NCLEX-RNPhysiological AdaptationHard
A client with septic shock develops oozing from IV insertion sites, petechiae, and blood in the urine. Laboratory results show a platelet count of 45,000/mm3, prolonged PT and aPTT, decreased fibrinogen, and elevated D-dimer. Which condition does the nurse suspect?
- AHeparin-induced thrombocytopenia
- BVon Willebrand disease
- CDisseminated intravascular coagulation
- DIdiopathic thrombocytopenic purpura
Show answer & explanationAnswer & explanation
Correct answer: C. Disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC) is a complication of sepsis in which widespread clotting consumes platelets and clotting factors, leading to simultaneous clot formation and hemorrhage. The combination of low platelets, prolonged PT/aPTT, decreased fibrinogen, and elevated D-dimer with active bleeding confirms DIC, and treatment focuses on managing the underlying cause and replacing clotting factors.
Why the other options are wrong
- A. HIT is associated with heparin exposure and thrombosis, not this global coagulopathy pattern.
- B. Von Willebrand disease is an inherited bleeding disorder, not an acute sepsis-related consumptive coagulopathy.
- D. ITP causes isolated thrombocytopenia without coagulation factor consumption or elevated D-dimer.
Disseminated Intravascular Coagulation (DIC)
A life-threatening condition where widespread activation of clotting consumes platelets and clotting factors, causing simultaneous microthrombi formation and hemorrhage.
- Common triggers: sepsis, trauma, obstetric complications, malignancy
- Labs: low platelets, low fibrinogen, prolonged PT/aPTT, elevated D-dimer
- Treatment: treat underlying cause, transfuse platelets/FFP/cryoprecipitate as needed
Memory trick: Clot then bleed—DIC's deadly creed