Southeast Asian College, Inc.

# 2 E. Rodriguez Sr. Avenue, Quezon City

COLLEGE OF NURSING
S.Y 2020-2021

A Case Presentation:

DISSEMINATED INTRAVASCULAR

COAGULATION (DIC)
RLE on Intensive Nursing Practicum

Submitted by:

Mata, Joanna Berina C. (Head Nurse)

Baron, Gi Anne T.

Lorenzana, Joeana Michelle Q.

Magalued, Ruany N.

Orfanel, Maria Carmela T.

Pablo, Christian Daryl T.

Protacio, John Marie C.

Yamsuan, Clarizza G.

Submitted by:

Prof. Anita E. Prodigalidad, RN, MAN

CASE SCENARIO

Mang Amboy, 59 years old male, residing at Espana, Manila was brought to the emergency

room of Sampaloc Hospital by his wife because of shortness of breath, fever and vomiting.

Upon initial examination, his vital signs are as follows: BP = 87/60 mmHg; HR= 160bpm;

RR=28 breaths/min. ; Temp. 40°C and O2 saturation of 87%.

On physical examination, he is tachypneic with intercostal retractions; cyanotic and on

auscultation made by Dr. JV, he is positive for bilateral wet crackles.

According to his wife, there is no family history of bleeding but

Mang Amboy has a history of untreated pneumonia caused by E. coli.

After 30 minutes in the E.R. , Mang Amboy started coughing of pink, frothy sputum and

then he began to bleed from his mouth, nose and ears.

Other findings include cold extremities, diffuse rash and abdominal petechiae.

• Laboratory examinations reveal the following

Haemoglobin= 6.7 g/dl.

Haematocrit = 19.5%

RBC = 1.7 m/uL

WBC = 7.7 k/uL

Platelets= 9k/uL

PT= 47 sec.

PTT=75 sec.

Fibrinogen level=<76mg./dl.

D-dimer (9.0 ug/ml.)

• Medications given to Mang Amboy are the following;

Dr JV ordered a transfusion of fresh frozen plasma immediately.

Heparin 10,000 units IV q8

Ceftazidime 1g IV q8
 PROGRAM

Prayer

Opening Remarks

Presentation

Introduction

Epidemiology

Patient’s Profile by: Ms. Joanna Berina Mata

Nursing Health History

Gordon’s Functional Health Pattern

Physical Assessment

Theoretical Framework

Anatomy & Physiology

Pathophysiology → by: Mr. JM Protacio

Diagnostic Study → by: Ms. Joeana Lorenzana

Pharmacology → by: Mr. Christian Daryl Pablo

Nursing Care Plan (Actual)

NCP #1 → by: Ms. Gi-Anne Baron

NCP #2 → by: Mr. Ruany Magalued

NCP #3 → by: Ms. Maria Carmela Orfanel

Discharge Plan → by: Ms. Clarizza Yamsuan

Closing Remarks → by: Ms. Joanna Berina Mata

INTRODUCTION

Disseminated intravascular coagulation (DIC) is characterized by systemic activation of

blood coagulation, which results in generation and deposition of fibrin, leading to microvascular

thrombi in various organs and contributing to multiple organ dysfunction syndrome (MODS).

Consumption of clotting factors and platelets in DIC can result in life-threatening hemorrhage.

Derangement of the fibrinolytic system further contributes to intravascular clot formation,

but in some cases, accelerated fibrinolysis may cause severe bleeding. Hence, a patient with DIC

can present with a simultaneously occurring thrombotic and bleeding problem, which obviously

complicates the proper treatment.

The subcommittee on DIC of the International Society on Thrombosis and Haemostasis

has suggested the following definition for DIC: “An acquired syndrome characterized by the

intravascular activation of coagulation with loss of localization arising from different causes. It

can originate from and cause damage to the microvasculature, which if sufficiently severe, can

produce organ dysfunction.”

DIC is estimated to be present in as many as 1% of hospitalized patients. DIC is not itself

a specific illness; rather, it is a complication or an effect of the progression of other illnesses. It is

always secondary to an underlying disorder and is associated with a number of clinical conditions,

generally involving activation of systemic inflammation.

Predisposing Factors:

a. Related to rapid blood transfusion

b. Massive burns

c. Massive trauma

d. Anaphylaxis

e. Septicemia

f. Neoplasia (new growth of tissue)

g. Pregnancy

Types of DIC

1. Acute DIC - develops when sudden exposure of blood to procoagulants (eg, tissue factor

[TF], or tissue thromboplastin) generates intravascular coagulation.

2. Chronic DIC- reflects a compensated state that develops when blood is continuously or

intermittently exposed to small amounts of TF.

