Name of Patient: Attending Physician: Dr.

_________
Age: 9___Sex: Female Civil Status: Single Diagnosis: closed fracture at right forearm_
Occupation:Student__________________ ___________________________________
Address: Chief Complaint: pain at right forearm________
Ward:Female Ortho Ward Bed No.: Bed #6 Date of Admission: August 31, 2016______

DATE/TIME BRAND NAME ACTION INDICATION ROUTE/DOSAGE DRUG INTERACTION ADVERSE EFFECT PRECAUTION NURSING
ORDERED / CONTRAINDICATIONS RESPONSIBILITES
TIME INTERVAL
Sept. 1, Medianon Anthranilic Capsules200 mg 50mg/5mL Avoid drinking CNS:Drowsiness, Hypersensitivity Assess patients
PO BID 10mL TID who develop
2016 Ponstan acid alcohol. It may insomnia, dizziness, todrug; GI
severe diarrhea
@ Ponstel derivative. increase risk of nervousness, inflammation,or and vomiting for
6pm Myrefen Like stomach bleeding. confusion, ulceration. Safety dehydration and
headache. inchildren<1/t y, electrolyte
ibuprofen imbalance.
Avoid taking GI:Severe diarrhea, duringpregnancy(c
GENERIC inhibits HALF LIFE ategory C),or
Lab tests: With
aspirin while ulceration, and long-term therapy
NAME prostaglandi 2 to 4 hours taking mefenamic bleeding; nausea, lactation is (not
Mefenamic n synthesis acid. vomiting notestablished. recommended)
Acid and affects Hematologic:Prolon obtain periodic
complete blood
CLASSIFI- platelet ABSORPTION EXCRETION gedprothrombin counts, Hct and
CATION function. No Well-absorbed Urine and bile time Hgb, and kidney
NSAID evidence Urogenital:Nephrot function tests.
Discontinue drug
that it is oxicity, dysuria, promptly if
superior to albuminuria diarrhea, dark
aspirin. Skin:Urticaria, rash, stools,
facial edema. hematemesis,
ecchymoses,
SpecSenses:Eye epistaxis, or rash
irritation, loss of occur and do not
color vision use again. Contact
BodyWhole:Perspir physician.
ation.

Name: Year & Sec:BSN 3_______ Group No.: ___________ Rating: __________
Reference:Lipincotts Nursing Drug Guide_____________________________________________________

Criteria: Promptness (5%) _________ Content (45%) _________

Format/Neatness (5%) _________ Nursing Responsibilities (35%) _________
Illustration (10%) _________ Clinical Instructor: