Disseminated Intravascular Coagulation Case Study (60 min)
Included In This Lesson
Study Tools For Disseminated Intravascular Coagulation Case Study (60 min)
Outline
Mrs. Terry was admitted to the ICU yesterday for severe acute septic shock. She was started on vasopressors and intubated for airway protection. During your morning assessment, you suction her ET Tube and find specks of blood in the sputum. You also note oozing at her PIV site.
What further nursing assessments should you perform?
You notify the provider and Respiratory Therapist (RT). Neither are concerned about the blood specks in the sputum due to a possible traumatic intubation the day before. Two hours later, you and a UAP are turning the patient when you notice a large flank hematoma and petechiae on the patient’s legs, arms, and abdomen. The patient’s left leg feels cool to touch.
What is the significance of the petechiae and flank bruising?
What diagnostic tests would you request from the provider?
You note that Mrs. Terry has even more bleeding from her IV site when you go to draw her blood. Before you can get the results back, the patient begins to vomit blood. You suction her mouth and throat, then the ET Tube and note even more blood secretions from the lungs. After a coughing fit, Mrs. Terry is now oozing blood from her eyes and nose. You immediately call the provider to the bedside and notify your charge nurse of the situation.
What is going on physiologically with Mrs. Terry?
What orders would you anticipate from the provider?
Explain the rationale for these medications. Why give clotting factors AND Heparin?
Over the next 8 hours, you transfuse a total of 6 units of Packed Red Blood Cells (PRBCs), 3 units of FFP, 1 unit of Cryo, and 3 liters of crystalloids. Mrs. Terry’s BP is 92/49, HR 118, Hemoglobin 7.2, Hematocrit 22%, and she is still bleeding from her ET Tube, nose, eyes, IV sites, and now rectally. The provider orders for you to insert a foley catheter to measure I&O.
How should you respond? Why?
During the night, Mrs. Terry develops severe acute kidney injury and is requiring 3 vasopressors. The nephrologist determines that she needs dialysis, but it is not possible because at this point it is not safe to place a Vascular Access Device. Despite continuous treatment, blood transfusions, and administration of clotting factors, Mrs. Terry’s heart stops. You and your coworkers perform CPR for more than 20 minutes, while blood is still coming from Mrs. Terry’s mouth, nose, etc. After 6 minutes in Asystole, the provider calls time of death.
Would you have done anything differently? Why?
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
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- Substance Abuse Disorders
- Bipolar Disorders
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- Concepts of Mental Health
- Eating Disorders
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- Health & Stress
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- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
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- Psychological Disorders
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- Note Taking
- Concepts of Population Health
- Basics of Human Biology