BULACAN STATE

UNIVERSITY
COLLEGE OF NURSING
City of Malolos, Bulacan

DRUG STUDY
Patient’s Initial: _______________________ Age: ________ Gender: _____ Date Handled: _________________ Medical Diagnosis: ______________
Chief Complaint: _________________________ Hospital: ________________________________________________ Ward/Clinical Area:
__________________

Medications Date Route of Mechanism of Indication Contraindication Client’s Response Nursing

Ordered/ Administration Action Responsibilities
Given/ /
Taken Dosage
Frequency
Generic: Date Dosage: N/A A Indicated in Contraindicated in Therapeutic Prior:
Diazepam Ordered: N/A benzodiazepin patients with patients with patients Effect: ➢ Verify
e that physician’s
Brand: Valium ➢ Anxiety ➢ Hypersensitivity Diazepam is used
Route: N/A potentiates the order
➢ Acute to drug, other to treat anxiety,
Date Given: effects of regarding drug
Classification alcohol benzodiazepines alcohol
N/A GABA, ➢ Assess patient
benzodiazepine withdrawal , alcohol, or withdrawal, and hypersensitivit
Frequency: depress the
s (Antihistamine ➢ Muscle tartrazine seizures. It is also y to drug.
N/A CNS, and
drug) spasm ➢ Coma or CNS used to relieve ➢ Review the
Date suppresses the
➢ Preoperativ depression muscle spasms patient’s chart
Discontinued spread of
e sedation ➢ Narrow-angle and to provide for allergies.
: N/A seizure activity.
➢ Adjunctive glaucoma. sedation before ➢ Enumerate
treatment medication not
 for seizure medical should be
disorder procedures. taken with
➢ Status Thioridazine.
Side Effect: ➢ Assess patient
epilepticus,
severe ➢ Drowsiness medical
recurrent ➢ Tiredness history
seizure or fatigue ➢ Warn the
➢ Patients on ➢ Muscle client to avoid
stable weakness alcohol during
regimens of ➢ Inability to treatment.
antiepileptic control ➢ Avoid eating
drugs who muscle grapefruit or
need movements drinking
diazepam (ataxia) grapefruit
intermittentl ➢ Headache juice.
y to control ➢ Tremor ➢ Discuss
bouts of ➢ Dizziness therapeutic
increased ➢ Dry mouth effect of the
seizure or drug
activity. excessive ➢ Provide
saliva appropriate
➢ Nausea health
➢ Constipatio teaching
n regarding the
drug
➢ Monitor vital
signs.
➢ Prepare
medication
according to
 the order of
the physician.

During:
➢ Administer
drug in right
route, right
dosage, right
time.
➢ Offer glass of
water upon
administering
the drug.
➢ Administer
drug with or
without food.
After:
➢ Reassess vital
signs
➢ Monitor the
patient
response to
the administer
drug.
➢ Note for the
client’s
response to
the drug
therapy
include the
 therapeutic
effect.
➢ For any
serious
adverse or
side effect
report to the
physician.

Student’s Name: Prieto, Stiffany T. Yr&Sec/Group No. 3B/G4 Clinical Instructor: Mrs. Jessica Villano RN, MAN

BulSU-OP-CON-23F1
Revision: 0