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Outline
Overview
Pathophysiology
Thrombocytopenia is when there is a low platelet count and an increased risk of bleeding. This is usually a side effect of another disease process such as leukemia and some immune system disorders, or the use of certain medications. Platelets, also called thrombocytes, are essential to the body as they clump together and form clots that seal blood vessels when injury or damage occurs. If bleeding does occur, it may be internal or external.
Etiology
Many factors influence the development of thrombocytopenia such as cancers, autoimmune diseases, infections, surgery, alcohol use and certain medications. The condition can be inherited or acquired. Generally, a low platelet count develops when the bone marrow fails to produce enough thrombocytes, the bone marrow makes enough, but the body destroys them or uses them too quickly, or when the spleen holds on to too many platelets.
Desired Outcome
Increase platelet production and availability, minimize risk of excessive bleeding, treat underlying cause
Thrombocytopenia Nursing Care Plan
Subjective Data:
- Easily bruises
- Bleeding gums when brushing teeth
** Patients may be completely asymptomatic **
Objective Data:
- Petechiae or purpura
- Abnormal vaginal bleeding
- Epistaxis
- Low platelet count on CBC (<100,000)
Nursing Interventions and Rationales
- Assess for signs of internal or external bleeding; blood in urine or stool, bleeding of mucous membranes such as gums, and skin
- Administer medications and blood or platelet transfusions as indicated
- Immunosuppressants
- Androgens (males only)
- Vinca alkaloids (vincristine)
- Despite low platelet count, administering platelets may not be indicated if there are no signs of active bleeding.
- Treatment depends on the cause of thrombocytopenia; immunosuppressants may be given if the underlying cause is autoimmune disease; androgens are not given to females as they have been known to cause unwanted hair growth; vinca alkaloids may be given if all other measures have failed
- Educate patient to avoid NSAIDs
- Initiate bleeding precautions; use only electric razors, limit needlesticks, use soft toothbrush, provide safety devices to prevent injury (non-skid shoes/socks, etc.)
- Nutrition and lifestyle education
- Avoid activities that could cause injury (contact sports, martial arts, etc)
- Limit or avoid alcohol
- Avoid NSAIDs
- Increase intake of leafy greens
- Monitor for signs of infection if splenectomy is required
References
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