Medication Administration Sheet Sample

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Medication Administration Sheet

Norwalk Community College Nursing 201-202

Patient Initials___MJ____ Allergies: Sulfa Drugs__________________________________________

Medication: trade & generic, dose, Category and Action Reason THIS patient is on this Nursing Implications: pertinent
route, schedule medication side effects

Ampicillin Antibiotic (broad spectrum) Infected venous stasis ulcer of right Check for allergic reaction
500 mg Semi-synthetic aminopenicillin leg Monitor for superinfection
IV q6h Bacteriocidal for gram + and some Check IV site for patency and s/s of
gram - complications

Digoxin Cardiac glycoside Hx of CHF Check apical rate prior to


0.25 mg QD Slows the heart rate, regulates heart Mrs. J is on this drug to improve administration
PO rhythm, improves cardiac output cardiac output and increase blood Hold if less than 50 (or as ordered)
flow to vital organs Check for s/s of dig toxicity: N/V,
visual changes, arrythmias

Lasix (Furosimide) Loop Diuretic Hx of CHF Check hydration status


40 mg Decreases renal vascular resistance, This med will decrease fluid load Monitor I & O
PO twice a day may increase renal blood flow to decrease work load of the heart Assess skin turgor and mucous
Increases urine output, increases membranes
excretion of NA, CL, and K Monitor BP
Check lab values: K, NA and CL
Give with food or milk to decrease
gastric irritation
Medication: trade & generic, dose, Category and Action Reason THIS patient is on this Nursing Implications: pertinent
route, schedule medication side effects

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