Disseminated Intravascular Coagulation

Which laboratory results would the nurse expect to find when assessing a patient with myelodysplastic syndrome (MDS)? Select all that apply. An excess of platelets An excess of red blood cells A deficiency of granulocytes A deficiency of clotting factors Inefficiently functioning platelets

A deficiency of granulocytes Inefficiently functioning platelets MDS commonly manifests as infection and bleeding caused by inadequate numbers of ineffective functioning circulating granulocytes or platelets. Red blood cells and platelets are decreased. Clotting factors are not affected by MDS.

Which nursing action is the priority when providing care for neutropenic patient admitted with a febrile episode? Administer an oral antibiotic. Obtain cultures of the throat. Obtain blood cultures from two sites. Administer a broad-spectrum IV antibiotic.

Administer a broad-spectrum IV antibiotic. The first nursing intervention for a febrile neutropenic patient is to administer a broad-spectrum antibiotic by IV route within one hour. Because of the rapid lethal effects of infection, this should be done even before obtaining cultures to determine a specific causative organism. Administration of a broad-spectrum antibiotic by the IV route is preferred to oral antibiotic for initial management because it is the faster administration method.

Which nursing intervention would be appropriate in the care of a patient diagnosed with immune thrombocytopenic purpura (ITP)? Administration of packed red blood cells Administration of clotting factors VIII and IX Administration of oral or IV corticosteroids Maintenance of reverse isolation and application of standard precautions

Administration of oral or IV corticosteroids Maintenance of reverse isolation and application of standard precautions Common treatment modalities for ITP include corticosteroid therapy to suppress the phagocytic response of splenic macrophages. Blood transfusions, administration of clotting factors, and reverse isolation are not interventions that are indicated in the care of patients with ITP. Standard precautions are used with all patients.

Which laboratory levels may be decreased in acute disseminated intravascular coagulation (DIC)? Select all that apply. Fibrin split products (FSPs) Antithrombin III (AT III) levels Fibrinogen and platelet levels Protein C and protein S levels D-dimers (cross-linked fibrin fragments)

Antithrombin III (AT III) levels Fibrinogen and platelet levels Protein C and protein S levels The laboratory report of a patient with acute DIC disorder may show reduced plasminogen levels due to imbalance in the coagulation system. The other results that are indicative of acute DIC include reduced antithrombin III (AT III) levels, reduced fibrinogen and platelet levels, and reduced protein C and protein S levels. Elevated FSPs and elevated D-dimers (cross-linked fibrin fragments) are also indicative of acute DIC disorder.

Which assessment finding may indicate the development of disseminated intravascular coagulation (DIC) in a patient who experienced an anaphylactic reaction? Scattered wheezes Increasing bradypnea Bradycardia and hypertension Blood oozing from venipuncture sites

Blood oozing from venipuncture sites Bleeding in a person with no previous history or obvious cause should be questioned because it may be one of the first manifestations of acute DIC. The patient will not have bradypnea or wheezing. Tachycardia and hypotension are found in patients with DIC (not bradycardia and hypertension).

Before beginning a transfusion of red blood cells (RBCs), which nursing action is the highest priority to avoid an error during the procedure? Check the identifying information on the unit of blood against the patient's ID bracelet. Select a new primary IV tubing primed with lactated Ringer's solution to use for the transfusion. Remain with the patient for 60 minutes after beginning the transfusion to watch for signs of a transfusion reaction. Add the blood transfusion as a secondary line to an existing IV and use the IV controller to maintain correct flow.

Check the identifying information on the unit of blood against the patient's ID bracelet. The patient's identifying information (name, date of birth, medical record number) on the ID bracelet should match exactly the information on the blood bank tag that has been placed on the unit of blood. If any information does not match, then the transfusions should not be hung because of possible error and risk to the patient. The transfusion is hung on blood transfusion tubing, not a secondary line, and cannot be hung with lactated Ringer's because it will cause red blood cell (RBC) hemolysis. Usually, the patient will need continuous monitoring for 15 minutes after the transfusion is started because this is the time most transfusion reactions occur. Then the patient should be monitored every 30 to 60 minutes during the administration.

