Medication Administration Tool (MAT

Student Name: Pt Initials: xx laxative MEDICATION INFORMATION To treat/prevent constipation Soft stools prevent trauma to episiotomy repair Osmotically active in GI tract, drawing water into the lumen and causing peristalsis Presence of bowel sounds, assess for abdominal distention, assess characteristics of stool NKDA No Use only for short term therapy, notify doctor of unrelieved constipation, rectal bleeding, muscle cramps or pain, dizziness No Medication Order: Drug Classification: Dolce Ibarra Allergies: NKDA Date: 1/27/11

MOM/magnesium hydroxide 30ml PO qhs PRN for constipation

RIGHT PATIENT Why does the patient need this medication? How does it relate to or help with their diagnosis? RIGHT MEDICATION How does this medication work? Are there any assessments needed prior to or after administering this medication? Allergies to this medication? Is this medication contraindicated for this patient? Patient teaching completed/documented? RIGHT TIME Does this medication time need to be adjusted? (i.e. meals, labs, etc.) RIGHT DOSE Is the prescribed dose safe (single and 24 hr. dose)? Is the calculated dose correct? Is there a therapeutic drug level that I should verify for this medication prior to its administration? Are there adverse/toxic effects? What is the minimum safe dilution, infusion rate, and compatibility for this medication? RIGHT ROUTE Is it safe to administer this medication via the prescribed route? Can this medication be crushed or administered in another format better suited for this patient? If gastrointestinal tube, is placement verified?

Yes, take up to 200-400mg/day; liquid is 400mg/5ml Yes No

diarrhea N/A

Yes N/A


Nursing MAT Rev 06/10

Medication Administration Tool (MAT)
Appropriate site for injection? N/A

Nursing MAT Rev 06/10

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