 Pneumonia

E coli respiratory tract infections are uncommon and are almost always associated with E

coli UTI. No virulence factors have been implicated. E coli pneumonia may also result

from micro aspiration of upper airway secretions that have been previously colonized with

this organism in severely ill patients; hence, it is a cause of nosocomial pneumonia.

However, E coli pneumonia may also be community-acquired in patients who have

underlying disease such as diabetes mellitus, alcoholism, chronic obstructive pulmonary

disease, and E coli UTI. E coli pneumonia usually manifests as a bronchopneumonia of the

lower lobes and may be complicated by empyema. E coli bacteremia precedes pneumonia

and is usually due to another focus of E coli infection in the urinary or GI tract.

E coli bacteremia is usually associated with UTIs, especially in cases of urinary tract

obstruction of any cause. The systemic reaction to endotoxin (cytokines) or

lipopolysaccharides can lead to disseminated intravascular coagulation and death. E coli is

a leading cause of nosocomial bacteremia from a GI or genitourinary source.

EPIDEMIOLOGY

DIC may occur in 30-50% of patients with sepsis, and it develops in an estimated 1% of all

hospitalized patients. DIC occurs at all ages and in all races, and no particular sex predisposition

has been noted.

PATIENT PROFILE

Name: Mang Amboy

Age: 59 years old

Gender: Male

Religion: Roman Catholic

Marital Status: Married

Job: Construction worker

Weight: 50 kgs.

Height: 165 cm.

Date of Admission: March 15, 2021

Hospital #: 202100357

Diagnosis: Disseminated Intravascular Coagulation secondary to bacterial sepsis.

Chief Complaints:

➢ Shortness of breath

➢ Fever

➢ Vomiting
NURSING HISTORY

A. Present Health History

➢ Mang Amboy was brought by his wife at emergency room of Ospital ng Sampaloc

due to shortness of breath, fever and vomiting.

B. Past Health History

➢ Mang Amboy has a history of untreated pneumonia caused by E.coli.

C. Present & Past Surgery

➢ There is no known significant present nor past surgery.

D. Family History

➢ Mang Amboy had no known family history of any disease nor bleeding out.

➢ Extended type of family

➢ 12 members in the family (Wife, 3children with spouse and 4 grandkids)

➢ He had 1 son who had acquired TB a year ago and just finish TB medication.

➢ He had a 17year old daughter who had SPE (Severe pre-eclampsia) and gave birth

to premature.

E. Personal History

➢ Smoking: Heavy Smoker

➢ Alcohol: Occasional drinker

➢ Food Habit: Mixed diet but due to financial crisis they mostly eat canned goods and

instant noodles that have been donated by their barangay.

➢ Food Allergy: Unknown

➢ Drug Allergy: None

➢ Hobbies: He loves listening to AM radio station.

F. Socio-Economic History

➢ Type of house: Rented house made of light materials

➢ No. of rooms: 2 rooms

➢ Monthly income: Below Php7000

➢ Breadwinner: Mang Ambo as Construction Worker & Wife as partime labandera.

GORDON’S FUNCTIONAL HEALTH PATTERN

Before Hospitalization During Hospitalization

I. Health perception and Mang Amboy viewed health Mang Amboy stated that he
health management as a state in which he can feels unhealthy due to his
perform his work daily and worsening condition. He is
Pattern
with the absence of illness and willing to accept and listen to
disease, he considered himself health teaching for his easy
as unhealthy human being recovery.
3weeks ago that started to
experience on and off fever, a
dry cough, muscle pain and
weakness that progresses to
increasing cough and
shortness of breath. He cannot
recall if he is fully immunized.

II. Nutritional and Mang Amboy has no allergies Mang Amboy is under BRAT
Metabolic Pattern to foods and drugs. He eats and no dark colored food. He
meals 3 times a day with. He eats the food served in the
drinks 7-8 glasses of water. He hospital. He drinks 3-4 glasses
also drinks coffee in the of water a day.
morning and afternoon. At the
age of 18 he started to drink
alcohol and smoke 1 pack of
cigar daily.