Which manifestation would the nurse monitor for in a patient with chronic disseminated intravascular coagulation (DIC) disorder? Hyperactive bowel sounds Cyanosis of the extremities Elevation in BP Decreased prothrombin time (PT)

Cyanosis of the extremities Ineffective peripheral tissue perfusion and acute pain are the nursing diagnoses related to a patient with chronic DIC disorder. The priority nursing intervention while caring for the patient is to examine for cyanosis of the extremities. Cyanosis is related to the widespread clotting that occurs along with thrombi or emboli and impairs tissue perfusion. Bleeding causes a drop in BP. Elevation in BP is not associated with DIC. In DIC, bowel sounds would be decreased due to thrombotic occlusion of blood vessels. PT is prolonged in a patient with DIC disorder.

Which information would the nurse include when preparing to discuss the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? The coagulation pathway is overstimulated. DIC is due to the depletion of hemolytic factors. The coagulation pathway is genetically altered. DIC is a secondary disease of clotting and hemorrhage

DIC is a secondary disease of clotting and hemorrhage DIC disorder is a disorder in which underlying disease stimulates the coagulation system leading to diffuse clotting and hemorrhage. It is a disorder in which the underlying disease depletes clotting factors in blood. DIC is a disorder in which tissue factor released at the site of injury leads to overstimulation of the coagulation process in the vasculature. The coagulation pathway is not genetically altered in DIC.

Which laboratory result may be found in patients with disseminated intravascular coagulation (DIC) disorder? Decreased D-dimers Increased hematocrit Increased platelet count Decreased protein C and S

Decreased protein C and S Multiple traumatic injuries are predisposing factors for the development of DIC disorder. The presence of blood in the urine and feces is a bleeding manifestation associated with DIC. The nurse expects decreased protein C and S levels in the laboratory report of this patient due to depletion of clotting factors. The nurse finds elevated D-dimers in the laboratory report of patient with DIC disorder. Increased hematocrit is found in the laboratory report of a patient with polycythemia vera. Reduced platelet count may be found in a patient with DIC disorder.

Which condition associated with disseminated intravascular coagulation (DIC) may require treatment with fresh frozen plasma? Fulminant DIC Deficiency in clotting factors Fibrinogen level of 50 mg/dL Platelet count of 30,000/µL and bleeding

Deficiency in clotting factors DIC disorder may cause bleeding episodes due to deficiency in plasma clotting factors. Fresh frozen plasma is rich in clotting factors and replaces the deficiency. Antithrombin III may be used in patients with fulminant DIC. Cryoprecipitates may be used in patients with a fibrinogen level of 50 mg/dL. Pooled platelets may be used in patients who have a platelet count of 30,000/µL with bleeding.

Which questions would the nurse ask to determine the presence of bleeding in a patient suspected of having disseminated intravascular coagulation (DIC)? Select all that apply. Do you get frequent headaches?" "Has your appetite or weight changed?" "Have you noticed changes in vision or dizziness?" "Have you noticed changes in your urine or stools?" "Are you experiencing breathing that is faster than normal?"

Do you get frequent headaches?" "Have you noticed changes in vision or dizziness?" "Have you noticed changes in your urine or stools?" "Are you experiencing breathing that is faster than normal?" The patient with suspected DIC shows bleeding manifestations due to depletion of platelets and coagulation factors. Neurologic manifestations include headaches, changes in vision, and dizziness. Renal manifestations associated with this disorder include hematuria. Therefore the nurse should ask the patient questions regarding the occurrence of frequent headaches, changes in vision or dizziness, and changes in urine or stools. Tachypnea is a manifestation associated with DIC; the nurse should ask the patient about this symptom. The patient with DIC does not necessarily have changes in weight.

Which interventions would the nurse include in the discharge teaching for a patient with neutropenia? Select all that apply. Encourage the patient to eat raw eggs. Encourage the patient to wash hands frequently. Encourage the patient to frequent crowded areas. Advise the patient to notify the health care provider if a fever develops. Advise the patient to brush the teeth four times a day with a soft toothbrush.

Encourage the patient to wash hands frequently. Advise the patient to notify the health care provider if a fever develops. Advise the patient to brush the teeth four times a day with a soft toothbrush. Neutropenia, or decreased neutrophil count, increases the risk of developing infection. Therefore measures should be taken to prevent infections. The self-care instructions provided by the nurse should include frequent hand washing to prevent transmission of germs. Brushing the teeth four times a day with a soft toothbrush prevents the risk of oral infections. Fever is an emergency situation in cases of neutropenia and should be immediately reported to the health care provider. Eating raw eggs and staying in crowded areas increase the risk of acquiring infections and should be avoided.

