Page 439 - Critical Care Nursing Demystified

424 CRITICAL CARE NURSING DeMYSTIFIED

Regardless of cause, the end result is the same: massive use of clotting activa-
tion and clotting factors cannot be replaced quickly enough by the liver and bone
marrow. This ultimately leads to bleeding and possible hemorrhagic shock.
Tissue hypoxia also results as clots formed in smaller capillaries and blood
vessels prevent delivery of nutrients to the cells and organs.
DIC can be recognized by three basic abnormalities that occur:

1. Massive clotting resulting in organ damage from tissue hypoxia
2. Accelerated production of natural anticoagulants
3. Splitting apart of existing clots

Prognosis
DIC carries a high mortality rate, especially in the elderly and in patients with
coexisting medical problems.

Interpreting Laboratory/Diagnostic Results
The following is an accounting of the levels of coagulation studies in DIC.

Decreased Levels Increased Levels 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.
Platelets counts FDP
Fibrinogen levels PT and PTT
Factor V D-dimer
Factor VIII BUN
Hct and Hgb Creatinine

Diagnostic Studies
There is no diagnostic study that confirms DIC. These studies look for possible
complications due to clotting then hemorrhage.
ECG – Can show changes indicative of MI (Q waves, ST elevation, T wave
inversion) if circulation to heart is decreased
Stools – May be positive for occult blood
CT scan – Can show evidence of stroke if there is cerebral hemorrhage

Hallmark Signs and Symptoms
Signs and symptoms affect many body systems and reflect tissue hypoxia
and bleeding, which occur with DIC. These include those found by systems in
Table 9–8. No one sign or symptom can tell the critical care nurse that DIC is