtain informed consent prior to administration.
  3. Medication Administration: Administer the medication accurately, adhering to the correct route and timing as specified in the physician’s orders.
  4. Monitoring: After administration, closely monitor the patient for any adverse reactions, pain relief, or side effects. This may include frequent pain assessments and vital sign monitoring.
  5. Documentation: Maintain precise and comprehensive documentation of the medication administration, noting the dose, date, time, and the patient’s response. Accurate record-keeping is essential for continuity of care.


In the context of terminal cancer, managing pain effectively is a critical aspect of patient care. Hydromorphone, when administered with precision, can significantly improve the patient’s quality of life in the face of severe pain.

To summarize, in a scenario where a patient with terminal cancer weighing 150 pounds is prescribed hydromorphone at 0.015 mg/kg with a stock solution of 4 mg/mL, approximately 0.26 mL should be administered. Nurses must not only excel in dosage calculations but also prioritize patient assessment, informed consent, accurate administration, vigilant monitoring, and meticulous documentation. By combining these elements, healthcare providers can ensure that terminally ill patients receive optimal pain management and compassionate care during their most challenging moments.


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