-tachycardia
-reduced kidney function
-bowel necrosis
QUESTION
Intravascular coagulation treatment
Answer:
anticoagulants (depending on stage),
clotting factors if hemorrhaging,
IV antibiotics.
QUESTION
Syndrome of Inappropriate Antidiuretic Hormone<\/li>\n<\/ul>\n\n\n\n
Answer:<\/p>\n\n\n\n
- \n
- excessive amounts of water that results in hyponatremia
QUESTION
SIAH S\/S
Answer:
Hyponatremia
Weakness
muscle cramps
Anorexia
Polyuria
Polydipsia
Myalgia (muscle pain & ache)
loss of appetite
fatigue
weight gain
confusion
Weakness
Coma
Seizure
death
QUESTION
SIAH Treatment
Answer:
Fluid correction
Furosemide therapy
Correction of serum sodium imbalance
QUESTION
SIAH Intervention<\/li>\n<\/ul>\n\n\n\nAnswer:
Monitor I&O
Monitor lab values
Implement seizure precautions
Manage comfort
QUESTION
Spinal cord compression
Answer:
Tumor compression of spinal cord
QUESTION
Spinal cord compression S\/S
Answer:
symptoms vary depending on location and severity of compression
Late paraplegia
Incontinence
Loss of sensory function
New onset backpain that worsens when laying dow
Constipation
QUESTION
Spinal cord compression Treatment
Answer:
Radiation
Surgical intervention
QUESTION
Spinal cord compression Interventions
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<\/a><\/figure>\n\n\n\nA client has disseminated intravascular coagulation\u200b (DIC). Which clinical manifestation should the nurse expect to\u200b observe? (Select all that\u200b apply.)<\/p>\n\n\n\n
A. Joint pain
B. Hypertension
C. Petechiae
D. Bleeding
E. Clotting
A, C, D, E<\/p>\n\n\n\n\u200bRationale: Manifestations of DIC include\u200b bleeding, clotting,\u200b petechiae, and joint pain.\u200b Hypotension, not\u200b hypertension, is also a manifestation of DIC.<\/p>\n\n\n\n
The client with which condition is at the greatest risk of developing acute disseminated intravascular\u200b coagulation?<\/p>\n\n\n\n
A. Gunshot wound to the distal arm
B. Bacterial pneumonia treated with antibiotics
C. Aortic aneurysm
D. Third-degree burns and septic shock
D. Third-degree burns and septic shock<\/p>\n\n\n\nRationale: Clients with severe sepsis and septic shock are at the greatest risk for developing acute DIC. Aortic aneurysm is a risk for chronic DIC. Gunshot wounds and bacterial infections are a risk for\u200b DIC, but sepsis is a greater risk.<\/p>\n\n\n\n
The nurse concludes that both clotting and bleeding occur during disseminated intravascular coagulation\u200b (DIC) due to which\u200b process?<\/p>\n\n\n\n
A. Excess release of thrombin uses up clotting factors quicker than they can be replaced.
B. Only clotting occurs during\u200b DIC, as clotting factors are replaced and available to prevent excess bleeding.
C. Activation of intrinsic pathways results in release of excess clotting factors.
D. Tissue damage from bleeding uses up clotting factors quicker than they can be replaced.
\u200bA. Excess release of thrombin uses up clotting factors quicker than they can be replaced.<\/p>\n\n\n\nRationale: Widespread activation of either the intrinsic or the extrinsic pathways results in excess release of thrombin. Thrombin and emboli cause tissue and organ damage. Clotting factors are consumed faster than they are\u200b replaced, leading to excessive bleeding.<\/p>\n\n\n\n
Disseminated intravascular coagulation\u200b (DIC) is triggered by an injury or agent that activates the clotting cascade. Which condition should the nurse identify as a trigger for the clotting\u200b cascade?