Which type of blood product would the nurse anticipate incorporating into the plan of care for a patient with disseminated intravascular coagulation (DIC)? Albumin Platelets Frozen red blood cells (RBCs) Fresh frozen plasma

Fresh frozen plasma The liquid portion of whole blood is separated from cells and frozen to obtain fresh frozen plasma. It is rich in clotting factors. Therefore the nurse administers frozen plasma to the patient. Albumin is prepared from plasma, but it is not rich in clotting factors. Platelets and frozen RBCs will not help to provide clotting factors to the patient.

The nurse caring for a patient with polycythemia vera would expect which assessment finding? Orthopnea Peripheral edema Increased hemoglobin Increased C-reactive protein

Increased hemoglobin In polycythemia vera, hemoglobin and hematocrit are increased because of a hyperproliferation of red blood cells. Orthopnea, peripheral edema, and increased C-reactive protein are not associated with polycythemia vera.

Which action is appropriate for the nurse to take when infusing fresh frozen plasma (FFP)? Administer the FFP over four hours. Infuse the FFP as rapidly as the patient will tolerate. Infuse the FFP as a piggyback to a primary solution of normal saline. Administer the FFP as a piggyback to the primary IV solution.

Infuse the FFP as rapidly as the patient will tolerate. The fresh frozen plasma should be administered as rapidly as possible and should be used within 24 hours of thawing to avoid a decrease in Factors V and VIII. Fresh frozen plasma is infused using any straight-line infusion set. Any existing IV should be interrupted while the fresh frozen plasma is infused unless a second IV line has been started for the transfusion.

Which sign of microvascular thrombosis observed in a patient with disseminated intravascular coagulation (DIC) disorder is associated with the integumentary system? Paralytic ileus Venous distention Ischemic tissue necrosis Electrocardiogram (ECG) changes

Ischemic tissue necrosis Ischemic tissue necrosis, such as gangrene, is a sign of microvascular thrombosis associated with the integumentary system. Paralytic ileus is associated with the gastrointestinal (GI) system. ECG changes and venous distention are associated with the cardiovascular system.

Which information would the nurse include when teaching nursing students about treatment for disseminated intravascular coagulation (DIC)? Therapy is essential for chronic DIC. Oxygenation helps to stabilize the patient with DIC. Treatment for the underlying disease cannot reverse DIC. Blood products are not effective in treating the patient with DIC who has a bleeding disorder.

Oxygenation helps to stabilize the patient with DIC. As a part of collaborative care, it is necessary to diagnose DIC disorder quickly through oxygenation or volume replacement to control the thrombosis and bleeding. If chronic DIC disorder is diagnosed in a patient who is not bleeding, no therapy for DIC disorder is required. Treatment of the underlying disease is sufficient to reverse DIC disorder. If the patient with DIC disorder is bleeding, the therapy requires providing support with necessary blood products that aim to treat the primary disorder.

Which laboratory test can confirm the presence of fragmented erythrocytes in a patient suspected of having acute disseminated intravascular coagulation (DIC)? 1 Factor assays Peripheral blood smear Soluble fibrin monomer Fibrin split products (FSPs)

Peripheral blood smear Fragmented erythrocytes or schistocytes are indicative of partial occlusion of small vessels by fibrin thrombi. Peripheral blood smear test detects the presence of fragmented erythrocytes. Factor assays, soluble fibrin monomer, and FSPs tests do not detect the presence of fragmented erythrocytes; however, they are useful in determining the degree of fibrinolysis.

Which assessment would the nurse perform to determine the presence of external bleeding? Heart rate Petechiae Mental status Abdominal girth

Petechiae The nurse assesses parameters such as petechiae and injection sites to determine the signs of external bleeding. The nurse should assess other parameters such as heart rate, mental status, and abdominal girth to determine the signs of internal bleeding.

Which interventions are appropriate to include in the plan of care of a patient who has developed neutropenia? Select all that apply. Strict hand washing Daily nasal swabs for culture Monitoring temperature every hour Daily skin care and oral hygiene Encouraging eating all foods to increase nutrients Private room with a high-efficiency particulate air (HEPA) filter

Strict hand washing Daily skin care and oral hygiene Private room with a high-efficiency particulate air (HEPA) filter Private room with a high-efficiency particulate air (HEPA) filter Strict hand washing and daily skin and oral hygiene must be done with neutropenia because the patient is predisposed to infection from the normal body flora, other people, uncooked meats, seafood, eggs, unwashed fruits and vegetables, and fresh flowers or plants. Daily nasal swabs are not appropriate. Blood cultures and antibiotic treatment are used when the patient has a temperature of 100.4°F (38°C) or more, but temperature is not monitored every hour. The private room with HEPA filtration reduces the aerosolized pathogens in the patient's room.