III. Elimination Pattern
IV. Activity and Exercise Mang Amboy states that aside Mang Amboy stated that he
Pattern
V. Sleep-Rest Pattern
Mang Amboy usually void 3- Mang Amboy is on CBR
4 times a day, he defecates without bathroom privileges.
once a day daily, he doesn’t He is hook on IFC with
experience any problem in average output of 25-30ml/hr.
voiding and defecating. and with diaper for defecating.
from working 6 days at the becomes confused and
construction site, he also does anxious because of his
some errands like fixing condition. He can perform
broken tables and stuff. limited activity due to his
doctor’s order CBR without
privileges.
Mang Amboy usually sleeps Mang Amboy sleeps at
7-8hours, his earliest time in 10:00pm and wakes up at
going to sleep is at 8:00pm 6:00am, he can consume 7-8
 and he wakes up at 4:00 am, hours of sleep with
sometimes he takes a nap at interruptions of 1-2 hours due
noon during lunch break at to health care services. He
their work for about takes a nap at noon for 1-
30minutes. He has difficulty 2hours but sometimes
of going to sleep 3weeks ago distracted due to visitors and
due to coughing. other health care services.
VI. Coping Stress Mang Amboy copes up with Mang Amboy takes a nap and
stress by making himself busy rest when feeling tired. He
working at anything related to verbalizes desires to recover
carpentry. Whenever they and able to accept situation by
have a family problem, they cooperating with the medical
resolved it sometimes by advices.
talking to each other but
mostly Mang Amboy always
decides for decision making.
VII. Sexual Reproductive Mang Amboy recalls that he He and his wife claimed that
Pattern was circumcised when he was they are sexually inactive
10years old and got married at because of his health
the age of 29years old. They condition.
have 3 children.
VIII. Values Belief Pattern The patient religious Mang Amboy never blame
affiliation is roman catholic, God for his condition but he
he seldom goes to church due won’t deny that having a poor
to his job but he never forgot quality of life is something
to pray. He also believes in that affect his health condition
quack doctors. as well as his family’s safety.
IX. Cognitive and Mang Amboy is oriented to The patient is oriented to time
Perceptual Pattern people, time and place, and place but he’s still
responses to stimuli verbally experiencing slight anxiety
and physically. He can speak with his worsening health
and understand tagalog only. condition.
His educational attainment is
high school graduate and is
able to read and write.
X. Self-Perception/Self- Mang Amboy is able to Mang Amboy states that his
Concept express his feelings about his admission will help him to
condition, he feels annoyed recover and will bring him
about it, because it affects his back to his normal health
ability to work and earn status.
money for his family. He is
 always anxious and stress
about his family’s daily
income.
XI. Role Relationship The patient plays the role of a Mang Amboy is well-
Pattern father to his children, husband supported by his family. He
to his wife and a grandfather receives a positive
to his grandchildren. Mang reinforcement and although
Amboy stated that he only his children had little income,
spent time with his family they still provide him
during his day-off from work financially, reassurance and
but still maintaining a good comfort.
relationship to his family.
PHYSICAL ASSESSMENT

VITAL SIGN ➢ T – 40 oC

➢ P – 160 bpm

➢ R – 28 bpm

➢ BP – 87/60 mmHg

➢ O2 Sat – 87%

GENERAL APPEARANCE ➢ BMI – 18.4 kg/m2 (Mild Thinness)

➢ Posture is upright but slightly the head is forward

and slightly poor

➢ Patient is clean and neat

➢ No body odour or breath odour

➢ No physical deformities

MENTAL STATUS ➢ Coordinated and aware of time, place and person

he’s talking to but with mild confusion and

anxiety.

➢ Pleasant and cooperative.

SKIN ➢ Skin is noted for presence of petechiae

➢ presence of diffuse rash on both upper extremities

➢ Cyanosis is present

➢ Generally uniform but dry and wrinkled

➢ Prominent veins

➢ No edema

EARS ➢ No tenderness, warm, with elongated lobule with

linear wrinkles

➢ Presence of blood stain at the entrance of ear

canal.

NOSE ➢ Episodes of epistaxis is noted

➢ Flaring of nares is noted

MOUTH ➢ Slightly pale, dry and cracked lips

➢ Buccal mucosa is slightly pale

 ➢ Teeth looks yellowish-brown, missing teeth is

noted.

➢ Tongue is pale and slightly deep fissures.

➢ Episode of hemoptysis is noted

➢ Pink and frothy saliva with sputum is also noted

OROPHARYNX ➢ Tonsils are red and enlarged

➢ Uvula is at midline but slightly reddened

PNUEMOTHORAX ➢ Intercostal retractions are present

➢ RR – 28bpm (tachypnea)

➢ Less 2 inches thoracic expansion is noted

➢ Hyperresonance is heard over emphysematous

lungs

➢ High pitch bronchial breath sound is noted

➢ Bilateral wet crackles on both lungs

HEART ➢ PMI at 4th & 5th intercostal space

➢ Tachycardia is noted at 160bpm

➢ Rhythm is regular

ABDOMEN ➢ Presence of petechiae is noted.

➢ Gastric pain is noted

➢ No tenderness.

BACK & EXTREMITIES ➢ Symmetrical, regular, strong, peripheral pulses

➢ Nail shape is normal, thickened, yellow and brittle

nail.

