Disseminated Intravascular Coagulation DIC NCLEX Review Care Plans
Nursing Study Guide on Disseminated Intravascular Coagulation (DIC)
Disseminated intravascular coagulation (DIC), also known as consumption coagulopathy, is a medical condition that involves the clotting of blood abnormally in the blood vessels of the body.
There are two stages of DIC.
The early stage features the abnormal clotting that results to the formation of blood clots in the blood vessels, which can block and damage internal organs.
The later stage involves the lack of platelets and clotting factors. This can result to bleeding in the nasal or oral mucosa, underneath the skin, and inside the body.
DIC is a rare disorder that can be life-threatening as it can lead to serious complications such as multiple organ failure and internal bleeding or haemorrhage.
DIC is usually caused by another condition, such as an injury or infection, which can lead to overactive blood coagulation.
The prognosis of DIC is poor, as 20% to 50% of DIC cases lead to death, which is why DIC is a medical emergency.
It is managed by treating the underlying condition.
Signs and Symptoms of DIC
- Bruising – can be small dots or large patches
- Bleeding easily – in the nose, gums, or mouth, when brushing teeth, or having an injury
- Black or dark red, tarry stools – can indicate internal bleeding in the gastrointestinal tract
- Presence of blood in the urine
- Chest pain
- Shortness of breath
- Heavy periods more than usual
- Signs of Deep Vein Thrombosis of the leg, such as pain, warmth, swelling, and redness
- Hypotension- low blood pressure
- Neurological issues such as confusion, trouble speaking, speech changes, seizures, or dizziness
Causes and Risk Factors of DIC
DIC can have several causes, such as inflammatory response, severe tissue damage, and reduced platelets and clotting factors.
The body may have inflammation as a response to an illness, infection or injury. This may lead to an overactive blood coagulation resulting to DIC in the blood vessels.
Burns and trauma can cause severe tissue damage which may also trigger abnormal blood coagulation, while pregnancy complications (such as abruptio placentae) and cancer or chemotherapy may result to the overproduction of clotting factors.
The risk factors that may increase the development of DIC include:
- Sepsis or blood infection
- Organ damage such as liver cirrhosis, pancreatitis, burns, injury, or major surgery
- Illegal drug use such as ecstasy and cocaine
- Hemangiomas, aortic aneurysms, GI cancers, blood cancers, and heat stroke
- Pregnancy complications
- Snake venom
- Blood Transfusion or Transplant Rejection
Complications of DIC
- Venous thromboembolism (VTE). DIC may result to the blood clot formation and blood vessel blockage in the lungs which can result to pulmonary embolism. It can also lead to blood clot formation in the limbs, usually in the legs and may therefore result to Deep Vein Thrombosis (DVT).
- Stroke and myocardial infarction or M.I. (heart attack). Blood clots can block the blood vessels in the brain (stroke) or in the heart (M.I.).
- Severe hemorrhage that may lead to death
Diagnosis of DIC
- Physical exam – to check for signs of bleeding or excessive clotting
- History taking – to check for underlying conditions that have caused DIC
- Blood tests – Complete blood count to check for high or low platelet count, and infection (elevated white blood cells); Blood clotting tests will show longer clotting time such as prothrombin time (PT) and partial thromboplastin time (PTT) ; Comprehensive metabolic panel (CMP) to check for any kidney or liver damage ; D-dimer tests to check for blood clots
- Peripheral blood smear – to visualize the characteristics of the platelets (i.e. number, shape, and size) and to check for any fragmented red blood cells using a microscope
- Serum fibrinogen tests – to check the fibrinogen in the blood; fibrinogen is a protein that promotes blood clotting; low fibrinogen count suggests DIC
- Additional tests – liver biopsy may be prescribed if there is suspected liver damage; ADAMTS13 testing to measure blood levels and diagnose a platelet disorder called thrombotic thrombocytopenic purpura (TTP)
Treatment of DIC
- Clotting Factor Replacement. To manage the bleeding, the physician may prescribe the replacement of clotting factors such as fibrinogen.
- Oxygen Therapy. Blood clots may prevent the oxygen to be delivered to the organs, especially the lungs and the heart. Therefore, oxygen therapy is required to support oxygenation in the body.
- Transfusion. Platelet transfusion can help immediately increase the platelet levels and treat bleeding. Fresh Frozen Plasma (FFP) transfusion can help increase the clotting factors such as fibrinogen in order to treat bleeding.
