CASE PRESENTATION ON

DIABETES MELLITUS
By:
Benigno Joy C. Villanueva III
BSN-Level IV

CONTENTS
I.

INTRODUCTION

II.

ANATOMY AND PHYSIOLOGY

III. DEMOGRAPHIC DATA & HEALTH HISTORY

IV. Gordons Functional Health Pattern
V.

PHYSICAL ASSESSMENT

VI. LABORATORIES
VII. PATHOPHYSIOLOGY
VIII. DRUG STUDY
IX. NCP

INTRODUCTION

Diabetes mellitus is a group of metabolic diseases characterized by increased levels

of glucose in the blood resulting from defects in insulin secretion or insulin action.
- The beta cells of the pancreas are impaired.

TYPES OF DIABETES MELLITUS:

1. Type 1 DM characterized by destruction of pancreatic beta
cells, leading to absolute insulin deficiency.
Usually the diagnosis is before the age of 30 years
old.
2. Type 2 DM most common form of DM usually diagnosed
after the age of 40 years old.
3. Gestational DM a diagnosis of DM that applies only to
women in whom glucose intolerance develops or is first
discovered during pregnancy.

COMPLICATIONS
Acute Complications
Chronic Complications

ACUTE COMPLICATIONS
A. Hypoglycemia occurs when blood glucose level falls below
60mg/dl.

B. Diabetic Ketoacidosis (DKA) - is a life threatening

complication of Type 1 DM. This is due to severe insulin
deficiency.

C. Hyperglycemic Hyperosmolar non-ketotic syndrome - is

severe hyperglycemia that occurs without ketosis and acidosis.
- Syndrome occurs in type 2 diabetes.

CHRONIC COMPLICATIONS
A. Diabetic Retinopathy - is chronic and progressive
impairment of the retinal circulation that eventually causes
hemorrhage.

B. Diabetic Nephropathy - is progressive loss of kidney

function.

C. Diabetic Neuropathy - is the general deterioration of the

nervous system throughout the body.

RISK FACTORS
Predisposing Factors
Precipitating Factors

PREDISPOSING FACTORS

Age - Type 2 DM usually occurs at the age 40 years old and

above. Type 2 DM occurs most commonly in people older than
30 years who are obese.

Heredity - Type 2 DM has a strong genetic component.

Although the major gene that places the patient at risk is not
yet identified, it is clear that the disease is polygenic and
multifactorial. Individuals with a parent with type 2 DM have
an increased risk for diabetes. Genetic factors are thought to
play a role in insulin resistance and impaired insulin secretion
in type 2 DM.

Women who are Multigravida with large babies during

pregnancy human placental lactogen is produced.

Autoimmune disorders it is more associated with type 1

DM. This is because it is the children who are more prone to
viral infections.

Viral infection increase risk to autoimmune disorders that

may affect the pancreas.

PRECIPITATING FACTORS

Obesity adipose tissues are resistant to insulin. Therefore

glucose uptake by the cells is poor.

Environmental Factors/Stress An increase in stress

hormone triggers the release of epinephrine and
norepinephrine which will promote the secretion of glucose
leading to hyperglycemia.

Inactive Lifestyle A risk factor that had contributed in the

occurrence of DM due to the fact that lack of muscle activities
decreases the need for the body to utilize glucose as a form
of energy.

Diet Foods rich in carbohydrates can easily promote the

increasing level of glucose along the bloodstream.

ANATOMY AND PHYSIOLOGY

ANATOMY OF THE PANCREAS:

The pancreas is an elongated, tapered organ located

across the back of the abdomen, behind the stomach.
The right side of the organ (called the head) is the
widest part of the organ and lies in the curve of the
duodenum (the first section of the small intestine). The
tapered left side extends slightly upward (called the
body of the pancreas) and ends near the spleen (called
the tail).
The pancreas is made up of two types of tissue:
Exocrine tissue
the exocrine tissue secretes digestive enzymes. These
enzymes are secreted into a network of ducts that join
the main pancreatic duct, which runs the length of the
pancreas.
Endocrine tissue
the endocrine tissue, which consists of the islets of
Langerhans, secretes hormones into the bloodstream.

