University of Southern Mindanao

College of Health Sciences

Department of Nursing

DRUG STUDY
Name of Patient: ___________________________________________________ Age: ______ Sex: _____ Room: ________ Date: ___________________________
Admitting Diagnosis: _______________________________________________ Attending Physician: __________________________ Diet: __________________

NAME OF CLASSIFICATION INDICATION MECHANISM OF CONTRAINDICATIO SIDE EFFECTS ADVERSE NURSING

DRUG ACTION N EFFECTS RESPONSIBILITIES

Tetanus Toxoid Pharmacologic  Prevention  Promotes  Contraindicated in  CNS: Seizures,  CNS: Seizures,  Advise patient to
class: Vaccine against tetanus in immunity to tetanus immunosuppressed slight fever, slight fever, avoid using hot or cold
children and adult by including patients, in those with headache, headache, compresses at
Pregnancy risk antitoxin production. severe hypersensitivity malaise, malaise, injection site; this may
category C or neurologic reactions encephalopathy. encephalopathy. increase severity of
to toxoid or its local reaction.
ingredients.  CV:  CV:
Contraindicated in Tachycardia, Tachycardia,  Instruct patient to
patients with hypotension, hypotension, report persistent or
thrombocytopenia or flushing. flushing. severe adverse
other coagulation reactions.
disorders that would  Musculoskeletal: Musculoskeletal:
contraindicate I.M. Aches, pains. Aches, pains. Advise patient of
injection unless benefits proper fever-reducing
outweigh risks.  Skin: erythema,  Skin: erythema,
induration, nodule induration, nodule
at injection site, at injection site,
urticaria, pruritus. urticaria, pruritus.
Bibliography: _________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________

Submitted By: Submitted to:

___________________________________ ___________________________________
Student Nurse Clinical Instructor

University of Southern Mindanao

College of Health Sciences
Department of Nursing

DRUG STUDY
Name of Patient: ___________________________________________________ Age: ______ Sex: _____ Room: ________ Date: ___________________________
Admitting Diagnosis: _______________________________________________ Attending Physician: __________________________ Diet: __________________

NAME OF CLASSIFICATION INDICATION MECHANISM OF CONTRAINDICATIO SIDE EFFECTS ADVERSE NURSING

DRUG ACTION N EFFECTS RESPONSIBILITIES

. Use absorbed form Other: Other:

cautiously in infants or Anaphylaxis, chills. Anaphylaxis,
children with cerebral chills
damage, neurologic
disorders, or history of
febrile seizures.

Postpone vaccination
in patients with acute
illness and during polio
outbreaks, except in
emergencies.
Bibliography: _________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________

Submitted By: Submitted to:

___________________________________ ___________________________________
Student Nurse Clinical Instructor