UNIVERSITY OF CEBU – BANILAD

COLLEGE OF NURSING
DRUG STUDY

Patient : ___________________________________________________________ Age : ______________ Hospital No. _______________________ Room No. _____________
Impression/Diagnosis : _______________________________________________ Attending Physician(s) : _______________________________________________________
Allergy to : _____________________________________________________________________________________________________________________________________
Indication / Pharmacodynamics Side Effects / Adverse Nursing Responsibilities
Generic / Brand Name & Dosage, Timing &
of drug Reaction / Contraindication (Nursing Process Approach) Patient Teaching (20%)
Classification (5%) Duration (5%)
(20%) (10%) (40%)
Drug form & Dosage Indications:
Generic Name : Ordered:

Timing: Pharmacodynamics:
Brand Name:

Duration:
Classification Name:

Other drugs forms:

___________________________________________________ _________________________________________________
Printed Name and Signature Printed Name and Signature
Clinical Instructor Student
 Indication / Pharmacodynamics Side Effects / Adverse Nursing Responsibilities
Generic / Brand Name & Dosage, Timing &
of drug Reaction / Contraindication (Nursing Process Approach) Patient Teaching (20%)
Classification (5%) Duration (5%)
(20%) (10%) (40%)