FUNCTIONS OF THE PANCREAS:

The pancreas has digestive and hormonal functions:
The enzymes secreted by the exocrine tissue in the
pancreas help break down carbohydrates, fats,
proteins, and acids in the duodenum. These enzymes
travel down the pancreatic duct into the bile duct in an
inactive form. When they enter the duodenum, they are
activated. The exocrine tissue also secretes bicarbonate
to neutralize stomach acid in the duodenum.
The hormones secreted by the endocrine tissue in the
pancreas are insulin and glucagon (which regulate the
level of glucose in the blood), and somatostatin (which
prevents the release of the other two hormones .

Insulin is secreted by beta cells, which are one of four

types of cells in the islets of Langerhans in the pancreas.
Insulin is an anabolic, or storage, hormone. When a
person eats a meal, insulin secretion increases and moves
glucose from the blood into muscle, liver, and fat cells. In
those cells, insulin:
Transports and metabolizes glucose for energy
Stimulates storage of glucose in the liver and muscle
(in the form of glycogen)
Signals the liver to stop the release of glucose
Enhances storage of dietary fat in adipose tissue
Accelerates transport of amino acids (derived from
dietary protein) into cells
Insulin also inhibits the breakdown of stored glucose,
protein, and fat.

DEMOGRAPHIC DATA
Ms. EP is a 56 year old female born on
September 27, 1957. She lives in Sagkahan,
Tacloban City. His spouses name is Rufo. They
have 6 children, all but 1 have their own
families now and is living separately from
them. Her religious preference is Roman
Catholic. She pays for her health care through
their income from their mini restaurant
business.

CHIEF COMPLAINT
The patient was hospitalized because of a nonhealing wound at the right foot. She had
complaints of pain which she cannot bear and
is affecting her ADLs.

HISTORY OF PRESENT ILLNESS

Three weeks before admission the patient was
apparently well when she had eaten a certain
type of fish which made her foot itchy and
then she scratched it until it was wounded.
Unfortunately, the wound didnt heal; instead,
it got worse and became gangrenous and
painful which prompted this admission.

PAST HISTORY
The patient had experienced blurring of
vision and then black out. She was brought to
the hospital and was treated early and run some
tests on her. There she was diagnosed of having
diabetes and gave her some medications
namely, metformin and losartan as maintenance
.The patient could not recall having experienced
any childhood illnesses. She has no known
allergies to food and medications.

FAMILY HISTORY
The patient has family history of hypertension
from her mothers side and DM from her father.

GORDONS FUNCTIONAL HEALTH

PATTERN

HEALTH PERCEPTION
Prior to admission, the patient perceives her general health
as good. She does not do anything particular to maintain her
health. She does not engage in exercise, but believes that her
daily activities at home and in work cover her exercise regimen.
She walks early in the morning to go to the market and then
walks again towards her mini restaurant. She also doesnt watch
the food she eats. She eats whatever she wants. Prior to
admission, she drinks soda for an average of 1 L/day. She also
drinks coffee often times and wants it sweet. According to her,
she doesnt smoke or drink alcoholic beverages.
At the moment, she perceives her general health as fair. She
says that talking drains her energy and since admission, she easily gets tired . She
sleeps most of the time. She follows the recommendations and
advices of Doctors and Nurses.

NUTRITION
The patient eats whatever she wants. Her typical
food intake is 2-3 cup/s of rice every meal depending on
the viand or appetite. She has no food intolerance. She
drinks up to 7 -8 glasses of water a day and soda of 1
L/day and often times coffee as well. She has good
appetite and has no difficulty in eating and swallowing.
She had no diet restrictions of any kind. She has no food
supplements. She takes her maintenance for her blood
glucose which is metformin but she often forgets to take it
and losartan for hypertension.
During hospitalization, she says that she has loss some
weight. Upon examination, she looks weak. She has no
more teeth and she says she cannot afford having
dentures. Her temperature during examination was 38.5 C. She is currently on

ELIMINATION PATTERN
Prior to hospitalization, she defecate everyday with no
discomfort. Her feces are yellowish to brown in color,
formed and with normal consistency. She also does not
need to use laxatives or suppositories. She has no
problem in controlling defecation but she frequently void
especially at night. Her urine is clear. She does not
perspire excessively.
Presently, she is constipated. She complains of not
defecating for 3 days.

ACTIVITY-EXERCISE PATTERN
Prior to hospitalization, the patient was well and
independent with activities of daily living. She perceives
herself as strong and with sufficient energy to perform
required activities. She walks early in the morning to go to
the market and then walks again towards her mini
restaurant which serves as her exercise. During her spare
time she watches television and movies.
Currently, she stays on bed, preferring the supine
position. She says that talking drains her energy and since
admission, she easily gets tired. Her blood pressure during
examination was 140/90 mmHg. Her respiratory rate was
28, with regular rhythm. She had no wheezes, crackles or
rales. No cough or sputum was noted.

