MEDICATION ADMINISTRATION WORKSHEET

NUR 112 - MEDICATION ADMINISTRATION WORKSHEET

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Med?
Medication
(Include dose, route, frequency)
Why Taking Med?
(Per patient history, progress notes, or consults)
Date/Time of Prescribed Order
Safe Dose Client Dose Usual Dose
Nursing Implications
(VS, labs, drug-drug/drug-food/drug-herb interactions)
No
Docusate
100 mg
PO
BID
Hold for loose stool
Opioid constipation prophylactic
11/13/13
Safe: PO: 50-500 mg/day in single daily dose or divided q6hr
Client:100 mg
Usual: 50-500mg

VS: Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
Labs: Long-term therapy may cause electrolyte imbalance and dependence.
Drug-Drug: No known interactions
Drug-Food: No known interactions
Drug-Herb: Increases levels of mineral oil by enhancing GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction

Home
Med?
Medication
(Include dose, route, frequency)
Why Taking Med?
(Per patient history, progress notes, or consults)
Date/Time of Prescribed Order
Safe Dose Client Dose Usual Dose
Nursing Implications
(VS, labs, drug-drug/drug-food/drug-herb interactions)
Yes
Clonazepam (Klonopin)
1 mg
PO
BID
Prophylaxis of: Petit mal, Lennox-Gastaut,Akinetic,
Myoclonic seizures. Panic disorder with or without agoraphobia. Unlabeled Use: Uncontrolled leg movements during sleep. Neuralgias. Infantile spasms. Sedation. Adjunct management of acute mania, acute psychosis, or insomnia.
11/13/13
Safe dose: less than 4 mg per day
Client dose: 1 mg
Usual dose: 0.5 mg TID
VS: Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically during therapy. Assess need for continued treatment regularly. Assess patient for drowsiness, unsteadiness, and clumsiness. These symptoms are dose related and most severe during initial therapy; may decrease in severity or disappear with continued or long