Medication Administration Sheet Sample

Medication Administration Sheet Norwalk Community College Nursing 201-202 Patient Initials___MJ____

Allergies: Sulfa Drugs__________________________________________

Medication: trade & generic, dose, route, schedule

Category and Action

Reason THIS patient is on this medication

Nursing Implications: pertinent side effects

Ampicillin 500 mg IV q6h

Antibiotic (broad spectrum) Semi-synthetic aminopenicillin Bacteriocidal for gram + and some gram -

Infected venous stasis ulcer of right Check for allergic reaction leg Monitor for superinfection Check IV site for patency and s/s of complications

Digoxin 0.25 mg QD PO

Cardiac glycoside Hx of CHF Slows the heart rate, regulates heart Mrs. J is on this drug to improve rhythm, improves cardiac output cardiac output and increase blood flow to vital organs

Check apical rate prior to administration Hold if less than 50 (or as ordered) Check for s/s of dig toxicity: N/V, visual changes, arrythmias

Lasix (Furosimide) 40 mg PO twice a day

Loop Diuretic Hx of CHF Decreases renal vascular resistance, This med will decrease fluid load may increase renal blood flow to decrease work load of the heart Increases urine output, increases excretion of NA, CL, and K

Check hydration status Monitor I & O Assess skin turgor and mucous membranes Monitor BP Check lab values: K, NA and CL Give with food or milk to decrease gastric irritation

Medication: trade & generic, dose, route, schedule

Category and Action

Reason THIS patient is on this medication

Nursing Implications: pertinent side effects