Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)

Join NURSING.com to watch the full lesson now.

Included In This Lesson

Study Tools

Outline

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

Subjective Data:

  • Chest pain
  • Shortness of breath
  • Pain in affected limb
  • Headache
  • Dizziness
  • Double vision

Objective Data:

  • Erythema
  • Warmth of affected area
  • Swelling
  • Blood in urine or stool
  • Petechiae
  • Uncontrolled bleeding

Nursing Interventions and Rationales

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

 

In both acute and chronic DIC, blood clots often form or travel to the lungs resulting in embolism. This will be evident by shortness of breath, cyanosis and complaints of chest pain

 

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

 

Tachycardia, changes in blood pressure and decreased cap refill are signs of deteriorating cardiovascular function.

 

  • Assess for changes in level of consciousness

 

Early signs of hypoxia include confusion and irritability; monitor for signs of stroke as blood clots may travel to the brain.

 

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

 

For optimal tissue perfusion, oxygen saturation should remain 90% or greater.

 

  • Provide wound care and pressure for external bleeding

 

Simple procedures such as venipuncture and IV access can cause external bleeding which is severe. Apply more than usual pressure to assist with clotting.

 

  • Assess amount and color of urine

 

Decreased perfusion to the kidneys may result in hematuria and decreased urination (output <30 mL/hr)

 

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

 

Dark blood in stool can indicate GI bleed, while bright red blood may indicate bleeding hemorrhoids or anal fissures.

 

  • Monitor for hemoptysis or blood in suctioning

 

This is a common indicator of DIC. When suctioning secretions, observe for blood. Note any blood in emesis.

 

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

 

Changes in these labs can help determine if treatment is effective.

 

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

 

Minimize risks of bleeding from friction, injury or pressure. Observe for petechiae or purpura which can indicate

 

  • Administer medications and blood products as necessary

 

Heparin may be used for chronic DIC when clotting is more of a problem; excessive blood loss may require transfusion; antibiotics are often given when infection or sepsis is the underlying factor.

Writing a Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)

A Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

Join NURSING.com to watch the full lesson now.

Transcript

Hey guys, let’s take a look at the care plan for disseminated intravascular coagulation also known as DIC. So in this lesson, we’ll briefly take a look at the pathophysiology and etiology of DIC. We’re also going to look at subjective and objective data, as well as nursing interventions and rationales. 

 

Okay. Let’s look closer at DIC. So this is a condition where small blood clots form throughout the body’s small blood vessels. Serious bleeding can occur internally and externally because these clots use up platelets and clotting factors in the blood. Acute DIC develops within a few hours or days and leads to serious bleeding. Chronic DIC develops over weeks or months, and doesn’t usually lead to excessive bleeding, but the formation of more clots. So, there are several diseases and disorders that cause DIC generally derived from one of two processes: either an inflammatory process, sepsis or major trauma, or exposure of a procoagulant material in the blood like cancer, a brain injury, or an obstetric event. DIC can also occur due to a venomous snake bite. 

 

Presentation and treatment depends on the cause and whether the DIC is acute or chronic. So, the desired outcome is going to be to treat the underlying cause, promote optimal gas exchange, restore clotting factors and reduce the risk of bleeding. Let’s take a look at some of the subjective and objective data that your patient with DIC may present with. 

 

Now, remember subjective data are going to be things that are based on your patient’s opinions or feelings, and for DIC, they may express chest pain, shortness of breath, pain in the affected limb, a headache, dizziness, or even double vision. 

 

Objective data may include erythema, warmth of the affected area, swelling, blood in the urine or the stool, BTKI, or of course, uncontrolled bleeding. 

 

Okay, now onto the nursing interventions necessary when caring for a patient with DIC. Assess and monitor the respiratory status, noting the rates, the rhythm, and if there is any cyanosis. Both acute and chronic DIC blood clots often form or travel to the lungs resulting in an embolism. This will be evident by shortness of breath, cyanosis, or complaints of chest pain. Be sure to auscultate the lungs for areas of absence and air movement. You’re also going to want to assess and monitor the cardiac status (including a 12 lead EKG) as indicated, and of course,  tachycardia and changes in blood pressure and decreased capillary refills are signs of deteriorating cardiovascular function. Next, assess for changes in level of consciousness because early signs of hypoxia include confusion and irritability and guys, monitor for signs of stroke as these clots can also travel to the brain. You’re also going to want to monitor arterial blood gases or ABG’s, and closely monitor oxygen saturation, administering oxygen when necessary keeping SATs greater than 90% for optimal tissue perfusion. 

 

So with DIC, even the simplest of procedures, like if any puncture or an IV can cause external bleeding, which is severe, you must apply more pressure than normal to help with clotting in these situations. Assess the amount and color of your patient’s urine as there could be decreased perfusion to the kidneys, which may result in hematuria, and decreased urine output of less than 30 MLS per hour, as well as, monitor for blood in the stool. Now, dark blood in the stool can indicate a GI bleed, while bright red blood may indicate hemorrhoids or anal fissures. It’s important for these patients to administer stool softeners, to avoid straining during bowel movements. A common indicator of DIC is blood with suctioning, so make sure you are observing for blood when suctioning or with MSS. Monitoring labs like platelet counts, PT and PTT, and the D-dimer level are critical to help determine if treatment is effective. 

 

So for DIC patients, it’s so important to minimize the risks of bleeding from friction, injury, or pressure. So, this means no razors, using a soft bristle toothbrush, limit needle sticks and BP readings as much as possible, and observe for petechiae and purpura. Heparin may be used for chronic DIC when clotting is more of a problem. Excessive blood loss may require a transfusion and antibiotics when sepsis or infection is the underlying factor. 

 

Okay, guys, here is a look at the completed care plan for DIC. We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

Join NURSING.com to watch the full lesson now.
[NextGen]
[NextGen]