Nursing Care Plan (NCP) for Thrombocytopenia
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Outline
Lesson Objectives for Thrombocytopenia
- Understanding Thrombocytopenia:
- Define thrombocytopenia as a condition characterized by a low platelet count, emphasizing its role in the risk of bleeding and impaired clotting.
- Etiology and Causes:
- Explore the various causes of thrombocytopenia, including underlying medical conditions, medications, autoimmune disorders, and genetic factors.
- Clinical Manifestations:
- Identify the clinical manifestations of thrombocytopenia, such as petechiae, ecchymosis, prolonged bleeding, and other signs indicating compromised hemostasis.
- Complications and Risk Factors:
- Discuss potential complications associated with thrombocytopenia, including the risk of spontaneous bleeding, particularly in critical areas such as the brain.
- Management and Nursing Interventions:
- Outline nursing interventions and management strategies to support patients with thrombocytopenia, emphasizing the importance of monitoring, bleeding precautions, and collaboration with the healthcare team.
Pathophysiology of Thrombocytopenia
- Decreased Platelet Production:
- Thrombocytopenia often results from impaired platelet production in the bone marrow, which can be caused by conditions such as leukemia, myelodysplastic syndromes, or chemotherapy.
- Increased Platelet Destruction:
- Accelerated destruction of platelets in the bloodstream or spleen is a common mechanism. Conditions like immune thrombocytopenic purpura (ITP) or drug-induced immune reactions can lead to the immune system targeting and destroying platelets.
- Sequestration in the Spleen:
- An enlarged spleen may sequester a significant number of platelets, reducing the circulating platelet count. Liver cirrhosis or other conditions leading to splenomegaly can contribute to this mechanism.
- Consumption in Coagulation Disorders:
- Certain coagulation disorders, such as disseminated intravascular coagulation (DIC), can consume platelets excessively, contributing to thrombocytopenia.
- Genetic Factors:
- Inherited conditions, like Wiskott-Aldrich syndrome or Bernard-Soulier syndrome, can affect platelet function or production, leading to thrombocytopenia.
Etiology of Thrombocytopenia
- Idiopathic Thrombocytopenic Purpura (ITP):
- ITP is an autoimmune disorder where the immune system mistakenly targets and destroys platelets, leading to a low platelet count.
- Drug-Induced Thrombocytopenia:
- Certain medications, such as heparin, quinine, or certain antibiotics, can induce an immune response that leads to platelet destruction.
- Underlying Medical Conditions:
- Chronic medical conditions like leukemia, myelodysplastic syndromes, or bone marrow disorders can disrupt normal platelet production.
- Viral Infections:
- Viral infections, such as HIV, hepatitis C, or Epstein-Barr virus, may affect platelet production or trigger immune-mediated destruction.
- Hematologic Disorders:
- Disorders affecting the hematologic system, like aplastic anemia or hemolytic-uremic syndrome, can contribute to thrombocytopenia.
Desired Outcome for Thrombocytopenia
- Maintain Safe Platelet Count:
- Achieve and maintain a platelet count within the acceptable range to prevent spontaneous bleeding and ensure adequate hemostasis.
- Prevent Bleeding Complications:
- Minimize the risk of bleeding complications by implementing appropriate interventions, monitoring for signs of bleeding, and promptly addressing any abnormalities.
- Patient Education and Understanding:
- Ensure the patient understands the condition, including potential triggers, symptoms of bleeding, and the importance of adherence to prescribed treatments and precautions.
- Prevent Complications of Thrombocytopenia:
- Identify and address potential complications early, such as infection or organ damage, to prevent worsening of the thrombocytopenic state.
- Improve Quality of Life:
- Enhance the patient’s quality of life by effectively managing thrombocytopenia, minimizing symptoms, and addressing psychosocial aspects related to the condition.
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 Assessment for Thrombocytopenia
- Baseline Platelet Count:
- Obtain and document the baseline platelet count to monitor changes and assess the severity of thrombocytopenia.
- Bleeding Risk Assessment:
- Assess the patient’s risk for bleeding by considering factors such as recent trauma, surgical history, or known bleeding tendencies.
- Integumentary Assessment:
- Monitor for signs of bleeding, including petechiae, ecchymosis, mucosal bleeding, or prolonged bleeding from minor injuries.
- Medication History:
- Review the patient’s medication history, focusing on drugs that may contribute to thrombocytopenia or increase bleeding risk.
- Physical Examination:
- Perform a thorough physical examination, with emphasis on the integumentary system, mucous membranes, and neurological status to identify signs of bleeding.
- Monitoring for Complications:
- Monitor for complications related to thrombocytopenia, such as infection or organ dysfunction, and intervene promptly as needed.
