This action might not be possible to undo. Are you sure you want to continue?
SCHWARTZ, GENNELY D.
BSN II NU401-C
Disseminated Intravascular Coagulation - also known consumptive coagulopathy and defibrination syndrome. - is a pathological activation of coagulation ( blood clotting ) mechanisms that happens in response to variety of diseases. - DIC leads to the formation of small blood clots inside the blood vessels throughout the body. As the small clots, consume coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin ( e.g. from the sites where the blood samples were taken ), the gastrointestinal tract, the respiratory tract and surgical wounds. The small clots also disrupt normal blood flow to organs ( such as the kidneys ), which may malfunction as a result. - DIC can occur acutely but also on a slower, chronic basis, depending on the underlying problem. It is common in he critically ill, and may participate in the development of multiple organ failure, which may lead to death. Acute DIC verus Chronic DIC DIC exists in both acute and chronic forms. DIC develops acutely when sudden exposure of blood to procoagulants occur, including tissue factor ( tissue thromblastin) generating intravascular coagulation. Abnormalities of blood coagulation parameters are readily identified, and organ failure frequently occurs in Acute DIC. Chronic DIC reflects a compensated state that develops when blood is continuously or intermittetntly exposed to small amounts of tissue factor, Chronic DIC is more frequently observed in solid tumors and in large aortic aneurysms. CAUSES: Acute DIC - Infections Bacterial ( gram-negative, sepsis, gram-positive, infections, ricketssial) Viral ( HIV, cytomegalovirus (CMV), varicella, hepatitis) Fungal ( Histoplasma ) Parasitic ( malaria ) - Malignancy Hematologic ( acute melocytic leukemias ) Metastic ( mucin-secreting adenocarcinomas ) - Obstetrics Placenta Abruption Amniotic fluid embolism Acute fatty liver pregnancy
Eclampsia - Trauma - Burns - Motor vehicle accidents - Snake bites - Transfusion - Hemolytic reactions - Massive transfusion - Liver disease – Acute hepatic failure - Prosthetic devices - Shunts - Ventricular assist devices Chronic DIC - Malignancies Solid tumors Leukemia - Obstetric Retained dead fetus syndrome Retained products of conception - Hematologic Myeloproliferative syndromes Paroxysmal nocturnal hemoglobinuria - Vascular Rheumatoid arthritis Raynaud disease - Cardiovascular Myocardial infarction - Inflammatory Ulcerative colitis Crohn’s disease Sarcoidosis - Localized DIC Aortic aneurysms Giant hemangiomas ( Rasabach – Merritt syndrome ) Acute renal allograft rejection Hemolytic uremic syndrome SIGNS and SYMPTOMS The affected person is often acutely ill and shocked with widespread hemorrhage ( common bleeding sites are mouth, nose, and venipuncture sites ), extensive bruising, renal failure, gangrene. Bleeding from surgical or invasive procedure sites and bleeding gums, cutaneous oozing, petechiae, ecchymoses,
blood vessel clotting and hematomas. May experience nausea and vomiting; severe muscle, back and abdominal pain; chest pain; hemoptysis; epistaxis; seizures; and oliguria. Peripheral pulses and blood pressure may decreased; may demonstrate confusion or other changes in mental status. Laboratory Diagnostic Procedures Platelet count A stable platelet count suggests that thrombin formation has stopped FDPs ( Fibrin degradation products ) and D-dimers Which may be measured as FDP by ELISA ( enzyme – linked immunosorbent assay ) PT and aPTT Fibrinogen Acts as an acute phase reactant and despite ongoing consumption, plasma levels can remain within the normal range for a long period of time Procedures - Base procedures on the underlying pathologic processs as well as an areas suggestive of thrombosis and hemorrhage - Conduct invasive procedures with care because of bleeding complications. Procedures should follow the administration of clotting factor and platelet repletion. NURSING MANAGEMENT - It is important to take a thorough history, especially in relation to previous bleeding disorders and any medications that include bleeding. - The patient should be turned q2h to prevent pressure ulcers and to minimize blood strasis and pooling, as this may precipitate clotting and thrombsis formation. - Skin should be thoroughly assessed at least two-hourly for pressure areas and any signs of bleeding, such as petechiae. - Prssure relieving mattresses the amount of manual handling required and the risk of skin trauma. - Skin should be kept clean and moisturized, as dry skin is more damaged. Reduced the risk of skin damage, sticky tapes should be avoided, and electric rather that blade razors should be used. - Temperature should be monitored and recorded at least four-hourly - Areas at risk can be washed gently with hydrogen peroxide and water to remove the crusted blood. - Pressure, cold compress, and topical hemostatic agents are applied to control bleeding.
MEDICAL MANAGEMENT 1. Remove the trigger or treat the underlying cause. 2. Maintain organ perfusion. 3. Restore the balance of homeostasis. 4. Provide supportive management of complications. MEDICATION Therapy should be appropriate aggressive for the patient’s age, disease, severity and location of hemorrhage/thrombosis. Anticoagulant agents Used in the treatment of clinically evident intravascular thrombosis when the patient continues to bleed after initiation of primary anf supportive therapy. Heparin - used to prevent or treat clots in the veins, arteries, lungs or heart. Antithrombin III - used for moderately severe –to- severe DIC or when level are depressed markedly Blood Components Are used to correct hemostatic parameters Packed red blood cells ( PRBCs ; washed ) Platelets Considered safe for Acute DIC Fresh frozen plasma ( FFP ) - This treatment entails removing blood from body Cryoprecipitate or Fibrinogen concentrates Antifibrinolytic Agents These agents after all other therapeutic modalities have been tried and deemed unsuccessful Aminocaproic Acid (Amicar) - Inhibits fibrinolysis via inhibition of plasminogen activator substances and, to a lesser degree, through antiplasmin activity Tranexamic acid cyklokapron - Used as alternative to aminocaproic acid - Inhibits fibrinolysis by displacing plasminogen from fibrin.
Pre-eclampsia Pregnancy- induced hypertension, the phase before the pregnant woman experiences a seizure. Charaterized by increasing hypertensive, proteinuria and edema The condition may progress rapidly from mild to severe and if untreated, to eclampsia. Leading cause of fetal and maternal morbidity and death.
The cause is unknown; however the incidence is higher among adolescents, in first pregnancies, in women who smoke, and in women who are diabetic or overweigh. The disease mechanisms found in pre-eclampsia include generalized vasopasm, damage to the glomerular membranes, and hypovolemia and hemoconcentration due to a fluid shift from intravascular to interstitials compartments. SIGN and SYMPTOMS - sudden weight gain - severe headaches - visual disturbances - complaints of epigastric or abdominal pain - generalized, presacral, and facial edema - oliguria - mypereflexia Pre-eclampsia Laboratory Tests - 24hour urine for protein and creatine clearance - AST - Fibrinogen - LDH - BUN - Bilirubin - Platelet Count - PT - PTT - Uric Acid - CBC NURSING MANAGEMENT - Monitor vital signs and FHR - Measure and record urine output, protein level, and specific gravity - Assess deep tendon reflexes q4h. - Asses for placental separation, headache and visual disturbances epigastric pain, and altered level of consciousness
Eclampsia treatment consists of administration of magnesium sulfate intravenously
MEDICAL MANAGEMENT - Provide treatment as prescribed. - Institute seizure precaution. Seizures may occur up to 72 hours after delivery - Monitor for and promote the resolution of, complications MEDICATION - Antihypertensive therapy ( Labetolol or Nicardipine ) - Cortocosteroids - Anticonvulsive medications
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.