MedSurg II-DIC

cdunbar4's version from 2017-04-06 16:59

Patho and Lab Findings

Question Answer
Definition of DIC aka "consumptive coagulopathy"syndrome that arises as a complication of some other life-threatening problem. It is a complex and abnormal response of body's normal clotting mechanisms to injury.
Characterized bybleeding AND thrombosis both of which are the result from the depletion of clotting factors
It is rare, but if DIC occurs it can end up leading to Multiple organ failure and death, needs to be treated quickly
Patho flow (my version)massive tissue destruction/sepsis/endothelial injury→activates coagulation cascade→widespread microvascular thrombosis (thrombi further damage vessel walls, the cycle is starting to get a bit circular here)→body releases even more clotting factors until their are no more left & massive hemorrhaging occurs →client hemorrhages & clots at same time in an unrelenting cycle
Patho flow map (her ppt's version)activation of systemic coagulation→consumption of clotting factors & platelet & intravascular fibrin deposits→occlusion of small vessels with microthrombi→fibrinolytic system activation → hemorrhage
What would the platelet counts be doing?Declining <50,000
Fibrin degradation products (FDPs) would be increased or decreased?They would be increased >40mcg/mL (this is not good)
What would the D-Dimer (fibrin fragment products) be in a person with DIC?They would be increased (in a normal, healthy person, it would be rare to see D-Dimer in labs)
Fibrinogen lab value<100mg/dL
Prothrombin (PT) (Extrinsic Pathway) Time in DIC>20 seconds
PTT (Intrinsic Pathway) time in DIC >100 seconds
aPTT time>70 seconds
Thrombin timeprolonged
Blood smear would show shistocytes, what are these? sheared RBCs
Mortality rateabout 50%
Psychosocial assessment r/t mortality rate of DICpt/family teaching of disorder; consider discussion of advanced directive; supportive care for families is imperative

Systems assessment

Question Answer
CNSaltered LOC: h/a, lethargy, irritability, sense of doom
Cardiac tachycardia, hypotension, circulatory collapse: angina, MI
RespiratoryAcute lung injury: SOB, refractory SaO2, Friction Rub (pleural), PE
GIstomach contents contain blood; stools have blood; hypoactive or absent bowel sounds; abdominal pain
GUanuria-oliguria; hematuria; back pain; unexplained uterine bleeding
Integumentarypetechiae; abrupt onset of bleeding from invasive sites (IV sites); oozing mucous membranes
Musculoskeletal↓ peripheral pulses; limb pain; paresthesia; paralysis


Question Answer
Main complicationexcessive bleeding
Other complicationsorgan dysfunction/failure; limb ischemia/death; death
How might excessive bleeding manifest (aside from normal s/s of bleeding)?cardiac tamponade; hemothorax; intracerebral bleed
Treatment aside from preventiontreat precipitating cause/trigger that is causing the abnormal clotting activity
Drugs for treatmentHeparin IV or SQ (controversial); Antithrombin III therapy; tissue factor pathway inhibitor
What is the basis for treatment of DIC with heparin?to inhibit activation of coagulation & ↓ thrombin production
IV heparin dose range in units/kg infusion50-100units/kg over 4 hours; if no improvement by 4-8 hours, discontinue heparin!
Heparin has been shown to be helpful in which kinds of patientsprimary thrombosis problem as an underlying factor for DIC; acute promyelocytic leukemia; early stages of amniotic fluid embolism; immediately following severe incompatible blood transfusion.
When is heparinization not advised?For patients with brain injury-DUH!
Transfusion with fibrinogen free blood productsWash packed RBCs; platelet concentrates; albumin; plasma protein fraction (PPF)

Nursing Interventions

Question Answer
Reduce bleeding by avoiding skin puncture; routine VS; gentle mouth care with non-alochol based swabs; use electric razor
Reposition patientto enhance blood flow & reduce pressure to ischemic areas
If venipuncture cannot be avoidedhold pressure for 3-5 minutes
Avoid use of what when taking VS?automatic BP cuffs; use manual cuffs & inflate only 20mmHg over usual BP; avoid rectal temps
If arterial puncture has to occur, how long should you hold pressure?10-15 minutes
Wound careleave dressings in place if possible so not to disturbed established clots
Pain managementintra-aterial bleeding can cause severe pain
Avoid medication with antiplatelet properties, such as?NSAIDS
Maintain PaO2 of __mmHg and SaO2 at or above _________% (unless contraindicated)80 and 95
Oxygen should be ____________ to prevent irritated airway and further bleeding.Humidified
Why should suction pressure be lowered?to reduce potential for damage while suctioning
Monitoring respiratory for signs and symptoms of hemoptysis; PE; ALI (refractory hypoxia)
Asses pt. cardiac status frequently for s/s of?shock or MI
Anticipate volume & blood component replacement due tothird spacing
Neuro assessmentGlasgow coma scale; screen for h/a signs of irritability, pt. exhibits sense of doom
Neuro precautionsseizure precautions; monitor for signs of cerebral bleed and/or thrombosis

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