➢ Slightly cyanotic nail bed color

➢ No lesions, deformities

➢ Spine is midline

➢ Able to do range of movements

Renal ➢ Oliguria, with IFC (25-30ml/hr)

➢ Hematuria
THEORETICAL FRAMEWORK

Virginia Henderson’s Need Theory

Virginia Henderson developed the Nursing Need Theory to define the unique focus of

nursing practice. The theory focuses on the importance of increasing the patient’s independence

to hasten their progress in the hospital. Henderson’s theory emphasizes the basic human needs and

how nurses can assist in meeting those needs.

Individual

Henderson states that individuals have basic health needs and require assistance to achieve

health and independence or a peaceful death. According to her, an individual achieves wholeness

by maintaining physiological and emotional balance. She defined the patient as someone who

needs nursing care but did not limit nursing to illness care. Her theory presented the patient as a

sum of parts with biopsychosocial needs, and the mind and body are inseparable and interrelated.

Environment

Although the Need Theory did not explicitly define the environment, Henderson stated that

maintaining a supportive environment conducive to health is one of her 14 activities for client

assistance. Henderson’s theory supports the private and public health sector’s tasks or agencies in

keeping the people healthy. She believes that society wants and expects the nurse’s acting for

individuals who cannot function independently.

Health

Although not explicitly defined in Henderson’s theory, health was taken to mean balance

in all realms of human life. It is equated with the independence or ability to perform activities

without any aid in the 14 components or basic human needs. On the other hand, nurses are key

persons in promoting health, preventing illness, and being able to cure. According to Henderson,

good health is a challenge because it is affected by numerous factors such as age, cultural

background, emotional balance, and others.

Nursing

She defined nursing as “the unique function of the nurse is to assist the individual, sick or well, in

the performance of those activities contributing to health or its recovery that he would perform

unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to

help him gain independence as rapidly as possible.” The nurse’s goal is to make the patient

complete, whole, or independent. In turn, the nurse collaborates with the physician’s therapeutic

plan.

Physiological Components

• 1. Breathe normally
• 2. Eat and drink adequately
• 3. Eliminate body wastes
• 4. Move and maintain desirable postures
• 5. Sleep and rest
• 6. Select suitable clothes – dress and undress
• 7. Maintain body temperature within normal range by adjusting clothing and modifying
environment
• 8. Keep the body clean and well-groomed and protect the integument
• 9. Avoid dangers in the environment and avoid injuring others

Psychological Aspects of Communicating and Learning

• 10. Communicate with others in expressing emotions, needs, fears, or opinions.

• 14. Learn, discover, or satisfy the curiosity that leads to normal development and health
and use the available health facilities.

Spiritual and Moral

• 11. Worship according to one’s faith

Sociologically Oriented to Occupation and Recreation

• 12. Work in such a way that there is a sense of accomplishment

• 13. Play or participate in various forms of recreation
 ANATOMY & PHYSIOLOGY

Hematological System

Blood Blood Vessels Blood Forming Organs

1. Plasma 1. Arteries 1. Liver

a. Albumin 2. Veins 2. Spleen
b. Globulin 3. Lymphoid Organ
c. Prothrombin & 4. Lymph Nodes
Fibrinogen clotting 5. Bone Marrow
factors
2. Formed Elements
a. RBC
b. WBC
c. Platelets

The anatomy, physiology, and functions of the hematopoietic system are all involved in
the production of blood. Hematologic activities, such as red blood cell formation and the clotting
cascade, require a complex series of events to allow good health and homeostasis. Without
leukocytes to protect us, our bodies could succumb to disease and infection.
Hematology is the science of blood and blood forming tissues. It includes both cellular and
non‐cellular blood components. The hematopoietic system consists of organs and tissues, primarily
the bone marrow, spleen, tonsils, and lymph nodes, involved in the production of blood.
The solid components of blood are formed by hematopoiesis, which is the continuous, regulated
formation of blood
cells.
There are three primary functions of hematopoiesis:
1. Oxygen delivery
2. Hemostasis
3. Host defense
Hematological activities occur in many organs of the body and have the potential for
multiple forms of pathology.
Blood is the life fluid of the human body, and it is essential for health and homeostasis.
The approximately 5 liters of blood continuously circulating in the human body provides nutrients
and oxygen to tissues while aiding in the excretion of waste products. Blood consists of plasma,
blood and platelets. Disease occurs when there are too few, too many, or dysfunctional blood
components. These conditions can result from congenital or genetic causes, but they can also be
acquired from medical treatment. Healthcare providers, especially nurses, play a pivotal role in
identifying those persons at risk and assisting in the management of these diseases.
 Plasma is a transport medium that carries the blood cells as well as antibodies, nutrients,
electrolytes, hormones, lipids, and waste products.
Leukocytes are key players in the inflammatory response and infectious process.
Erythrocytes are disk-shaped cells that carry oxygen to tissues and transport carbon
dioxide out of the tissues for its subsequent removal from the body. Erythrocytes contain proteins
and hemoglobin, which binds to oxygen, giving blood its red color. The brighter the shade of red,
the more the blood is saturated with oxygen.
Hematocrit refers to how much of the blood volume comprises erythrocytes.
Thrombocytes, along with clotting factors, control coagulation. Carried passively in the blood,
thrombocytes are coated with a sticky material that causes them to adhere to irregular surfaces.
Clotting is a quick chain reaction stimulated by the release of thromboplastin from damaged cells
lining the blood vessels in the area of an injury. In conjunction with the initiation of the clotting
cascade, platelets containing contractile proteins pull the edges of the wound together. Blood clots
do not persist indefinitely; if they did so, they would clog up the entire circulatory system. Plasmin
is an enzyme that dissolves clots once healing has occurred.

