Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation refers to a clinical-biological complication that majorly manifests through continuous activation of coagulation components. The continuous coagulation leads to fibrin deposition into the blood vessels that connect the other body parts to the heart translating to disfunction of several organs, depleting the clotting factors and chronic hemorrhage (Costello & Nehring, 2021). Disseminated Intravascular Coagulation is mainly caused by sepsis; the body’s response to infection translates to inflammations. The condition can also be caused by serious immunological reactions and damage to several tissues or organs in the body.

Pathophysiology of DIC

Disseminated Intravascular Coagulation mainly occurs due to the imbalance state established between the rate of coagulation and bleeding. The high-affinity receptors and cofactors responsible for factor VII are deposited within the circulatory system from the damaged vascular endothelial system due to trauma, tissue damage or exposure to bacterial endotoxins that activate tissue factors within the coagulation pathway (Costello & Nehring, 2021). Thrombin and fibrin emerge through the extrinsic mechanism due to clots in the circulatory system. As the process progresses, the accumulation of the fibrin and thrombin negatively interferes with the coagulation cascade by the positive feedback loop simulation and consumption of coagulation inhibitors. The result is the consumption of the clotting factors that translates to severe bleeding. The consumption mechanism can also consume the platelets (Costello & Nehring, 2021). Furthermore, Disseminated Intravascular Coagulation dysregulates the pathways that contain protein C and antithrombin III (Costello & Nehring, 2021).

The course of the condition operates within acute to chronic ranges. The acute phase is mostly caused by sepsis and is mostly acquired through coagulopathy. DIC in the microvascular regions translates to ischemia, cardiovascular embolism, and thrombosis. Fibrinolysis also manifests in some instances due to the release of fibrin degradation products into the damaged blood vessels. The Red Blood Cells are also damaged while forcing their way out through damaged blood vessels, causing hemolysis (Costello & Nehring, 2021). Due to insufficient clotting factors, the anticoagulant forces result in bleeding.

Diagnostic Findings

The effect of DIC on Prothrombin time

Disseminated Intravascular Coagulation leads to a reduction in the number of platelets, and the effect is increased coagulation times and an activation of partial thromboplastin time (Papageorgiou et al., 2018).

DIC’s effect on Partial Thromboplastin Time

Disseminated Intravascular Coagulation mainly manifests by elevated levels of the thrombin time and elevation of the bleeding times with a reduction in the number of platelets in return. The process is a consuming coagulopathy with simultaneous clot lysis and coagulation (Papageorgiou et al., 2018). The patients likely experience consumptive thrombocytopenia ischemia on the local tissues and blood escaping from the raptured vessels.

The effects of DIC Platelets

Disseminated Intravascular Coagulation reduces the number of platelets due to the consummative ability during coagulation (Papageorgiou et al., 2018). The consumption of the platelet’s implication of the activation of platelets.

The effect of DIC on fibrin degradation

Disseminated Intravascular Coagulation mainly manifests by activation of blood coagulation cascade that translates to generation and production of fibrin that reciprocates in thrombus in several microvascular organs that leads to several organ dysfunctions (Papageorgiou et al., 2018). And thus, the results manifest.

Priority for Nursing Diagnosis

The priority nursing diagnosis is the risk of severe bleeding as evidenced by the reduced platelets per milliliter of blood, below 150000-400000 platelets per milliliter of blood. Additionally, the evidence of the nursing diagnosis is due to the results from the laboratory indicating fibrin deposits within the blood vessels (Vera et al., 2019). The recommended management strategy for the condition is to manage the platelet counts and reduce the bleeding.

The Plan for the Patient Care

The Nurse needs to assess the respiratory status of the patient.

Assessment of the respiratory status makes it easier to know the rates and rhythms and any signs of synosis. Monitoring the respiratory status also makes it easier to detect embolism within the lungs, mainly manifested by shortness of breath experienced by the patient.

The Nurse needs to assess the cardiac status.

Monitoring the cardiovascular status makes it easier to detect the 12 EKG status bearing in mind that DIC manifests by clots in cardiovascular pathways that may translate into high EKG readings.

The Nurse needs to monitor the consciousness levels.

DIC primarily manifests as hypoxia due to clogs in the blood vessels. Monitoring the consciousness levels can help in detecting any instances of stroke. Additionally, the urine in the kidney needs to be assessed as there could be reduced kidney perfusion.

Monitoring the labs

The platelet count must be maintained at 15000-400000 platelets per milliliter of blood.

The Partial Thromboplastin Time also needs to be keenly monitored.

Keenly monitoring the diagnostic tests.

Monitoring of the oxygen saturation.

The oxygen saturation will help keep a close track of the respiratory rates. The optimal tissue perfusion levels should be at 90% and above, and any value beyond that should be treated with the utmost keenness.

The goals and outcomes related to the condition

Goal

To reduce the bleeding rates by restoration of the clotting factors

Outcomes related to the condition

Effective treatment of the condition’s cause, restoration of the clotting factors, and reduction of bleeding.  

The Care Plan for the Achievement of the outcome

The dietary modification Includes at least vegetables and fruits after each meal.

Adherence to medications such as anticoagulants and thinners to prevent clotting.

Taking a lot of fluids. The patient needs to take about 1000ml of fluids per day.

Maintaining the blood pressure level of the patient at 120/80mmHg.

Maintaining the respiratory levels to 90% and above.

Intervention to help In the Achievement of the Desired Goals

Blood Transfusion

Disseminated Intravascular Coagulation manifests by reduced blood platelets, thus increasing the risk of severe bleeding. The blood transfusion is mainly meant to transfer the platelets, regain the coagulative property of blood, and restore the platelet levels to 150000-400000, which is considered the normal platelet levels for a healthy individual (Wada et al., 2017). Research reveals that implementing the blood transfusion strategy helps manage the condition and reduces the severity of the effects, including death.

Administration of heparin.

The manifestation of clots in the blood vessels calls for the administration of anticoagulants to help remedy the condition. The anticoagulants work by activating the coagulation pathway, preventing the clots’ formation within the blood vessels, and facilitating faster blood flow that heals dysfunctional organs due to clogged vessels that run through them (Wada et al., 2017). The strategy will aim to restore the normal coagulative property of the blood, and the result is the maintenance of the homeostatic condition of the blood.

Regulation of the Protein Intake

Monitoring the intake of proteins is significant in increasing the platelets count (Wada et al., 2017). The regulation should e accompanied by a massive intake of vitamins, minerals and iron-rich foods such as pumpkins and vegetables, which effectively restore the platelet count in the body. The result is reduced bleeding and improved clotting ability.

References

Costello, R. A., & Nehring, S. M. (2021). Disseminated Intravascular Coagulation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441834/#:~:text=Disseminated%20intravascular%20coagulation%20can%20be

Papageorgiou, C., Jourdi, G., Adjambri, E., Walborn, A., Patel, P., Fareed, J., Elalamy, I., Hoppensteadt, D., & Gerotziafas, G. T. (2018). Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clinical and Applied Thrombosis/Hemostasis, 24(9_suppl), 8S28S. https://doi.org/10.1177/1076029618806424

Vera, M., BSN, & R.N. (2019, February 2). Nursing Diagnosis: Everything You Need to Know [2020 Guide]. Nurseslabs. https://nurseslabs.com/nursing-diagnosis/#:~:text=A%20nursing%20diagnosis%20has%20typically

Wada, H., Matsumoto, T., & Yamashita, Y. (2017). Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care, 2(1). https://doi.org/10.1186/2052-0492-2-15