Nursing Care Plan for Disseminated Intravascular Coagulation (DIC)

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

Nursing Interventions and Rationales

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

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

• Assess for changes in level of consciousness

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

• Provide wound care and pressure for external bleeding

• Assess amount and color of urine

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

• Monitor for hemoptysis or blood in suctioning

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

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

• Administer medications and blood products as necessary

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References

• https://emedicine.medscape.com/article/199627-treatment#d8
• https://www.nhlbi.nih.gov/health-topics/disseminated-intravascular-coagulation
• https://www.merckmanuals.com/home/blood-disorders/bleeding-due-to-clotting-disorders/disseminated-intravascular-coagulation-dic#v775325