Platelets are vital components of the coagulation process.

Normal platelet levels range from 150,000 to 350,000
cells/mL3. Thrombocytosis refers to increased platelet
levels, and thrombocytopenia describes the condition of
decreased platelet levels. Thrombocytosis increases the risk
of thrombus formation, while thrombocytopenia increases
the risk of bleeding and infection. Capillaries are relatively
delicate structures that can leak from even minor injuries.
Fortunately, the platelets, along with the coagulation process,
quickly halt any such leaking. Diseases of the platelets
include issues in quantity and quality of platelets.
PATHOPHYSIOLOGY
DIAGNOSTIC STUDY

Normal Values Result Remarks In DIC

Hemoglobin M – 13.7 – 17.5 g/dl 6.7 g/dl Hgb is the substance that gives color to red blood cells, it is the substance that
(grams per deciliter) allows for the transport of oxygen throughout the body. Low hemoglobin levels
lead to anemia, which causes symptoms like fatigue and trouble breathing.
Hematocrit 40.1 – 51.0 % 19.5 % Low hct indicates low volume of rbc in the blood that carrying oxygen
throughout the body.
RBC 4.63 – 6.08 m/μL 1.7 m/μL Signify bleeding.
(million per microliter)
WBC 4.23 – 9.07 k/μL 7.7 k/μL Within normal limit
(thousand per microliter)
Platelets 161 – 347 k/μL 9 k/μL A low platelet count may also be called thrombocytopenia. A trend toward
(thousand per microliter) decreasing platelet counts or a grossly reduced absolute platelet count is a
sensitive (though not specific) indicator of DIC. Low platelet indicates that your
blood does not produce and form enough blood clots to help to stop a bleeding.
PT (Prothrombin Time) 11.6 – 15.2 sec. 47 sec. When the PT is high, it takes longer for the blood to clot (47 seconds, for
example). This usually happens because the liver is not making the right amount
of blood clotting proteins, so the clotting process takes longer. A high PT usually
means that there is serious liver damage or cirrhosis.
aPTT (Activated Partial 25.3 – 337.3 sec. 75 sec. An abnormal (too long) PTT result may also be due to: Bleeding disorders, a
Thromboplastin Time) group of conditions in which there is a problem with the body's blood clotting
 process. Disorder in which the proteins that control blood clotting become over
active (disseminated intravascular coagulation)
Fibrinogen Level 177 – 466 mg/dl <76 mg/dl Reduced fibrinogen activity and antigen levels may affect your ability to form a
(microgram per deciliter) stable blood clot. Low fibrinogen levels that persist over time is related to the
body's inability to produce fibrinogen.
D – dimer 0.00 - 0.50 μg/ml 9.0 μg/ml A positive D-dimer result may indicate the presence of an abnormally high level Positive
(microgram per milliliter) of fibrin degradation products. It indicates that there may be significant blood
clot (thrombus) formation and breakdown in the body, but it does not tell the
location or cause.
 DRUG STUDY
DRUG ORDER DRUG CLASSIFICATION INDICATIONS OF CONTRAINDICATIONS TO SIDE/ADVERSE EFFECTS NURSING
AND PHARMACOLOGIC THE DRUG THE DRUG OF THE DRUG RESPONSIBILITIES
ACTION OR MECHANISM
Heparin Therapeutic class: Adults: 50 to 100 • Contraindicated in patients CNS: fever • Draw blood to establish
units/kg I.V. q4 hypersensitive to drug. baseline coagulation value
Anticoagulants Conditionally contraindicated EENT: rhinitis
hours as a single before starting therapy.
Dosage: 10,000 units injection or constant in patients with active Hematologic: hemorrhage, • Monitor the drug’s
infusion. If no bleeding, blood dyscrasia, or overly prolonged clotting time, effectiveness by measuring
Pharmacologic class: improvement in 4 to bleeding tendencies such as thrombocytopenia, white clot PTT carefully and regularly.
8 hours, stop drug hemophilia,
Route: IV Anticoagulants syndrome. Anticoagulation is present
thrombocytopenia, history of
heparin-induced when PTT values are 1 ½ and
Metabolic: hyperkalemia,
thrombocytopenia (HIT), or 2 times control values.
hypoaldosteronism
Frequency: q8 hepatic disease with • Check for bleeding before
hypoprothrombinemia; Skin: irritation, mild pain, giving the drug.
Action:
suspected intracranial hematoma, ulceration, • Provide for safety measures
Accelerates formation of hemorrhage; inaccessible cutaneous or subcutaneous (electric razor, soft toothbrush)
antithrombin III-thrombin ulcerative lesions (especially necrosis, pruritis, urticaria. to prevent injury from
complex and deactivates of GI tract) and open ulcerative bleeding.
wounds; extensive denudation Other: hypersensitivity
thrombin, preventing conversion reactions, including chills; • Always check compatibilities
of skin; ascorbic acid
of fibrinogen to fibrin anaphylactoid reactions. with other IV solutions.
deficiency; and other
conditions that cause increased • Mix well when adding heparin
papillary permeability. to IV infusion.
• Alert all health care providers
• Conditionally contraindicated of heparin use.
during or after brain, eye, or
spinal cord surgery; during
spinal tap or spinal anesthesia;
during continuous tube
drainage of stomach or small
intestine; and in subacute
bacterial endocarditis, shock,
advanced renal disease,
threatened abortion, or severe
hypertension.
 DRUG ORDER DRUG CLASSIFICATION INDICATIONS OF CONTRAINDICATIONS TO SIDE/ADVERSE EFFECTS NURSING
AND PHARMACOLOGIC THE DRUG THE DRUG OF THE DRUG RESPONSIBILITIES
ACTION OR MECHANISM

