DIC
description
Transcript of DIC
1
DIC
2
Coagulopathy
a.k.a. a clotting disorder or bleeding disorder Impaired coagulation hemorrhage e.g.
Hemophilia Thrombocytopenia Heparin overdose DIC
3
DIC - definition
Disseminated intravascular coagulopathy is a bleeding disorder characterized by:
1. inappropriate clotting trigger = the underlying disease
2. widespread clotting = thrombosis3. exhaustion of normal clotting mechanisms4. uncontrolled bleeding = hemorrhage
4
DIC - etiology
Inappropriate triggers Cancer* Envenomation Infection Liver disease* Pregnancy Rejection Shock SLE * Trauma
DIC is a syndrome, not the disease Must identify underlying disease
5
DIC - pathophysiology
How it should work Coagulation
Local damage to endothelium Platelets bind to exposed
collagen Release of Tissue Factor Clotting factor cascade fibrin
Fibrinolysis Plasmin cleaves fibrin Fibrin degradation products
(FDPs) released e.g., d-dimer
6
DIC - pathophysiology
What happens instead Coagulation
Inappropriate trigger Tissue Factor released in excess Widespread clotting Widespread ischemia, necrosis
Fibrinolysis More clots means more clot
busting Excess of FDPs released
anticoagulant
7
DIC - pathophysiology
Clotting mechanism exhausted Platelets consumed faster than replaced Clotting factors consumed faster than replaced Inability to form new clots when needed
r/f hemorrhage
Clinical Manifestations
S/S of DIC depend on cause, and whether condition is acute or chronic
Acute DIC: clotting usually occurs first, followed by bleeding. But bleeding is often the first obvious sign. With acute blood loss, emergency care is needed.
Blood clotting occurs with chronic DIC, and doesn’t always lead to bleeding. The condition lasts longer and may have no signs, so it wont be recognized as quickly as acute DIC
8
9
DIC - Clinical manifestations - Clotting
Systemic clotting throughout the body’s small blood vessels.
Respiratory: tachypnea, dyspnea, SOB, S/S of PE and ARDS
Cardio: chest pain, EKG changes, S/S MI GI: abdominal pain, paralytic ileus GU: kidney damage, oliguria, ARF DVT: pain, redness, warmth, edema CVA: headaches, speech changes, paralysis Skin: cyanosis, ischemic tissue necrosis
DIC - Clinical manifestations - Bleeding
Internal bleeding can occur in any organ and the bleeding can be life threatening
Respiratory: tachypnea, hemoptysis, orthopnea Neuro: vision changes, dizziness, headache,
change in mental status Cardio: hypotension, tachycardia GU: hematuria GI: frank/occult stool, upper and lower GI bleed Skin: purpura, petechiae, pallor, oozing,
hematomas, bruising, prolonged bleeding from minor cuts
Epistaxis, bleeding gums, heavy menstrual bleed
10
Diagnostic Testing
CBC with blood smear APTT PT/INR Serum fibrinogen: Fibrinogen is a protein that helps
the blood clot. Fibrin degradation products (fibrin split products):
Product left behind when clots dissolve D-dimer: a polymer from the breakdown of fibrin Factor assays: for factors V,VII,VIII,X,XIII
11
12
Nursing Assessments
Petechiae, purpura, hematomas
IV sites, wound sites, drains GI and GU bleeding Hemoptysis Mentation Vital Signs (hypotension,
tachycardia) Pain
Nursing Interventions
Monitor PT/INR Bleeding precautions Injury prevention Turn and Position q2hours to prevent pressure Administer Heparin to inhibit coagulation Decrease anxiety
Nursing Diagnoses
Ineffective peripheral tissue perfusion Acute Pain Decreased Cardiac Output Anxiety Risk for Injury
Collaborative Care
Bleeding Chronic DIC with no active bleeding-Treat
underlying cause DIC with bleeding-Supportive treatment for
symptom management and blood transfusion therapy and treatment of underlying cause/disease
Thrombosis Heparin or Lovenox
What does the Evidence show? Transfusion therapy should be reserved for
patients with life threatening hemorrhage only Patients with DIC have activated coagulation
and blood transfusions pose major risks. Early identification can reduce complications Treatment of underlying disease must occur Manage inflammatory-immune response Stabilize patient and achieve hemostasis Inflammation activates coagulation so all
patients with injury, sepsis, trauma or systemic inflammation have altered coagulation and require careful and close monitoring
(Dressler, 2012)
17
DIC Summary slide
1. DIC includes 2 life-threatening conditions:
widespread clotting uncontrollable hemorrhage***
2. Clinical s/s include both clotting and bleeding. Be aware of the changes that occur in both situations
T/F: DIC is a life-threatening disease.
A. TrueB. False
18Tru
eFa
lse
0%0%
T/F: The primary threat with DIC is widespread clotting throughout the body.
A. TrueB. False
19Tru
eFa
lse
0%0%
An RN is assessing a pt being tested for DIC. Which symptom would not be noted?
A. HTNB. OliguriaC. SOBD. Paralytic ileus
20
HTN
Oliguria SOB
Paralyti
c ileus
0% 0%0%0%
:15
21
Q&A
Anything needing further explanation?
Feelings to be shared?
22
References
Frazier, T. (2012) Disseminated intravascular coagulation and implications for
medical-surgical nurses. Med-Surg Matters, 21(3/4), 8-11.
Hinds, M. H., Hyland, J. R., Lovric, A., Nibert, Ainslie, & Upchurch, S. (2011).
HESI comprehensive review for the NCLEX-RN examination (3rd ed.). St.
Louis, MOElsevier.
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M.
(2011). Medical-surgical nursing: Assessment and management of clinical
problems. Saint Louis, MO: Elsevier Mosby.
NIH/MedlinePlus. (2014, February 5). Disseminated Intravascular Coagulation
(DIC). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000573.htm