A nurse is caring for a client who has disseminated intravascular coagulation ✅ Tốt
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Lê Bình Nguyên đang tìm kiếm từ khóa A nurse is caring for a client who has disseminated intravascular coagulation được Update vào lúc : 2022-12-19 19:40:16 . Với phương châm chia sẻ Thủ Thuật về trong nội dung bài viết một cách Chi Tiết Mới Nhất. Nếu sau khi đọc Post vẫn ko hiểu thì hoàn toàn có thể lại phản hồi ở cuối bài để Ad lý giải và hướng dẫn lại nha.Laboratory testing for DIC is appropriate in patients with bleeding or microthrombi in combination with an associated DIC risk factor, including sepsis, obstetric disease, malignancy, and liver disease.
Nội dung chính Show- Criteria for DiagnosisOvert Disseminated Intravascular CoagulationNonovert Disseminated Intravascular CoagulationLaboratory TestingClotting TimesARUP Laboratory TestsWhat is the priority nursing action when caring for a client with disseminated intravascular coagulation?Which intervention would the nurse anticipate for a client with disseminated intravascular coagulation quizlet?How would you treat a patient with intravascular coagulation?What is a supportive treatment for a client with disseminated intravascular coagulation?
Criteria for Diagnosis
Overt Disseminated Intravascular Coagulation
The ISTH has developed a scoring system to aid in the diagnosis of overt DIC using laboratory testing results. This scoring system is appropriate for patients with an underlying disorder known to be associated with DIC. A score of ≥5 is compatible with overt DIC. Repeat testing is important to monitor the dynamic progression of DIC.
ISTH Overt DIC Scoring SystemScore0123Platelet count (k/µL)>10050-100<50—D-dimer (µg/mL FEU)No increase—Moderate increaseStrong increaseFibrinogen (g/L)>1<1——PT (increase in seconds)<33-6>6—Source: Toh, ISTH, 2007Nonovert Disseminated Intravascular Coagulation
There are also nonovert (chronic) forms of DIC that have more subtle coagulopathy. The nonovert DIC scoring system described below is appropriate for patients with an underlying disorder known to be associated with DIC; use repeat testing to determine a patient’s evolving score.
ISTH Nonovert DIC Scoring SystemScore-101Platelet count (k/µL)—>100<100Trend in platelet countIncreasing over timeStableDecreasing over timeD-dimer, (µg/mL FEU)—NormalElevatedTrend in D-dimerDecreasing over timeStableIncreasing over timePT (increase in seconds)—<3>3Trend in PTDecreasing over timeStableIncreasing over timeSource: Toh, ISTH, 2007Laboratory Testing
Platelets
Low platelet count is a key laboratory finding in DIC; however, it is not a specific feature of DIC and may be seen in other conditions. Moderate to low thrombocytopenia (platelet count of 50-100 k/µL) is observed in the majority of patients with DIC, although severe thrombocytopenia (platelet count of <50 k/µL) may also occur. In the early stages of DIC, or when there is significant acute phasing of platelets due to illness, the platelet count may be normal.
D-Dimer
D-dimer is a product of the plasmin degradation of fibrin cross-linked by factor XIIIa (FXIIIa); D-dimer is only produced if thrombin, FXIIIa, and plasmin are active. D-dimer measurement is the best single laboratory test for DIC diagnosis but is not used in isolation. D-dimer concentrations are increased in patients with overt and nonovert (chronic) DIC; however, D-dimer elevation may also occur with trauma, venous thromboembolism, or other conditions. In these conditions, the elevations are usually milder than those seen in DIC. A normal D-dimer level has excellent negative predictive value and generally excludes a diagnosis of DIC. Repeated, sequential measurement of D-dimer concentrations, to capture evolving illness, may provide additional diagnostic information in patients when there is a high clinical suspicion for DIC but the initial D-dimer value is normal or not elevated to the DIC range.
Fibrinogen
Fibrinogen is an acute phase reactant and, despite its ongoing consumption, can remain normal concentrations for a long time after DIC onset. Repeated, sequential measurement of fibrinogen concentrations may provide additional diagnostic information. Fibrinogen remains a component of the ISTH scoring system and can contribute to the overall clinicopathologic picture.
Clotting Times
Because of the consumption of coagulation factors, PT and activated partial thromboplastin time (aPTT) are prolonged in most cases of DIC , although normal or shortened PT and aPTT may also be observed in patients with DIC because of circulating activated clotting factors early in the course of DIC or in chronic DIC. The ISTH scoring system includes evaluation of PT prolongation. Clotting times may also be prolonged in the presence of anticoagulant drugs. Refer to Impacts of Common Anticoagulants on Coagulation Testing for possible interferences with coagulation assays based on the specific drug administered.
ARUP Laboratory Tests
0030057
D-Dimer 0030057
Method
Immunoturbidimetry
0030130
Fibrinogen 0030130
Method
Electromagnetic Mechanical Clot Detection
0030215
Prothrombin Time 0030215
Method
Electromagnetic Mechanical Clot Detection
0030235
Partial Thromboplastin Time 0030235
Method
Electromagnetic Mechanical Clot Detection
2014318
Prolonged Clot Time Reflex Panel 2014318
Method
Electromagnetic Mechanical Clot Detection/Qualitative Hemagglutination/Platelet Agglutination/Microlatex Particle-Mediated Immunoassay
References
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Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009;145(1):24-33.
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Boral BM, Williams DJ, Boral LI. Disseminated intravascular coagulation. Am J Clin Pathol. 2022;146(6):670-680.
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Levi M. Diagnosis and treatment of disseminated intravascular coagulation. Int J Lab Hematol. 2014;36(3):228-236.
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Spiezia L, Boscolo A, Poletto F, et al. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost. 2022;120(6):998‐1000.
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Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2022 infection. Clin Chem Lab Med. 2022;58(7):1131-1134.
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Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2022;18(4):844‐847.
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Iba T, Nisio MD, Levy JH, et al. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ Open. 2022;7(9):e017046.
17096704
Toh CH, Hoots WK, SSC on Disseminated Intravascular Coagulation of the ISTH. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost. 2007;5(3):604-606.
What is the priority nursing action when caring for a client with disseminated intravascular coagulation?
Your priorities of care are to decrease bleeding, monitor for abnormal clotting, and address the underlying cause.Which intervention would the nurse anticipate for a client with disseminated intravascular coagulation quizlet?
A client with disseminated intravascular coagulation (DIC) is experiencing joint pain. Which nursing intervention is appropriate for this client? Explanation: A) Joint pain associated with DIC can be reduced by applying cool compresses to the affected joints to reduce the transmission of pain impulses.How would you treat a patient with intravascular coagulation?
Those treatments are:. Plasma transfusions to reduce bleeding. Plasma transfusion replace blood clotting factors affected by DIC.. Transfusions of red blood cells and/or platelets.. Anti-coagulant medication (blood thinners) to prevent blood clotting..What is a supportive treatment for a client with disseminated intravascular coagulation?
Supportive treatments may include: Plasma transfusions to replace blood clotting factors if a large amount of bleeding is occurring. Blood thinner medicine (heparin) to prevent blood clotting if a large amount of clotting is occurring. Tải thêm tài liệu liên quan đến nội dung bài viết A nurse is caring for a client who has disseminated intravascular coagulation