Ceftazidime Third-generation Serious infections of • Contraindicated in patients CNS: dizziness, fever, • Before giving first dose, ask
cephalosporin lower respiratory and hypersensitive to drug or other headache, seizures patient about previous reactions
urinary tracts, cephalosporins. to cephalosporins or penicillin.
• GI: abdominal cramps,
Dosage: 1g bacteremia, Use cautiously in patients with • Obtain specimen for culture and
history of sensitivity to diarrhea, nausea, vomiting,
Chemical effect: Inhibits cell septicemia. Among sensitivity tests.
penicillin and with renal pseudomembranous colitis
wall synthesis, promoting susceptible • If adverse GI reactions occur,
impairment
Route: I.V. osmotic instability, usually microorganisms are GU: candidiasis, genital monitor patient’s dehydration.
bactericidal streptococci pruritus • Tell the patient to report any
Hematologic: agranulocytosis, adverse reactions.
Frequency: Q8 leucopenia, thrombocytosis • Instruct the patient to
Therapeutic effect: Hinders or immediately report to
kills susceptible bacteria prescriber any change in
urinary output.
 DRUG ORDER DRUG CLASSIFICATION
AND PHARMACOLOGIC
ACTION OR MECHANISM
Fresh Frozen Plasma
Drug class: Blood components
Brand Name: Octaplas
Mechanism of action: Each unit
provides all plasma proteins and
45-70mg/ml clotting factors to support
adequate hemostasis to treat or
prevent bleeding or to treat other
protein deficiencies that cannot
be replaced with protein specific
concentrates
INDICATIONS CONTRAINDICATIONS TO THE SIDE/ADVERSE NURSING
OF THE DRUG DRUG EFFECTS OF THE DRUG RESPONSIBILITIES
Used for • FFP should not be used solely for ≥1% (Octaplas) • Monitor VS (pre, during, &
management and volume expansion, or to "correct" post)
Nervous system: Headache,
prevention of a mildly prolonged PT or PTT • Make sure the product is ABO
without active bleeding; patients paresthesia compatible to the patient to
bleeding, as a
coagulation factors may have a mildly prolonged PT Gastrointestinal: Nausea prevent transfusion reaction.
replacement, and to or PTT and yet have • Tell patient that abnormal
treat thrombotic hemostatically stable levels of Skin and subcutaneous dreams or anesthesia awareness
coagulation factors tissue disorders: Pruritus, may occur.
thrombocytopenic
• Plasma should not be given for urticaria • Monitor the infusion rate (to
purpura (TTP).
replacement of isolated factor or avoid hypervolemia).
specific protein deficiencies if the • No other medication should be
appropriate factor concentrates are transfused at the same line.
available
• Plasma should not be given for
vitamin K deficiency or warfarin
reversal if correction can safely be
achieved using vitamin K
supplementation
• IgA deficiency
• Severe protein S deficiency
• History of hypersensitivity to fresh
frozen plasma (FFP) or to plasma-
derived products including any
plasma protein
• History of hypersensitivity
reaction to Octaplas.
 NURSING CARE PLAN

