Patient’s Name: Age/Sex: Ward/Bed No:

Medical Diagnosis: Date of Assignment:

(HYDROCORTISONE) ( )

NURSING RESPONSIBILITIES:
Indications for Use: (This should include all warnings, specific instructions on preparation, mixing, administration, monitoring, etc. You may list all, and then tick the
□ Analgesia boxes applicable for your patient. Include IV and oral preparations.)
□ Inflammation
□ Allergies Preparation Administration Monitoring
□ Neoplasms
□ cerebral edema Indication: Classification: corticosteroid- long acting
□ septic shock Direct IV PO route □ Monitor for the following adverse side
□ collagen disorders □ Diluent: May be given undiluted. □ Give with food or milk to decrease GI effects:
□ dexamethasone suppression test for Cushing syndrome, □ Concentration: 4–10 mg/mL. symptoms CNS: Depression, flushing, sweating,
□ adrenocortical insufficiency □ Rate: Administer over 1–4 min if dose is 10 □ Provide assistance with ambulation in headache, mood changes, euphoria,
□ TB mg. patient with bone tissue disease to prevent psychosis, seizures, insomnia, pseudotumor
□ Meningitis Intermittent Infusion: fractures cerebri
□ acute exacerbations of MS □ Diluent: High-dose therapy IM route CV: Hypertension, circulatory collapse,
should be added to D5W or 0.9% NaCl □ IM inj deep in large muscle mass; rotate thromboembolism, heart failure,
solution. Solution should be clear and colorless
sites; avoid deltoid; use 21-G needle dysrhythmias, tachycardia, edema,
to light yellow; use diluted solution within 24
hr.
□ In one dose in am to prevent adrenal cardiomyopathy
Contraindications: suppression; avoid SUBCUT EENT: Fungal infections, increased
□ Concentration: Up to 10 mg/mL.
□ Psychosis administration, may damage tissue intraocular pressure, blurred vision,
□ Rate: Administer infusions over 15–30 min.
□ hypersensitivity to corticosteroids cataracts, glaucoma
□ sulfites, or benzyl alcohol ENDO: Hypothalmic-pituitary-adrenal axis
□ idiopathic thrombocytopenia, suppression, hyperglycemia, sodium, fluid
□ acute glomerulonephritis, retention
□ amebiasis, GI: Diarrhea, nausea, abdominal distention,
□ fungal infections, GI hemorrhage, increased appetite,
□ nonasthmatic bronchial disease, pancreatitis
□ child ,2 yr, HEMA: Thrombocytopenia, transient
□ AIDS, leukocytosis, thromboembolism
□ TB, INTEG: Acne, poor wound healing,
□ Glaucoma ecchymosis, petechiae, hirsutism,
□ ocular infection angioedema
META: Hypokalemia
MS: Fractures, osteoporosis, weakness,
References: arthralgia, myopathy
Patient’s Name: Age/Sex: Ward/Bed No:
Medical Diagnosis: Date of Assignment:

(FAMOTIDINE) ( )

Indication: Classification: H2-histamine receptor antagonist, antiulcer agent

NURSING RESPONSIBILITIES:
Indications for use: (This should include all warnings, specific instructions on preparation, mixing, administration, monitoring, etc. You may list all, and then tick the
□ Short-term treatment of active duodenal ulcer boxes applicable for your patient. Include IV and oral preparations.)
□ maintenance therapy for duodenal ulcer
□ Zollinger-Ellison syndrome Preparation:
□ multiple endocrine adenomas
Direct IV route
□ gastric ulcers
□ Give IV direct after diluting 2 ml of product
□ Heartburn
(10 mg/ml) in 0.9% NaCl to total volume of 5-
□ gastroesophageal reflux disease 10 ml
□ inject over 2 min to prevent hypotension
Intermittent IV infusion route
□ Administer after diluting 20 mg of product in
100 ml of LR, 0.9% NaCl, D5W, D10W; run
over 15-30 min
Continuous IV infusion route
□ Adults: Dilute 40 mg/250 ml D5W or NS,
infuse over 24 hr, run at 11 ml/hr, use infusion
Contraindications: device
□ Hypersensitivity □ Store in cool environment (oral); IV sol is
stable for 48 hr at room temperature; do not use
discolored sol
Administration:
PO route
□ Give antacids 1 hr before or 2 hr after
famotidine; may be given with foods or liquid
□ Administer oral susp after shaking well;
discard unused sol after 1 mo
□ Store in cool environment (oral)
Monitoring
□ Monitor for the following:
CNS: Headache, dizziness, paresthesia,
depression, anxiety, somnolence, insomnia,
fever, seizures in renal disease
CV: Dysrhythmias, QT prolongation (impaired
renal functioning)
EENT: Taste change, tinnitus, orbital edema
GI: Constipation, nausea, vomiting, anorexia,
cramps, abnormal liver enzymes, diarrhea
HEMA: Thrombocytopenia, aplastic anemia
INTEG: Rash, toxic epidermal necrolysis,
Stevens-Johnson syndrome
MS: Myalgia, arthralgia
RESP: Pneumonia

