University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date__11/02/2009_______________________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CLASSIFICATION OF THE
THIS PATIENT
DRUG
USUAL DOSE/SAFE DOSE
AND ADMINISTRATION
Brand Name: Zofran
Prevention of nausea and
Generic Name: Ondansetron
vomiting
Classification: Antiemetrics,
5-HT, antagonist
Dosage PO active ulcer
Child: 1 month -16yr 2-4
mg/kg bid up to 300mg Reflux
and erosive esophagitis :
Child 1 month- 16yr 5-10
mg/kg in 2 divided doses
Maintenance ulcer: Child: 1
month-16yr 2-4 mg/kg PO
daily up to 150mg Heartburn:
adults and child age 12 and
older 75- 150 mg PO daily
Page _____ of ______
Student _Tammy Barton__________
NURSING IMPLICATIONS/
CONSIDERATIONS FOR
THIS PATIENT
EVALUATION OF DESIRED
EFFECT FOR THE PATIENT.
INCLUDING ASSESSMENT,
LAB RESULTS AND
PROCEDURES
Monitor for headaches,
dizziness, drowsiness, fatique,
weakness, constipation,
diarrhea, abdominal pain, dry
mouth
Monitor bowel sounds prior to
and after administration.
Monitor for increased liver
enzymes
Assess for extrapyramidal
effects, involuntary
movements, facial grimaces.
Assess for nausea and
vomiting, abdominal distention
and bowel sounds
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date_____10/07/2009
________________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CLASSIFICATION OF THE
THIS PATIENT
DRUG
USUAL DOSE/SAFE DOSE
AND ADMINISTRATION
Name Brand: Pepcid
Management of gastric
Generic Name: Famotidine
hypersecretory states.
Decreased abdominal pain.
Classification: Histamine H2
receptor antagonists
Unlabeled use: Management
of GI symptoms with use of
NSAIDs, management of
urticara
Availability: (Tablets)10mg,
20mg,40mg. (Gelcaps) 10mg
(Oral liquid) 40mg/5ml
(premixed infusion)
20mg/50ml 0.9% NaCl
Injection: 10 mg/ml
Healing and prevention of
ulcers
Decreased symptoms of
gastroesophageal reflux.
Tx of heartburn, acid,
indigestion, and sour stomach.
Decrease secretion of gastric
acid.
Tx and prevention of gastric or
duodenal irritation and
bleeding.
GERD Tx: 20 mg/bid up to
40mg/bid
Page _____ of ______
Student _Tammy Barton____________
NURSING IMPLICATIONS/
CONSIDERATIONS FOR
THIS PATIENT
EVALUATION OF DESIRED
EFFECT FOR THE PATIENT.
INCLUDING ASSESSMENT,
LAB RESULTS AND
PROCEDURES
Assess pt for epigastric or
abdominal pain and flank pain
or occult blood in stool, emesis,
or gastric aspirate
Instruct pt to take as directed
for full course of Tx
Advise pt to report onset of
black, tarry stools, fever, sore
throat, diarrhea, dizziness,
confusion, or hallucinations.
Dosage Po IV children 1-16yr
peptic ulcer: 0.5 mg/kg/day at
Hs or in 2 divided doses. Gerd:
1 mg/kg/day in 2 divided doses.
May cause false positive results
for urine protein ; using
Multistix
PO infants > 3 mo – 1yr
GERD: 0.5 mg/kg/dose BID
PO infants and neonates < 3
mo GERD: 0.5 mg/kg/dose
once daily.
Monitor CBC with differential
May cause false negative
results in skin tests using
allergenic extracts
May cause an increase in serum
transaminases and serum
creatinine.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date_________________ Client’s Initials ________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CLASSIFICATION OF THE
THIS PATIENT
DRUG
USUAL DOSE/SAFE DOSE
AND ADMINISTRATION
Brand Name: Senokot-S
Treatment
of constipation
associated with slow transit
Generic Name:
(Senna/Docusate Sodium)
time, constipating drugs and
irritable or spastic bowel
Classification: Laxativesyndrome..
stimulant
Chem. class: Anthraquinone
-Adult:
PO: 1-8 tabs/day or ½ to 4 tsp
of granules (1tsp-4 ml) added
to water or juice.