CUES NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Goal: After 15minutes of nursing
Objective Impaired gas exchange In 15minutes of nursing 1. Assess the respiratory depth, 1. The client will adapt breathing intervention patient
- Intercostal retractions related to altered intervention patient will rate, and rhythm. patterns over time to facilitate gas demonstrated optimal gas
are present oxygen-carrying demonstrate optimal gas exchange. Rapid, shallow exchange, as evidenced by
- RR – 28bpm capacity of blood as exchange, as evidenced by respirations may result from increase oxygen saturation
(tachypnea) evidence by confusion, increase oxygen saturation of hypoxia or from the acidosis with of 90% or greater; alert and
- Cyanotic and shortness of breath. 90% or greater; alert and the shock state. The development responsive mentation and
- High pitch bronchial responsive mentation and of hypoventilation indicates that decrease or elimination of
breath sound is noted decrease or elimination of immediate ventilator support is confusion; and relaxed
- Bilateral wet crackles confusion; and relaxed needed. breathing and demonstrate
on both lungs Source: Nurse’s Pocket breathing and demonstrate 2. Assess the client’s breath 2. Changes in breath sounds may normal respiratory rate.
- Signs of use of Guide Edition 13 by normal respiratory rate. sounds. Assess cough for reveal the cause of impaired gas
accessory muscles. Doenges, Moorhouse & signs of bloody sputum. exchange. Hemoptysis is an
Murr. Page 421. indication of bleeding in the
respiratory tract.
3. Assess for tachycardia, 3. These signify an increased work of
shortness of breath, and use breathing. With initial hypoxia, HR
of accessory muscles. increases. The use of accessory
muscles increases chest excursion
4. Monitor oxygen saturation to facilitate effective breathing.
and assess arterial blood 4. Pulse oximetry is a useful tool to
gases. detect early changes in oxygen
saturation. Oxygen saturation
 should be kept at 90% or greater.
Increasing PaCo2 and decreasing
PaO2 are signs of hypoxemia and
respiratory acidosis.
5. Change the client’s 5. These maneuvers facilitate the
positioning every 2hours, and movement and drainage of
perform chest physiotherapy. secretions.
6. Position the client in a high-
Fowler’s position as 6. An upright position allows for
indicated. adequate diaphragmatic and lung
excursion and promotes optimal
7. Assist with coughing or lung expansion.
suction as indicated. 7. Productive coughing is the most
effective way to remove moist
secretions. If the client is unable to
perform independently, suctioning
may be needed to promote airway
patency and reduce the work of
breathing.
8. Maintain an oxygen 8. The appropriate amount of oxygen
administration device as must be delivered continuously so
ordered. that the client maintains an oxygen
saturation of 90% or greater.
9. Anticipate the need for 9. Early intubation and mechanical
intubation and mechanical ventilation are recommended to
ventilation. prevent full decompensation of the
client. Mechanical ventilation
provides supportive care to
maintain adequate oxygenation and
ventilation to the client.
 CUES NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Objective: Short term: After 2 hours of nursing
- BP = 87/60 mmHg Ineffective tissue In 2 hours of nursing 1. Assess for contributing 1. When the proteins used in the intervention the patient:
- RR=28breaths/min perfusion related to intervention, the patient will factors. normal clotting process become a. Verbalized
- O2 saturation of 87% blood circulation be able to: overly active, it can cause DIC. understanding of
- Presence of Skin disruption as evidence by Infection, severe trauma, condition, therapy
petechiae changes in respiratory a. Verbalize understanding of inflammation, surgery, Obstetrical regimen.
- Urine Output: rate and depth and condition, therapy complications (such as abruptio b. Demonstrated
hematuria 25-30ml/hr. decreased urine output. regimen. placenta, intrauterine fetal death) behavior changes to
b. Demonstrate behavior and cancer are all known to improve circulation.
changes to improve contribute with DIC. c. Demonstrated
circulation. 2. Assess for the signs and 2. Bleeding, from mucous membranes, increased perfusion as
c. Demonstrate increased symptoms of DIC. venipunctures sites, and areas from individually
Source: Nurse’s Pocket perfusion as individually the gastrointestinal and urinary appropriate.
Guide Edition 13 by appropriate. tracts.
Doenges, Moorhouse & 3. Assess for chest pain and 3. Blood clots may form in the blood After 2 days of nursing
Murr. Page957. Long term: shortness of breath. vessels of the lungs and heart intervention, the client
In 2 days of nursing therefore blocking the blood flow improved blood supply.
intervention, the client will that can cause these symptoms
have improved blood supply. 4. Assess amount and color of 4. Hematuria and oliguria occur (urine
urine. output less than 30 ml/hour) due to
decreased perfusion to the kidneys
as a result of tissue injury and clotted
capillary beds.
5. Assess client’s level of 5. A decreased level of consciousness
consciousness. can be precipitated by hemorrhagic
changes or insufficient oxygenation
of the brain.
6. Assess arterial blood gases 6. Arterial blood gases may reveal a
(ABGs). compensatory respiratory alkalosis
in an attempt to decrease hydrogen
ion concentration from hypoxia
striking at the tissue level.
7. Position client in a semi- 7. Upright positioning promotes
Fowler’s to high-Fowler’s as improved alveolar gas exchange.
tolerated.
8. Provide oxygen therapy as 8. This saturates circulating
necessary. hemoglobin and augments the
efficiency of blood that is reaching
the ischemic tissues.
9. Monitor platelet count. 9. These laboratory values are typically
prolonged as coagulation factors are
consumed.
10. Monitor PT (prothrombin 10. These laboratory values are typically
time) and PTT (partial prolonged as coagulation factors are
thromboplastin time). consumed
11. Monitor D-dimer levels. 11. This is a test that detects a protein
that results from clot break-down; it
is often markedly elevated with DIC.
12. Administer parenteral fluids 12. Maintenance of an adequate blood
as prescribed. volume is vital for maintaining
cardiac output and systemic
perfusion.
13. Administer heparin as 13. Treatment with anticoagulant is used
prescribed. primarily to prevent the formation of
new clots by decreasing the normal
activity of the clotting mechanism.
14. Administer Ceftazidime as 14. To treat a wide variety of bacterial
prescribed. infections.
 CUES NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Independent:
Objective: Altered body In 4 hours of nursing 1. Monitor vital signs at least ➢ To have a brief baseline data and After 4 hours of nursing
temperature related to intervention, the patient will every hour. assist for effectiveness of the intervention, the patient
- BP = 87/60 mmHg infection as evidence by be able to have a stabilize treatment particularly the fever- has stabilized temperature
- HR= 160bpm increase body temperature. reducing and antibiotic within a normal range.
- RR=28 breaths/min temperature, elevated medications administered.
- Temperature= 40°C respiratory rate and heart 2. Encourage a tepid sponge bath. ➢ To facilitate the body in cooling
- O2 saturation of 87% rate. and provide comfort.
3. Elevating the head of the bed. ➢ To help improve expansion of
the lungs and help the patient to
breathe more effectively.
4. Adjust the room temperature ➢ To regulate the temperature of
and remove unnecessary clothing the surroundings to make it more
and blankets. comfortable for the patient.

