Laboratory value findings in a patient with disseminated intravascular coagulopathy (DIC)-

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Medical & Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Disseminated Intravascular Coagulation (DIC) is a consumptive coagulopathy, meaning it uses up the body's clotting components.
The widespread formation of microthrombi throughout the circulatory system leads to the rapid consumption and depletion of platelets.
This results in thrombocytopenia (a platelet count below the normal range), which is a cardinal laboratory sign of DIC.
The low platelet count, along with the depletion of clotting factors, contributes significantly to the risk of severe bleeding in patients with DIC.

Option A: Prothrombin time (PT) is prolonged (increased) in DIC, not reduced. This occurs because essential clotting factors, including prothrombin (Factor II), are consumed in the widespread coagulation process, leading to a longer time for clot formation.
Option B: Fibrinogen levels are low (hypofibrinogenemia) in DIC. Fibrinogen is the soluble precursor to fibrin, the protein that forms the meshwork of a blood clot. In DIC, fibrinogen is rapidly converted to fibrin and consumed, causing its plasma concentration to fall.
Option C: Levels of fibrin degradation products (FDPs), including D-dimer, are significantly elevated in DIC. As the body attempts to break down the numerous microthrombi through fibrinolysis, these breakdown products are released into the circulation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Laboratory findings in Disseminated Intravascular Coagulation (DIC) to guide bedside assessment, documentation, and the next nursing action.
Nurses must meticulously monitor patients with or at risk for DIC for any signs of bleeding, such as oozing from IV sites, petechiae, ecchymosis, hematuria, or gastrointestinal bleeding.
It is critical to track laboratory trends (platelets, PT/INR, aPTT, fibrinogen, D-dimer) to assess the progression of DIC and the effectiveness of treatment, which often includes addressing the underlying cause and providing blood product support.
Nursing care involves implementing strict bleeding precautions, such as using soft-bristled toothbrushes, avoiding unnecessary venipuncture, applying prolonged pressure to puncture sites, and protecting the patient from falls or injury.

How to Approach the Question

First, identify the core concept of the question, which is Disseminated Intravascular Coagulation (DIC).
Recall the fundamental pathophysiology of DIC: it is a 'consumption coagulopathy.' This keyword 'consumption' is the key to solving the question.
Think about what is being consumed: platelets and clotting factors (like prothrombin and fibrinogen).
Evaluate each option based on the concept of consumption:
If platelets are consumed, their count will be low. This matches 'Thrombocytopenia'.
If clotting factors are consumed, it will take longer for blood to clot, so PT will be prolonged (high), not reduced.

Concept Tested & Keywords

Concept Tested: Laboratory findings in Disseminated Intravascular Coagulation (DIC)
Stem keywords: Laboratory value, disseminated intravascular coagulopathy, DIC
Lead-in keywords: findings
Negative lead-in flag: false

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