Primary Nursing Diagnosis

Fluid volume deficit related to blood loss

OUTCOMES. Fluid balance; Circulation status; Cardiac pump effectiveness; Hydration

INTERVENTIONS. Bleeding reduction; Fluid resuscitation; Blood product administration; Intravenous therapy; Circulatory care; Shock management

298 Disseminated Intravascular Coagulation

^ PLANNING AND IMPLEMENTATION Collaborative

Since DIC always occurs in association with another condition, medical treatment focuses on correcting the underlying disorder. In addition, the physician seeks to return the patient to normal hemostasis. Active bleeding is managed by blood component therapy. To ascertain the success of cell and factor replacement, constant surveillance of laboratory values is critical to determine which blood components should be administered. In general, packed red blood cells are used to improve oxygen delivery by increasing the hemoglobin content of the blood. Fresh-frozen plasma replaces many of the clotting factors, whereas cryoprecipitate is the best source of fibrinogen and factors V VIII, and XIII. Platelet transfusion is used when the platelet count falls below 100,000/mm3.

If the patient is critically ill, the physician may place a pulmonary artery catheter (PAC) to monitor the patient's hemodynamic status. Note that increased bleeding tendencies make the insertion time of central access devices important; central catheters such as a PAC should be placed when the coagulation profile has been corrected with blood component therapy to prevent dangerous bleeding into the cardiopulmonary system.

If the patient is pregnant, fetal monitoring is continuous; notify the physician of late decelerations, decreased variability, or bradycardia. Keep the patient on her left side, and administer oxygen by mask at a rate of 10 L per minute. Turn and reposition the patient frequently and gently to avoid further bleeding. The goal is to keep the fetus oxygenated while stabilizing the mother so that a cesarean section can be done.

Pharmacologic Highlights

Medication or

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