ALG Module 2-DIC - ALG PDF

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Health Problems of Adult and Elderly Populations (Adult II) – NURS 435 Active Learning Guide: DIC

DIC Active Learning Guide Directions: Use this active learning guide to help you whittle down DIC into its most essential components and apply it to patient care. The major events associated with DIC are identified in the table; associate them with patient assessment, lab results, and nursing interventions. Fill out the table provided using the textbook and your ATI resources.

Major event Inflammatory insult- One of the most common causes of DIC is a systemic infection, especially when the patient has the infection in addition to other risk factors for DIC. Bacteria, parasites, fungi, and viruses release endotoxins that activate tumor necrosis factor and initiate the extrinsic pathway. Common causes include gram-negative and gram-positive infections caused by Streptococcus A, E. coli, and Proteus vulgaris.

Physical assessment Medical history, diagnose quickly, assess for vital signs ( fever 380) electrolytes, stabilize with 02 & volume replacement, Nature of underlying primary cause, fever or hypothermia, tachycardia, tachypnea. Assess for contributing factors: Assess for the signs and symptoms of DIC. Assess for chest pain and shortness of breath. Assess amount and color of urine.

Activation of clotting cascade DIC refers to a complex disorder of the blood characterized by abnormal clotting, leading to consumption of clotting factors that ultimately results in abnormal bleeding. It’s impossible to understand DIC without a basic understanding of the complex structures of the coagulation cascade.

Timely notification to the requesting health-care provider of any critical findings and related symptoms is a role expectation of the professional nurse. Signs and symptoms of microvascular thrombosis include: cyanosis, ischemic tissue necrosis, petechiae, hemorrhagic necrosis, tachypnea, dyspnea, venous distention, pulmonary emboli, abdominal pain, and oliguria.

Formation of microemboli

Assess for the underlying cause of DIC. Assess peripheral pulses and mark with skin marker if diminished. Doppler ultrasound as needed to

Lab values Nursing interventions Monitor for signs &symptoms of infection, Screening assays early septic shock, administration of IV (global coagulation Health Problems of Adult and Elderly Populations (Adult II) – NURS 435 antibiotics, monitor cultures of sputum , tests) using scoring Active Learning Guide: DIC throat, lesions, urine; CT scans, parameters: bronchoscopy to prevent pneumonic prothrombin time, infiltrates. fibrinogen level, Pt’s education on disease complications and platelet count, and prevention. levels of fibrinHAND WASHING! related markers, provide important information about the degree of coagulation factor activation and consumption. Blood cultures, change in blood leukocyte , WBC count, bone marrow biopsy, CXRay Laboratory findings Possible interventions include identification include decreased and treatment of the underlying cause, platelets and support through administration of required decreased fibrinogen. blood products (cryoprecipitate or fresh ( Fibrinogen: Less frozen plasma), and administration of than 80 mg/dL (SI: heparin. Cryoprecipitate may be a more Less than 2.4 effective product than fresh frozen plasma in micromol/L) cases where the fibrinogen level is less than prolonged 100 mg/dL (SI: 2.94 micromol/L), the prothrombin (or PT) minimum level required for adequate time, prolonged hemostasis, because it delivers a partial thromboplastin concentrated amount of fibrinogen without time (or PTT), as much plasma volume. elevated levels of Ddimer, which is a fibrin degradation product that is produced when fibrin clots are broken down. Screening assays Monitor BP and assess for signs of (global coagulation hypovolemia. Assess the client’s heart rate tests) using scoring and blood pressure. Observe for signs of parameters: orthostatic hypotension. Elevate extremities....