Chapter 23: Disseminated Intravascular Coagulation (DIC) Flashcards
A 10-year-old child with a history of gram-negative bacterial sepsis is admitted with gingival bleeding, petechiae, and hematuria. Laboratory results reveal prolonged PT, aPTT, and low fibrinogen levels. What is the priority nursing intervention?
A. Prepare the patient for a platelet transfusion.
B. Administer intravenous antibiotics.
C. Administer oral vitamin K.
D. Monitor blood glucose levels.
A. Prepare the patient for a platelet transfusion.
Rationale: In DIC, replacement of platelets and clotting factors is a priority to address bleeding. Antibiotics are important but secondary in this case. Vitamin K would not be effective, and glucose monitoring is unrelated.
A child undergoing chemotherapy for leukemia develops tachycardia, hypotension, and oozing from injection sites. Labs confirm DIC. What interventions are appropriate? (SATA)
A. Start heparin infusion as ordered.
B. Administer cryoprecipitate.
C. Monitor vital signs frequently.
D. Restrict fluid intake to avoid overload.
E. Provide pressure dressings for bleeding sites.
A. Start heparin infusion as ordered.
B. Administer cryoprecipitate.
C. Monitor vital signs frequently.
E. Provide pressure dressings for bleeding sites.
Rationale: Heparin may be used in DIC to prevent uncontrolled clotting. Cryoprecipitate helps restore clotting factors, frequent vitals assess hemodynamic status, and pressure dressings manage bleeding. Fluid restriction is not typically indicated unless fluid overload is present.
A child with disseminated intravascular coagulation has a platelet count of 40,000/mm³, elevated D-dimer levels, and hematuria. What lab value is most critical to monitor?
A. Hemoglobin and hematocrit levels
B. Serum electrolytes
C. Blood glucose levels
D. Creatinine levels
A. Hemoglobin and hematocrit levels
Rationale: Monitoring hemoglobin and hematocrit is critical to evaluate blood loss and the need for transfusion in a patient with DIC.
A 7-year-old with purpura, mucosal bleeding, and a history of fungal infection is suspected of having DIC. What clinical finding would confirm the diagnosis?
A. Positive fibrin degradation products
B. Increased platelet count
C. Decreased D-dimer levels
D. Shortened aPTT
A. Positive fibrin degradation products
Rationale: Elevated fibrin degradation products, along with increased D-dimer levels, are characteristic findings in DIC due to excessive fibrinolysis and clot breakdown.
A nurse is caring for a 9-year-old with DIC who is receiving a platelet transfusion. The child’s vital signs show tachycardia, hypotension, and rising respiratory rate. What is the nurse’s next priority action?
A. Notify the healthcare provider immediately.
B. Stop the transfusion and assess for allergic reaction.
C. Administer IV fluids to address hypotension.
D. Document findings and continue monitoring.
B. Stop the transfusion and assess for allergic reaction.
Rationale: The symptoms suggest a possible transfusion reaction, requiring the transfusion to be stopped and the patient assessed immediately.
Which is the hallmark laboratory finding in disseminated intravascular coagulation?
A. Increased platelet count
B. Shortened PT and aPTT
C. Normal fibrinogen levels
D. Elevated D-dimer levels
D. Elevated D-dimer levels
Rationale: Elevated D-dimer levels indicate fibrin breakdown and are a hallmark finding in DIC. Platelets decrease, and PT/aPTT are prolonged in DIC.
Which clinical sign would the nurse expect to see in a child with early DIC?
A. Localized swelling
B. Tachycardia with petechiae
C. Increased urinary output
D. Flushed skin
B. Tachycardia with petechiae
Rationale: Early signs of DIC include tachycardia and petechiae due to microvascular clotting and platelet depletion.
What is the rationale for administering heparin in some cases of DIC?
A. To increase platelet aggregation
B. To stimulate fibrinogen production
C. To inhibit uncontrolled clot formation
D. To increase red blood cell count
C. To inhibit uncontrolled clot formation
Rationale: Heparin is administered in some cases to prevent uncontrolled clot formation and further depletion of clotting factors.