SLEEP-REST PATTERN
Prior to admission, the patient gets an average of 7-8
hours of sleep at night. She has no problems sleeping. She
wakes up rested and ready for her daily activities. She
doesnt take any sleeping medications. Her usual activity
to relax is watching television.
When she started to have the wound on her foot, she
noticed it was not healing until it got bigger and worse in
which she experiences too much pain that she cannot
sleep well.
During hospitalization, she cannot sleep at night
because of pain. She sometimes asks the nurse for pain
medications so that she could sleep soundly. She says she
could not find a suitable position for sleep. She tries to
take naps during the day to regain her energy.

COGNITIVE-PERCEPTUAL
PATTERN
Prior to admission the patient has no hearing difficulties but
she had experienced blurring of vision. She doesnt wear hearing
aids and uses eyeglasses only when reading. She learns through
observation and demonstration. But most of the time, she tries
to learn things on her own. She has good memory and she
sometimes has difficulty making important decisions but she
does not like seeking advice from others.

Upon examination, the patient is oriented to time, place and

person. She can hear a whisper and can distinguish sounds well.
She has no problem distinguishing colors, sizes and shapes. She
has limited attention span when she is in pain, though she can
have long conversations when she is comfortable .

SELF-PERCEPTION AND SELFCONCEPT PATTERN

The patient describes herself as simple and strong.
Though she can easily get along well with others, she still
prefers to spend her time with her family. Most of the
time, she feels good about herself.
She currently feels sad by her illness. The patient is
able to maintain eye contact. She has limited attention
span when she is in pain. Her voice can be loud and full
when she has the energy to talk. But she is not able to
talk for long periods because she easily gets exhausted.

ROLE-RELATIONSHIP PATTERN
The patient lives in her house with her husband. They
have 6 children, 3 males and 3 females. The eldest works
in manila, the other 4 have their own family and the
youngest lives with them. She has a good relationship
with her spouse and sharing both problems. She also has
good relationship with her 6 children.

SEXUAL-REPRODUCTIVE
PATTERN
The patient is not anymore active in sex. She considers her
age as not sexually active. She had her menopause at the age of
43.

COPING STRESS TOLERANCE

PATTERN
The patient generally feels calm most of the time. There
had been no crisis in the last few years. There had been
no change for her prior to the hospitalization except for
her illness. Her family is very much helpful when problems
arise. When she has problems she usually shares it to her
spouse.

VALUE-BELIEF PATTERN
She generally does not get what she wants from life. She
has no long term plans for the future. Her immediate goal
is to decrease her Capillary Blood glucose level. She is a
Roman Catholic but does not go to religious activities
regularly. She believes that there is a God and she is
thankful and contented to his life .

PHYSICAL ASSESSMENT
VITAL SIGNS:
T-38.5 C
PR-92 bpm
RR-28 cpm
BP-140/90 mmHg
General Survey:
Upon examination, patient appears lethargic, shows signs
of weakness, oriented (time, place, person) well-nourished
and calm, and looks according to age.

Skin
Color: Pale
Texture: smooth

Turgor: fair

Moisture: dry

skin is warm to touch

Head
Configuration: normocephalic
Facial movements: symmetrical

Hair is black with minimal white hair strands

Hair: even distribution

Scalp: No dandruff observed

(-) masses

(-) scars

(-) tenderness

Eyes
Lids: symmetrical
Visual acuity: grossly normal
Peripheral vision: intact
Pink conjunctiva, (-) discharge
anicteric sclera
Ears
External canal is clean
No discharge noted
Gross hearing: symmetrical

Pinna recoils after it is folded

Nose
Septum: midline
Mucosa; pinkish
Patency: both patent
Gross smell: symmetrical
No discharge seen
Mouth
Lips: pallor, dryness
Tongue: midline
Teeth: missing
Gums: pinkish

Neck
Trachea: midline
Thyroid: no palpable mass
Normal range of motion
Chest and Lungs
Breathing pattern: regular
Lung expansion: symmetrical
Breath sounds: clear
HEART

PMI at 5th ICS

Regular rhythm

Abdomen
Configuration: symmetrical

Bowel sounds: hyperactive

(+) Distention
Back and Extremities
Peripheral pulses: diminished
Nail and beds: pallor
ROM: full symmetrical
Muscle tone and strength: equal strength

