Disseminated Intravascular Coagulation

Which risk factor should the nurse look for while performing an assessment on a client with a diagnosis of disseminated intravascular coagulation​ (DIC)? ​ (Select all that​ apply.) A. Hematological disorder B. History of abnormal bleeding episodes C. Recent abortion D. History of diabetes mellitus E. Presence of known malignant tumor

A, B, C, E Rationale: Risk factors include recent abortion​ (spontaneous or​ therapeutic), current​ pregnancy, presence of known malignant​ tumor, history of abnormal bleeding​ episodes, and a history of hematologic disorders. Diabetes mellitus is not considered a risk factor for the development of DIC.

The client with which condition is at the greatest risk of developing acute disseminated intravascular​ coagulation? A. Gunshot wound to the distal arm B. Bacterial pneumonia treated with antibiotics C. Aortic aneurysm D. Third-degree burns and septic shock

D. Third-degree burns and septic shock Rationale: Clients with severe sepsis and septic shock are at the greatest risk for developing acute DIC. Aortic aneurysm is a risk for chronic DIC. Gunshot wounds and bacterial infections are a risk for​ DIC, but sepsis is a greater risk.

The nurse is caring for a client with suspected disseminated intravascular coagulation​ (DIC). Which diagnostic test result supports the diagnosis of​ DIC? A. Decreased​ D-dimer B. Normal fibrinogen levels C. Decreased fibrin degradation products D. Increased platelet count

​B. Normal fibrinogen levels Rationale: Fibrinogen levels may be normal or even decreased in circumstances where elevated levels are expected.​ D-dimer will be elevated in both acute and chronic DIC. Decreased platelet count and the presence of schistocytes on the CBC indicate DIC. Fibrin degradation products will be increased as a result of fibrinolysis.

The nurse is caring for a client diagnosed with placental abruption who now has disseminated intravascular coagulation​ (DIC). Which statement correctly explains why this client is at risk for​ DIC? A. Septic shock due to blood loss. B. Amniotic fluid embolism. C. Onset of infection. D. Leaked fluid is similar to a coagulation factor.

​D. Leaked fluid is similar to a coagulation factor. Rationale: Leakage of fluid similar to a coagulation factor from a placental abruption can trigger DIC. Onset of infection and amniotic fluid embolism are not the greatest risk. Hemorrhagic shock is caused by blood​ loss, not septic shock.

A client has disseminated intravascular coagulation​ (DIC). Which clinical manifestation should the nurse expect to​ observe? (Select all that​ apply.) A. Joint pain B. Hypertension C. Petechiae D. Bleeding E. Clotting

A, C, D, E ​Rationale: Manifestations of DIC include​ bleeding, clotting,​ petechiae, and joint pain.​ Hypotension, not​ hypertension, is also a manifestation of DIC.

The nurse assesses a client who has bacterial pneumonia and finds​ tachycardia, hypotension,​ oliguria, and acrocyanosis of a foot. Schistocytes are found in a complete blood​ count, and the​ D-dimer is elevated. Which collaborative action should the nurse​ anticipate? A. Heparin therapy B. Warfarin therapy C. Dialysis D. Foot amputation

A. Heparin therapy ​Rationale: The client has signs and symptoms of disseminated intravascular coagulation​ (DIC). Low-molecular-weight heparin is used to interfere with the clotting cascade and reduce the consumption of clotting factors by uncontrolled thrombosis. Warfarin is not used to treat DIC. Dialysis and amputation are not indicated at this time.

The nurse is caring for a client who has not responded to platelet and whole blood transfusions as treatment for acute disseminated intravascular coagulation​ (DIC). Which action should the nurse anticipate​ next? A. Unfractionated heparin therapy B. End-of-life protocol C. Low-molecular-weight heparin therapy D. Coumadin therapy

C. Low-molecular-weight heparin therapy ​Rationale: Low-molecular-weight heparin has a lower risk of bleeding and organ failure when treating clients with DIC as compared to unfractionated heparin. Coumadin is not appropriate.​ End-of-life protocol is not indicated at this time.

