Disseminated Intravascular Coagulation Sherpath

A new nurse is caring for a patient with thrombotic symptoms of disseminated intravascular coagulation (DIC), including chest pain and difficulty breathing. The new nurse asks another nurse to explain why the symptoms are occurring. Which explanations by the nurse best describe the pathophysiological events leading to these symptoms? - "Intravascular thrombin is lacking." - "Fibrin has been deposited in the patient's capillaries." - "Abundant intravascular thrombin is being produced." - "Tissue factor is released at the site of tissue injury." - "The blood has lost the ability to clot at injury sites."

- "Fibrin has been deposited in the patient's capillaries." During DIC, there is widespread fibrin and platelet deposition in capillaries and arterioles, resulting in thrombosis. - "Abundant intravascular thrombin is being produced." During DIC, abundant intravascular thrombin is produced. It catalyzes the conversion of fibrinogen to fibrin and enhances platelet aggregation. This process leads to thrombolytic symptoms. - "Tissue factor is released at the site of tissue injury." Tissue factor is released at the site of tissue injury in some malignancies, and it enhances normal coagulation mechanisms. This process leads to the thrombolytic symptoms of DIC.

A family member asks the nurse why a patient with disseminated intravascular coagulation (DIC) is receiving heparin. Which response by the nurse is appropriate? - "Heparin will help replace important factors lost through bleeding." - "The patient will need an alternate anticoagulant if bleeding occurs." - "This patient has an acute hemorrhage associated with DIC, and therefore low-dose heparin will be useful." - "This patient has a thrombotic form of DIC, and therefore heparin is needed to treat this patient's acute condition and prevent further clotting."

- "This patient has a thrombotic form of DIC, and therefore heparin is needed to treat this patient's acute condition and prevent further clotting." Heparin will help to prevent further clotting in this patient if the patient is in a thrombotic state. The patient will need to be monitored carefully, since DIC can alternate between bleeding and clotting states.

The acute care nurse is assessing a patient being treated for sepsis. Which assessment finding would prompt the nurse to alert the provider immediately? - Absent bowel sounds - Patient's report of trouble sleeping. - Nail bed capillary return of 2 seconds - Urinary output of 600 mL over the previous 12 hours

- Absent bowel sounds Absent bowel sounds may indicate paralytic ileus as a result of thrombotic disseminated intravascular coagulation (DIC). This finding should be reported to the provider immediately.

A nurse is monitoring a patient who has been diagnosed with disseminated intravascular coagulation (DIC). Which assessment finding indicates a complication of DIC and merits further assessment by the nurse? - Hypertension - Loose bowels - Increased urine output - Altered cognitive ability

- Altered cognitive ability A change in the patient's neurological status may indicate intracranial bleeding and warrants further assessment by the nurse.

A patient with disseminated intravascular coagulation (DIC) who is being treated with heparin begins to develop oozing from an intravenous (IV) site. Which nursing interventions are most appropriate? - Check blood pressure - Administer blood products. - Hold pressure on the IV site. - Continue to administer heparin. - Monitor for further bleeding episodes.

- Check blood pressure. All patients with DIC will need to have their blood pressure monitored; blood pressure can fall and lead to shock. - Administer blood products. Administration of blood products is a priority for a patient with a bleeding episode. - Hold pressure on the IV site. Holding pressure on the IV site helps to slow bleeding and promotes clotting. This intervention is appropriate. - Monitor for further bleeding episodes. The patient may develop an acute bleed and will need to be monitored closely.

Which nursing interventions are appropriate for a patient with disseminated intravascular coagulation (DIC)? Select all that apply. Reduce fluid intake. - Check the patient's skin frequently. - Assess the patient for further bleeding. - Measure the patient's temperature rectally. - Encourage the patient to ambulate independently to prevent deep vein thrombosis (DVT).

- Check the patient's skin frequently. Minimizing tissue damage is important, since any area susceptible to tissue tearing can increase the risk for bleeding. Skin integrity will need to be monitored carefully, especially in areas that may be susceptible to injury, such as sites of intravenous and catheter lines. - Assess the patient for further bleeding. The patient with DIC should be monitored carefully for signs of bleeding, since bleeding and clotting episodes can alternate. The nurse must respond quickly if changes are noted.

A patient with late-stage cancer has been diagnosed with chronic disseminated intravascular coagulation (DIC) but does not have hemorrhagic symptoms. The nurse should give the patient information about which appropriate treatment? - Administration of fresh frozen plasma (FFP) - Platelet administration - Chemotherapy - Cryoprecipitate administration

- Chemotherapy No treatment for DIC is needed because the patient is not bleeding, but treatment of the underlying disease may be sufficient to reverse DIC. In this case, chemotherapy drugs, such as methotrexate, are used when DIC is caused by the patient's cancer.

A hemorrhaging patient with disseminated intravascular coagulation (DIC) needs to have fibrinogen replaced. The nurse should prepare to administer which medication to the patient? - Aspirin - Heparin - Cryoprecipitate - Antithrombin III

- Cryoprecipitate Cryoprecipitate replaces factor VIII and fibrinogen and would be appropriate to give to this patient.