References: Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2014). Davis’s drug guide for nurses / edition 14 (14th ed.). Philadelphia, PA: F. A. Davis
Company.
Patient’s Name: Age/Sex: Ward/Bed No:
Medical Diagnosis: Date of Assignment:
(PHYTONADIONE/ VITAMIN K) ( )

Indication: Classification: vitamin K, fat-soluble vitamin

NURSING RESPONSIBILITIES:
Indications for Use: (This should include all warnings, specific instructions on preparation, mixing, administration, monitoring, etc. You may list all, and then tick the
□ Vitamin K malabsorption boxes applicable for your patient. Include IV and oral preparations.)
□ hypoprothrombinemia,
□ prevention of hypoprothrombinemia caused by oral Preparation: Administration: Monitoring
anticoagulants
□ prevention of hemorrhagic disease of the newborn □ Do not confuse Mephyton (phytonadione) Intermittent Infusion □ Monitor for the following:
with methadone. □ Administer over 30–60 min. Rate should not CNS: Headache, brain damage (large
□ The parenteral route is preferred for exceed 1 mg/ min. doses)
phytonadione therapy but, because of severe, GI: Nausea, decreased liver function tests
potentially fatal hypersensitivity reactions, IV HEMA: Hemolytic anemia,
vitamin K is not recommended. hemoglobinuria, hyperbilirubinemia
□ Administration of whole blood or plasma INTEG: Rash, urticaria
may also be required in severe bleeding because
RESP: Bronchospasm, dyspnea, chest
of the delayed onset of this medication.
constriction, respiratory arrest
□ Phytonadione is an antidote for warfarin
overdose but does not counteract the
anticoagulant activity of heparin.
Contraindications:
□ Hypersensitivity Intermittent Infusion:
□ severe hepatic disease □ Diluent: Dilute in 0.9% NaCl, D5W, or
□ last few wk of pregnancy D5/0.9% NaCl.

References: Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2014). Davis’s drug guide for nurses / edition 14 (14th ed.). Philadelphia, PA: F. A. Davis
Company.
Patient’s Name: Age/Sex: Ward/Bed No: W14B-B40
Medical Diagnosis: Date of Assignment:

(SPIRONOLACTONE) ( )
 NURSING RESPONSIBILITIES:
Indications for Use: (This should include all warnings, specific instructions on preparation, mixing, administration, monitoring, etc. You may list all, and then tick the
□ Edema of CHF boxes applicable for your patient. Include IV and oral preparations.)
□ Hypertension
□ diuretic-induced hypokalemia
□ primary hyperaldosteronism (diagnosis, short-term treatment, Indication: Classification: potassium sparing diuretic- aldosterone antagonist
long-term treatment) PO □ Monitor for the following: R
□ edema of nephrotic syndrome e □ Give in am to avoid interference with CNS: Headache, confusion, drowsiness, f
e sleep lethargy, ataxia r
□ cirrhosis of the liver with ascites
e ELECT: Hyperchloremic metabolic acidosis, n
□ Give with food if nausea occurs;
c hyperkalemia, hyponatremia e
s absorption may be increased; take at same :
ENDO: Impotence, gynecomastia, irregular
time each day. Effect may take 2 wk
menses, amenorrhea, postmenopausal bleeding,
hirsutism, deepening voice, breast pain
GI: Diarrhea, cramps, bleeding, gastritis,
vomiting, anorexia, nausea, hepatocellular
toxicity
HEMA: Agranulocytosis
Contraindications: INTEG: Rash, pruritus, urticaria
□ Pregnancy D
□ Hypersensitivity
□ Anuria
□ severe renal disease
□ hyperkalemia

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2014). Davis’s drug guide for nurses / edition 14 (14th ed.). Philadelphia, PA: F. A. Davis Company.

