Page 438 - Critical Care Nursing Demystified

Chapter 9 CARE OF THE PATIENT WITH CRITICAL HEMATOLOGIC NEEDS 423

Initiate drotrecogin alfa (Xigris) therapy for patients with severe sepsis and
MOSD.
Use strict aseptic technique when performing invasive procedures to decrease
introduction of pathogens.
Introduce nutritional support early to help with repair and replacement of
injured cells.
Institute deep vein thrombosis prophylaxis, which includes turning, anti-
thrombic stockings, sequential inflation stockings, and low molecular weight
heparin to prevent blood clots and pulmonary emboli.
Provide emotional support to patient and significant others as this is a highly
fatal situation.

Disseminated Intravascular Coagulopathy (DIC)
What Went Wrong?
DIC is a complex, serious disorder of the vascular system where massive clot-
ting factors are stimulated and used up. Since the body cannot manufacture
platelets immediately according to need, the patient starts to bleed. So this
syndrome of events is a paradox. Either the intrinsic and/or extrinsic clotting Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
cascade is activated, leading to massive clotting throughout the body. Causes of
DIC include those listed in Table 9–7.

TABLE 9–7 Extrinsic and Intrinsic Causes of DIC
Method of Injury Types
Extrinsic causes Injury of the inner lining of Abruptio placenta
the endothelium expos- Fetal demise
ing the surface to circu-
lating clotting factors Pre-eclampsia and eclampsia
Trauma from burns,
crushing injury
Malignant disease like
leukemia
Intrinsic causes Clotting is activated by Bacterial, fungal, and viral
substances like free infections, especially
radicals, chemical gram-negative sepsis
irritants, and inflammatory Acute hemolytic blood
mediators like necrosis reaction
factor and cytokines
Trauma from internal injuries
can result in this as well