DIC

Question 1

DIC

Answer 1

-sign of underlying condition
-combination of clots (micro/macro-thrombi) and bleeding
-continuum disorder
-high mortality rate

Question 2

what comes first in DIC?

Answer 2

clots, then body tries to break up clots which breaks up clotting factors & prolongs bleeding time

Question 3

causes of DIC

Answer 3

-shock (anaphylactic/neurogenic)
-sepsis
-trauma (crush injury)
-abrupto placentae
-other conditions (hepatic/renal failure)
-allergic reactions (severe/anaphylaxis)
-cancer (b/c blood is in hypercoaguable state with cancer)

Question 4

manifestations of DIC

Answer 4

-compromised organ function or failure
-excessive clotting triggers fibrinolytic system to release fibrin products which act as anticoagulants, thus furthering bleeding

Question 5

which lab values are increased in DIC?

Answer 5

INR, aPTT, PT, etc

Question 6

which lab values are decreased in DIC?

Answer 6

platelet count & fibrinogen

Question 7

signs of thrombosis

Answer 7

-decrease in temperature of skin & decrease in sensation
-increase in pain & cyanosis in extremities
-decrease in pulses
-increase in cap refill time
-hypoxia (from PE)
-dyspnea
-chest pain
-gastric pain
-heart burn
-decrease in urine output (b/c renal failure)
-increase in creatinine & BUN (b/c renal failure)
-decrease in LOC

Question 8

signs of frank bleeding

Answer 8

-petechiae, bleeding from gums, oozing from wounds/IV sites, epistaxis
-tachycardia, low BP
-tachypnea, s/s ARDS
-hematemesis, melena, BRBPR, RP bleed
-hematuria
-changes in LOC

Question 9

medical management of DIC

Answer 9

-treat underlying cause (1st goal)
-correct ischemia
-replace fluids
-address electrolyte imbalance
-administer vasopressors as needed
-blood products

Question 10

Types of blood products

Answer 10

-packed RBCs (PRBCs)
-fresh-frozen plasma (FFP)
-platelets
-cryoprecipitate

Question 11

why would you give cryoprecipitate?

Answer 11

helps increase clotting factor

Question 12

why give FFP?

Answer 12

-give 2 units at a time
-helps body clot
-also given pre procedure for high aPTT

Question 13

blood product transfusion procedure

Answer 13

1. follow facility procedures
2. 2 licenses personnel (RNs, APRNs, MDs) verify product and 2 patient identifiers (name & DOB)
3. assess vital signs before initiation, after 15 minutes, and at completion
4. stay with patient for first 15 minutes pf ten transfusion to monitor any reaction
   (reaction signs = Sob, fever, rash, itching, increase/decrease BP)
5. continually assess hemodynamic function
6. start transfusion slow, increase if the patient is tolerating
7. discontinue any blood product that has been hanging for more than 4 hours
   *** use the same BP buff & thermometer b/c can give false run if not

Question 14

what patients would need a slower transfusion over 4 hours?

Answer 14

heart failure and fluid overload

Question 15

what do you prime tubing for a blood transfusion with?

Answer 15

normal saline

Question 16

do you use heparin in patients with DIC?

Answer 16

depends on patient presentation, if it’s more frank versus clotting

Question 17

DIC nursing implications

Answer 17

-avoid procedures that can increase ICP (noise, straining, movement, suctioning)
-monitor VS closely with Neuro checks (b/c stroke)
-avoid meds that interfere with platelet function (aspirin, clopidogrel, PAD med)
-avoid rectal probes/meds
-avoid IM injections
-monitor external bleeding
-low pressure suctioning
-careful oral care
-avoid dislodging clots
-monitor skin integrity
-monitor fluid balance, pulmonary function
-identify coping and support mechanisms