Which patient is at the highest risk for developing disseminated intravascular coagulation?
A. A 4-year-old with viral gastroenteritis
B. A 10-year-old with asthma exacerbation
C. A 7-year-old with a fungal bloodstream infection
D. A 12-year-old with type 1 diabetes
C. A 7-year-old with a fungal bloodstream infection
Rationale: Sepsis, especially from fungal or gram-negative infections, is the most common cause of DIC in pediatric patients.
What is the primary goal of medical management in a pediatric patient with DIC?
A. Preventing sepsis
B. Replenishing clotting factors and platelets
C. Administering broad-spectrum antibiotics
D. Lowering fibrin degradation products
B. Replenishing clotting factors and platelets
Rationale: The primary goal in DIC is to replenish clotting factors and platelets to control bleeding and stabilize the patient.
Which of the following are expected lab findings in a child with disseminated intravascular coagulation? (SATA)
A. Decreased platelet count
B. Elevated D-dimer levels
C. Prolonged PT and aPTT
D. Increased fibrinogen levels
E. Decreased hemoglobin
A. Decreased platelet count
B. Elevated D-dimer levels
C. Prolonged PT and aPTT
E. Decreased hemoglobin
Rationale: DIC causes decreased platelet count, elevated D-dimer levels, prolonged PT/aPTT, and decreased hemoglobin. Fibrinogen levels are typically decreased, not increased.
Which symptoms should prompt the nurse to suspect DIC in a child? (SATA)
A. Gingival bleeding
B. Petechiae and purpura
C. Hemoptysis
D. Jaundice
E. Polyuria
A. Gingival bleeding
B. Petechiae and purpura
C. Hemoptysis
Rationale: Symptoms of DIC include gingival bleeding, petechiae, purpura, and hemoptysis due to clotting abnormalities. Jaundice and polyuria are not primary indicators of DIC.
A 6-year-old patient with disseminated intravascular coagulation (DIC) is being monitored in the pediatric intensive care unit. The nurse observes oozing blood at the IV site and notes petechiae on the patient’s back. What is the nurse’s priority action?
A. Apply a pressure dressing to the IV site.
B. Notify the healthcare provider immediately.
C. Monitor the IV site every 15 minutes and continue observation.
D. Increase the IV infusion rate to prevent further pooling of blood.
A. Apply a pressure dressing to the IV site.
Rationale: Applying pressure to control bleeding is the priority. Frequent monitoring of the IV site should continue after intervention, and increasing the infusion rate is not appropriate without provider orders.
A 9-year-old patient with DIC is experiencing significant bleeding from the gums and has blood-tinged stool. The patient’s blood pressure is 85/50 mmHg, and heart rate is 130 beats per minute. What nursing intervention should take priority?
A. Administer prescribed platelet transfusion.
B. Perform a focused cardiovascular assessment.
C. Notify the healthcare provider about the vital signs.
D. Measure and record the amount of blood loss.
A. Administer prescribed platelet transfusion.
Rationale: In DIC, addressing the immediate bleeding by administering prescribed platelets is crucial. While monitoring and reporting are important, the transfusion will directly address the hemodynamic instability.
A pediatric nurse is assessing a 7-year-old with DIC who has petechiae and oozing blood from multiple sites. Which interventions should the nurse prioritize? (SATA)
A. Monitor intake and output hourly.
B. Administer anticoagulants to prevent thrombosis.
C. Observe dependent areas for blood pooling.
D. Provide emotional support to the family.
E. Check the patient’s IV site every hour.
A. Monitor intake and output hourly.
C. Observe dependent areas for blood pooling.
D. Provide emotional support to the family.
Rationale: Accurate monitoring of intake/output, observing for pooling in dependent areas, and supporting the family are essential in DIC management. Anticoagulants are used selectively, and IV sites in DIC should be assessed every 15 minutes.
