How would you answer this question?
This morning rapid response is called for Ms. Shepard who was admitted with a urinary tract infection and sepsis. Her blood pressure dropped during the evening hours and she is now hypotensive and is having difficulty breathing. Her IV sites are oozing and there is blood in the urinary catheter. Her physician suspects disseminated intravascular coagulation (DIC). The primary mechanism in the development of DIC is:
a. destruction of platelets by lymphocytic antibodies.
b. destruction of malignant cells through radiation or chemotherapy.
c. formation of heparin antibodies.
d. damage to the endothelium.
The correct answer is "d" damage to the endothelium
Ms. Shepard was admitted with urosepsis and is now developing septic shock and multiple organ dysfunction (MODS). Sepsis causes a systemic inflammatory response (SIRS) that results in vasodilation, causing hypotension, capillary permeability, causing third spacing of fluid, and clotting. The stimulation of clotting in SIRS results in millions of tiny blood clots throughout the body, and depletes platelets leading to bleeding. This is the process of DIC.
DIC can also be initiated by hemorrhage, trauma, or surgery. Regardless of etiology, the common thread in the development of DIC is damage to the endothelium, resulting in activation of the coagulation mechanism, that causes clots and depletes platelets.
Decreased platelet count is one of the first signs that Ms. Shepard will demonstrate. Laboratory findings usually precede clinical observation of occult or frank bleeding, and it is important to evaluate the platelet count in any patient suspected of being at risk for DIC.
Treatment focuses on correcting the underlying condition that caused the endothelial damage -- treat the sepsis, or stop the hemorrhage. Heparin is used in severe cases to stop the initial clotting which will decrease the platelet loss.
Congratulations to Tina Collins who won this week's drawing for an autographed copy of my 101 Tips to Improve Your Nursing Care book!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
PS. I guarantee that you will pass the certification exam. See Certification Central for more information.
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