Page 678 - Saunders Comprehensive Review For NCLEX-RN

hemorrhage.
VI. Disseminated Intravascular Coagulation (DIC)
A. Description: DIC is a maternal condition in which the clotting
cascade is activated, resulting in the formation of clots in the
microcirculation (Fig. 22-1).

The rapid and extensive formation of clots that occurs in DIC causes the

platelets and clotting factors to be depleted; this results in bleeding and the potential
vascular occlusion of organs from thromboembolus formation.
B. Predisposing conditions (Box 22-3)

C. Assessment

1. Uncontrolled bleeding
2. Bruising, purpura, petechiae, and ecchymosis
3. Presence of occult blood in excretions such as stool
4. Hematuria, hematemesis, or vaginal bleeding
5. Signs of shock
6. Decreased fibrinogen level, platelet count, and
hematocrit level
7. Increased prothrombin time and partial
thromboplastin time, clotting time, and fibrin
degradation products
D. Interventions
1. Remove underlying cause.

2. Monitor vital signs; assess for bleeding and

signs of shock.
3. Prepare for oxygen therapy, volume replacement,
blood component therapy, and possibly heparin
therapy.
4. Monitor for complications associated with fluid and
blood replacement and heparin therapy.
5. Monitor urine output and maintain at least 30 mL/hr
(renal failure is a complication of DIC).
VII. Ectopic Pregnancy
A. Description
1. Implantation of the fertilized ovum outside of the
uterine cavity
2. Most common location is the ampulla of the fallopian
tube (Fig. 22-2).
B. Assessment
1. Missed menstrual period
2. Abdominal pain
3. Vaginal spotting to bleeding that is dark red or brown

4. Rupture: Increased pain, referred shoulder

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