MEDICATION ADMINISTRATION EVALUATION FORM

DATE: 11/16 /2011 PATIENT INITIALS: D.C. STUDENT: FAYE BARRERAS DIAGNOSIS: OSTEOARTHRITIS ALLERGIES: PROMETHAZINE HCL RASH, RANITHAZINE HCL HIVES,
CIMETIDINE HCL DIARRHEA, SULFANAMIDE RASH, DIAZEPAM RASH, SULFAMETHOXAZOLE RASH, TRIMETHOPRIM RASH, CIMETIDINE DIARRHEA

DRUG NAMES (GENERIC & TRADE), ROUTE, DOSAGE/USUAL RANGE, FREQUENCY, CLASSIFICATION G T R D F C G T R D F C G T R D F C
CIT AL OP CE RA LE M PO XA HY DR 40 OB M RO DA G MI ILY (2 DE AN

FOR THIS PATIENT PURPOSE Depression TEACHING

Take around the same time every day. May take 1-4 weeks before you feel full benefit of the med. Keep taking it even if you feel well. If you suddenly stop taking the med, you may experience withdrawal symptoms such as mood changes, irritability agitation, dizziness, numbness or tingling in the hands or feet, headache, tiredness, and difficulty falling asleep or staying asleep. Avoid taking aspirin as may increase the risk of bleeding. This meds may cause you for unusual bleeding, bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing. Report immediately if experience S/S noted above.

THERAPEUTIC EFFECT

SIDE/ADVERSE EFFECTS NOTED n/v/d, stomach pain, drowsiness, excessive tiredness, uncontrollable shaking of part of the body, excitement, nervousness, muscle/joint pain, dry mouth, loss appetite

G T R

TA TI BS DE ) PR DA ES LT SA EP FR ARI NT AG N SQ / MI SO SS N DIU 25 RIs M 00 (PO DA URCI ILY 0.2 NE) AN ML TI DO CO CU AG SA CO UL TE LA AN SO H2 PO CE T DIU BL M 10 OC 0 M HY KE M BI M OR M DR RS G ME ME D LE G THY 8PH OR O NO HY CO FE /TO ON MA HY LA PR VO FE (1 10 IN PH M RC DR RT RR AN 20 DA 15 AL DR CL ED XA TH RR CA E IN OR O OC IC 20 AOU TI M NS ML OX OP NIS FA TIV YR OU P) GSU E PH 10/ OD OS M ME SY S HI G Q4 ET (0. SU / AN RA OLI MO OXI S E NE Q4 0.8 LF DIL ON TE GTH Ho 0.0 NT 32 SU ST (1 4M RO AN Q6 5 SP AL TIE 5M MI TID PE NE SU SO INE H/ -DE AT 2-4 AU OP 1-2 E RO 0.5 AP rm HR Mi 5 LF AM UD ME 6H/ IV ZO N TA H UD EN HY MT GRE PC SO LF / D PO 1M E PR DI HC IOI Q4 AP Q8 VI RE on 60 OI ner M AT IN BI TA TI 2M OR FR CI PR BO SI DR IC Q6 1M GL HC DIU AT ID SU DS IM IJ N L B AP S H AL IL e 0 al G P D B) CS D N T) PO ON OX S H IV AN V M EO CC

Prevent blood clots from forming.

Upset stomach, vomiting or spitting blood, unusual bleeding,

She has a hx of constipation. Meds given to treat or prevent constipation

Advice pt. that med should only for short-term therapy, because long-term may cause electrolyte imbalance and dependence on med. Encourage to take med with 1 glass of water or juice, increase bulk in the diet, and increase mobility. Decrease dose or stop taking this med if you develop diarrhea. Relief is usually seen in 1-3 days. Report experience of side effects heartburn, chest pain, and such as impair thinking or reaction. Be careful to do anything that requires you to be awake and alert.

Stomach pain, diarrhea, cramping, irritated throat,

Treat GERD by decreasing the amount of acid produced in the stomach

Dizziness, headache, n/v/d, dry mouth, pancreatitis, urinary retention, rash, bronchospasm.