Patient’s Name: Age/Sex: Ward/Bed No: W14B-B40

Medical Diagnosis: Date of Assignment:

(PHENOBARBITAL) ( )
 NURSING RESPONSIBILITIES:
Indications for Use: (This should include all warnings, specific instructions on preparation, mixing, administration, monitoring, etc. You may list all, and then tick the
□ Anticonvulsant in tonic-clonic (grand mal) boxes applicable for your patient. Include IV and oral preparations.)
□ Partial and febrile seizures in children
□ Preoperative sedative and in other situations in which sedation
may be required. Indication:
□ Hypnotic (short-term) □ Do not confuse phenobarbital with
□ Unlabeled Use: e
pentobarbital.
Prevention/treatment of hyperbilirubinemia in neonates. □e When changing from phenobarbital to
e n
another anticonvulsant, gradually decrease
c e
phenobarbital
s dose while concurrently
increasing dose of replacement medication
to maintain anticonvulsant effects.
IV
□ Doses may require 15–30 min to reach
peak concentrations in the brain.
Administer minimal dose and wait for
Contraindications: effectiveness before administering 2nd
□ Hypersensitivity dose to prevent cumulative barbiturate-
□ Comatose patients or those with pre-existing CNS depression; induced depression.
□ Severe respiratory disease with dyspnea or obstruction; Direct IV
□ Uncontrolled severe pain □ Diluent: Reconstitute sterile powder for
□ Known alcohol intolerance (elixir only); IV dose with a minimum of 3 mL of sterile
water for injection. Dilute further with 10
mL of sterile water. Do not use solution
that is not absolutely clear within 5 min
after reconstitution or that contains a
precipitate. Discard powder or solution that
has been exposed to air for longer than 30
min.
□ Concentration: 130 mg/mL (undiluted).
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2014). Davis’s drug
guide for nurses / edition 14 (14th ed.). Philadelphia, PA: F. A. Davis
Company.
Classification: anticonvulsants, sedative/hypnotics
PO □ Supervise ambulation and transfer of R
□ Tablets may be crushed and mixed with patients following administration. Two side f
food or fluids (do not administer dry) for rails should be raised and call bell within r
patients with difficulty swallowing. Oral reach at all times. Keep bed in low
solution may be taken undiluted or mixed position. Institute seizure and fall :
with water, milk, or fruit juice. precautions.
□ Use calibrated measuring device for
accurate measurement
of liquid doses.
IM
□ Injections should be given deep into the
gluteal muscle to minimize tissue irritation.
□ Do not inject 5 mL into any one site,
because of tissue irritation.
Direct IV
□ Rate: Do not inject IV faster than 1
mg/kg/min with a maximum of 30 mg over 1
min in infants and children and 60 mg over 1
min in adults. Titrate slowly for desired
response. Rapid administration may result in
respiratory depression.
□ Solution is highly alkaline; avoid
extravasation, which may cause tissue damage
and necrosis. If extravasation
occurs, injection of 5% procaine into affected
area and application of moist heat
may be ordered.

Patient’s Name: Age/Sex: Ward/Bed No:

Medical Diagnosis: Date of Assignment:

(METOCLOPRAMIDE) ( )

Indications for Use:
□ ORAL: Symptomatic treatment of diabetic gastroparesis,
gastroesophageal reflux
□ IV/IM: Symptomatic treatment of diabetic gastroparesis,
placement of enteral feeding tubes, prevent/treat nausea/vomiting
with chemotherapy or after surgery.
Contraindications:
□ Concurrent use of medications likely to produce extrapyramidal
reactions, GI hemorrhage, GI obstruction/perforation, history of
seizure disorder, pheochromocytoma
□ Cautions: Renal impairment, HF, cirrhosis, hypertension,
depression, Parkinson’s disease, elderly
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2014). Davis’s drug
guide for nurses / edition 14 (14th ed.). Philadelphia, PA: F. A. Davis Company
NURSING RESPONSIBILITIES:
(This should include all warnings, specific instructions on preparation, mixing, administration, monitoring, etc. You may list all, and then tick the
boxes applicable for your patient. Include IV and oral preparations.)
Indication: Classification: GI Emptying Adjunct, Peristaltic Stimulant,
Antiemetic
Preparation Reconstitution □ Extrapyramidal reactions occur most
□ Injection Solution: 5 mg/ml. Syrup: 5 mg/5ml □ Dilute doses greater than 10 mg in 50 ml frequently in children, young adults (18–30 yrs) R
□e Tablets: 5 mg, 10 mg D5W or 0.9% NaCl. receiving large doses (2 mg/kg) during f
e Rate of Administration chemotherapy and usually are limited to r
□ Tablets, Orally Disintegrating: 5 mg,10 mg
e □ Infuse over 15–30 min. akathisia (involuntary limb movement, facial n
Storage
c □ May give undiluted slow IV push at rate of grimacing, motor restlessness). Neuroleptic e
□s Store vials at room temperature. :
10 mg over 1–2 min. Too-rapid IV injection malignant syndrome (diaphoresis, fever,
□ After dilution, IV infusion (piggyback) is
may produce intense feeling of anxiety, unstable B/P, muscular rigidity) has been
stable for 24 hrs.
restlessness, followed by drowsiness. reported.
PO
□ Give 30 min before meals and at bedtime. □
Tablets may be crushed.
□ Do not cut, divide, break orally
disintegrating tablets. Place on tongue, swallow
with saliva..