Name of Patient: Attending Physician: _____________________________ Age:

Ward/Bed Number: Impression / Diagnosis: ___________________________

Dosage, Route,
Name of Drug Frequency and Mechanism of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing
Binds to #-opioid receptors, Management of moderate to May have prolonged duration of Pregnancy/Lactation: Crosses BASELINE ASSESSMENT
Generic: Dosage: Assess onset, type, location, duration of
inhibits moderately action, cumulative effect in pts placenta.
tramadol 30 mg reuptake of norepinephrine, severe pain. with hepatic/ Distributed in breast milk. pain. Assess drug history, esp. carbamazepine,
serotonin. renal impairment, serotonin Pregnancy analgesics, CNS depressants, MAOIs.
Reduces intensity of pain stimuli syndrome Category C. Children: Safety and Review past medical history, esp. epilepsy,
Brand: Route: incoming (agitation, hallucinations, efficacy not established. Elderly: seizures. Assess renal/hepatic function lab
IV from sensory nerve endings. tachycardia, Age-related values.
ConZip INTERVENTION/EVALUATION
Therapeutic hyperreflexia). renal impairment may require
Effect: Reduces pain. dosage Monitor pulse, B/P, renal/hepatic function.
adjustment. Assist with ambulation if dizziness, vertigo
occurs. Dry crackers, cola may relieve
nausea. Palpate bladder for urinary retention.
Classification Contraindications Side Effects Monitor daily pattern of bowel
Functional: Frequency: Acute alcohol intoxication, Dizziness, vertigo, activity, stool consistency. Sips of tepid
concurrent use of centrally nausea, constipation, headache, water may relieve dry mouth. Assess for
Analgesic Once acting drowsiness. clinical improvement, record onset of relief
analgesics, hypnotics, Vomiting, of pain.
opioids, psychotropic pruritus, CNS stimulation (e.g., PATIENT/FAMILY TEACHING
drugs, hypersensitivity to nervousness, • May cause dependence. • Avoid alcohol,
Chemical: opioids. anxiety, agitation, tremor, OTC medications (analgesics, sedatives).
Centrally Timing: euphoria, • May cause drowsiness, dizziness, blurred
mood swings, hallucinations), vision. • Avoid tasks requiring alertness,
acting synthetic opioid Post-op diaphoresis, motor skills until response to drug is
analgesic.
dyspepsia (heartburn, indigestion, established.
epigastric • Inform physician if severe constipation,
pain), dry mouth, diarrhea. difficulty breathing, excessive sedation,
vasodilation, anorexia, seizures, muscle weakness, tremors,
flatulence, rash, blurred vision, chest pain, palpitations occur.

Student’s Name: __________________________________________