Disseminated intravascular coagulation is a coagulation disorder causing an over-activation of the clotting cascade. This results in simultaneous thrombosis and hemorrhage. May be acute or chronic; highly fatal. Because of the overuse of clotting factors, bleeding is a problem despite the abnormal rates of coagulation. Two contrasting problems cause high difficulty in treatment for severe cases.
- Signs and Symptoms:
- Clotting: Chest pain, shortness of breath, myocardial infarction (from obstruction of coronary arteries), cerebral effects from decreased perfusion (LOC changes)
- Internal Bleeding: hematuria, melena/occult blood in stool, hemoptysis, cerebral hemorrhaging (changes in LOC)
- External Bleeding: hematoma (subcutaneous bleeding), mucosal bleeding, purpura/petechiae/bruising.
- Diagnostics: CBC (Platelet count and clotting factor counts are reduced, PT and PTT times are increased)
- Medical Management: treat the underlying cause (if known).
- Secondarily, correct ischemia by improving oxygenation, replacing fluids, correcting electrolyte imbalances, and administering vasopressor medications.
- Replace overused clotting factors and platelets via transfusion of cryoprecipitate and fresh-frozen plasma.
- Controversial in use, but heparin may also be used
- Nursing Interventions:
- Maintain hemodynamic status: observe procedures to minimize wounding and risk for bleeding.
- Monitor for imbalanced fluid volume: faulty circulation may result in fluid retention. Assess for edema and monitor breath sounds. Administer diuretics and minimize IV volume as prescribed.
- Assess for ineffective tissue perfusion related to microthrombi: assess neurologic, pulmonic, and skin systems.