Medication List: This should include ALL medications your patient is currently taking. (Attach additional sheets if necessary) Medication Name (Trade and Generic) and Drug Class Dose (with appropriate units) /Route/Time Ordered (ex: 30mg PO 1xD 8am) Why is YOUR patient on this medication? (Indication) Normal Dose Range for Indication Required nursing interventions for THIS medication in THIS patient. Pre/Post administration physical assessments, pertinent labs, specific time to re-evaluation effectiveness. Is this a home med? Y/N These are the medication Entresto 49/51mg Toprol XL 100mg Lasix 80mg Farxiga 10mg Atorvastatin 80 mg Spironolactone 50mg Patient lab work UWBC: 100,000 BUN/Creat: 60/3.0 GFR: 40 K+: 5.9 Na+: 135

3-2-1 Code It
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Chapter10: Cpt Anesthesia
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Medication List: This should include ALL medications your patient is currently taking. (Attach additional sheets if necessary) Medication Name (Trade and Generic) and Drug Class Dose (with appropriate units) /Route/Time Ordered (ex: 30mg PO 1xD 8am) Why is YOUR patient on this medication? (Indication) Normal Dose Range for Indication Required nursing interventions for THIS medication in THIS patient. Pre/Post administration physical assessments, pertinent labs, specific time to re-evaluation effectiveness. Is this a home med? Y/N These are the medication Entresto 49/51mg Toprol XL 100mg Lasix 80mg Farxiga 10mg Atorvastatin 80 mg Spironolactone 50mg Patient lab work UWBC: 100,000 BUN/Creat: 60/3.0 GFR: 40 K+: 5.9 Na+: 135
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