DIC Flashcards
DIC
Sign of an underlying condition
Combination of clots and bleeding
Continuum disorder
High mortality rate
Causes of DIC
Shock
Sepsis
Trauma
Abruptio placentae
Allergic reactions
Cancer (hypercoaguable)
Anaphylaxis
Hepato/renal failure
Pathophysiology of DIC
Triggered inflammatory response
Leads to formation of clots
Takes up all clotting factors
Leads to bleeding
Manifestations of DIC
Compromised organ function or failure, usually result of excessive clot formation
Excessive clotting triggers fibrinolytic system to release fibrin products which act as anticoagulants, thus furthering bleeding
DIC Lab values
Platelets and fibrinogen DECREASED
Everything else increased
Signs of thrombosis
Decreased temperature sensation
Increased pain
Cyanosis in extremities
Decreased pulses, increased capillary refill time
Hypoxie (PE), dyspnea, chest pain
Gastric pain, heart burn
Decreased urine output
Increased BUN and creatinine
Decreased LOC
Signs of frank bleeding
Petechiae, spontaneous bleeding gums, oozing from wounds/IV sites, epistaxis (bloody nose)
Tachycardia
Tachypnea, s/s ARDS
Hematemesis, melena, BRBPR, RP bleed (on back)
Hematuria
Change in LOC
Medical management of DIC
Treat the underlying cause
Correct ischemia
Replace fluids
Address electrolyte imbalance
Administer vasopressors as needed
Blood products
Packed red blood cells (PRBCs)
Hemoglobin <7 and hematocrit
Fresh frozen plasma (FFP)
Helps body clot
Platelets
Signs of active bleeding, if PT is going to procedure
Cryoprecipitate
Factor 5 clotting factor, helps with bleeding
Blood product transfusion
Follow facility procedures
2 licensed personnel verify product and 2 patient identifiers (name and DOB)
Assess vital signs before, after 15 minutes, and at completion use same BP cuff and thermometer
Continually assess hemodynamic function
Start transfusion slow, increase if patient is tolerating
Discontinue any blood product that has been hanging for more than 4 hours
Heparin and DIC
Case by case basis
Nursing implications for DIC
Avoid procedures that can increase intracranial pressure (suctioning, movement, noise, laying flat, coughing, bearing down)
Monitor VS closely with neuro checks
Avoid meds that interfere with platelet function (aspirin, clopidogrel, celestizol)
Avoid rectal probes/meds
Avoid IM injections
Monitor external bleeding
Low pressure suctioning
Careful oral hygiene
Avoid dislodging clots (leave tape/bandages on)
Monitor skin integrity
Monitor fluid balance, pulmonary function
Identify coping and support mechanisms
