Which of the following are risk factors for disseminated intravascular coagulation (DIC)? (Select All that Apply.)
Cancer
Sepsis
Trauma
Pregnancy complications
Blood transfusion reactions
Correct Answer : A,B,C,D,E
Choice A Reason:
Cancer is a significant risk factor for DIC, particularly certain types of leukemia and metastatic cancers. Cancer can trigger DIC through the release of procoagulant substances from tumor cells, leading to widespread clotting and subsequent bleeding. The hypercoagulable state associated with malignancies increases the risk of thrombotic events, which can precipitate DIC. Patients with advanced cancer are particularly susceptible due to the aggressive nature of the disease and the body's inflammatory response.
Choice B Reason:
Sepsis is one of the most common causes of DIC. Sepsis triggers a systemic inflammatory response that activates the coagulation cascade, leading to the formation of microthrombi throughout the vasculature. This widespread clotting depletes clotting factors and platelets, resulting in a paradoxical increase in bleeding risk. The severity of sepsis correlates with the likelihood of developing DIC, making early recognition and treatment of sepsis crucial.
Choice C Reason:
Trauma can lead to DIC through extensive tissue injury and the release of tissue factor into the bloodstream. Severe trauma, such as that from major accidents or surgeries, can overwhelm the body's hemostatic mechanisms, leading to uncontrolled clotting and bleeding. The inflammatory response to trauma further exacerbates the coagulation process, increasing the risk of DIC. Prompt management of traumatic injuries and monitoring for signs of DIC are essential in these patients.
Choice D Reason:
Pregnancy complications such as placental abruption, amniotic fluid embolism, and severe preeclampsia can precipitate DIC. These conditions cause significant endothelial damage and the release of procoagulant substances, triggering the coagulation cascade. The physiological changes during pregnancy, including increased blood volume and hypercoagulability, further predispose pregnant women to DIC. Early intervention and management of pregnancy-related complications are vital to prevent DIC.
Choice E Reason:
Blood transfusion reactions can lead to DIC through immune-mediated mechanisms. Incompatible blood transfusions can cause hemolysis and the release of procoagulant substances, initiating the coagulation cascade. The resulting widespread clotting and consumption of clotting factors can lead to bleeding complications. Careful matching of blood products and monitoring for transfusion reactions are critical to prevent DIC in transfusion recipients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Pneumonia is an infection of the lungs, not the ear. It primarily affects the alveoli, causing symptoms like cough, fever, and difficulty breathing. While respiratory infections can sometimes lead to ear infections, pneumonia itself does not directly infect the ear.
Choice B Reason:
Endocarditis is an infection of the inner lining of the heart chambers and valves. It is typically caused by bacteria entering the bloodstream and does not affect the ear. Symptoms include fever, heart murmurs, and fatigue.
Choice C Reason:
Myocarditis is an inflammation of the heart muscle, usually caused by viral infections. It affects the heart's ability to pump blood and does not involve the ear. Symptoms can include chest pain, fatigue, and shortness of breath.
Correct Answer is A
Explanation
Choice A Reason:
Urine output is one of the most reliable indicators of adequate fluid resuscitation in burn patients. The goal is to maintain a urine output of 0.5 to 1 mL/kg/hour in adults³. This parameter is crucial because it directly reflects renal perfusion and, by extension, overall circulatory volume status. When fluid resuscitation is adequate, the kidneys receive enough blood flow to produce urine at this rate, indicating that the body's tissues are being adequately perfused. Monitoring urine output is a non-invasive and straightforward method, making it a preferred choice in clinical settings.
Choice B Reason:
Heart rate can be an indicator of fluid status, but it is less reliable than urine output. Tachycardia (an increased heart rate) can occur due to pain, anxiety, or other stressors, not just fluid deficit. While a decreasing heart rate might suggest improving fluid status, it is not a definitive indicator on its own. Other factors must be considered in conjunction with heart rate to assess fluid resuscitation adequacy.
Choice C Reason:
Blood pressure is another parameter used to assess fluid status, but it can be influenced by many factors, including the patient's baseline blood pressure, medications, and the presence of other medical conditions. While maintaining adequate blood pressure is important, it is not as sensitive or specific as urine output for assessing fluid resuscitation in burn patients. Blood pressure can remain within normal ranges even when fluid resuscitation is inadequate, especially in the early stages.
Choice D Reason:
Mental status can be affected by fluid status, but it is a late indicator of inadequate perfusion. Changes in mental status, such as confusion or decreased level of consciousness, can occur when there is significant hypoperfusion and shock. By the time mental status changes are observed, the patient may already be in a critical state. Therefore, it is not a primary indicator for assessing fluid resuscitation adequacy.
Choice E Reason:
Capillary refill time is a quick and simple test to assess peripheral perfusion. However, it is not as reliable as urine output for evaluating overall fluid status. Capillary refill can be affected by ambient temperature, lighting conditions, and the examiner's technique. While a prolonged capillary refill time can indicate poor perfusion, it is not as specific or sensitive as urine output for assessing fluid resuscitation adequacy.
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