Disseminated intravascular coagulation (DIC) is a coagulation disorder that prompts overstimulation of the normal clotting cascade and results in simultaneous thrombosis and hemorrhage. The formation of microclots affects tissue perfusion in the major organs, causing hypoxia, ischemia, and tissue damage. Coagulation occurs in two different pathways: intrinsic and extrinsic. These pathways are responsible for the formation of fibrin clots and blood clotting, which maintains homeostasis. In the intrinsic pathway, endothelial cell damage commonly occurs because of sepsis or infection. The extrinsic pathway is initiated by tissue injury such as from malignancy, trauma, or obstetrical complications. DIC may present as an acute or chronic condition.
An essential medical management of DIC is primarily aimed at treating the underlying cause, managing complications from both primary and secondary cause, supporting organ function, and stopping abnormal coagulation and controlling bleeding. Morbidity and mortality depend on underlying cause and severity of coagulopathy.
The following are the common nursing care planning and goals for clients with DIC: maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, prevention of complications.
Here are four (4) nursing care plans (NCP) and nursing diagnosis for patients with disseminated intravascular coagulation:
Ineffective Tissue Perfusion
May be related to
- Blood circulation disruption
Possibly evidenced by
- Abnormal blood profile
- Capillary refill >3 seconds
- Changes in the level of consciousness
- Chest pain
- Shortness of breath
- Client will maintain optimal peripheral tissue perfusion in the affected extremity, as evidenced by strong palpable pulses, reduction in and/or absence of pain, warm, and dry extremities, and adequate capillary refill.
|Assess for contributing factors:||When the proteins used in the normal clotting process become overly active, it can cause DIC. Infection, severe trauma, inflammation, surgery, Obstetrical complications (such as abruptio placenta, intrauterine fetal death) and cancer are all known to contribute with DIC.|
|Assess for the signs and symptoms of DIC.||Bleeding, from mucous membranes, venipunctures sites, and areas from the gastrointestinal and urinary tracts.|
|Assess for chest pain and shortness of breath.||Blood clots may form in the blood vessels of the lungs and heart therefore blocking the blood flow that can cause these symptoms.|
|Assess amount and color of urine.||Hematuria and oliguria occurs (urine output less than 30 ml/hour) due to decreased perfusion to the kidneys as a result of tissue injury and clotted capillary beds.|
|Assess client’s level of consciousness.||A decreased level of consciousness can be precipitated by hemorrhagic changes or insufficient oxygenation of the brain.|
|Assess arterial blood gases (ABGs).||Arterial blood gases may reveal a compensatory respiratory alkalosis in an attempt to decrease hydrogen ion concentration from hypoxia striking at the tissue level.|
|Monitor platelet count.||Thrombocytopenia (a common cause of abnormal bleeding, can occur as a result of insufficient platelets production by the bone marrow, or due to increased platelet destruction).|
|Monitor PT (prothrombin time) and PTT (partial thromboplastin time).||These laboratory values are typically prolonged as coagulation factors are consumed.|
|Monitor D-dimer levels.||This is a test that detects a protein that results from clot break-down; it is often markedly elevated with DIC.|
|Position client in a semi-Fowler’s to high-Fowler’s as tolerated.||Upright positioning promotes improved alveolar gas exchange.|
|Provide oxygen therapy as necessary.||This saturates circulating hemoglobin and augments the efficiency of blood that is reaching the ischemic tissues.|
|Administer parenteral fluids as prescribed.||Maintenance of an adequate blood volume is vital for maintaining cardiac output and systemic perfusion.|
|Administer heparin as prescribed.||Treatment with anticoagulant is used primarily to prevent the formation of new clots by decreasing the normal activity of the clotting mechanism.|
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