(Select all that\u200b apply.)<\/p>\n\n\n\nA. Placenta previa
B. Acute leukemia
C. Acute glomerulonephritis
D. Head injury
E. Bacterial infection
B, C, D, E<\/p>\n\n\n\nRationale: Tissue damage such as head\u200b injury, abruptio\u200b placenta, and acute leukemia can trigger DIC. Vessel damage such as acute glomerulonephritis can trigger DIC.\u200b Infections, bacterial or\u200b viral, can also trigger DIC. Placenta previa is not directly associated with DIC.<\/p>\n\n\n\n
The nurse suspects that a patient who has severe sepsis now has disseminated intravascular coagulation\u200b (DIC). Which\u200b finding, if\u200b observed, helps confirm this\u200b suspicion?<\/p>\n\n\n\n
A. Bradycardia
B. Clear breath sounds
C. Petechiae
D. Polyuria
\u200bC. Petechiae<\/p>\n\n\n\nRationale: Petechiae is a symptom of DIC due to the impaired clotting mechanism leading to bleeding and impaired tissue perfusion. Oliguria or anuria would be\u200b expected, as would tachycardia. Decreased breath\u200b sounds, tachypnea, and pleural friction rub are clinical manifestations of DIC.<\/p>\n\n\n\n
The nurse is preparing an educational program about disseminated intravascular coagulation\u200b (DIC). Which condition should the nurse include as a risk factor for the development of this\u200b condition?
(Select all that\u200b apply.)<\/p>\n\n\n\nA. Fetal demise
B. Primigravida
C. Preeclampsia
D. Prolonged labor
E. Septic abortion
\u200bA, C, E<\/p>\n\n\n\nRationale: Pregnant clients are at risk for the development of acute DIC from the complications of\u200b preeclampsia, placental\u200b abruption, fetal\u200b demise, amniotic fluid\u200b embolism, and septic abortion. Prolonged labor and primigravida are not considered risk factors for the development of DIC.<\/p>\n\n\n\n
The nurse is caring for a client with suspected disseminated intravascular coagulation\u200b (DIC). Which diagnostic test result supports the diagnosis of\u200b DIC?<\/p>\n\n\n\n
A. Decreased\u200b D-dimer
B. Normal fibrinogen levels
C. Decreased fibrin degradation products
D. Increased platelet count
\u200bB. Normal fibrinogen levels<\/p>\n\n\n\nRationale: Fibrinogen levels may be normal or even decreased in circumstances where elevated levels are expected.\u200b D-dimer will be elevated in both acute and chronic DIC. Decreased platelet count and the presence of schistocytes on the CBC indicate DIC. Fibrin degradation products will be increased as a result of fibrinolysis.<\/p>\n\n\n\n
The nurse assesses a client who has bacterial pneumonia and finds\u200b tachycardia, hypotension,\u200b oliguria, and acrocyanosis of a foot. Schistocytes are found in a complete blood\u200b count, and the\u200b D-dimer is elevated. Which collaborative action should the nurse\u200b anticipate?<\/p>\n\n\n\n
A. Heparin therapy
B. Warfarin therapy
C. Dialysis
D. Foot amputation
A. Heparin therapy<\/p>\n\n\n\n\u200bRationale: The client has signs and symptoms of disseminated intravascular coagulation\u200b (DIC). Low-molecular-weight heparin is used to interfere with the clotting cascade and reduce the consumption of clotting factors by uncontrolled thrombosis. Warfarin is not used to treat DIC. Dialysis and amputation are not indicated at this time.<\/p>\n\n\n\n
The nurse is caring for a client who has signs of acute disseminated intravascular coagulation. Which intervention is\u200b appropriate?
(Select all that\u200b apply.)<\/p>\n\n\n\nA. Elevate the head of the bed.
B. Encourage deep breathing and effective coughing exercises.
C. Encourage ambulation.
D. Continuously monitor oxygen saturation.
E. Administer analgesics and anti-anxiety\u200b medications, as ordered.
A, B, D, E<\/p>\n\n\n\nRationale: Microclots in the pulmonary vasculature can cause impaired gas exchange. Bedrest reduces oxygen demand and cardiac workload. The head of the bed is elevated to promote diaphragmatic movement and alveolar ventilation. Monitoring oxygenation saturation measures gas exchange. Controlling pain and anxiety reduces respiratory rate and improves the quality of ventilation and gas exchange. Deep breathing and effective coughing clear airways and improve alveolar ventilation and oxygenation.<\/p>\n\n\n\n
A client with a diagnosis of chronic disseminated intravascular coagulation\u200b (DIC) is being discharged home. Which statement by the client requires the nurse to follow\u200b up?<\/p>\n\n\n\n
