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INDEX NURS 2236 Clinical Form 3: Clinical Medications Worksheet

(You will need to made additional copies of these forms)


Generic Trade Classification Dose Route Time/Frequency
Name Name

Peak Onset Duration Normal Dosage range

Why is your patient taking this medication? For IV meds, compatability with IV drips and/or solutions

Mechanism of action and indications Nursing Implications (what to focus on)


Contraindications/warnings/interactions

Common side effects

Interactions with other patient drugs, OTC, or herbal Lab value alterations caused by medicine
medicines (ask patient specifically)

Be sure to teach the patient the following about this medication

Nursing Process - Assessment Assessment Evaluation


(Pre-administration assessment Why would you hold or not give Check after giving
this med?

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