Memory and Everything
Worst case scenario for DIC
Can result in MODS and Death
A nurse is teaching a newly licensed nurse about heparin‑induced thrombocytopenia. Which of the following risk factors for this disorder should the nurse include in the teaching?
A. Warfarin therapy for atrial fibrillation
B. Placental abruption
C. Systemic lupus erythematosus
D. Heparin therapy for deep‑vein thrombosis
D. Heparin therapy for deep‑vein thrombosis
The client who is receiving heparin therapy for longer than 1 week is at increased risk for the development of HIT.
Some risk factors for DIC
Septicemia
CP arrest
Trauma (hemorrhage, burns, crush injuries)
Obstetric Complications
Cancer
Allergic Reaction
Fill in the blanks
Management of care includes:
1. Treat _________ cause
2. ______ products PRN
3. Pulmonary ______
4. _______ Perfusion
5. Monitor
6. Push _______
7. PPI: risk for ______
8. _____ and _____
(need to get at least 4 for half points, 6 for full points)
Management of care includes:
1. Treat Underlying cause
2. Blood products PRN
3. Pulmonary Hygine
4. Tissue Perfusion
5. Monitor
6. Push Fluids
7. PPI: risk for ulcers
8. Intake and Output
The charge nurse in the intensive care unit is making client assignments. Which client should the charge nurse assign to the graduate nurse who has just finished the 3 month orientation?
1. The client with an abnormal peritoneal resection who has a colostomy
2. The client diagnosed with pneumonia who has acute respiratory distress syndrome
3. The client with a head injury developing disseminated intravascular coagulation
4. The client admitted with a gunshot wound who has an H&H of 7 and 22
1. This is major surgery but has a predictable course with no complications identified in the stem and a colostomy is expected with this type of surgery. The graduate nurse could be assigned this patient.
Causes of DIC
OB Patient : TF RELEASED
#1 - Sepsis
Endotoxins trigger TF
Tissue ischemia + necrosis
A nurse is assessing a client and suspects the client is experiencing DIC. Which of the following physical findings should the nurse anticipate?
A. Bradycardia
B. Hypertension
C. Epistaxis
D. Xerostomia
C. Epistaxis
Epistaxis is unexpected bleeding of the gums and nose and is a finding indicative of DIC.
Which therapy will the healthcare provider prescribe for the client with chronic disseminated intravascular coagulation (DIC)?
A. Fresh frozen plasma
B. Heparin
C. Whole blood
D. Aspirin regimen
What is B?
The nurse writes a diagnosis of "potential for fluid volume deficit related to bleeding" for a client diagnosed with DIC. Which would be an appropriate goal?
1. The client's clot formations will resolve in two days
2. The saturation of the client's dressings will be documented
3. The client will use lemon-glycerin swabs for oral care
4. The client's urine output will be > 30 mL per hour
4. The problem is addressing the potential for hemorrhage, and a urine output of greater than 30 mL/hr indicates the kidneys are being adequately perfused and the body is not in shock.
What does a D-dimer help diagnose?
It’s used to diagnose blood clots or Disseminated Intravascular Coagulation (DIC).
The nurse is caring for a client diagnosed with placental abruption who now has disseminated intravascular coagulation (DIC). Which statement correctly explains why this client is at risk for DIC?
A. Septic shock due to blood loss.
B. Leaked fluid is similar to a coagulation factor.
C. Onset of infection.
D. Amniotic fluid embolism.
B
What are some bleeding precautions?
- pressure relief mattress
- handle gently - draw sheet
- protect from trauma
- fall precautions
- AVOID IM
- Firm pressure for 10 mins
- 16 to area of trauma
????no manual BP / no automatic????
- electric razor
- soft-tooth brush
- Test urine + stool
The nurse is caring for a client who has not responded to platelet and whole blood transfusions as treatment for acute disseminated intravascular coagulation (DIC). Which action should the nurse anticipate next?