The nurse concludes that both clotting and bleeding occur during disseminated intravascular coagulation​ (DIC) due to which​ process? A. Excess release of thrombin uses up clotting factors quicker than they can be replaced. B. Only clotting occurs during​ DIC, as clotting factors are replaced and available to prevent excess bleeding. C. Activation of intrinsic pathways results in release of excess clotting factors. D. Tissue damage from bleeding uses up clotting factors quicker than they can be replaced.

​A. Excess release of thrombin uses up clotting factors quicker than they can be replaced. Rationale: Widespread activation of either the intrinsic or the extrinsic pathways results in excess release of thrombin. Thrombin and emboli cause tissue and organ damage. Clotting factors are consumed faster than they are​ replaced, leading to excessive bleeding.

The nurse is evaluating the lab results for a client suspected of having disseminated intravascular coagulation​ (DIC). Which laboratory finding supports the​ diagnosis? (Select all that​ apply.) A. Increased fibrin degradation products B. The presence of schistocytes C. Shortened pro-thrombin time D. Decreased platelet count E. Elevated hemoglobin

A, B, D ​Rationale: Laboratory findings that support a diagnosis of DIC include the presence of​ schistocytes, a decreased platelet​ count, and an increase in fibrin degradation products or fibrin split products. The client with DIC would not have an elevated hemoglobin or shortened prothrombin time.

Disseminated intravascular coagulation​ (DIC) is triggered by an injury or agent that activates the clotting cascade. Which condition should the nurse identify as a trigger for the clotting​ cascade? (Select all that​ apply.) A. Placenta previa B. Acute leukemia C. Acute glomerulonephritis D. Head injury E. Bacterial infection

B, C, D, E Rationale: Tissue damage such as head​ injury, abruptio​ placenta, and acute leukemia can trigger DIC. Vessel damage such as acute glomerulonephritis can trigger DIC.​ Infections, bacterial or​ viral, can also trigger DIC. Placenta previa is not directly associated with DIC.

The nurse is assessing a client suspected of having chronic disseminated intravascular coagulation​ (DIC). Which finding supports the​ diagnosis? (Select all that​ apply.) A. The client has a history of cancer. B. Development of DIC has taken months. C. The client has multiple bruises on his skin. D. The client has excessive blood clotting. E. The​ client's IV infusion site continues to ooze blood.

A, B, D Rationale: Chronic DIC may develop over a period of months or weeks and typically lasts longer. Chronic DIC is not diagnosed rapidly as in the case of the acute form. Excessive blood​ clotting, as opposed to​ hemorrhage, is usually seen with chronic DIC. Cancer is the most common cause of chronic DIC. Multiple bruises and an oozing IV site would be noted most often in clients with acute DIC.

The nurse is caring for a client who has signs of acute disseminated intravascular coagulation. Which intervention is​ appropriate? (Select all that​ apply.) A. Elevate the head of the bed. B. Encourage deep breathing and effective coughing exercises. C. Encourage ambulation. D. Continuously monitor oxygen saturation. E. Administer analgesics and anti-anxiety​ medications, as ordered.

A, B, D, E Rationale: Microclots in the pulmonary vasculature can cause impaired gas exchange. Bedrest reduces oxygen demand and cardiac workload. The head of the bed is elevated to promote diaphragmatic movement and alveolar ventilation. Monitoring oxygenation saturation measures gas exchange. Controlling pain and anxiety reduces respiratory rate and improves the quality of ventilation and gas exchange. Deep breathing and effective coughing clear airways and improve alveolar ventilation and oxygenation.

Which therapy will the healthcare provider prescribe for the client with chronic disseminated intravascular coagulation​ (DIC)? A. Fresh frozen plasma B. Aspirin regimen C. Heparin D. Whole blood

C. Heparin Rationale: Heparin may be administered by continuous infusion using a portable pump if needed for​ long-term therapy, as in the client with chronic DIC.

The nurse is assessing a client suspected of having acute disseminated intravascular coagulation​ (DIC). Which assessment finding supports the​ diagnosis? (Select all that​ apply.) A. Pale, cool extremities B. Bleeding at the IV insertion site C. Multiple bruises on various skin surfaces D. A history of thyroid disease E. A history of a malignant tumor

​A, B, C Rationale: Bleeding may result in multiple bruises on various skin surfaces and mucous membranes. Puncture sites such as those from injections or intravenous infusions may ooze blood when a client has DIC.​ Pale, cool extremities may be noted when a client is bleeding because blood is diverted back to major organs to maintain oxygenation. History of a malignant tumor supports the diagnosis of chronic DIC. Thyroid disease is not a known risk factor for acute DIC.