-Child 1 mo-1 yr.:
SYR: 1.25-2.5 ml at bedtime.
Acute constipation; Bowel
preparation for surgery or
examination.
Po children 6-12yrs: 6-25mg Po children >12yrs: 12-50mg
1-2 times a day.
1-2 times a day.
Page _____ of ______
Student ____________________________
NURSING IMPLICATIONS/
CONSIDERATIONS FOR
THIS PATIENT
EVALUATION OF DESIRED
EFFECT FOR THE PATIENT.
INCLUDING ASSESSMENT,
LAB RESULTS AND
PROCEDURES
GI: Nausea, vomiting,
anorexia, cramps, diarrhea,
flatulence.
GU: Pink, red or brown, black
urine.
META: Hypocalcemia,
enteropathy, alkalosis,
hypokalemia, tetany.
Contraindications:
Hypersensitivity, GI bleeding,
obstruction, CHF,
breastfeeding, abdominal pain,
nausea/vomiting, appendicitis,
acute surgical abdomen.
Assess:
-Stool: color, consistency,
amount.
-Blood, urine electrolytes if
product is used often.
-I&O ratio to identify fluid loss
-Therapeutic response:
decrease in constipation
-Cause of constipation; fluids,
bulk, exercise missing,
constipating products.
-Cramping, rectal bleeding,
nausea, vomiting; product
should be discontinued.
Precautions: Pregnancy
Po children 2-6 yrs: 3-12.5 mg
1-2 times a day.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date________________________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CLASSIFICATION OF THE
THIS PATIENT
DRUG
USUAL DOSE/SAFE DOSE
AND ADMINISTRATION
BrandName: Prilosec
Maintenance of healing in
Generic Name: omeprazole
erosive esophagitis. Duodenal
ulcers. Short term treatment of
active benign gastric ulcer.
Dosages Po children > 2yrs Decreased abdominal pain
and < 20kgs: 10 mg once a
day. Po children > 2 yrs > 20
kg: 20mg once a day. PO
children alternate doseing: 1
mg/kg/day in 2 divided doses.
Page _____ of ______
Student ___Tammy Barton____________
NURSING IMPLICATIONS/
CONSIDERATIONS FOR
THIS PATIENT
EVALUATION OF DESIRED
EFFECT FOR THE PATIENT.
INCLUDING ASSESSMENT,
LAB RESULTS AND
PROCEDURES
Assess for epigastric pain,
abdominal pain, frank or occult
blood in the stool, emesis, or
gastric aspirate.
May cause drowsiness,
dizziness.
Advise patient to avoid alcohol,
products that conations aspirin,
or NSAIDs, and foods that may
cause gastric irritation.
Advise patient to report black
tarry stools.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Page _____ of ______
Date_________________________
Student ___Tammy Barton_____________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
NURSING IMPLICATIONS/
EVALUATION OF DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CONSIDERATIONS FOR
EFFECT FOR THE PATIENT.
CLASSIFICATION OF THE
THIS PATIENT
THIS PATIENT
INCLUDING ASSESSMENT,
DRUG
LAB RESULTS AND
USUAL DOSE/SAFE DOSE
PROCEDURES
AND ADMINISTRATION
Brand Name: Phenergan
Treatment of nausea, vomiting, May cause dizziness,
May increase blood glucose
Generic Name: Promethazine
and pain after surgery. Also
drowsiness, blurred vision, dry levels
used as a sedative
mouth, stuffy nose, tinnitus,
constipation
Dosage Po adults: 6.25-12.5
Drug interactions: CNS
Exercise caution with use with
mg TID/day and 25mg at HS.
depressants (alcohol,
patients who have asthma or
benzodiazepines, opioids)
allergies
IM, IV, Rectal Adult: 25mg
Drug interactions: lithium,
Teaching advise patient to take
PO children > 2yrs:
0.1mg/kg/dose (not to exceed
may repeat in 2 hrs.
