Question

The nurse is comparing laboratory results on admission with laboratory results following treatment of a client with DIC. Which change in laboratory values from admission indicates a positive response to therapy? A. Decrease in platelet count B. Increase in fibrinogen level C. D-dimer assay increase D. Decreased bleeding time

Short answer

An increase in fibrinogen level (B) indicates a positive response to therapy in a patient with DIC.

Step-by-step solution

Understanding Disseminated Intravascular Coagulation (DIC)

Recognize that DIC is a disorder characterized by systemic activation of blood clotting, which results in the generation and deposition of fibrin, leading to microvascular thrombi in various organs. During this condition, over time, consumption of clotting factors and platelets occurs, which can lead to bleeding.

Identifying Positive Response to Therapy in DIC

Understand that a positive response to therapy in a patient with DIC would include restoration of clotting factors and platelets to stop excessive bleeding. This would manifest as an increase in fibrinogen level (the protein that is converted into fibrin during the clotting process), normalization of the platelet count, decrease in D-dimer (a fibrin degradation product), and improvement in bleeding times.

Evaluating the Options

Analyze the given options in the context of DIC therapy. A decrease in platelet count (A) may suggest ongoing consumption and is not a positive sign. Similarly, an increase in D-dimer assay (C) suggests increased fibrin degradation, indicative of ongoing clotting and thus not a positive response. Decreased bleeding time (D) might indicate a positive response; however, it is a nonspecific test and not a direct indicator of improved clotting factor levels. An increase in fibrinogen level (B), on the other hand, directly reflects the availability of essential clotting proteins, suggesting a positive response to therapy.

Key concepts

Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation (DIC) is a complex and potentially life-threatening condition where systemic blood clotting occurs, leading to the formation of clots in small blood vessels throughout the body. This can cause organ damage due to restricted blood flow. Additionally, because clotting factors and platelets are consumed in this process, a paradoxical risk of bleeding arises, as there may not be enough clotting resources remaining to manage any actual breaches in vascular integrity.

Ideally, in managing DIC, healthcare providers aim to treat the underlying condition causing the abnormal clotting while supporting the body's ability to maintain hemostasis. Monitoring laboratory results is critical in determining the effectiveness of treatment and the progression of the disorder. Improving lab values, such as stabilization or increase of fibrinogen levels and platelet count, might indicate that the body’s coagulation system is recovering.

fibrinogen level indicator

The fibrinogen level in the blood is a pivotal indicator when analyzing the coagulation status of a patient, especially in conditions like DIC. Fibrinogen is a protein produced by the liver and is the precursor to fibrin, which forms the essential mesh in blood clots. In DIC, extensive clotting depletes this protein, and, hence, a drop in fibrinogen can signal an aggravation of the condition.

Therefore, when assessing the response to DIC therapy, an increasing fibrinogen level is a positive sign. It suggests that the rampant clotting has been controlled and that the body is replenishing its reserves of clotting factors. Restoring normal levels, alongside other treatment goals, helps stabilize the patient’s condition and prevents further complications.

lab values in DIC

Key laboratory values are integral to diagnosing and monitoring Disseminated Intravascular Coagulation. Common tests include:

• Platelet count: Low levels may indicate platelet consumption in DIC.
• Fibrinogen level: As a primary clotting factor, low fibrinogen can signal active DIC.
• D-dimer: Elevated levels suggest increased fibrinolytic activity, which occurs when the body is breaking down clots.
• Prothrombin time (PT) and activated partial thromboplastin time (aPTT): Prolonged times can reflect a deficiency in clotting factors.

Seeing improvements in these lab values, such as an increase in platelet count and fibrinogen level along with a reduction in D-dimer, would indicate a therapeutic win in a patient with DIC. These improvements mean the body's hemostasis is approaching normal functionality and excessive clot formation along with the bleeding risk is declining.

NCLEX-RN examination study

For nursing students preparing for the NCLEX-RN examination, understanding DIC and its laboratory assessments is crucial. The examination often includes scenario-based questions that test the ability to interpret lab values and apply clinical knowledge to patient care situations.

When studying DIC in the context of the NCLEX, it's important to remember the pathophysiology of the disorder, the significance of key labs indicative of the condition, such as fibrinogen levels, platelet count, and D-dimer, and the implications of lab trends on patient outcomes. Additionally, knowing which interventions are priority and how they relate to lab values is essential for safe and effective patient care. By integrating DIC into their study regimen, nursing students can enhance their clinical reasoning skills and prepare for real-world nursing challenges.