The nurse determined that a client with disseminated intravascular coagulation is experiencing pain. Which intervention should the nurse​ provide? (Select all that​ apply.) A. Using standard pain scale to evaluate and monitor pain and analgesic effectiveness B. Applying cool compresses to painful joints C. Handling extremities gently D. Encouraging frequent turning and coughing E. Continuously monitoring oxygen saturation and oxygen administration as ordered

​A, B, C Rationale: Interventions for managing pain include using a standard pain scale to evaluate and monitor pain and analgesic​ effectiveness, handling extremities​ gently, and applying cool compresses to painful joints. Monitoring oxygen saturation and encouraging frequent turning and coughing will not assist the client with treatment of pain. These interventions are more appropriate for promoting effective tissue perfusion.

The nurse is caring for a client with disseminated intravascular coagulation​ (DIC). Which collaborative therapy should the nurse include in the​ client's care?​ (Select all that​ apply.) A. Monitoring for organ damage B. Monitoring need for mechanical ventilation C. Monitoring intracranial pressure D. Monitoring client allergies E. Monitoring for intracranial bleeding

​A, B, C, E Rationale: Care of the client with DIC may include mechanical ventilation and control of organ damage from reduced tissue perfusion. Clients with DIC may develop intracranial bleeding resulting in altered levels of​ consciousness, damage to the respiratory​ center, and increased intracranial pressure. Monitoring for client allergies is an independent nursing intervention that would be implemented for all clients.

The nurse is preparing an educational program about disseminated intravascular coagulation​ (DIC). Which condition should the nurse include as a risk factor for the development of this​ condition? (Select all that​ apply.) A. Fetal demise B. Primigravida C. Preeclampsia D. Prolonged labor E. Septic abortion

​A, C, E Rationale: Pregnant clients are at risk for the development of acute DIC from the complications of​ preeclampsia, placental​ abruption, fetal​ demise, amniotic fluid​ embolism, and septic abortion. Prolonged labor and primigravida are not considered risk factors for the development of DIC.

A client with a diagnosis of chronic disseminated intravascular coagulation​ (DIC) is being discharged home. Which statement by the client requires the nurse to follow​ up? A. ​"I should call my healthcare provider if I have excessive​ bleeding." B. "The effects of the disorder will resolve​ completely." C. "I will need to be on a portable infusion pump of​ heparin." D. "I understand home healthcare will visit me to monitor the​ infusion."

​B. "The effects of the disorder will resolve​ completely." Rationale: Even though the immediate crisis is​ resolved, the client may continue to have effects from​ DIC, such as impaired tissue integrity. Subcutaneous injections of heparin or a portable infusion pump may be required. The healthcare provider should be called for excessive bleeding or recurrent clotting. A referral should be made to home healthcare for IV maintenance assistance.

The nurse assesses a client who is diagnosed with chronic disseminated intravascular coagulation​ (DIC). Which finding should the nurse suspect as the probable cause of the​ client's diagnosis? A. History of nosebleeds B. Chronic constipation C. History of a cancerous tumor D. Diminished bowel sounds

​C. History of a cancerous tumor Rationale: Chronic DIC develops​ slowly, over weeks or months. It lasts longer and typically is not diagnosed as quickly as acute DIC. Chronic DIC causes excessive blood​ clotting, but usually does not lead to bleeding. Nosebleeds would be unlikely with chronic DIC. Cancer is the most common cause of chronic DIC. Constipation and diminished bowel sounds are not generally associated with chronic DIC.

The nurse suspects that a patient who has severe sepsis now has disseminated intravascular coagulation​ (DIC). Which​ finding, if​ observed, helps confirm this​ suspicion? A. Bradycardia B. Clear breath sounds C. Petechiae D. Polyuria

​C. Petechiae Rationale: Petechiae is a symptom of DIC due to the impaired clotting mechanism leading to bleeding and impaired tissue perfusion. Oliguria or anuria would be​ expected, as would tachycardia. Decreased breath​ sounds, tachypnea, and pleural friction rub are clinical manifestations of DIC.