Clotting: Disseminated Intravascular Coagulation

Question 1

What is Disseminated Intravascular Coagulation?

Answer 1

A disruption of hemostasis characterized by widespread intravascular clotting and bleedin

Question 2

What is the pathophysiology of DIC?

Answer 2

Proteins that control clotting become overactive and causes small clots to form in blood vessels. These clots restrict blood flow to the brain, liver, or other organs

Question 3

How can DIC be triggered?

Answer 3

It can be triggered by damage of endothelial tissues, the release of tissue factors into circulation, or inappropriate activation of the clotting cascade by endotoxin or products of microorganisms.

Question 4

What conditions can make DIC occur in regard to tissue damage?

Answer 4

1. Trauma: burns, gunshot wounds, frostbite, head injury
2. Obstetric complications: Septic abortions, abruptio placenta, amniotic fluid embolus, retained dead fetus
3. Neoplasms: acute leukemia, adenocarcinomas
4. Hemolysis
5. Fat embolisms

Question 5

What conditions can make DIC occur in regard to vessel damage?

Answer 5

1. aortic aneurysm
2. Acute glomerulonephritis
3. Hemolytic uremic syndrome

Question 6

What conditions can make DIC occur in regard to infections?

Answer 6

1. Bacterial infection or sepsis
2. Viral or mycotic infections
3. Malaria

Question 7

What are the risk factors for DIC?

Answer 7

1. hemolytic reactions to blood transfusions, blood infections by bacteria or fungi, and improperly formed blood vessels
2. Leukemia, pancreatitis, and liver diseases
3. recent surgery or anesthesia and severe tissue damage such as burns or head injuries also increase the risk of developing DIC
4. pregnancy complications

Question 8

What is the difference between acute and chronic DIC?

Answer 8

Acute DIC develops rapicly over hours or days and requires immediate treatment.

Chronic DIC develops slowly, over weeks or months. It causes excessive blood clotting but usually does not lead to bleeding. Pts with cancerous tumors and aortic aneurysms are commonly affected by chronic DIC.

Question 9

What are the clinical manifestations of the cardiovascular system with DIC?

Answer 9

1. Decreased perfusion
2. Shock
3. Inappropriate clotting
4. Tissue necrosis and gangrene
5. Oozing from wounds, IV sites, and mucous membranes

Question 10

What are the clinical therapies for cardiovascular manifestations for DIC?

Answer 10

1. administer fluids as ordered
2. monitor intake and output
3. monitor vital signs
4. maintain bed rest

Question 11

What are the respiratory clinical manifestations of DIC?

Answer 11

impaired gas exchange resulting from micro clots in the pulmonary vasculature

Question 12

What are the clinical therapies for respiratory clinical manifestations of DIC?

Answer 12

1. monitor respiratory status

2. Maintain ventilatory support if required

Question 13

What are the CNS clinical manifestations of DIC?

Answer 13

Impaired cerebral perfusion

Question 14

What are the clinical therapies for CNS manifestations for DIC?

Answer 14

Conduct neurologic assessment every 2 hours during the critical period, then every 4 hours until stabilized.

Question 15

What are the urinary clinical manifestations of DIC?

Answer 15

1 impaired renal perfusion

2. Impaired clotting mechanism leading to bleeding

Question 16

What are the clinical therapies for urinary manifestations of DIC?

Answer 16

1. Monitor urine output hourly
2. Maintain patent urinary catheter
3. Monitor urine for blood

Question 17

what are the GI clinical manifestations of DIC?

Answer 17

1. impaired clotting mechanisms leading to bleeding (GI bleeding, abdominal distention, Bleeding from mucous membranes, occult blood in stool or emesis)

Question 18

What are the Clinical therapies for GI manifestations of DIC?

Answer 18

1. monitor for occult blood in stools and emesis
2. Monitor for overt signs of bleeding from gums
3. Measure abdominal girth every 4 hours

Question 19

What are the Integumentary clinical manifestations for DIC?

Answer 19

1. petechiae
2. purpura
3. ecchymosis
4. Bleeding or oozing from wounds or IV access site
5. Pallor
6. Cool extremities
7. Cyanosis of extremities

Question 20

What are the clinical therapies for the integumentary manifestations for DIC?

Answer 20

1. monitor skin for evidence of bleeding
2. protect from injury
3. Monitor distal pulses, temperature, and capillary refill

Question 21

What are the diagnostic tests that are used to diagnose DIC and evaluate the risk of hemorrhage?

