HISTORY. Obtain a history specific to the precipitating disorder. If the patient is alert, ask if he or she has any chest, joint, back, or muscle pain, which is often severe in DIC. Recognize that the patient may be confused and disoriented as a result of blood loss or the underlying condition, so that historic information may not be accurate.

PHYSICAL EXAMINATION. Assess the patient's skin for any petechiae, ecchymoses, hematoma formation, epistaxis, bleeding from wounds, vaginal bleeding in the labor or postpar-tum patient, hematuria, conjunctival hemorrhage, and hemoptysis. Bruising can occur anywhere in the body. In addition, assess the patient's skin for bleeding or oozing at any intravenous (IV), intramuscular (IM), or epidural sites. Assess the patient's vital signs. If the patient is hypov-olemic, expect to find a decreased blood pressure, rapid thready pulse, and increased respiratory rate. The patient may be restless, agitated, and confused. Measure the abdominal girth to obtain a baseline for further assessments. Note the presence of oliguria and compare current urine output with previous readings.

PSYCHOSOCIAL. Patients may feel a sense of "impending doom," and the family is probably fearful of losing a loved one. This situation is intensified if the patient is a young pregnant or newly delivered mother. Note that increased blood or bleeding is associated with death and dying for many people; the visible presence of multiple bleeding or oozing sites and the need for multiple transfusions may also be a source of anxiety.

Diagnostic Highlights

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