Nursing Care Plan for Disseminated Intravascular Coagulation (DIC)

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Pathophysiology

A condition in which small blood clots form throughout the body’s small blood vessels. Since these clots use up the platelets and clotting factors in the blood, serious bleeding can occur both internally and externally. Acute DIC develops over a few hours or days and leads to serious bleeding. Chronic DIC develops over weeks or months and generally does not lead to excessive bleeding, but the formation of more clots.

Etiology

There are several diseases and disorders that cause DIC, but it is generally derived from one of two processes:  inflammatory response, such as sepsis or major trauma or exposure of procoagulant material in the blood, such as cancer, brain injury or obstetric event. It is also a common result of venomous snake bites.  Presentation and treatment usually depends on the cause and whether the condition is acute or chronic.

Desired Outcome

Treat the underlying cause; optimal gas exchange,  restore clotting factor and reduced risk of bleeding

Disseminated Intravascular Coagulation (DIC) Nursing Care Plan

Subjective Data:

  • Chest pain
  • Shortness of breath
  • Pain in affected limb
  • Headache
  • Dizziness
  • Double vision

Objective Data:

  • Erythema
  • Warmth of affected area
  • Swelling
  • Blood in urine or stool
  • Petechiae
  • Uncontrolled bleeding

Nursing Interventions and Rationales

  • Assess and monitor respiratory status; note rate, rhythm, cyanosis; auscultate the lungs for areas of absent air movement

 

In both acute and chronic DIC, blood clots often form or travel to the lungs resulting in embolism. This will be evident by shortness of breath, cyanosis and complaints of chest pain

 

  • Assess and monitor cardiac status;  perform 12-lead ECG as indicated

 

Tachycardia, changes in blood pressure and decreased cap refill are signs of deteriorating cardiovascular function.

 

  • Assess for changes in level of consciousness

 

Early signs of hypoxia include confusion and irritability; monitor for signs of stroke as blood clots may travel to the brain.

 

  • Administer oxygen as necessary; monitor Arterial Blood Gas (ABG) and oxygen saturation

 

For optimal tissue perfusion, oxygen saturation should remain 90% or greater.

 

  • Provide wound care and pressure for external bleeding

 

Simple procedures such as venipuncture and IV access can cause external bleeding which is severe. Apply more than usual pressure to assist with clotting.

 

  • Assess amount and color of urine

 

Decreased perfusion to the kidneys may result in hematuria and decreased urination (output <30 mL/hr)

 

  • Monitor for blood in stool; administer stool softeners to avoid straining during bowel movements

 

Dark blood in stool can indicate GI bleed, while bright red blood may indicate bleeding hemorrhoids or anal fissures.

 

  • Monitor for hemoptysis or blood in suctioning

 

This is a common indicator of DIC. When suctioning secretions, observe for blood. Note any blood in emesis.

 

  • Monitor diagnostic tests (labs):
    • Platelet count- decreased
    • PT / PTT- increased
    • D-dimer level- markedly increased

 

Changes in these labs can help determine if treatment is effective.

 

  • Initiate bleeding precautions; no razors, soft toothbrush, limit needle sticks as much as possible, limit BP readings

 

Minimize risks of bleeding from friction, injury or pressure. Observe for petechiae or purpura which can indicate

 

  • Administer medications and blood products as necessary

 

Heparin may be used for chronic DIC when clotting is more of a problem; excessive blood loss may require transfusion; antibiotics are often given when infection or sepsis is the underlying factor.

 


References

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