NURSING PROCESS: THE PATIENT WITH DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
Nurses need to be aware of patients who are at risk for DIC. Sep-sis and acute promyelocytic leukemia are the most common causes of DIC. Patients need to be assessed thoroughly and fre-quently for signs and symptoms of thrombi and bleeding and monitored for any progression of these signs (see Table 33-7).
Based on the assessment data, major nursing diagnoses for the pa-tient with DIC may include the following:
• Risk for deficient fluid volume related to bleeding
• Risk for impaired skin integrity related to ischemia or bleeding
• Potential for excess fluid volume related to excessive blood/ factor component replacement
• Ineffective tissue perfusion related to microthrombi
• Anxiety and fear of the unknown and possible death
Collaborative problems include the clinical conditions that pre-cipitated the DIC. Based on the assessment data, potential com-plications may include:
• Renal failure
• Pulmonary embolism or hemorrhage
• Altered level of consciousness
• Acute respiratory distress syndrome
Major patient goals include maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, en-hanced coping, and absence of complications (see Plan of Nurs-ing Care).
See Plan of Nursing Care: The Patient with Disseminated In-travascular Coagulation.
Despite aggressive measures, the lack of renal perfusion may result in acute renal failure, sometimes necessitating dialysis. Placement of a large-bore dialysis catheter is extremely hazardous in this pa-tient population and should be accompanied by adequate platelet and plasma transfusions.
See the Plan of Nursing Care for evaluation and expected out-comes for the patient with DIC.
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