The nurse admits a client with sepsis and has developed cool ecchymotic fingertips and toes. The healthcare provider determines that the client has developed disseminated intravascular coagulation (DIC). Which findings support the pathophysiology of DIC?

A) An increase in afterload results in decreased systolic pressure, which creates a decreased cardiac output:

This statement is incorrect. According to the Frank-Starling law, afterload refers to the resistance against which the heart must pump blood during systole. An increase in afterload typically results in increased systolic pressure, not decreased, as the heart works harder to overcome the increased resistance. However, increased afterload can lead to decreased cardiac output due to the increased work of the heart.

B) A decrease in afterload causes the cardiac muscles to hypertrophy, resulting in increased diastolic volume:

This statement is incorrect. A decrease in afterload typically reduces the workload on the heart, which may lead to reverse remodeling and a reduction in cardiac hypertrophy. Increased diastolic volume may occur due to reduced afterload, but it's not the direct result of hypertrophy.

C) An increase in preload results in greater shortening of myocardial fibers, thereby increasing contractility:

Correct. The Frank-Starling law states that an increase in preload (end-diastolic volume or stretch of myocardial fibers) leads to greater overlap of actin and myosin filaments within myocardial fibers during systole. This increased overlap results in stronger myocardial contraction (increased contractility), leading to an increased stroke volume and cardiac output.

D) A decrease in preload results in increasing diastolic muscle fiber length, which impedes contractility:

This statement is incorrect. Preload refers to the degree of stretch of the myocardial fibers at the end of diastole. A decrease in preload would lead to decreased stretch of the myocardial fibers, not increasing diastolic muscle fiber length. Decreased preload typically results in decreased contractility rather than an impediment to contractility due to reduced myocardial stretch.

A) Peripheral neuropathy:

Peripheral neuropathy involves damage to the peripheral nerves and is not directly related to the described crushing injury. While nerve injury can occur as a result of trauma, the signs and symptoms described in the scenario, such as unequal strength between the left and right thighs, are more indicative of a potential vascular or musculoskeletal issue rather than peripheral neuropathy.

B) Osteomyelitis:

Osteomyelitis is a bone infection that can occur secondary to trauma or as a complication of open fractures. While it is possible for a crushing injury to lead to osteomyelitis if there is bone involvement or an open wound, the scenario mentions that x-rays revealed no broken bones. Additionally, the signs and symptoms described, such as bruising and swelling of the thighs, are not specific to osteomyelitis.

C) Fat embolism:

Fat embolism occurs when fat globules enter the bloodstream, often following traumatic injury to long bones or orthopedic procedures. While a crushing injury can theoretically lead to fat embolism, the absence of long bone fractures in the x-rays makes this less likely. Additionally, fat embolism typically presents with respiratory symptoms such as dyspnea and hypoxemia, which are not described in the scenario.

D) Compartment syndrome:

Correct. Compartment syndrome is a serious condition that can occur following a crushing injury, especially in the extremities. It is characterized by increased pressure within a muscle compartment, leading to compromised blood flow and potential tissue damage. Signs and symptoms of compartment syndrome include severe pain, swelling, bruising, decreased or absent pulses, and neurological deficits. The unequal strength between the left and right thighs could indicate neurological deficits due to compromised blood flow or nerve compression, making assessment for signs of compartment syndrome crucial in this client's plan of care. If compartment syndrome is suspected, prompt medical intervention, such as fasciotomy to relieve pressure, may be necessary to prevent complications.