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.
Risk for Bleeding
May be related to
- Abnormal blood profile (depleted coagulation factors)
- Drug therapy (adverse effects of heparin)
Possibly evidenced by
- [not applicable]
- Client will experience reduced episode of bleeding and hematomas.
- Client will experience reduced side effects of medication therapy.
- Client will maintain therapeutic levels of coagulation laboratory profiles (prothrombin, partial prothrombin time, fibrinogen, fibrin split products, bleeding time).
|Assess for the underlying cause of DIC.||DIC is not a primary disease but occurs in response to a precipitating factor such as an infection or tumor. Successful treatment of DIC includes management of the underlying disorder.|
|Assess the client’s heart rate and blood pressure. Observe for signs of orthostatic hypotension.||Tachycardia and hypotension are signs of decreased cardiac output. Orthostasis (a drop of more than 15 mm Hg when changing from a supine to a sitting position) indicates reduced circulating fluids.|
|Observe for signs of internal bleeding, such as pain or changes in the level of consciousness. Institute a neurological checklist.||Changes in the level of consciousness may occur with the decreased fluid volume or with decreasing hemoglobin.|
|Observe for signs of external bleeding from the gastrointestinal (GI) and genitourinary (GU) tracts.||One of the diagnostic hallmarks of acute DIC can be manifested as bleeding simultaneously from at least three unrelated sites associated with shock, respiratory failure, or renal failure. For example, the client may have increased skin bruising, hemoptysis, and hematuria.|
|Note any hemoptysis or blood obtained during suctioning.||These are the common manifestation of acute DIC.|
|Examine the skin surface for signs of bleeding. Note petechiae; purpura; hematomas; oozing of blood from IV sites, drains, and wounds; and bleeding from the mucous membranes.||Prolonged oozing of blood from injection sites or venipuncture sites could be the first indication of DIC.|
|Monitor hemoglobin and hematocrit levels.||Decreased hemoglobin and hematocrit levels are associated with bleeding from DIC.|
|Monitor serial coagulation profiles.||Initially, accelerated clotting is noted. As the clotting then stimulates the fibrinolytic system, clotting factors become depleted and large quantities of proteins are produced as part of the fibrin degradation process. Common laboratory values in DIC are PT greater than 15 seconds, PTT greater than 60 to 90 seconds, hypofibrinogenemia, thrombocytopenia, elevated fibrin split products (FSPs), elevated d-dimers, and prolonged bleeding time. All put the client at risk for increased bleeding. Specific deficiencies guide treatment therapy.|
|If heparin therapy is initiated, observe for:
|Heparin is used for milder cases when clotting is more of a problem than bleeding. It aborts the clotting process by blocking thrombin production.|
|Institute precautionary measures:
|Nursing interventions should be planned and implemented to eliminate potential sources of bleeding and to control the amount of potential bleeding and tissue injury.|
|Administer heparin therapy as prescribed. The dose may be titrated based on laboratory values and the clinical situation. If bleeding is increased, notify the physician of the possible need to decrease the IV drip.||Heparin is used for milder cases when clotting is more of a problem than bleeding. Heparin augments antithrombin III activity that interrupts the clotting cycle and conversion of fibrinogen to fibrin. It also blocks the intrinsic and extrinsic pathways by inhibiting factor X, which slows clot formation. As the clinical situation improves, the need for heparin decreases. The challenge lies in differentiating the blood loss as an untoward effect of heparin therapy from a worsening DIC.|
|Administer parenteral fluids as prescribed. Anticipate the need for an IV fluid challenge with the immediate infusion of fluids for clients with hypotension.||Maintenance of an adequate blood volume is vital for maintaining cardiac output and systemic perfusion.|
|Administer blood products as prescribed: red blood cells (RBCs), fresh frozen plasma (FFP), cryoprecipitate, and platelets.||Blood and plasma transfusions replace blood clotting factors. RBCs increase oxygen carrying capacity; FFP replaces clotting factors and inhibitors; platelet and cryoprecipitate provide proteins for coagulation.|
|Administer additional medications or investigational drugs as ordered:|
||This is a cofactor of heparin used for more severe cases. The anti-inflammatory properties may be of benefit when sepsis is the causative factor.|
||This antifibrinolytic agent is reserved for when other measures have failed. Its use can lead to organ failure from large vessel thrombosis, and thus its use is controversial.|
||This is a thrombin inhibitor and neutralizer; Limited clinical experience exists with this drug.|
||This inhibits factors Va and VIIIa of the coagulation cascade.|
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