Medication Research Form

Medication Order(written the way the MD ordered it)

generic name

(lower case)

aspirin

Brand name: (One only)

Dose

(mg, mcg,
gm,
units, etc.)

80mg

Route

(po, sl, PR, TD, IM,

Frequency(daily, BID tid, qid,

at hs, ac,
q2h, 4, 6, PRN

subcut., IV,

(for what?)

PO

alka-selzer

daily

Maximum Safe Dose in 24 hours: 350 mg

Classification: analgesic, antiplatelet, antipyrectic

Indication(s): (Uses) to relieve pain of low to moderate intensity, for inflammatory condition:
osteoartritis

Common Side Effects (CSE): (only common as indicated in your pocket drug guide)
Nausea, heartburn and stomach pain
Life Threatening Side Effects: (LTSE ) (as indicated in your pocket drug guide)
(If none write
NONE DO NOT LEAVE Blank)
Bronchospasm, anaphylactic shock, hemolytic anemia

Drug Drug Interactions DDI

(List all that apply, or may apply)

(If none Write NONE DO

NOT LEAVE Blank)

Multiple drug to drug interaction

Food Drug Interactions FDI (List all that apply, or may apply) (If none Write NONE
DO NOT LEAVE Blank)

Garlic, ginger increases bleeding potential

Nursing Implications (individualized to your client)

To include Assessment/Labs to

monitor/client/family education

Report signs of bleeding

Maintain adequate fluid intakew

Monitor for loss of tolerance to aspirin 15-3 hrs after ingestion, n/v,
intestinal cramp.

RNSG 1362 Medication Research Form supplement to Form B_sp2013_williams

Medication Research Form

MEDICATION:

(GENERIC NAME) ________asprin_______________________

RNSG 1362 Medication Research Form supplement to Form B_sp2013_williams