Hematology: Disseminated Intravascular Coagulation DIC

DIC: Diagnostic Test Results - a DIC panel (what is increased, elevated or prolonged, what is decreased or delayed)

-bleeding time increased -PT/PTT: prolonged -platelet: decreased Fibrin split products elevated D-dimer: elevated

How is the process of blood given - what is needed? Signs of a reaction?

-type and cross -make sure the patient receives right blood with right antibodies -2 RNs check blood type before administer -blood has to be kept in cooler until it is ready to be used -blood has to be administered within 4 hours (because of bacteria growth, etc) -Vital Signs are taken BEFOREHAND, then in 15 minutes-protocol is that someone stays with patient for first 15 minutes. Biggest signs there is a reaction: TEMP ELEVATION - Patient has chills if reaction-so STOP BLOOD INFUSION. -if stop blood, switch lines out/bag and give NORMAL SALINE

fibrin

A blood protein essential to blood clotting. The conversion of fibrinogen to its active form (fibrin) is among the final steps in clot formation, and is triggered by thrombin.

DIC Clinical Manifestation -bleeding signs Integumentary Respiratory Cardiovascular GI GU Neurologic Musculoskeletal

Bleeding signs are a result of consumption and depletion of platelets and coagulation factors as well as clot lysis and formation of fibrin split products that have anticoagulant properties Integumentary: pallor, petechia, purpura, venipuncture site oozing of blood, hematomas Respiratory: tachypnea, dyspnea, orthopnea Cardiovascular: hypotension, tachycardia GI: upper and lower GI bleeding, abdominal distention GU: hematuria Neurologic: vision changes, dizziness, headache, changes in mental status, irritability Musculoskeletal: bone and joint pain (especially if there is bleeding into the joints)

ileus

Bowel obstruction

DIC: Collaborative Care

Need 1:1 care Diagnose and stabilize Treat underlying cause first oxygen and fluid volume replacement GIVE BLOOD PRODUCTS if bleeding heparin (Only if clotting-this is controversial, doctor's call)

D-Dimer is? Levels ____ during DIC?

Tests for thrombosis-clots in blood (Coagulation). Elevated during DIC

DIC Clinical Manifestations -Thrombotic signs Integumentary Respiratory GI GU

Thrombotic signs are a result of fibrin or platelet deposition in the microvascular Integumentary: cyanosis, necrosis Respiratory: tachypnea, dyspnea, PE, acute respiratory distress syndrome GI: abdominal pain, paralytic ileus GU: oliguria, kidney damage leading to failure

paralytic ileus

Usually temporary paralysis of intestinal wall that may occur after abdominal surgery or peritoneal injury and that causes cessation of peristalsis; leads to abdominal distention and symptoms of obstruction

Why is cyanosis a sign for DIC

because it means that there is clotting somewhere keeping blood from going to the tissue

Platelets are ____ during DIC

decreased

During DIC, bleeding time is ____

increased

DIC: Nursing Management

perceptive assessment (KEY THING) (is patient becoming SOB, pale, etc) active attention and manifestations early detection of bleeding administration of blood products and medications correctly

DIC Etiology

profuse bleeding that results from the depletion of platelets and clotting factors NOT a disease -but an abnormal response of normal clotting cascade stimulated by a disease process disorder

During DIC PT/PTT is

prolonged

oilguria

scanty urine production

What are some neurologic changes that happen with DIC

vision changes, dizziness, HA, changes in mental status, irritability (all this is from bleeding)

orthopnea

Ability to breathe only in an upright position

Disseminated Intravascular Coagulation (definition)

Acquired hemorrhagic syndrome in which clotting and bleeding occur simultaneously

fibrin split products? During DIC____

Coagulation test to measure the breakdown products of fibrin and fibrinogen. Elevated during DIC

ileum

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