A. \u200b”I should call my healthcare provider if I have excessive\u200b bleeding.”
B. “The effects of the disorder will resolve\u200b completely.”
C. “I will need to be on a portable infusion pump of\u200b heparin.”
D. “I understand home healthcare will visit me to monitor the\u200b infusion.”
\u200bB. “The effects of the disorder will resolve\u200b completely.”<\/p>\n\n\n\nRationale: Even though the immediate crisis is\u200b resolved, the client may continue to have effects from\u200b DIC, such as impaired tissue integrity. Subcutaneous injections of heparin or a portable infusion pump may be required. The healthcare provider should be called for excessive bleeding or recurrent clotting. A referral should be made to home healthcare for IV maintenance assistance.<\/p>\n\n\n\n
The nurse is evaluating the lab results for a client suspected of having disseminated intravascular coagulation\u200b (DIC). Which laboratory finding supports the\u200b diagnosis? (Select all that\u200b apply.)<\/p>\n\n\n\n
A. Increased fibrin degradation products
B. The presence of schistocytes
C. Shortened pro-thrombin time
D. Decreased platelet count
E. Elevated hemoglobin
A, B, D<\/p>\n\n\n\n\u200bRationale: Laboratory findings that support a diagnosis of DIC include the presence of\u200b schistocytes, a decreased platelet\u200b count, and an increase in fibrin degradation products or fibrin split products. The client with DIC would not have an elevated hemoglobin or shortened prothrombin time.<\/p>\n\n\n\n
The nurse is caring for a client with disseminated intravascular coagulation\u200b (DIC). Which collaborative therapy should the nurse include in the\u200b client’s care?\u200b (Select all that\u200b apply.)<\/p>\n\n\n\n
A. Monitoring for organ damage
B. Monitoring need for mechanical ventilation
C. Monitoring intracranial pressure
D. Monitoring client allergies
E. Monitoring for intracranial bleeding
\u200bA, B, C, E<\/p>\n\n\n\nRationale: Care of the client with DIC may include mechanical ventilation and control of organ damage from reduced tissue perfusion. Clients with DIC may develop intracranial bleeding resulting in altered levels of\u200b consciousness, damage to the respiratory\u200b center, and increased intracranial pressure. Monitoring for client allergies is an independent nursing intervention that would be implemented for all clients.<\/p>\n\n\n\n
Which therapy will the healthcare provider prescribe for the client with chronic disseminated intravascular coagulation\u200b (DIC)?<\/p>\n\n\n\n
A. Fresh frozen plasma
B. Aspirin regimen
C. Heparin
D. Whole blood
C. Heparin<\/p>\n\n\n\nRationale: Heparin may be administered by continuous infusion using a portable pump if needed for\u200b long-term therapy, as in the client with chronic DIC.<\/p>\n\n\n\n
The nurse is caring for a client diagnosed with placental abruption who now has disseminated intravascular coagulation\u200b (DIC). Which statement correctly explains why this client is at risk for\u200b DIC?<\/p>\n\n\n\n