Non-healing, gangrenous wound on right foot

LABORATORIES
HEMATOLOGY
7/8/13

Test Name

Result

Reference Range

Implication

Hemoglobin
Hematocrit
Erythrocytes
Leukocytes
MCV
MCH
MCHC
Differential Count

100
0.32
4.51
29.38
70.8
22.0
311

120-150
0.35-0.47
4.2-5.4
4.5-10
80-95
27-31
320-360

Anemia
Anemia
Normal
Infection
Decreased
Decreased
Decreased

Neutrophils
Lymphocytes

0.80
0.13

0.50-0.75
0.20-0.35

Increased
Decreased

0.02-0.06
0.3-0.05
0-0.01

Normal
Decreased
Normal

Blood Monocytes
Type: B Rh positive
0.06
Eosinophils
Basophils

0.00
0.01

CLINICAL CHEMISTRY
7/10/13

Sodium
Potassium

Result
141.2
4.8

Normal
135-155mmol/L
3.5-5.5mmol/L

URINALYSIS
7/11/13

Color:
Transparency:

Yellow
Clear

RBC:
EpithelialCells:

0-3/hpf
Few

pH:
Specific Gravity:

6.0
1.015

Bacteria:
AUrates:

Few
Rare

Albumin:
Sugar:

(+)
(++)

MucusThreads:

Few

Pus Cells:

2-5/hpf

Others:Ketones:

(++)

CBG MONITORING

DATE
7/9/13
7/9/13
7/9/13
7/10/13
7/11/13
7/12/13

TIME
8:30am
11:15am
2:15pm
9:15am
11:00am
11:00am

BLOOD SUGAR
325mg/dL
478mg/dL
424mg/dL
319mg/dL
225mg/dL
71mg/dL

DRUG STUDY
DRUG NAME/
DOSAGE
Cefuroxime 750mg
IVTT q 8h
Classifications:
Therapeutic:
anti-infectives
Pharmacologic:
second-generation
cephalosporins

ACTION
TherapeuticEffects:
Bactericidalaction
againstsusceptible
bacteria.

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

Treatmentof
Skinandskinstructure
infections

Contraindicatedin:
Hypersensitivityto
cephalosporins;
Serioushypersensitivity
topenicillins.

CNS:SEIZURES(high
doses).
GI:
PSEUDOMEMBRANO
USCOLITIS,diarrhea,
cramps,nausea,
vomiting.
Derm:rashes,urticaria.
Hemat:
agranulocytosis,
bleeding(increasewith
cefotetanand
cefoxitin),eosinophilia,
hemolyticanemia,
neutropenia,
thrombocytopenia.
Local:painatIMsite,
phlebitisatIVsite.
Misc:allergicreactions
Including
ANAPHYLAXISand
SERUMSICKNESS,
superinfection.

NURSING
RESPONSIBILITIES
Observepatientfor
signsandsymptomsof
anaphylaxis(rash,
pruritus,laryngeal
edema,wheezing).
Discontinuethedrug
immediatelyifthese
symptomsoccur.Keep
epinephrine,an
antihistamine,and
resuscitationequipment
closebyintheeventof
ananaphylactic
reaction.
Monitorbowel
function.Diarrhea,
abdominalcramping,
fever,andbloodystools
shouldbereportedto
healthcare
professionalpromptly
asasignof
pseudomembranous
colitis.May
beginuptoseveral
weeksfollowing
cessation
oftherapy

DRUG NAME/
DOSAGE
Ketorolac 30mg IVTT
q 8h for pain
Classifications:
Therapeutic:
nonsteroidal antiinflammatory
agents, nonopioid
analgesics
Pharmacologic:
pyrroziline
carboxylic acid

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

Inhibitsprostaglandin
synthesis,producing
peripherallymediated
analgesia.Alsohas
antipyreticandantiinflammatory
properties.
TherapeuticEffects:
Decreasedpain.

Indication:
Short-term
managementofpain
(nottoexceed5
daystotalforallroutes
combined).

