ILOILO DOCTORS’ COLLEGE
College of Nursing
West Avenue, Molo, Iloilo City
Name of patient: ________________________________ DRUG TEST Impression & Diagnosis: ________________________
Age & Sex: _____________________________________ Ward / Bed: __________________________________
Prescribed Drug Classification and Indication and Side Effects or Adverse
Special Precautions Nursing Responsibilities
(Dosage, Route, frequency, Timing) Mechanism of Action Contraindication Reaction
Generic Name: Classification: Indications: Side Effects: allergic to lidocaine, Monitor serum lidocaine
lidocane Antiarrythmic and Decrease cardiac excitabi- CNS: Confusion, tremor, anesthetics, or any other levels throughout
Brand Name: Anesthetic lity, cardiac contraction is lethargy, somnolence, drugs theraphy; therapreutic
Xylocaine delayed in the atrium and stupor, restlessness range 1.5-5 mcg/ml/
Action: ventricle anxiety, hallucinations, Monitor intake and
1-1.5 mg/kg IVP or ETT Decrease cardiac nervousness, seizure. CV: output.
(double dose if giving via ET contraction is delayed in Contraindications: hypotension, bradychardia, Do not mix in the same
tube), may repeat q 5-10 min. the atrium and ventricle Contraindicated in patients new or worsened syringe with amphoterin
Max 3 mg/kg; If conversion hypersensitive to amide- arrhythmias EENT: B or cefazolin.
successful start an infusion of Type local anesthetics and tinnitus, blurred or double Administer Lidocaine
2-4 mg/min in those with Adams Stroke vision. TIV.
syndrome. Wolff-Parkinsons Respiratory: Respiratory In case of circulatory
White Syndrome, or severe depression and arrest depression have
degrees of SA, AV, or Skin: soreness at injection Dopamine available.
intraventricular block in site
the absence of pacemaker. Other: anaphylaxis,
Students Name: ____________________ Yr. & Sec: ___________ Date: _________ C.I’s Printed Name & Signature: _____________________________
Prepared by: Mrs. Maria Luz M. Chan
NAL Coordinator