DIC

Question 1

Sequence of DIC

Answer 1

• Clotting cascade stimulated
• Excess thrombin overwhelms natural anticoagulants
• widespread clotting occurs in capillaries
• thrombi and emboli impair tissue perfusion
• Ischemia, infarction, necrosis of tissue results
• clotting factors are used up faster than they can be replaced
• clotting activates fibrinolytic processes which begin to break down clots
• clotting factors have been depleted, ability to form clots is lost, hemorrgage occurs

Question 2

Causes of DIC

Answer 2

• Sepsis
• Shock
• Gram negative- Gram positive organisms
• Viruses
• Fungi
• parasites

Question 3

Risk factors for DIC

Answer 3

Pregnant pt with HELLP
Cancer
SEPSIS

Question 4

Diagnostic Tx for DIC

Answer 4

1) CBC
a) H &H, Platelets low

2) Coagulation
a) increased PT (Normal value: 10-13 seconds)
b) Increased PTT (Normal: 60-70 seconds)
c) Decreased Fibrinogen

Question 5

Treatment for DIC

Answer 5

• Transfuse w/fresh frozen plasma
• Heparin Therapy
• Supportive care for organ failure

Question 6

Most common cause of Chronic DIC is ___________

Answer 6

cancer

Question 7

Clinical Manifestations of DIC

Answer 7

• Organ dysfunction r/t tissue necrosis caused by ischemia d/t excessive clotting of capillaries
• HYPOVOLEMIA- d/t hemorrhage
• NEURO (Confusion, coma, seizures)
• CV (Tachycardia, hypotension, thrombosis)
• RESPIRATORY (tachypnea, decreased breath sounds)*GU (Hematuria, Oliguria, Renal failure)
• INTEGUMENTARY: (petechiae, ecchymosis, pallor, bleeding, cyanosis, cool extremities)

Question 8

Priority Nursing interventions

Answer 8

1) Assess for adequate perfusion
2) Monitor gas exchange
3) Monitor renal function

Question 9

4 types of blood products

Answer 9

1) whole blood
2) PRBC- Packed Red Blood Cells
- erythrocytes only with some plasma and leukocytes
3) FFP- Fresh Frozen Plasma
- has all coagulation factors
4) Platelets

Question 10

Pre-Procedure Blood transfusion(6) steps

Answer 10

1) Confirm that transfusion is ordered
2) check type and cross match
3) informed consent signed
4) Client teaching
5) baseline VSS
6) 20 gauge or larger IV access

Question 11

Steps taken during blood transfusion (8)

Answer 11

1) obtain unit of PRBC (after IV access and VS)
2) Check unit label with another nurse (ABO & RH type)
3) Check for bubbles or discoloration
4) Infuse with NS only, use blood administration set
5) Start Infusion within 30 minutes of removal from blood bank
6) Start infusion at 5ml/min for first 15 minutes-check for transfusion reaction and vss per protocol
7) change blood tubing after every 2 units or per protocol
8) Monitor for s/s of fluid overload

Question 12

Post procedure BLOOD TRANSFUSION steps (3)

Answer 12

1) obtain VSS to compare with baseline
2) document procedure and client assessment
3) monitor response to transfusion- RBC’s, H & H

Question 13

(5) TYPES OF TRANSFUSION REACTIONS

Answer 13

1) FEBRILE NON-HEMOLYTIC
2) ACUTE HEMOLYTIC
3) ALLERGIC
4) CIRCULATORY OVERLOAD
5) BACTERIAL CONTAMINATION

Question 14

FEBRILE NON-HEMOLYTIC
-S/S…?

• RISK FACTORS
• TREATMENT

Answer 14

• 1 DEGREE CELCIUS INCREASE IN TEMPERATURE into febrile range during or soon after transfusion, CHILLS, MUSCLE STIFFNESS
• PREVIOUS TRANSFUSION
• ANTIPYRETICS, LEUKOREDUCED PRBC’S

Question 15

ACUTE HEMOLYTIC
-S/S?

• TX?
• PREVENTION/

Answer 15

• MOST DANGEROUS-caused by transfusion of incompatible blood: ABO or RH
• S/S: Fever, chills, low back pain, chest tightness, nausea, dyspnea, hypotension, bleeding, renal failure
• TX: maintain blood pressure and renal perfusion
• PREVENTION: accurately identify your patient

Question 16

ALLERGIC REACTION DURING BLOOD TRANSFUSION IS CAUSES BY A SENSITIVITY TO A __________

Answer 16

PLASMA PROTEIN

Question 17

S/S OF ALLERGIC REACTION FROM BLOOD TRANSFUSION

Answer 17

• URTICARIA (hives)
• ITCHING
• FLUSHING
• SEVERE BRONCHOSPASM
• SEVERE LARYNGEAL EDEMEA

Question 18

TX FOR ALLERGIC REACTION TO BLOOD TRANSFUSION

Answer 18

• ANTIHISTAMINES
• EPI-PEN
• CORTICOSTEROIDS

Question 19

CIRCULATORY OVERLOAD FROM BLOOD TRANSFUSION
-RISK FACTORS…

• S/S
• TX…
• PREVENTION

Answer 19

RISK FACTORS:
heart failure & multiple transfusions

S/S: dyspnea, tachycardia, orthopnea, JVD, pulmonary crackles, htn

TX: SLOW RATE OF TRANSFUSION

PREVENTION: administer diuretics between units

Question 20

BACTERIAL CONTAMINATION FROM BLOOD TRANSFUSION

• S/S
• TX

Answer 20

• *can be fatal
• *causes by organism on the skin

S/S: fever, chills, hypotension

TX: stop transfusion-monitor VS- cardiopulmonary status

**obtain blood cultures- send blood container and tubing to blood bank - document procedure