Disseminated Intravascular Coagulation (DIC)

In this video, we're going to walk through Disseminated Intravascular Coagulation, or dic. We'll go over the pathophysiology, the symptoms and the treatment for it. So you'll know what to look for at clinical and you'll be able to get these questions right on your nursing school exams. Let's dive in now before we dive in, I want to make sure that you know about this free critical thinking cheat sheet that I have for you. We'll put the link to it in the description below for you to snag it and use it while you study. It will be really, really helpful for you go through nursing school and it will help you be more prepared for your nursing exams because you're always going to be tested on critical thinking. So be sure to snag that after watching this video. So there's two things that you need to know about DIC right from the get go. Number one, it does not just happen on its own. It's always caused by something else like a critical illness like cancer or sepsis. We'll talk more about the causes of DIC in a minute, but that's a huge thing to know right up front. The second thing to know is that DIC is a medical emergency and needs to be caught and treated immediately or it is fatal. So just keep these two things in mind and remember them for your exams because they are really, really important to know. So what's going on with the pathophysiology of dic? Well, DIC is when there is an overstimulation of the clotting cascade and the clotting process in the blood happens systemically all throughout the body and it's uncontrollable. There's a lot of blood clotting happening uncontrollably which compromises blood flow to the organs in the tissues. This is a medical emergency and it needs to be reversed quickly. Like we just mentioned, DAC doesn't just happen on its own, but it is a complication from other severe and acute illnesses such as major infections, cancer, sepsis, trauma, reactions to a blood transfusion, or in some cases pregnancy complications. So here's what happens. We'll put it into simple steps for you to follow to help you learn it faster. As you know, I always love to put pathophysiology and these more difficult concepts into step by step processes for you to follow. This is exactly how we teach inside the nursing SOS membership community as well. So we'll do that here too. But if you Want more pathophysiology and med surg videos just like this one for the disorders that you need to know about in nursing school, Be sure to to join the community. You're gonna love it my friend. The link is down below in the description for the details. So step number one of this process in DIC is when the clotting cascades are triggered and uncontrollable clotting starts all over the body. This overstimulation of the clotting cascade leads to many micro clots to form and it compromises blood flow to those areas that the blood is supposed to go to. Now this is step number two. There is a reduced flow blood flow to the tissues and the organs. It's often compromising blood flow to major organs and since the clots form all over the body, it can lead to multi system organ failure from a lack of blood flow. And then in step number three, if DIC progresses, the body will use up all of its platelets, the fibrinogen and the clotting factors and it can no longer clot which will result in hemorrhaging, which is now step number four. So, so since there are small clots forming all over the body, reducing blood flow to the organs and the clotting cascade and the factors are being consumed for those clots, the body is also hemorrhaging. So during dic, the clotting cascade is an overdrive and the blood is clotting uncontrollably all throughout the body. This compromises blood flow to the organs and the tissues and depletes the clotting factors that fibrinogen and the platelets and leading to hemorrhage. Now remember, our first key point of this DIC doesn't just happen on its own, it is triggered by another acute and serious illness. So identifying the symptoms of DIC in patients who might be at risk is really important. So let's walk through the signs and symptoms that you should keep an eye out for in your patients who are at risk for developing dic. Like we said, these would be patients who have cancer, sepsis, major infections, trauma or having a transfusion reaction, or even some pregnancy complications. Acute organ failure, dyspnea or shortness of breath, or active and uncontrolled bleeding from openings in the body are all signs that DIC could be occurring. These patients are usually very sick to begin with, so monitoring their organ function, their respiratory status and for any bleeding is very important. An increased PT or PTT would demonstrate prolonged bleeding time and this along with A decrease in platelets and fibrinogen levels would indicate depletion of the clotting cascade and potential development of dic. In evaluation of the labs, D dimer will also be elevated, demonstrating clot formation. Like we said, DIC is a medical emergency. So keeping an eye out for these signs and symptoms mean very vigilant will be really important as you care for your patients who at risk for developing it. Now let's talk about some of the nursing assessments that you should do for patients at risk for dic. These patients are usually very critically ill to begin with, like we said, right? So they should have a thorough head to toe assessment very frequently. And DIC is a medical emergency and it needs to be reversed quickly. So make sure that you catch it early and that you're constantly assessing your patients who are at risk for developing it. In addition to the head to toe assessments, focused respiratory and neurological assessments will be needed to assess for any changes which could indicate small clots forming and the development of dic. Then assessing for changes in their level of consciousness or changes in their respiratory status, such as things like shortness of breath, that will help you really identify if DIC could be possibly occurring. You'll want to assess for any modeling color changes or temperature changes in their extrem remedies which could indicate that clots are forming in the body. Then any changes in vital signs that might indicate bleeding or organ failure will also be important too, especially increased heart rate, decreased blood pressure and an increased respiratory rate. You'll assess their prothrombin time, their partial thromboplastin time, their platelet D dimer and fibrinogen levels, as well as renal function to monitor for kidney failure caused by clots and reduced blood flow. It's really important to keep an eye out for any patient who is at risk for it because it can come on really fast and progress really fast. Now let's talk about the treatment for DIC and what nursing interventions you'll do. The main goal of your nursing interventions for DIC is to identify and treat the underlying cause. Remember, it doesn't happen on its own, but takes an event to activate that overstimulation of the clotting cascade. This could be trauma, sepsis, a malignancy, or a pregnancy complication. So the interventions will focus on identifying that cause and treating it while trying to play catch up with that clotting and the hemorrhaging that would be happening. DIC is a medical emergency, like we said, and it can quickly lead to death. So it's really important that it's caught early and reversed as soon as possible. In some cases, if DAC is caught early enough, anticoagulants can be used to stop the initial clotting process. But this can be controversial because there is often hemorrhaging present at the same time because of the depletion of clot, clotting factors and the exhaustion of that clotting cascade. So you could see where this could become a really tricky balance. If we give anticoagulants so the blood can't clot but the patient is hemorrhaging, it will just make it worse. You will need to replace the depleted blood and clotting factors with fresh frozen plasma and platelets. IV fluids can be given to try to replace the fluid and the volume losses, as well as maintain their vital signs, especially their blood pressure, to make sure that the organs can continue to be perfused. All of the clotting will dramatically reduce blood flow to the organs, so helping to replace the blood, the fluid and the clotting factors will really help increase that blood flow and reduce the hemorrhaging. Then IV antibiotics may also be used to help prevent infection and get the patient back on the right track to healing. The key is to catch DIC early and intervene immediately. The faster it can be reversed, the better off the patient will be. Now, if you are struggling to study in nursing school, one of the best things that you can do is learn how to make concept maps. So in this video here, I'm going to walk you through how to make concept maps so you can learn things faster and study more effectively to pass your exams. And if you love this video, write love in the comments below and go become the nurse that God created only you to be. And I will see you over there in that next video.