A patient is diagnosed with disseminated intravascular coagulation (DIC). Which laboratory results would the nurse expect to see for this patient? Select all that apply. - Lowered fibrin-split product (FSP) levels - Elevated FSP levels - Lowered D-dimer levels - Elevated D-dimer levels - Elevated fibrinogen level - Reduced fibrinogen level

- Elevated FSP levels Elevated FSP level would be an expected laboratory result for a patient with DIC. - Elevated D-dimer levels Elevated D-dimer levels would be an expected laboratory result for a patient with DIC. - Reduced fibrinogen level A reduced fibrinogen level would be an expected laboratory result for a patient with DIC.

Match the blood product with the blood component it supplements during treatment.

- Fresh frozen plasma Factor X - Cryoprecipitate Red blood cells - Platelets Factor VIII

The nurse is caring for a patient being treated for disseminated intravascular coagulation (DIC) exhibiting the clinical manifestations of thrombosis. Which treatment would the nurse most likely prepare to administer to this patient? - Heparin - Platelets - Cryoprecipitate - Antithrombin III - Fresh frozen plasma (FFP)

- Heparin Heparin is appropriate for treating this patient's DIC because the need to prevent further thrombus formation outweighs the risk of bleeding. - Antithrombin III Antithrombin III is appropriate for treating this patient's DIC because the need to prevent further thrombus formation outweighs the risk of bleeding.

Which nursing assessments are appropriate to identify bleeding in a patient with disseminated intravascular coagulation (DIC)? Select all that apply. - Inspect the patient's skin. - Auscultate bowel sounds. - Evaluate the patient's stool. - Evaluate the patient's vomitus. - Assess the patient's cognitive status.

- Inspect the patient's skin. The nurse can inspect the patient's skin to assess for bleeding. Bleeding may be indicated by petechiae, or small red or purple spots. - Evaluate the patient's stool. Bleeding may be indicated by hematochezia, or bloody stool. The nurse can evaluate the patient's stool to assess for bleeding. - Evaluate the patient's vomitus. Bleeding may be indicated by hematemesis, or bloody vomitus. The nurse can evaluate the patient's vomitus to assess for bleeding. - Assess the patient's cognitive status. An altered cognitive status may indicate intracranial bleeding, specifically intracranial hemorrhage.

A patient presents with a minor laceration and is concerned about the potential for disseminated intravascular coagulation (DIC). The nurse explains that which conditions are predisposing factors for acute DIC? - Leukemia - Pregnancy - Septic Shock - Cerebral trauma - Acute liver failure

- Leukemia Malignancies, including leukemia, can predispose a person to acute DIC. - Septic shock Major physiological assaults, including sepsis or septic shock, can predispose a person to acute DIC. - Cerebral trauma Major physiological assaults, including severe head injury or cerebral trauma, can predispose a person to acute DIC. - Acute liver failure Acute liver failure can predispose a person to acute DIC.

The nurse is caring for a patient with thrombotic manifestations of disseminated intravascular coagulation (DIC). What are the primary goals for management of this patient? Select all that apply. - Preventing further bleeding - Keeping the skin moisturized - Maintaining neurological function - Preparing the patient for discharge - Evaluating the patient for complications

- Maintaining neurological function Nursing interventions for the patient with DIC include maintaining neurological function. - Evaluating the patient for complications Nursing interventions for a patient with DIC include evaluating the patient for further complications.

A patient with disseminated intravascular coagulation (DIC) is actively hemorrhaging. On assessment, the nurse determines that the patient's condition is unstable. Which blood products should the nurse prepare to administer to this patient? - Heparin - Platelets - Cryoprecipitate - Fresh frozen plasma (FFP) - Antithrombin III concentrate

- Platelets Platelets are administered to correct thrombocytopenia and therefore prevent further bleeding. - Cryoprecipitate Cryoprecipitate is administered to replace factor VIII and fibrinogen lost through bleeding. - Fresh frozen plasma (FFP) FFP will be needed to replace clotting factors. This will be a priority for the prevention of excessive life-threatening hemorrhaging.

Which clinical manifestations of disseminated intravascular coagulation (DIC) are due to the depletion of clotting factors? Select all that apply. - Purple spots - Heart rate of 48 beats/min - Heart rate of 120 beats/min - Gangrene of the nose - Blood pressure 88/54 mm Hg - Blood pressure 110/66 mm Hg

- Purple spots Bruising that appears as reddish or purplish spots, also known as petechiae, is an expected hemorrhagic manifestation of DIC. - Heart rate of 120 beats/min Tachycardia, or a heart rate over 100 bpm, is an expected hemorrhagic manifestation of DIC. - Blood pressure 88/54 mm Hg A blood pressure of 88/54 mm Hg would qualify as hypotension. Hypotension is an expected hemorrhagic manifestation of DIC.

Indicate, by matching, whether the clinical manifestations of disseminated intravascular coagulation are hemorrhagic or thrombolytic or both in nature.

-Thrombolytic Shortness of breath - Hemorrhagic Dark stools - Both thrombolytic and hemorrhagic Peripheral cyanosis

A patient asks the nurse to explain how tissue injury can lead to excessive bleeding associated with disseminated intravascular coagulation (DIC). In which order should the nurse describe the pathophysiological steps that lead to the hemorrhagic phase of DIC.

1. Tissue factor is released at site of injury. 2. Abundant intravascular thrombin is produced. 3. Fibrin and platelets are deposited in the microvasculature. 4. Thrombosis results. 5. Excessive clotting activates the fibrinolytic system. 6. Normal clotting does not occur at injury sites