atropine, warfarin, propanolol, with food
12.5mg) every 6 hrs during the Rectal children > 2yrs:
MAO inhibitors, sedatives
day and 0.5 mg/kg dose at HS 0.5mg/kg every 4-6 hrs or
0.5mg/kg at HS
(not to exceed 25 mg)
Caution patient before
ambulation
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date_________________________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CLASSIFICATION OF THE
THIS PATIENT
DRUG
USUAL DOSE/SAFE DOSE
AND ADMINISTRATION
Brand Name: Bentyl
Management of irritable bowel
Generic Name: Dicyclomine
syndrome in patients who do
not
respond
to
usual
interventions.
Dosages PO children > 2yrs:
10mg 3-4 times a day. PO
children 6mo-2yrs: 5-10mg 34 times a day.
PO adult: 10-20mg 3-4 times a
day
IM adults: 20 mg every 4-6
hrs
Page _____ of ______
Student __Tammy Barton_______________
NURSING IMPLICATIONS/
CONSIDERATIONS FOR
THIS PATIENT
EVALUATION OF DESIRED
EFFECT FOR THE PATIENT.
INCLUDING ASSESSMENT,
LAB RESULTS AND
PROCEDURES
Assess for symptoms of
irritable bowel syndrome
(abdominal cramping,
alternating constipation, and
diarrhea, mucus in stools before
and during treatment.
Assess for abdominal
distension and for bowel
sounds
Instruct patient to take as
directed. In addition, to make
position changes slowly to
minimize orthostatic
hypotension.
Monitor intake and output
Instruct patient to notify doctor
if eye pain or increased
sensitivity to light occurs.
May cause urinary retention.
Advise patient to consult doctor
before taking any OTC
medications.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date_________________________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CLASSIFICATION OF THE
THIS PATIENT
DRUG
USUAL DOSE/SAFE DOSE
AND ADMINISTRATION
Brand Name: Lomotil
Treatment of diarrhea inhibits
excess GI motility.
Generic Name:
Diphenoxylate/atropine
Dosages children use liquid
only: 0.3-0.4 mg/kg/day 4
divided doses.
PO adult: 5 mg 3-4 times daily
initially then 5 mg once a day
(not to exceed 20 mg/day
Page _____ of ______
Student _Tammy Barton___________
NURSING IMPLICATIONS/
CONSIDERATIONS FOR
THIS PATIENT
EVALUATION OF DESIRED
EFFECT FOR THE PATIENT.
INCLUDING ASSESSMENT,
LAB RESULTS AND
PROCEDURES
May cause dizziness,
confusion, headache, insomnia,
nervousness, dry mouth,
constipation
Risk for dependence
Instruct patient to avoid alcohol
and other CNS depressants.
Instruct patient to avoid driving
until they know how
medication will affect them.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Page _____ of ______
Date________________________
Student __Tammy Barton_____________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
NURSING IMPLICATIONS/
EVALUATION OF DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CONSIDERATIONS FOR
EFFECT FOR THE PATIENT.
CLASSIFICATION OF THE
THIS PATIENT
THIS PATIENT
INCLUDING ASSESSMENT,
DRUG
LAB RESULTS AND
USUAL DOSE/SAFE DOSE
PROCEDURES
AND ADMINISTRATION
Brand Name: Colace
Prevention of constipation
Assess for bowel sounds,
Advise patient not to use
Generic Name: Docusate
abdominal distension, usual
laxatives when abdominal pain
sodium
bowel patterns
is present
Advise patient that laxative
Dosages Adults and children Soft formed bowel movements Assess color, consistency and
6-12 yrs PO: 50-400 mg in 1-4
amount of stool produced.
should be used for a short time.
divided doses. PO children 3-6
yrs: 20-60 mg in 1-4 divided
Instruct patient with cardiac
doses. Po children < 3yrs: 10disease to avoid straining.
40 mg in 1-4 divided doses.