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?
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System