Question

. A patient admitted to the hospital with abruptio placentae is exhibiting manifestations of disseminated intravascular coagulation (DIC).

·  Discuss medical management the nurse would expect for a patient with DIC.

·  Describe the role of heparin in the management of DIC.

·  Identify one nursing diagnosis that would be relevant for this patient. Include one (1) client-focused goal and 3-5 nursing interventions.

Answer 1

Sudden rupture of placenta resulting in bleeding is referred to be abruptio placenta in pregnancy. Normally the blood after bleeding should clot and stop bleeding but in case of disseminated intravascular coagulation these clots formed inside travels through the blood vessels and leading to further bleeding and complications.

● Medical management

• Fresh frozen plasma to initiate the clotting factors responsible for its normal function of coagulation
• Infusion of human activated protein C to be administered
• Platelets to improve clotting and preventing bleeding when the platelets are below 50000
• Prothrombin administration
• Unfractiomed heparin infusion in continuous form to prevent acral ischemia

● The main role of heparin in DIC treatment is there are high chances for thrombus formation in the artery or vein ,sacral ischemia and skin infarction can occur and complicate the condition. The therapeutic doses of heparin in an infractions low continuous dose can decrease the complications because of its very short half life.

● Ineffective tissue perfusion related to impaired coagulation as evidenced by short capillary refilling,dyspnea,decre areas ed saturation

Client focused goal

To maintain normal oxygen saturation

Nursing intervention

• Monitor the patient's vital signs to get the baseline data and plan for care
• Position the patient in Fowler's position to improve lung capacity
• Administer heparin to prevent further clotting as oer order
• Assess for signs of chest pain,dyspnea to rule out thromboembolism
• Monitor the conciousness of the patient to rule out any hypoxia due to decrease oxygen supply to brain