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Name: ___________________________Date of Care: __________________Patient’s Initials_____________ Room Number _________

Allergy Reaction Allergy Reaction

Medication Teaching
Which medication?

What did you teach and how did you adapt your teaching style to meet individual need or special considerations?

Evidence of understanding, effectiveness of teaching, action plan:

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

67
Name: ____________________________________________Date of Care: __________________Patient’s Initials_____________ Room Number _________

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

Date Medication Times 1) Class Nursing Implications Expected Outcome Evaluation


Ordered Trade Name given
Generic Name 2) Action
Dose
Route 3) Side Effects
Frequency
Safe Range 4) Why administered
Age Related Considerations

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