A. Coumadin therapy
B. End-of-life protocol
C. Low-molecular-weight heparin therapy
D. Unfractionated heparin therapy
C. Low molecular weight...
Which lab result would the nurse expect in the client diagnosed with DIC?
1. A decreased prothrombin time (PT)
2. A low fibrinogen level
3. An increased platelet count
4. An increased white blood cell count
2. Fibrinogen level helps predict bleeding in DIC. As it becomes lower, the risk of bleeding increases.
Medication therapy for DIC?
Heparin therapy
The client who is receiving heparin therapy for longer than 1 week is at increased risk for the development of HIT.
A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following laboratory values indicates the client's clotting factors are depleted? (Select all that apply)
A. Platelets 100,000/mm3
B. Fibrinogen levels 57 mg/dL
C. Fibrin degradation products 4.3 mcg/mL
D. D‑dimer 0.03 mcg/mL
E. Sedimentation rate 38 mm/hr
A. Platelets 100,000/mm3
B. Fibrinogen levels 57 mg/dL
In DIC, platelet levels are decreased, causing clotting factors to become depleted. Clotting times are increased, which raises the risk for fatal hemorrhage.
In DIC, fibrinogen levels are decreased, causing clotting factors to become depleted. Clotting times are increased, which raises the risk for fatal hemorrhage.
What are some clinical manifestations?
(at least 4)
Decreased LOC
Poor kidney perfusion
Absent Bowel Sounds
LOW BP
LOW CO
Absolute Hypovolemia
Bloody UO
Hem. Stroke
The nurse determined that a client with disseminated intravascular coagulation is experiencing pain. Which intervention should the nurse provide? (Select all that apply.)
A. Encouraging frequent turning and coughing
B. Handling extremities gently
C. Continuously monitoring oxygen saturation and oxygen administration as ordered
D. Using standard pain scale to evaluate and monitor pain and analgesic effectiveness
E. Applying cool compresses to painful joints
B D E
Disseminated intravascular coagulation (DIC) is triggered by an injury or agent that activates the clotting cascade. Which condition should the nurse identify as a trigger for the clotting cascade? (Select all that apply.)
A. Acute glomerulonephritis
B. Head injury
C. Bacterial infection
D. Acute leukemia
E. Placenta previa
a, b, c, d
EXPLAIN THE PATHOPHYS of DIC
- Damage to endothelium which leads to systemic coagulation
- Tissue factors release
- Surge of clot formation occurs which consumes clotting factors in the cap. clotting system too fast for the factor replenishes
- Clot/clot dissolution imbalance
- Occlusion by thrombi=tissue ischemia=organ failure
- FDP Is released which leads to excessive bleeding
The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply.
A.A primigravida with mild preeclampsia
B.A primigravida who delivered a 10-lb infant 3 hours ago
C.A gravida II who has just been diagnosed with dead fetus syndrome
D.A gravida IV who delivered 8 hours ago and has lost 500 mL of blood
E.A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia
C and E. In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Dead fetus syndrome is considered a risk factor for DIC. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.
The charge nurse is reviewing lab values that can be affected by DIC. Which of the following will the new nurse correctly identify (select all that apply)
a. Thrombocytopenia (50% decrease) out of CF
b. PT and PTT have prolonged clotting time
c. PT and PTT have shortened clotting time
d. Decreased d-dimer
e. Increased d-dimer
f. Decreased fibrogen (less than 100)
A
B
E
F
The nurse is caring for a client with disseminated intravascular coagulation (DIC). Which collaborative therapy should the nurse include in the client's care? (Select all that apply.)
A. Monitoring client allergies
B. Monitoring for organ damage
C. Monitoring need for mechanical ventilation
D. Monitoring intracranial pressure
E. Monitoring for intracranial bleeding
B C D E
The nurse is preparing an educational program about disseminated intravascular coagulation (DIC). Which condition should the nurse include as a risk factor for the development of this condition? (Select all that apply.)
A. Septic abortion
B. Primigravida
C. Fetal demise
D. Preeclampsia
E. Prolonged labor
a, c, d