Dependent:
1. Administer antibiotic as per
doctor’s order.
2. Administer the prescribed
fever-reducing medicine.
➢ To treat bacterial infection in
which is the underlying cause of
the patient’s hyperthermia.
➢ To help normalize the body
temperature of the patient.
DISCHARGE PLAN

• Antibiotics are given to help treat infection caused by bacteria.

• Blood thinners help prevent blood clots. Clots can cause strokes, heart attacks, and death.
The following are general safety guidelines to follow while you are taking a blood thinner:
o Watch for bleeding and bruising while you take blood thinners. Watch for bleeding
from your gums or nose. Watch for blood in your urine and bowel movements. Use
a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can
keep your skin and gums from bleeding. If you shave, use an electric shaver. Do
not play contact sports.
o Tell your healthcare providers that you take a blood thinner. Wear a bracelet or
necklace that says you take this medicine.
o Do not start or stop any other medicines unless your healthcare provider tells you
to. Many medicines cannot be used with blood thinners.
o Take your blood thinner exactly as prescribed by your healthcare provider. Do not
skip does or take less than prescribed. Tell your provider right away if you forget
to take your blood thinner, or if you take too much.
o Warfarin is a blood thinner that you may need to take. The following are things
you should be aware of if you take warfarin:
▪ Foods and medicines can affect the amount of warfarin in your blood. Do
not make major changes to your diet while you take warfarin. Warfarin
works best when you eat about the same amount of vitamin K every day.
Vitamin K is found in green leafy vegetables and certain other foods. Ask
for more information about what to eat when you are taking warfarin.
▪ You will need to see your healthcare provider for follow-up visits when you
are on warfarin. You will need regular blood tests. These tests are used to
decide how much medicine you need.
• Take your medicine as directed. Contact your healthcare provider if you think your
medicine is not helping or if you have side effects. Tell him of her if you are allergic to any
medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts,
and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry
your medicine list with you in case of an emergency.