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Shauna Herrmannon 4 February 2014
Transcript of DIC
You give antibiotic, draw her blood, and take it to the lab.
6 hours later to administer another dose of antibiotics. She is upset and ushers you to the bathroom.
you find blood in the toilet
she has been urinating blood for the past 2 or 3 hours. She also shows bloody-appearing sputum. She tells you she has been coughing up blood and shows you the bloody drainage from the blood draw 6 hours earlier.
You notify the physician, who instructs you to call 911 and get the patient to the emergency department (ED) immediately.
Platelet counts and fibrinogen and clotting factor titers are decreased, leading to prolonged PT, aPTT, and INR. Labs tests= PT, PTT (prolonged), INR (increased), Fibrinogen (decreased), Clotting factors V, VIII, X, XIII (decreased), Fibrin degradation products and D-dimer (positive), Clotting inhibitors: antithrombin III and protein C (decreased).
SBAR-Dr. X, this is Cindy and I am doing a home health care visit on patient K.M.- Situation-pt K.M. is currently showing signs of a dark red rash on her trunk (petechiae) and ecchymotic area over right upper arm. She also has serosanguinieous fluid around her PICC site. Background-21 yo K.M., ruptured appendix about 10-14 days earlier. Assessment-K.M. is currently stable. Recommendation-Pt needs some tests run on her coagulation, possible transfusion therapy, oxygen therapy, anticoagulant therapy (heparin)
The physician orders blood to be drawn for coagulation studies and a CBC with differential. He says he would like to evaluate K.M. for disseminated intravascular coagulation (DIC)
What laboratory tests would you expect to see performed in coagulation studies?
oozing of serosanguineous fluid around the PICC insertion site
The rash is confined to the trunk.
What vital information will you relay to the physician?
Complete a full assessment
What other information would you want to gather?
NO, not caused by the BP cuff
When did you notice rash?
How is your appetite?
K. M. is a 21-year-old woman diagnosed with a ruptured appendix.
developed peritonitis; discharged 9 days later with a left peripherally inserted central catheter (PICC) to home care for IV antibiotic therapy. You work for the home care department of the hospital. You have been assigned to K.M’.s case, and this is your first home visit. You are to do a full assessment on K.M.
During the assessment, you notice a large ecchymotic area over the right upper arm. You ask her if she fell and hit her arm.
1. Do you accept K.M.'s explanation? Why or why not?
In examining K.M.. further, you find a fine, nonraised, dark red rash over her trunk (petechiae). What questions would you ask K.M. to elicit additional information?
What are you going to tell the triage nurse?
K.M. is 21 yr-old female with appendix rupture 2 weeks ago, after a 9 day stay in the hospital she was discharged home. During my home health visit I noticed a large ecchymotic bruise on upper right arm and dark rash/ petechiae on her trunk, she is also oozing serisanguous drainage from PICC line. We drew labs this morning for coag studies. When I returned 6 hours later she had symptoms of bloody urine, bloody sputum, and blood drainage from IV draw site. Her labs should be available and her doctor is Dr. X.
Are the patient’s presenting signs and symptoms (S/S) consistent with DIC?
Yes, patient is showing S/S of DIC: petechiae, bleeding from IV sites and bloody mucous membranes, hematuria, and abdomen tender to palpatations
The following labs were prolonged: PT/INR, PTT, split fibrin products, and D-dimer specifically. The following labs were decreased: platelets, platelet aggregation time, clot retraction time, and fibrinogen level. The WBC was 12.5 thou/cmm, and platelet count 46 thou/cmm. D.V. is diagnosed with DIC.
List at least three priority needs for D.V.
1. Implamentation of bleeding precautions
2. Fluid balance maintenance
3. Acid-base balance and oxygenation maintenance
4. Maintenance of skin integrity 5. Psychosocial support
D.V. is stabilized with oxygen, fluids, and blood products, and medication therapy is initiated. She is transferred to the ICU in guarded condition.
Fluid volume deficit r/t depletion of clotting factors AEB hemorrhage
Risk for ineffective Tissue perfusion r/t tachycardia, hypotension, circulatory collaps
Fear r/t threat to well-being
Impaired gas exchange r/t microclots in the pulmonary vascular