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.
Nursing Care Plans
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.
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.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans for hematologic and lymphatic system disorders:
- Anaphylactic Shock | 4 Care Plans
- Anemia | 4 Care Plans
- Aortic Aneurysm | 4 Care Plans
- Deep Vein Thrombosis | 5 Care Plans
- Disseminated Intravascular Coagulation | 4 Care Plans
- Hemophilia | 5 Care Plans
- Leukemia | 5 Care Plans
- Lymphoma | 3 Care Plans
- Sepsis and Septicemia | 6 Care Plans
- Sickle Cell Anemia Crisis | 6 Care Plans