MDC 2 clinical

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Pt Room/ Initials: / Age: Clinical Date(s): Student Name:_____________________

Allergies:________________________________________________________________________________________________________________

Scheduled Medications

1.Med

2.Dose

3.Frequency

4.Route

1.Pharmacologic class

2.Therapeutic class

1. Indication

2. Action

1.Side effects

2.Adverse Reactions

3. Contraindications

1.Nursing Actions and

Considerations

Patient/family education

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KAE; updated 8.2.10, approved ADP 02.16.12,