- Anticoagulants. To treat thrombosis or the presence of blood clots, anti-coagulants may be prescribed.
Nursing Care Plans for DIC
Nursing Care Plan 1
Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen-carrying capacity of the blood as evidenced by shortness of breath, oxygen saturation of 82%, restlessness, and reduced activity tolerance
Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by an oxygen saturation within the target range (at least 96% for non-COPD patients, and 88 to 92% for COPD patients).
|Assess the patient’s vital signs, especially the respiratory rate and depth. Auscultate the lungs and monitor for wheezing or other abnormal breath sounds.||To create a baseline set of observations for the patient, and to monitor any changes in the vital signs as the patient receives medical treatment.|
|Monitor the color of skin and mucous membrane.||Peripheral cyanosis (bluish discoloration of the skin, ear lobes, or nail beds) may be evident with hypoxemia. Central cyanosis involving the mucosa may indicate further reduction of oxygen levels.|
|Monitor oxygen saturation and arterial blood gases or ABG levels.||A pulse oximeter can be used to monitor the oxygen saturation in the body. Monitoring ABGs can help determine the patient’s progress or deterioration. Increased PaCO2 and decreased PaO2 may indicate hypoxemia and respiratory acidosis.|
|Provide supplemental oxygen therapy as prescribed.||To ensure that the patient has sufficient oxygen level in the body, as evidenced by an increase in oxygen saturation levels.|
|Reposition the patient by elevating the head of the bed and encouraging him/her to sit on an upright position. Encourage pursed lip breathing and deep breathing exercises.||To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse.|
|Assess the need for mechanical ventilation.||To enable to patient to receive adequate oxygenation and ventilation that will result to improved gas exchange and will avoid full decompensation.|
Nursing Care Plan 2
Nursing Diagnosis: Ineffective Tissue Perfusion (Peripheral) related to the presence of microthrombi and the disruption of blood circulation as evidenced by chest pain, shortness of breath, cyanosis abnormal blood profile, capillary refill >3 seconds, and hematuria
Desired Outcome: The patient will maintain optimal tissue perfusion as evidenced by having strong and palpable pulses, and reduced calf pain, warmth, and tenderness.
|Assess the patient’s vital signs at least every 4 hours, or more frequently if there is a change in them.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for DIC.|
|Measure the circumference of the left leg (affected extremity) 10 cm below the tibial tuberosity with a tape measure. Then, measure the circumference of the same leg but 10 –15 cm above the patella.||DIC can result to deep venous thrombosis, which affects the legs. DVT is to be suspected if the difference is greater than 3 cm between the extremities.|
|Administer the prescribed anticoagulants.||To prevent blood clot formation using anticoagulants such as heparin or warfarin.|
|Administer analgesics as prescribed.||To provide pain relief especially in the calf area.|
|Elevate the legs and apply compression stocking. Provide heat on the affected extremity. Encourage to mobilize and perform exercise.||To decrease the swelling and reduce the risk of clot formation. To provide comfort and help decrease the inflammation. To reduce the risk of clot formation.|
|Ensure adequate hydration whether orally or parenterally.||Increased blood viscosity is a contributory factor to clotting and venous stasis. Adequate hydration helps reduce blood viscosity.|
Adequate blood volume needs to be maintained through parental fluids to support systemic perfusion and cardiac output.
Nursing Care Plan 3
Nursing Diagnosis: Risk for Bleeding related to anticoagulant therapy for DIC
Desired Outcome: To prevent any bleeding episode while the patient is on anticoagulant therapy.
|Assess the patient’s vital signs and perform a focused physical assessment, looking for any signs of bleeding.||Anticoagulants put the patient at risk for bleeding. Early signs of bleeding include gum bleeding, epistaxis, and unexplained bruises. Low blood pressure, low temperature, and dizziness may result from excessive bleeding.|
|Obtain blood samples and monitor platelet counts as well as coagulation levels (INR, PT, and PTT).||To ensure that the anticoagulant dosing is in line with the target therapeutic range, thus reducing the risk of bleeding.|
|Administer the anticoagulant as prescribed.||There are different anticoagulants in different forms. The most common ones are IV heparin, subcutaneous low-molecular weight heparin (LMWH), and oral warfarin.|
|Recommend to switch from IV anticoagulant to subcutaneous or oral anticoagulant to the doctor when the therapeutic range has been reached.||To facilitate safe transition of anticoagulation therapy from clinical management to patient self-management before discharge.|
Other possible nursing diagnoses:
- Activity Intolerance
- Acute Pain
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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