The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient?
1. Plan to discuss with the physician the need to decrease the patient's insulin based on serum glucose levels.
2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.
3. Plan to assess the patient for petechiae, epistaxis, and hematuria.
4. Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.
2
Rationale 1: Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.
Rationale 2: Phenytoin (Dilantin) can increase serum glucose levels, and the patient may need additional insulin.
Rationale 3: All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus.
Rationale 4: All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with type 1 diabetes mellitus.
Global Rationale: Phenytoin (Dilantin) can increase serum glucose levels, and the patient may need additional insulin. All patients receiving phenytoin (Dilantin) are at risk for dizziness and ataxia; this is not specific to the patient with type 1 diabetes mellitus. All patients receiving phenytoin (Dilantin) are at risk for petechiae, epistaxis, and hematuria; this is not specific to the patient with type 1 diabetes mellitus. Phenytoin (Dilantin) can increase serum glucose levels, not decrease them.
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