POLYTECHNIC COLLEGE OF DAVAO DEL SUR, INC.

MacArthur Highway, Brgy. Kiagot, Digos City, Davao del Sur, Philippines 8002
DRUG STUDY
Name of Patient: Attending Physician:__________________________
Age: Sex: Civil Status:
Diagnosis:__________________________________
Occupation: Religion: Chief Complaint:_____________________
Address: __________________________________________________
 DATE/ ROUTE/ PRECAUTION
TIME BRAND NAME ACTION INDICATION DOSAGE/TIME DRUG ADVERSE CONTRAINDICA- NURSING
ORDERED INTERVAL INTERACTION EFFECT TIONS RESPONSIBILITIES
Vital C Elicits Dietary
osmotic Supplement; PO/OD Ascorbic Acid has GI: Use of sodium Secure doctor’s
laxative Frank and no known severe Nausea, ascorbate in Order
effect and Subclinical interactions with vomiting patients on sodium Do hand washing
replenishes scurvy; other drugs. heartburn, restriction, Assess patient’s
electrolyte Extensive burns diarrhea Use of calcium Condition
GENERIC HALF-LIFE Moderate Hematologic: ascorbate on Give medication on
s; induces Delayed
NAME 1-2 hours interactions of .. patient receiving Right timing
catharsis fracture
through Or wound ascorbic acid Acute digitalis. Inform patient
Ascorbic Acid include:
strong healing hemolytic About the possible
electrolyte Sever febrile or Amphetamine anemia Side effects of the
and Chronic disease Deferasirox CNS: Drugs
osmotic States, Deferoxamine Head ache Instruct patient to
CLASSIFI- effects To prevent ABSORPTION (high Be cautious of the
CATION vitamin doses) Contraindications
GI TRACT Mild interactions Urogenital: .. Of the drugs
Cin patients
Vitamins of ascorbic acid Urethritis, Return the
with
include: dysuria Medication ticket
Poor nutritional
Aluminum crystalluria On the right box for
Habits;
hydroxide Others: The next timing
To acidify urine
Aspirin Mild sireness Do the charting or
Macular
Aspirin rectal dizziness, The documentation
Degeneration.
Aspirin/citric faintness
acid/sodium with rapid IV
bicarbonate administration
Balsalazide
Bazedoxifene/
conjugated
estrogens
Butabarbital
Ward: Room No: Bed No: Date of Admission: _________________
Student Name: Year & Sec.: Group No.:_____
Rating:__________________
References:
Criteria: Promptness (5%), Format/Neatness (10%), Content (40%), illustration (10%), Nursing Responsibilities (35%)
Clinical Instructor:____________________________________________________