Nursing Diagnosis for Disseminated Intravascular Coagulation (DIC)

Disseminated Intravascular Coagulation (DIC) can occur in virtually all persons without distinction of race, sex, and age. The symptoms of DIC, generally strongly associated with the underlying disease, plus additional symptoms due to thrombosis, embolism, organ dysfunction, and bleeding. Disseminated Intravascular Coagulation (DIC) is a complex diagnosis that involves a component of blood clots as a result of other diseases that precede.



Definition of Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation is a syndrome characterized by bleeding / clotting disorders are caused by the formation of plasmin which is a specific plasma protein that is active as a fibrinolytic in getting the circulation (Healthy Cau's)

In general, disseminated intravascular coagulation (DIC) is defined as a complex disorder or blood clotting disorder due to excessive stimulation of procoagulant and anticoagulant mechanisms in response to injury (Yan Euphrates Sembiring, Paul Tahalele)


Etiology of Disseminated Intravascular Coagulation

Bleeding occurs due to the following matters:

• Hypofibrinogenemia.
• Thrombocytopenia (a common cause of abnormal bleeding, can occur due to insufficient production of platelets by the bone marrow, or due to increased destruction of platelets).
• Circulating anticoagulant in blood circulation.
• Excessive fibrinolysis.

Diseases that predispose to DIC is as follows:

• Infections (dengue hemorrhagic fever, sepsis, meningitis, severe pneumonia, tropical malaria, rickettsial infection by some types). Where bacteria release endotoxins (a substance that causes clotting activation).
• Pregnancy complications (placental abruption, intrauterine fetal death, amniotic fluid embolism).
• After surgery (lung surgery, bypass cardiopulmonal, lobectomy, gastrectomy, splenectomy).
• malignancies (prostate carcinoma, lung carcinoma, acute leukemia).
• Acute liver disease (acute liver failure, obstructive jaundice).
• Palepasan severe trauma occurs to the network with a large number of blood vessels. The release coincides with hemolysis and endothelial damage that would release blood clotting factors in large numbers then activates blood coagulation systemically.

Clinical Manifestations of Disseminated Intravascular Coagulation

1. Bleeding from puncture area, wounds and mucous membranes in patients with shock, obstetric complications, sepsis (widespread infection), or cancer. If bleeding occurs under the skin, vascular lesions will appear.
2. Changes in the level of consciousness.
3. Cyanosis and tachypnea (increased respiratory rate) due to poor tissue perfusion and oxygenation are common. Splotches on the skin indicates tissue ischemia.
4. Hematuria (blood in the urine) due to bleeding or oliguria (decreased urine output) due to poor perfusion.

Complication

• Clot which formed much will cause obstruction or hindrance of blood flow in all organs of the body. Organ failure can occur at large. The mortality rate of more than 50%.
• Shock.
• Acute tubular necrosis.
• Pulmonary edema.
• Chronic renal failure.
• Convoluted.
• Coma.

Assessment for Disseminated Intravascular Coagulation (DIC)

1. Predisposing factors:

• Septicemia (most common cause).
• Obstetric complications.
• Severe and extensive burns.
• Neoplasia.
• Liver disease.
• Trauma.

2. Patterns of health functions
a. Health Perception and Management

• nausea, vomiting
• minus liquid
• Ht (if that exit the plasma, hematocrit rise; wrote out all that blood, Ht down)

b. Nutritional metabolic

• Impaired elimination patterns, both bladder and bowel movements. In bowel constipation or diarrhea occurs. Melena
• Hematuri
• Hematemesis

c. Activity exercise

• Changes in vital signs, SaO2 (descending)
• The need for assistance to meet their daily needs.
• Weak muscle contraction.

d. Sleep rest

• Changes meet the needs sleep (quality and quantity).

e. Cognitive-perceptual

• abdominal pain; pain, coldness in the fingers accompanied by numbness and tigling.

f. Role relationship

• With the long treatment, there will be obstacles in carrying out its role as before.

g. Sexuality reproductive

• Decreased sexual function
• Changes in menstrual patterns

h. Value-Belief Pattern

• Religious or cultural beliefs influence the selection of treatment.

Nursing Diagnosis for for Disseminated Intravascular Coagulation (DIC)

1) Ineffective Tissue Perfusion r / t disruption of blood circulation.

2) Risk for fluid volume deficit r / t bleeding.

3) Acute pain r / t tissue trauma.

4) Anxiety r / t threat of death from chronic diseases suffered...

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