ST.

LUKE’S COLLEGE OF NURSING

1st Semester
School Year: 2020-2021
LEVEL 3 RLE
NCM 112

3RD CASE DISSEMINATED INTRAVASCULAR COAGULATION

A 22-year-old primigravida with pregnancy-induced hypertension and severe anemia with 28 weeks' amenorrhea was referred to Provincial Hospital, on 6 November
2020 at 5 a.m. with severe abdominal pain and bleeding per vagina, which was diagnosed as a case of pregnancy-induced hypertension with abruptio placentae.
Intrauterine fetal death was confirmed on the ultrasound. Initially, the patient was given a tablet of 25 mg misoprostol vaginally and an attempt was made to artificially
rupture the membrane for vaginal delivery; however, the attempt failed and her vitals became unstable.

On physical examination her blood pressure was found to be 150/90 and heart rate was 100 beats/min;
laboratory investigations suggested DIC
Hemoglobin 6.03 g/dl
White blood cell 18 200/mm 3
Blood urea 50.3 mg/dl
Serum creatinine 1.8 mg/dl
Platelet count 78 000/mm 3
Fibrin degradation product more than 5 mcg/ml
D-dimer assay more than 9000 mcg/ml
Serum fibrinogen 94 mg/dl

On catheterization, blood-stained urine was observed; therefore, prompt decision was taken to terminate the pregnancy by lower-segment cesarean section on an
emergency basis. A well informed consent was taken on account of patient's clinical condition.

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General anesthesia was planned, and the patient was attached to all available monitors. She was premedicated intravenously with 0.2 mg glycopyrollate, 8.0 mg
ondansetron, and l50 µg fentanyl. After 3 min of preoxygenation, anesthesia was induced with 350 mg thiopentone and 70 mg succinylcholine intravenously and the
patient was intubated with an endotracheal cuffed tube No.7.0 mm internal diameter and maintained on sevoflurane, 50% nitrous oxide in oxygen. Mechanical
ventilation was instituted after atracurium.

Two units of packed cells (packed cell volume), 4 U of fresh frozen plasma, and 4 U of platelet concentrate were transfused intraoperatively. An intrauterine dead baby
weighing 1.4 kg was delivered and 20 U of oxytocin infusion was started intravenously. Surgery was completed uneventfully, and after extubation the patient was
shifted to the postoperative recovery ward for observation as her urine output was diminished.

Provide for the following LEARNING PACKETS

I. PATHOPHYSIOLOGY
II. DIAGNOSING THE DISEASE/discuss
III. CORRELATE DOCTOR’S ORDER TO LABORATORY RESULTS TO PT’S S/SX (PATHOPHY)
IV. FORMULATION OF PLAN OF CARE
V. DRUG STUDY OF MEDICATIONS ON BOARD AND OTHER MEDICATIONS RELATED TO THE DEASE
VI. ANY SPECIAL PROCEDURE OR OPERATION
VII. DISCHARGE HEALTH TEACHINGS ABOUT THE DISEASE AND ITS COMPLICATIONS
VIII. ANY SPECIAL PROCEDURE OR OPERATION

IX. DISCHARGE HEALTH TEACHINGS ABOUT THE DISEASE AND ITS COMPLICATIONS

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