UNIVERSITY OF CEBU – LAPULAPU AND MANDAUE

COLLEGE OF NURSING

DRUG STUDY

Patient: Age: Hospital No. Room No.

Impression / Diagnosis: Attending Physician (s):
Allergy to:

Generic/ Brand Name Dose, Strength & Indication/ Mechanisms of Adverse/ Side Effects of Drug Nursing Responsibilities Rationale Client Teaching
& Formulation (10)% Drug Action Interaction (20%) (10%) (20%)
Classification (10%) (15%) (15%)

Generic: Ordered: Indication:

200 mg-400 mg P.O

Brand: Timing:
Q4H (every 4 hours)

Duration: Mechanism of Action:

Classification: 1-2 days

Other Forms:

Printed Name and Signature Printed Name and Signature

Clinical Instructor
Student Note: Please provide additional sheet/s if necessary