Which of the clients would the nurse identify as being at the greatest risk for developing disseminated intra… - AIIMS Bhatinda NO - 2019

AIIMS Bhatinda NO - 2019

Obstetrics & Gynaecology

Medium

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

The client diagnosed with dead fetus syndrome (prolonged retention of a dead fetus in utero) is at the highest risk for developing DIC.
The underlying mechanism is the gradual release of thromboplastin, a potent clotting factor, from the degenerating fetal and placental tissues into the maternal circulation.
This influx of thromboplastin triggers a massive, systemic activation of the coagulation cascade, leading to the consumption of platelets and clotting factors, which culminates in DIC.
While other conditions are risk factors, the direct and sustained release of thromboplastic material makes dead fetus syndrome a classic and very high-risk antecedent to DIC.

Option A: A blood loss of 500 ml after a vaginal delivery meets the definition of postpartum hemorrhage (PPH), but it is not considered massive. While severe PPH is a risk factor for DIC, a 500 ml loss is a significantly lower risk compared to dead fetus syndrome.
Option C: Mild pre-eclampsia is associated with endothelial dysfunction, but the risk of it progressing to DIC is low. Severe pre-eclampsia or HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) would present a much higher risk for DIC.
Option D: This describes a normal, uncomplicated delivery. A baby weighing 3.5 kg is of average weight, and there are no other risk factors mentioned that would predispose this client to DIC.

Clinical Relevance

Nursing practice connection: Knowing Identification of the greatest risk factor for Disseminated Intravascular Coagulation (DIC) in an obstetric population helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse must prioritize monitoring for DIC in any patient with a retained dead fetus. Key assessments include checking for bleeding from gums, nose, IV sites, and the GI/GU tract, as well as observing for petechiae and ecchymosis.
Essential nursing interventions include frequent monitoring of vital signs for signs of shock, serial monitoring of coagulation studies (platelets, fibrinogen, PT/aPTT, D-dimer), and preparing for potential blood product transfusion.
Patient safety is paramount. The nurse should ensure that blood products are readily available and that there is a plan for prompt delivery of the fetus to remove the source of the thromboplastin.

How to Approach the Question

First, identify the core concept of the question, which is to determine the greatest risk for Disseminated Intravascular Coagulation (DIC) among pregnant clients.
Recall the major obstetric causes of DIC. These include placental abruption, amniotic fluid embolism, severe pre-eclampsia/HELLP syndrome, sepsis, and retained dead fetus (IUFD).
Evaluate each option based on this knowledge. Compare the relative risk posed by each scenario.
Option A involves a 500 ml blood loss, which is PPH but not necessarily severe.
Option B, 'dead fetus syndrome,' directly relates to the classic cause of DIC from retained tissue.
Option C specifies 'mild' pre-eclampsia, which carries a much lower risk than severe forms.

Concept Tested & Keywords

Concept Tested: Identification of the greatest risk factor for Disseminated Intravascular Coagulation (DIC) in an obstetric population.
Stem keywords: greatest risk, disseminated intravascular coagulation, DIC, nurse, clients
Lead-in keywords: Which
Negative lead-in flag: false

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E6 Obstetrics Williams p. 89-95