Sample Care Plan Template Page 19
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51In your own words.
Medication Worksheet
Drug Name
Contraindications &
Nursing Interventions /
Classification/
Actions/Indications
Patient dose/
Generic and
Most common or serious
Major Interactions
Patient Teaching
Mechanism of
(Reason MY patient
route/
Brand &
side effects
(Food/Drug)
(What you need to know/ do
action
is on this medication)
frequency
TIME DUE
before administering)
Albuterol
Albuterol acts
My patient was
5 mg,
Albuterol has multiple
Contraindications for the
Nurse should assess
by producing
diagnosed with
nebulizer,
adverse reactions
drug are hypersensitivity to
respiratory status and pulse
the
aspiration
q4day
including: edema,
adrenergic amines (Deglin,
ox. Suction secretions to
physiological
pneumonia and this
abdominal pain, ataxia,
Vallerand, & Sanoski,
improve adventitious lung
effects of the
drug was ordered
angina, cough,
2012, p.113).
sounds and respiratory rate.
sympathetic
because of his right
diaphoresis, fever,
nervous
lower lobe airspace
glossitis, conjunctivitis,
symptom.
opacities.
hyperglycemia,
Albuterol’s
hypokalemia, and
main
lymphadenopathy
mechanism of
(Deglin, Vallerand, &
action to
Sanoski, 2012, p.113).
stimulate the
receptors of
the smooth
muscle in the
lungs (Deglin,
Vallerand, &
Sanoski, 2012,
p. 112).
Chlorhexidine
Chlorhexidine
The patient is taking
15 ml, q3day,
Change in the taste of
Hypersensitivity.
Nurse should assess the
gluconate
gluconate is a
this medication
swish and spit
food/drink, tongue/tooth
patient for any signs of
salt and acts a
because it is used for
staining, and
hypersensitivity or severe
germicidal
ventilated patients to
mouth/throat irritation
side effects.
mouthwash.
help prevent
(Deglin, Vallerand, &
aspiration
Sanoski, 2013).
pneumonia and
mouth sores.
Page 19
F:\group\MEPN\MEPN Level III\NURS610B\2013NURS 610B\610BCarePlan
12/17/2012
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