Contraindicatedin:
Hypersensitivity;
Cross-sensitivitywith
otherNSAIDsmay
exist;Pre-or
perioperativeuse;
Knownalcohol
intolerance(injection
only);Perioperative
painfromcoronary
arterybypassgraft
(CABG)surgery;OB:
Chronicusein3rd
trimestermaycause
constrictionof
ductusarteriosus.May
inhibitlaborand
increasematernal
bleedingatdelivery;
Lactation:Lactation

AdverseEffects:
CNS:drowsiness,
abnormalthinking,
dizziness,euphoria,
headache.
Resp:asthma,
dyspnea.
CV:edema,pallor,
vasodilation.
GI:GIBLEEDING,
abnormaltaste,
diarrhea,drymouth,
dyspepsia,GI
pain,nausea.
GU:oliguria,renal
toxicity,urinary
frequency.
Derm:EXFOLIATIVE
DERMATITIS,
STEVENS-JOHNSON
SYNDROME,TOXIC
EPIDERMAL
NECROLYSIS,
pruritus,purpura,
sweating,urticaria.
Hemat:prolonged
bleedingtime.
Local:injection
Sitepain.
Neuro:paresthesia.
Misc:allergicreactions
including,anaphylaxis.

NURSING
RESPONSIBILITIES
Patientswhohave
asthma,aspirininducedallergy,and
nasalpolypsareat
increasedriskfor
developing
hypersensitivity
reactions.Assessfor
rhinitis,asthma,and
urticaria.
Pain:Assesspain
(notetype,location,
andintensity)priorto
and12hrfollowing
administration.

DRUG NAME/
DOSAGE
Ranitidine 50 mg
IVTT q 8h
Classifications:
Therapeutic:
antiulcer agents
Pharmacologic:
histamine H2
antagonists

ACTION

INDICATION

MechanismofAction:
Inhibitstheactionof
histamineattheH2receptorsitelocated
primarilyingastric
parietalcells,resulting
ininhibitionofgastric
acidsecretion.
TherapeuticEffects:
Healingand
preventionofulcers.
Decreasedsymptoms
ofgastroesophageal
reflux.Decreased
secretionofgastric
acid.

Short-termtreatment
ofactiveduodenal
ulcersandbenign
gastriculcers.

CONTRAINDICATION

ADVERSE EFFECT

NURSING
RESPONSIBILITIES
Contraindicatedin:
CNS:confusion,
Assessforepigastric
Hypersensitivity;
dizziness,drowsiness, orabdominalpainand
Someproducts
hallucinations,
frankoroccultblood
containalcoholand
headache.
inthestool,emesis,or
shouldbeavoidedin
CV:ARRHYTHMIAS.
gastricaspirate.
patientswithknown
GI:constipation,
Geri:Assess
intolerance;Some
diarrhea,druggeriatricand
productscontain
inducedhepatitis
debilitatedpatients
aspartameandshould (nizatidine,
routinelyfor
beavoidedinpatients cimetidine),nausea.
confusion.Report
withphenylketonuria.
GU:decreasesperm promptly.
count,erectile
dysfunction
(cimetidine).
Endo:gynecomastia.
Hemat:
AGRANULOCYTOSIS
,APLASTICANEMIA,
anemia,neutropenia,
thrombocytopenia.
Local:painatIMsite.
Misc:hypersensivity
reactions,Vasculitis

DRUG NAME/
DOSAGE
Metronidazole
500mg IVTT q8h
Classification
Therapeutic:
anti-infectives,
antiprotozoals,
antiulcer agents

ACTION
TherapeuticEffects:
Bactericidal,
trichomonacidal,or
amoebicidalaction.

INDICATION

CONTRAINDICATIO
N
Treatmentofskinand Contraindicatedin:
skinstructure
Hypersensitivity;
infections
Hypersensitivityto
parabens(topical
only);OB:First
trimesterof
pregnancy.

ADVERSE EFFECT

NURSING
RESPONSIBILITIES
CNS:SEIZURES,
Assessforinfection
dizziness,headache, (vitalsigns;
asepticmeningitis
appearanceofwound,
(IV),encephalopathy sputum,urine,and
(IV).
stool;WBC)at
EENT:optical
beginningofand
neuropathy,tearing
throughouttherapy.
(topicalonly).
Obtainspecimens
GI:abdominalpain,
forcultureand
anorexia,nausea,
sensitivitybefore
diarrhea,drymouth,
initiatingtherapy.First
furrytongue,glossitis, dosemaybegiven
unpleasanttaste,
beforereceiving
vomiting.
results.
Derm:STEVENSMonitorneurologic
JOHNSON
statusduringand
SYNDROME,rash,
afterIVinfusions.
urticaria;topicalonly,
Informphysicianif
burning,milddryness, numbness,
skinirritation,
paresthesia,
transientredness.
weakness,ataxia,or
Hemat:leukopenia.
seizuresoccur.
Local:phlebitisatIV
Monitorintakeand
site.
outputanddaily
Neuro:peripheral
weight,especiallyfor
neuropathy.
patientsonsodium
Misc:superinfection
restriction.Each500
mgofFlagylIVfor
dilutioncontains
5mEqofsodium;
each500mgofFlagyl
RTUcontains14mEq
ofsodium.

