Week 5 DIC Flashcards
The nurse caring for a client with disseminated intravascular coagulation (DIC) expects which assessment findings:
- Increased platelet levels.
- Unresponsiveness to painful stimuli.
- Glossitis and cheilitis.
- Abdominal petechiae.
- Abdominal petechiae.
This answer is correct because abdominal petechiae are expected in a client with DIC due to the breakdown of many microvascular clots.
The nurse is caring for a client recovering from disseminated intravascular coagulation. Which safety measure should the nurse implement?
Caution against shaving with electric razor blades
Teach the importance of avoiding freshly cracked pepper
Demonstrate use of a cane on the side of the weak leg
Suggest using a soft, manual toothbrush
Suggest using a soft, manual toothbrush
This answer is correct because using a soft, manual toothbrush is a safety measure to help reduce bleeding in the gums and mouth. Other hygiene considerations for this client include using electric razors rather than razor blades and soft washcloths.
Which statement best explains how clients with sepsis may develop disseminated intravascular coagulation (DIC)?
Systemic infection leads to inflammation that over-activates the clotting cascade
Deposits of bacteria collect on platelets and inhibit clotting mechanisms
Bacterial toxins in the bloodstream from sepsis produce excessive amounts of vitamin K
Bacteria concentrate in the kidneys and abnormally stimulate erythropoietin production
Systemic infection leads to inflammation that over-activates the clotting cascade
This answer is correct because during sepsis, toxins from infectious agents in the bloodstream trigger widespread inflammation. This widespread inflammation causes abnormal activation of the proteins that control clotting in the body. Eventually, the body exhausts its supply of platelets and clotting factors, which results in an inability to stop bleeding.
Which client(s) may display increased risk of developing disseminated intravascular coagulation (DIC)? Select all that apply.
A client with a retained placenta
A client with Hashimoto’s disease
A client with psoriasis
A client with bacterial sepsis
A client with leukemia
A client with a retained placenta
This answer is correct because a retained placenta is a complication of pregnancy that can cause DIC. Normally, after giving birth, the uterus contracts, which compresses the blood vessels. When the placenta is left behind longer than 30 minutes after giving birth, the retained placenta prevents adequate uterine contraction and allows for continued bleeding, which can trigger DIC.
A client with bacterial sepsis
This answer is correct because bacterial sepsis is a causative factor of DIC. During sepsis, toxins from infectious agents trigger widespread inflammation. This widespread inflammation causes abnormal activation of the proteins that control clotting in the body.
A client with leukemia
This answer is correct because leukemia is a causative factor of DIC. Abnormal cells in leukemia (and certain types of solid tumors) can secrete substances that trigger an abnormal activation of the clotting cascade. Other known causes include sepsis and complications from surgery or pregnancy.
Which test result may help confirm a suspected case of disseminated intravascular coagulation (DIC)?
Sodium level of 132 mEq/L
Fibrinogen level of 35 mg/dL
Hemoglobin level of 13 cells/microliter
Platelet level of 348,000/microliter
Fibrinogen level of 35 mg/dL
This answer is correct because a level of 35 mg/dL is well below the normal range of 200-400 mg/dL. Fibrinogen is a specific protein that is used up when the blood clots. Low fibrinogen levels are consistent with abnormal clotting associated with DIC.
- What is the primary characteristic of disseminated intravascular coagulation (DIC)?
a) Decreased platelet count
b) Accelerated clotting within blood vessels
c) Decreased fibrinogen levels
d) Uncontrolled activation of the fibrinolytic system
- b) Accelerated clotting within blood vessels
- Which enzyme is responsible for converting fibrinogen into fibrin in the final step of the coagulation cascade?
a) Thrombin
b) Plasmin
c) Factor Xa
d) Factor Ia
- a) Thrombin
- What triggers the activation of the coagulation cascade in response to an injury?
a) Platelet aggregation
b) Release of thromboxane A2
c) Vasoconstriction
d) Fibrinolysis
- a) Platelet aggregation
- What is the most common cause of disseminated intravascular coagulation (DIC)?
a) Cancer
b) Sepsis
c) Trauma
d) Incompatible blood transfusion
- b) Sepsis
- Which of the following is NOT a potential cause of DIC?
a) Placental abruption
b) Snake venom
c) Myocardial infarction
d) Amniotic fluid embolism
- c) Myocardial infarction
- What is the role of thrombin in the coagulation cascade?
a) Converts fibrinogen into fibrin
b) Initiates platelet aggregation
c) Converts plasminogen into plasmin
d) Inhibits the activation of factor X
- a) Converts fibrinogen into fibrin
- How does DIC lead to increased consumption of platelets and clotting factors?
a) By promoting fibrinolysis
b) By inhibiting thrombin production
c) By activating the coagulation cascade excessively
d) By causing platelet aggregation
- c) By activating the coagulation cascade excessively
- What is the final step in the coagulation cascade before the initiation of fibrinolysis?
a) Activation of factor XII
b) Conversion of factor Ia into fibrinogen
c) Conversion of factor X into thrombin
d) Conversion of fibrinogen into fibrin
- d) Conversion of fibrinogen into fibrin
- What clinical manifestation is common in DIC due to increased consumption of platelets?
a) Hypotension
b) Cyanosis
c) Gastrointestinal bleeding
d) Deep vein thrombosis
- c) Gastrointestinal bleeding
- How does DIC contribute to organ dysfunction?
a) By causing excessive bleeding
b) By promoting sepsis
c) By obstructing blood flow in small vessels
d) By increasing oxygen delivery to tissues
- c) By obstructing blood flow in small vessels