A. Septic shock due to blood loss.
B. Amniotic fluid embolism.
C. Onset of infection.
D. Leaked fluid is similar to a coagulation factor.
\u200bD. Leaked fluid is similar to a coagulation factor.<\/p>\n\n\n\nRationale: Leakage of fluid similar to a coagulation factor from a placental abruption can trigger DIC. Onset of infection and amniotic fluid embolism are not the greatest risk. Hemorrhagic shock is caused by blood\u200b loss, not septic shock.<\/p>\n\n\n\n
The nurse is caring for a client who has not responded to platelet and whole blood transfusions as treatment for acute disseminated intravascular coagulation\u200b (DIC). Which action should the nurse anticipate\u200b next?<\/p>\n\n\n\n
A. Unfractionated heparin therapy
B. End-of-life protocol
C. Low-molecular-weight heparin therapy
D. Coumadin therapy
C. Low-molecular-weight heparin therapy<\/p>\n\n\n\n\u200bRationale: Low-molecular-weight heparin has a lower risk of bleeding and organ failure when treating clients with DIC as compared to unfractionated heparin. Coumadin is not appropriate.\u200b End-of-life protocol is not indicated at this time.<\/p>\n\n\n\n
The nurse assesses a client who is diagnosed with chronic disseminated intravascular coagulation\u200b (DIC). Which finding should the nurse suspect as the probable cause of the\u200b client’s diagnosis?<\/p>\n\n\n\n
A. History of nosebleeds
B. Chronic constipation
C. History of a cancerous tumor
D. Diminished bowel sounds
\u200bC. History of a cancerous tumor<\/p>\n\n\n\nRationale: Chronic DIC develops\u200b slowly, over weeks or months. It lasts longer and typically is not diagnosed as quickly as acute DIC. Chronic DIC causes excessive blood\u200b clotting, but usually does not lead to bleeding. Nosebleeds would be unlikely with chronic DIC. Cancer is the most common cause of chronic DIC. Constipation and diminished bowel sounds are not generally associated with chronic DIC.<\/p>\n\n\n\n
The nurse is assessing a client suspected of having acute disseminated intravascular coagulation\u200b (DIC). Which assessment finding supports the\u200b diagnosis? (Select all that\u200b apply.)<\/p>\n\n\n\n
A. Pale, cool extremities
B. Bleeding at the IV insertion site
C. Multiple bruises on various skin surfaces
D. A history of thyroid disease
E. A history of a malignant tumor
\u200bA, B, C<\/p>\n\n\n\nRationale: Bleeding may result in multiple bruises on various skin surfaces and mucous membranes. Puncture sites such as those from injections or intravenous infusions may ooze blood when a client has DIC.\u200b Pale, cool extremities may be noted when a client is bleeding because blood is diverted back to major organs to maintain oxygenation. History of a malignant tumor supports the diagnosis of chronic DIC. Thyroid disease is not a known risk factor for acute DIC.<\/p>\n\n\n\n
Which risk factor should the nurse look for while performing an assessment on a client with a diagnosis of disseminated intravascular coagulation\u200b (DIC)? \u200b (Select all that\u200b apply.)<\/p>\n\n\n\n
A. Hematological disorder
B. History of abnormal bleeding episodes
C. Recent abortion
D. History of diabetes mellitus
E. Presence of known malignant tumor
A, B, C, E<\/p>\n\n\n\nRationale: Risk factors include recent abortion\u200b (spontaneous or\u200b therapeutic), current\u200b pregnancy, presence of known malignant\u200b tumor, history of abnormal bleeding\u200b episodes, and a history of hematologic disorders. Diabetes mellitus is not considered a risk factor for the development of DIC.<\/p>\n\n\n\n
The nurse is assessing a client suspected of having chronic disseminated intravascular coagulation\u200b (DIC). Which finding supports the\u200b diagnosis?
(Select all that\u200b apply.)<\/p>\n\n\n\nA. The client has a history of cancer.
B. Development of DIC has taken months.
C. The client has multiple bruises on his skin.
D. The client has excessive blood clotting.
E. The\u200b client’s IV infusion site continues to ooze blood.
A, B, D<\/p>\n\n\n\nRationale: Chronic DIC may develop over a period of months or weeks and typically lasts longer. Chronic DIC is not diagnosed rapidly as in the case of the acute form. Excessive blood\u200b clotting, as opposed to\u200b hemorrhage, is usually seen with chronic DIC. Cancer is the most common cause of chronic DIC. Multiple bruises and an oozing IV site would be noted most often in clients with acute DIC.<\/p>\n\n\n\n
The nurse determined that a client with disseminated intravascular coagulation is experiencing pain. Which intervention should the nurse\u200b provide?
(Select all that\u200b apply.)<\/p>\n\n\n\nA. Using standard pain scale to evaluate and monitor pain and analgesic effectiveness
B. Applying cool compresses to painful joints
C. Handling extremities gently
D. Encouraging frequent turning and coughing
E. Continuously monitoring oxygen saturation and oxygen administration as ordered
\u200bA, B, C<\/p>\n\n\n\nRationale: Interventions for managing pain include using a standard pain scale to evaluate and monitor pain and analgesic\u200b effectiveness, handling extremities\u200b gently, and applying cool compresses to painful joints. Monitoring oxygen saturation and encouraging frequent turning and coughing will not assist the client with treatment of pain. These interventions are more appropriate for promoting effective tissue perfusion.<\/p>\n\n\n\n