DRUG NAME/
DOSAGE
Insulin (regular)
Classification:
Therapeutic:
antidiabetics,
Pharmacologic:
Pancreatics

ACTION
Lowerbloodglucose
by:stimulating
glucoseuptakein
skeletalmuscleand
fat,inhibitinghepatic
glucoseproduction.
Otheractions:
inhibitionoflipolysis
andproteolysis,
enhancedprotein
synthesis.
TherapeuticEffects:
Controlof
hyperglycemiain
diabeticpatients.

INDICATION

CONTRAINDICATIO
N
Controlof
Contraindicatedin:
hyperglycemiain
Hypoglycemia;Allergy
patientswithtype1or orhypersensitivityto
type2diabetes;can
aparticulartypeof
beusedtotreat
insulin,preservatives,
diabeticketoacidosis. orotheradditives.
Concentratedinsulin
U-500:Onlyforusein
patientswithinsulin
requirements200
units/day.

ADVERSE EFFECT

NURSING
RESPONSIBILITIES
Endo:
Assessfor
HYPOGLYCEMIA.
symptomsof
Local:erythema,
hypoglycemia
lipodystrophy,pruritis, (anxiety;
swelling.
restlessness;tingling
Misc:allergic
inhands,feet,lips,or
reactions
tongue;chills;cold
Including
sweats;confusion;
ANAPHYLAXIS.
cool,paleskin;
difficultyin
concentration;
drowsiness;
nightmaresortrouble
sleeping;excessive
hunger;headache;
irritability;nausea;
nervousness;
tachycardia;tremor;
weakness;unsteady
gait)and
hyperglycemia
(confusion,
drowsiness;flushed,
dryskin;fruit-like
breathodor;rapid,
deepbreathing,
polyuria;lossof
appetite;nausea;
vomiting;unusual
thirst)periodically
duringtherapy.
Monitorbodyweight
periodically.Changes
inweightmay
necessitatechanges
ininsulindose.

DRUG NAME/
DOSAGE
Paracetamol
300mg IVTT
Classification:
Non-narcotic
analgesic, Antipyr
etic

ACTION

INDICATION

Inhibitsthe
Hyperthermia
synthesisof
prostaglandinsthat
mayserveas
mediatorsofpain
andfever,primarily
intheCNS.Have
nosignificantantiinflammatory
propertiesorGI
toxicity.

TherapeuticEffects:
Analgesia.
Antipyresis.

CONTRAINDICATI
ON
Contraindicatedin:
Previous
hypersensitivity;
Productscontaining
alcohol,aspartame,
saccharin,sugar,or
tartrazine(FDC
yellowdye#5)
shouldbeavoided
inpatientswho
have
hypersensitivityor
intolerancetothese
compounds.

ADVERSE EFFECT
GI:HEPATIC
FAILURE,
HEPATOTOXICITY
(overdose).
GU:renalfailure
(highdoses/chronic
use).
Hemat:
neutropenia,
pancytopenia,
leukopenia.
Derm:rash,
urticaria.

NURSING RESPONSIBILITIES

Donotexceed4gm/24hr.in
adultsand75mg/kg/dayin
children.
Donottakefor>5daysfor
paininchildren,10daysfor
paininadults,ormorethan3
daysforfeverinadults.
Extended-Releasetablets
arenottobechewed.
MonitorCBC,liverandrenal
functions.
Assessforfecaloccultblood
andnephritis.
AvoidusingOTCdrugs
withAcetaminophen.
Takewithfoodormilkto
minimizeGIupset.
ReportN&V.cyanosis,
shortnessofbreathand
abdominalpainasthese
aresignsoftoxicity.
Reportpaleness,weakness
andheartbeatskips
Reportabdominalpain,
jaundice,darkurine,
itchinessorclay-colored
stools.
Phenmacetinmaycause
urinetobecomedarkbrown
orwine-colored.
Reportpainthatpersistsfor
morethan3-5days
Avoidalcohol.