San Beda College

COLLEGE OF NURSING
P.O. BOX 4457 1005 MANILA, PHILIPPINES TELEFAX: 735-6011 to 15 LOC 4131

-DRUG STUDYStudent Information
Name of Student:_______________________________________________________
Year/Section:____________
Group:_________Area/Ward Assignment:____________________________________ Shift:_______________
Inclusive Dates of Rotation:______________________ Clinical
Instructor:_______________________________
Patient Information
Name of Patient:________________________________________________________ Age:__________
Sex:______
Diagnosis:_______________________________________________________________________________________
Chief
Complaint:__________________________________________________________________________________

PATIENT-CENTERED DRUG ANALYSIS
Drug Information
Drug Class:
Brand Name:
Route of Administration:
A. Mode/Mechanism of Action

B. Indications & Contraindications

C. Side Effect & Adverse Reaction

Generic Name:
Dosage:

Nursing Considerations F. Drug Interaction (Drug-Drug/Drug-Food/Drug-Laboratories) E.D. Health Teachings Prepared by: _______________________________________ Date:__________________ Signature over Printed Name (Student Nurse) Checked by: _______________________________________ Date:__________________ Rating:__________________ Signature over Printed Name (Clinical Instructor) .

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