DIC Presentation
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Disseminated Intravascular Coagulation (DIC)Alyssa Cardinal
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Don’t letthe
namefoolyou.
The term disseminated intravascular coagulation can be misleading because it suggests the blood is clotting.
This is not necessarily the case.
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DIC is a massive activation of the coagulation system leading to systemic clot formation and emboli.
Consumption of clotting factors faster than synthesis leads to systemic BLEEDING!
So, what is it?
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EtiologyDIC is:
not a disease
an abnormal response of the normal clotting cascade stimulated by a disease process or disorder
DIC can:occur as an acute, subacute, or chronic condition
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Clinical Manifestations
Bleeding manifestations:
Pallor, petechiae, purpura, oozing blood,
venipuncture site bleeding, hematomas, and occult
hemorrhage
Respiratory manifestations:
Tachypnea, hemoptysis, and orthopnea
Cardiovascular manifestations:
Tachycardia, hypotension
GI manifestations:
Upper and lower GI bleeding, abdominal distention,
and bloody stools
Urinary manifestations:
Hematuria
Neurological manifestations
Vision changes, dizziness, headache, changes in mental
status, and irritability
Musculoskeletal manifestations
Bone and joint pain
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Diagnostic Studies clotting breakdown of fibrin and fibrinogen fibrin split products (FSPs)
• FSPs interfere with blood coagulation
• D-dimer is a specific marker for the degree of fibrinolysis.
• Fragmented erythrocytes (schistocytes) may be found on blood smears.
• Tests that measure raw materials needed for coagulation (e.g., platelets, fibrinogen) are reduced, and values that measure times to clot (e.g., PT, PTT) are prolonged.
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LABS
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Collaborative CareDiagnose quickly
Stabilize if needed (O2, volume replacement)
Treat the underlying cause
Control the ongoing thrombosis and bleeding
Apply pressure to leaking IV/central line/arterial line sites
Administer PLATELETS to correct thrombocytopenia ifPlatelet count is < 20,000 or <50,000 with bleeding
Administer CRYOPRECIPITATE to replace factor VIII and fibrinogen if the fibrinogen level is < 100 mg/dL
FRESH FROZEN PLASMA replaces all clotting factors except platelets and provides a source of antithrombin
HEPARIN therapy is used to treat thrombosis, ONLY when the benefit (reduce clotting) outweighs the risk (further bleeding)
Chronic DIC does not respond to oral anticoagulants, but it can be controlled with long-term use of HEPARIN
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Nursing Diagnoses Ineffective peripheral tissue perfusion related to
bleeding and sluggish or diminished blood flow secondary to thrombosis
Acute pain related to bleeding into tissues and diagnostic procedures
Decreased cardiac output related to fluid volume deficit
Anxiety related to fear of the unknown, disease process, diagnostic procedures, and therapy
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QUIZ1. Which of the following is true in relation to DIC? (select the
best answer)a. DIC exhibits widespread clotting in capillaries.b. DIC results in systemic bleedingc. The consumption of clotting factors leads to hemorrhaged. A and B onlye. All of the above
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QUIZ1. Which of the following is true in relation to DIC? (select
the best answer)a. DIC exhibits widespread clotting in capillaries.b. DIC results in systemic bleedingc. The consumption of clotting factors leads to hemorrhaged. A and B onlye. All of the above
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QUIZ1. Which of the following are primary causes of DIC? (select all that
apply)a. Shockb. Septicemiac. Mismatched blood transfusionsd. Abruptio placentaee. Cancerf. Fat and pulmonary embolig. Acute anoxiah. Burnsi. Snakebitesj. Systemic lupus erythematosus
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QUIZ1. Which of the following are primary causes of DIC? (select all that
apply)a. Shockb. Septicemiac. Mismatched blood transfusionsd. Abruptio placentaee. Cancerf. Fat and pulmonary embolig. Acute anoxiah. Burnsi. Snakebitesj. Systemic lupus erythematosus
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QUIZ1. Which of the following labs are prolonged in DIC?
a. PTb. PTTc. Fibrinogend. Platelets
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QUIZ1. Which of the following labs are prolonged in DIC?
a. PTb. PTTc. Fibrinogend. Platelets