Republic of the Philippines

CEBu NORMAL UNIvERSITy

Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254
4837 Email: cn@cnu.edu.ph
Website: www.cnu.edu.ph

DRUG STUDY

Patient’s Initials: Date of Admission: Diagnosis:

Age: Height: Weight.: Clinical Intervention:
Sex: Ward: Bed No.: Name of Physician: _
Drug Information Classification Mechanism of Action Indication Contraindications Side Effects Nursing Responsibilities
Generic Name: Pharmacologic Pharmacodynamics or General Indication/s: (per system preferably) Before Drug Administration:
Classification: Mechanism of Action:

Trade Name:

Minimum Dose:

Therapeutic Pharmacokinetics: Patient’s

Classification: Indication:
Maximum Dose:

During Drug Administration:

Patient’s Dose:

Route:

Certification Date: 1 February 2021

Recertification due date: 24 January 2024 For
SDF-CON-304-071-00
verification of the certificate please access
www.gcl-intl.com (Certification check and Page 1 of 3
type the registration number)

Registration No. 52Q18778

 Republic of the Philippines
CEBu NORMAL UNIvERSITy
Osmeña Blvd., Cebu City, 6000, Philippines

College of Nursing
Telephone No.: (+63 32) 254
4837 Email: cn@cnu.edu.ph
Website: www.cnu.edu.ph

Frequency:

After Drug Administration:

Availability/Form:

Contents:

References (at least 2):

Certification Date: 1 February 2021

Recertification due date: 24 January 2024 For
SDF-CON-304-071-00
verification of the certificate please access
www.gcl-intl.com (Certification check and Page 2 of 3
type the registration number)

Registration No. 52Q18778

 PRODUCT ASSESSMENT RUBRICS FOR DRUG STUDY

Student Name: Year/Section: Date: Score: /30

Directions: Please select the appropriate rating using the following descriptions.

Element Very Satisfactory Satisfactory Needs Improvement Comments

Drug ☐ Accurately presented all of the patient and drug information ☐ Accurately presented most of the patient and drug ☐ Accurately presented some of the patient and drug information
Information (name [brand & generic], dosage [patient’s dose; min. & max], information related to the case. 1 missing information or error related to the case. 2 or more missing information or errors noted.
(10%) frequency, route, availability, contents) related to the case. [3] noted. [2] [1]

Classification ☐ Accurately presented the classification (therapeutic and ☐ Accurately presented the classification related to the drug ☐ Inaccurately presented the classification related to the drug.
(10%) pharmacologic) related to the drug. [3] but with 1 irrelevant information or error noted. [2] Classification is not relevant to the drug. [1]
☐ Accurately presented the indication/s (general & patient- ☐ Accurately presented the indication/s related to the drug ☐ Inaccurately presented the indication/s related to the drug.
Indication (10%) specific) related to the drug. [3] but with 1 irrelevant information or error noted. [2] Indication is not relevant to the drug. [1]
Mechanism of ☐ Accurately presented the mechanism of action ☐ Accurately presented the mechanism of action of the drug ☐ Inaccurately presented the mechanism of action of the drug.
Action (10%) (pharmacokinetics, pharmacodynamics) of the drug. [3] but with 1 irrelevant information or error noted. [2] Mechanism of action is not relevant to the drug. [1]
☐ Accurately presented all of the common contraindications ☐ Accurately presented most of the common ☐ Accurately presented some of the common contraindications
Contraindication related to the drug. [3] contraindications related to the drug. 1 missing information related to the drug. 2 or more missing information or errors noted.
(10%) or error noted. [2] [1]
Side Effects ☐ Accurately presented all of the common side effects related ☐ Accurately presented most of the common side effects ☐ Accurately presented some of the common side effects related
(10%) to the drug. [3] related to the drug. 1-2 missing information or errors noted. to the drug. 3 or more missing information or errors noted. [1]
[2]
Nursing ☐ Accurately presented all of the common nursing ☐ Accurately presented most of the common nursing ☐ Accurately presented some of the common nursing
Responsibilities responsibilities (before, during, and after) related to the drug. [9] responsibilities related to the drug. 1-2 missing information or responsibilities related to the drug. 3 or more missing information
(30%) errors noted. [7] or errors noted. [3]
☐ Presented at least 2 sources that are updated (within 5 years), ☐ Presented only one source that is updated (within 5 years), ☐ No source was presented. Sources are not updated (more than
References relevant, and credible. [3] relevant, and credible. Other sources are not updated, credible 5 years), relevant, and credible. [1]
(10%) or relevant. [2]
Sub-score = = =

Evaluated by:

Signature over Printed Name of Clinical Instructor