The nurse assesses a patient and identifies signs of hemorrhage based on which changes in the mucous membranes? Pallor Purpura Epistaxis Hematoma

The nurse assesses a patient and identifies signs of hemorrhage based on which changes in the mucous membranes? Epistaxis The signs of hemorrhage that are manifested by changes in mucous membranes include epistaxis and gingival oozing. The signs of hemorrhage such as pallor, purpura, and hematoma are associated with the integumentary system.

which disorder is the most common cause of mortality in patients with polycythemia vera? Leukemia Thrombosis Heart failure Pulmonary edema

Thrombosis The major cause of morbidity and mortality from polycythemia vera is related to thrombosis (e.g., stroke). Leukemia may develop in some patients with polycythemia vera; however, the incidence is low. The patient may develop heart failure, but it is not common. Pulmonary edema is not common in patients with polycythemia vera.

Which intervention would the nurse anticipate incorporating into the plan of care for a patient newly diagnosed with disseminated intravascular coagulation (DIC)? Administer heparin Administer whole blood Treat the causative problem Administer fresh frozen plasma

Treat the causative problem Treating the underlying cause of DIC will interrupt the abnormal response of the clotting cascade and reverse the DIC. Blood product administration occurs based on the specific component deficiencies and is reserved for patients with life-threatening hemorrhage. Heparin will be administered if the manifestations of thrombosis are present and the benefit of reducing clotting outweighs the risk of further bleeding.

Which order would the nurse perform the interventions listed on the plan of care for a patient with hemophilia who developed bleeding after a fall?

correct order 1. Rest the knee and pack in ice. 2.Administer specific coagulation factor. 3.Administer prescribed analgesic. 4.Encourage mobilization as soon as bleeding ceases. Acute nursing intervention for a hemophilic patient with a bleeding knee is to stop the topical bleeding by resting the knee and packing it in ice. The patient is administered specific coagulation factor to raise the level of deficient coagulation factor. Analgesics that do not contain aspirin or aspirin compounds are administered to reduce severe pain. The patient should be encouraged to mobilize the joint through range-of-motion exercises and physiotherapy as soon as bleeding ceases; however, weight bearing is avoided until all swelling has resolved and muscle strength has returned.

Which instructions would the nurse include when educating a patient with chemotherapy induced thrombocytopenia? Select all that apply. Reduce water intake. Walk with sturdy shoes. Use a suppository if required. Avoid blowing the nose forcefully. Use an alcohol-based mouthwash. Shave only with an electric shaver.

Walk with sturdy shoes. Avoid blowing the nose forcefully. Shave only with an electric shaver. The nurse should instruct the patient to shave only with an electric shaver and avoid using blades. The patient should avoid blowing the nose forcefully; instead, gently pat it with a tissue. The patient should always walk with sturdy shoes for safety. The patient should drink plenty of fluids to prevent constipation. The patient should avoid using a suppository without the permission of the health care provider; the patient may be prescribed stool softeners. Alcohol-based mouthwashes should be avoided because they can dry the gums and increase bleeding.

Which percentage of blood volume would the nurse suspect a patient may have lost when vital signs are normal at rest but which manifest postural hypotension and tachycardia with ambulation? 10% 20% 30% 40%

Which percentage of blood volume would the nurse suspect a patient may have lost when vital signs are normal at rest but which manifest postural hypotension and tachycardia with ambulation? 30% Manifestations of loss of 30% of blood volume include normal supine BP and pulse at rest but postural hypotension and tachycardia with exercise.

Which order would the nurse place the events associated with disseminated intravascular coagulation (DIC) disorder that lead to multiple organ dysfunction syndrome (MODS)?

correct order 1. Release of tissue factor at the site of injury 2. Abundant production of intravascular thrombin 3. Conversion of fibrinogen to fibrin 4. Deposition of platelets in capillaries and arterioles In DIC disorder, the tissue factor is released at the site of injury. Abundant intravascular thrombin, which is a powerful coagulant, is produced. It catalyzes the conversion of fibrinogen to fibrin and enhances platelet aggregation. Widespread fibrin and platelet deposition occurs in capillaries and arterioles, resulting in thrombosis. These events lead to MODS.