San Beda College

COLLEGE OF NURSING
P.O. BOX 4457 1005 MANILA, PHILIPPINES TELEFAX: 735-6011 to 15 LOC 4131

-DRUG STUDYStudent Information

Name of Student:_______________________________________________________
Year/Section:____________
Group:_________Area/Ward Assignment:____________________________________ Shift:_______________
Inclusive Dates of Rotation:______________________ Clinical
Instructor:_______________________________
Patient Information
Name of Patient:________________________________________________________ Age:__________
Sex:______
Diagnosis:_______________________________________________________________________________________
Chief
Complaint:__________________________________________________________________________________

PATIENT-CENTERED DRUG ANALYSIS

Drug Information
Drug Class:
Brand Name:
Route of Administration:
A. Mode/Mechanism of Action

B. Indications & Contraindications

C. Side Effect & Adverse Reaction

Generic Name:
Dosage:

D. Drug Interaction (Drug-Drug/Drug-Food/Drug-Laboratories)

E. Nursing Considerations

F. Health Teachings

Prepared by:
_______________________________________ Date:__________________
Signature over Printed Name
(Student Nurse)

Checked by:
_______________________________________ Date:__________________ Rating:__________________
Signature over Printed Name
(Clinical Instructor)