Answer 21

1. complete blood count and platelet count
2. Coagulation studies
3. Fibrin degradation products or fibrin split products
4. Fibrinogen
5. D-dimer

Question 22

What can be done to restore clotting factors and platelets for DIC?

Answer 22

Fresh frozen plasma, cryoprecipitate, and platelet concentrates are given

Question 23

What drug may be controversial if given to someone who has DIC?

Answer 23

Heparin because it can exacerbate bleeding and prevent further clotting

Question 24

When can heparin be used with someone who has DIC?

Answer 24

When bleeding is not controlled by plasma and platelets and when the pt has manifestations of thrombotic problems such as acrocyanosis and possible gangrene.

Question 25

Why are newborns at an increased risk of bleeding disorders?

Answer 25

1. They have natural deficiencies in the quality and quantity of coagulation factors compared to older children or adults. 2. Birth trauma 3. asphyxia 4. necrotizing enterocolitis 5. sepsis predisposed infants to DIC

Question 26

What are the manifestations of DIC in infants and children?

Answer 26

1. integumentary issues 2. hypotension 3. infarction or ischemia

Question 27

What are some manifestations of DIC in neonates?

Answer 27

1. blood oozing from the umbilicus or circumcision | 2. more birth-related bruising than is normal

Question 28

What are some manifestations of DIC in older children?

Answer 28

1. headaches 2. lightheadedness 3. nosebleeds 4. bleeding gums 5. blood in the urine or stool

Question 29

What increases the risk of DIC for pregnant women?

Answer 29

1. preeclampsia 2. fetal death 3. amniotic fluid embolism 4. septic abortion 5 placental abruption 6. hemolysis 7. elevated liver enzymes 8. low platelet counts (HELLP- hemolysis, elevated liver enzymes, low platelet count)

Question 30

What are the manifestations of DIC in pregnant women?

Answer 30

1. bleeding 2. ecchymosis 3. mucosal oozing 4. bleeding of the GI tract or incision sites 5. altered mental state 6. hypoxia Severe blood loss: 7. renal failure 8. hypovolemic shock 9. abdominal compartment syndrome

Question 31

What are the treatments used for pregnant women with DIC?

Answer 31

1. replacement of blood and blood products 2. anticoagulants 3. supportive care

Question 32

What should a nurse assess for in a pt with DIC during their observation and pt interview?

Answer 32

1. hx of blood transfusions or trauma 2. pregnancy, recent spontaneous or therapeutic abortions 3. presence of any known malignancies 4. hx of abnormal bleeding episodes or hematologic disorders 5. exposure to infectious diseases 6. look for nosebleeds, bleeding gums, and bruising

Question 33

How should a nurse assess for DIC?

Answer 33

1. VS, heart, and breath sounds 2. Color, temp, and skin condition of extremities 3. look at the contour of the abdomen, listen to bowel sounds 4. palpate abdomen, and look for tenderness or guarding 5. Look for petechiae or purpura on skin or mucous membranes 6. assess puncture wounds, injection sites, IV sites, or incisions 7. note any abnormal bleeding from nose, mouth, or mucous membranes

Question 34

What are the nursing interventions to promote effective tissue perfusion with DIC?

Answer 34

1. assess extremity's pulses, warmth, cap refill 2. monitor LOC 3. reposition every 2 hours 4. discourage pt from crossing the legs, and do not elevate knees on the bed or with a pillow (impairs arterial and venous flow in lower extremities, increases risk form Thrombosis) 5. minimize the use of tape on the skin; use binders, nonadhesive dressings, and other devices as needed. (prevents skin trauma)

Question 35

What are the nursing interventions to monitor the gas exchange with DIC?

Answer 35

1. monitor O2 2. Place pt in Flower or high Flower position (raise HOB) 3. Maintain bedrest (reduces O2 demand) 4. Encourage deep breathing and effective coughing 5. institute cautious nasotracheal suctioning if cough is ineffective or an endotracheal tube is in place 6. administer analgesics and antianxiety drugs as needed to control pain and anxiety

Question 36

What are the nursing interventions to manage pain with DIC?

Answer 36

1. handle extremities gently. (gentle handling reduces the risk of further injury to and pain in ischemic tissues) 2. apply cool compresses to painful joints

Question 37

What teaching should be given to a pt and family with DIC after they are discharged?

Answer 37

1. foot care 2. dressing changes 3. medication instructions 4. SubQ injection teaching 5. how to use a heparin infusion pump 6. HH and Home IV services 7. manifestations of excessive bleeding or recurrent clotting