- Psychosocial Assessment:
- Assess the patient’s emotional well-being and psychosocial status, addressing any anxiety, fear, or concerns related to the diagnosis and its impact on daily life.
- Patient Education:
- Educate the patient about the importance of adhering to prescribed treatments, medications, and precautions to prevent bleeding complications.
Implementation for Thrombocytopenia
- Platelet Transfusions:
- Administer platelet transfusions as prescribed to rapidly increase platelet levels in cases of severe thrombocytopenia or active bleeding.
- Medication Administration:
- Administer medications as prescribed, such as corticosteroids, immune globulin, or other immunosuppressive agents to address immune-mediated causes of thrombocytopenia.
- Bleeding Precautions:
- Implement bleeding precautions, including the use of soft toothbrushes, avoidance of invasive procedures, and careful monitoring during activities that pose a risk for bleeding.
- Patient Education:
- Educate the patient on the importance of adhering to prescribed treatments, medications, and lifestyle modifications to prevent exacerbation of thrombocytopenia and reduce the risk of bleeding.
- Regular Monitoring and Assessment:
- Conduct regular monitoring of platelet counts, clinical manifestations of bleeding, and any potential complications. Adjust interventions based on assessment findings.
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
Observe skin for petechiae, purpura and open wounds. Bleeding may be minimal, non-existent or severe.
- 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
NSAIDs such as ibuprofen and aspirin can increase the risk of bleeding and should be avoided. If pain relief is necessary, recommend acetaminophen or non-pharmacological alternatives.
- Initiate bleeding precautions; use only electric razors, limit needlesticks, use soft toothbrush, provide safety devices to prevent injury (non-skid shoes/socks, etc.)
Decreased platelet counts do not always indicate bleeding, but may lead to excessive bleeding if injury occurs.
- 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
Avoid high-risk activities that may result in injury to reduce the risk of bleeding; alcohol slows the production of platelets; NSAIDs increase the likelihood of bleeding; leafy greens are high in vitamin K which helps promote clotting.
- Monitor for signs of infection if splenectomy is required
Removing the spleen may be necessary to treat thrombocytopenia. If so, it increases the risk of infection. Monitor for fever, rash and other signs of infection.
Evaluation for Thrombocytopenia
- Platelet Count Stabilization:
- Evaluate whether interventions have effectively stabilized the platelet count within the target range to minimize the risk of bleeding.
- Prevention of Bleeding Complications:
- Assess whether bleeding precautions and interventions have successfully prevented bleeding complications or minimized their severity.
- Patient Adherence:
- Evaluate the patient’s adherence to prescribed medications, treatments, and lifestyle modifications to determine the impact on platelet levels and overall management of thrombocytopenia.
- Resolution of Symptoms:
- Monitor for the resolution of symptoms associated with thrombocytopenia, such as petechiae, ecchymosis, or mucosal bleeding, indicating improved platelet function.
- Quality of Life Improvement:
- Assess whether the patient’s quality of life has improved, considering both the physical and psychosocial aspects related to the management of thrombocytopenia.
Frequently Asked Questions
What are the causes of thrombocytopenia?
The main causes of thrombocytopenia are aplastic anemia, autoimmune disorders, and heparin-induced.
What are the main points of patient education for thrombocytopenia?
With thrombocytopenia the patient needs to be taught bleeding precautions and to make sure to get permission from primary care provider before taking aspirin or other anticoagulants.
What is thrombocytopenia?
Thrombocytopenia is when there is a low platelet count and an increased risk of bleeding.
References
- http://jhoponline.com/itp
- https://www.nhlbi.nih.gov/health-topics/thrombocytopenia
- https://www.mayoclinic.org/diseases-conditions/thrombocytopenia/symptoms-causes/syc-20378293
- https://www.webmd.com/a-to-z-guides/thrombocytopenia-symptoms-causes-treatments#2-3
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Thrombocytopenia
- Risk for Bleeding: Thrombocytopenia increases the risk of bleeding. This diagnosis highlights the potential for bleeding events and the need for precautions.
- Impaired Skin Integrity: Patients with thrombocytopenia may develop petechiae or ecchymosis. This diagnosis addresses the risk of skin integrity issues.
- Altered Comfort: Thrombocytopenia-related bleeding can lead to discomfort and pain. This diagnosis focuses on comfort measures.
Transcript
Hey guys, let’s take a look at the care plan for thrombocytopenia. In this lesson, we’ll briefly take a look at the pathophysiology and etiology of thrombocytopenia. We’re also going to take a look at additional things that would be included in this care plan, like subjective and objective data, as well as nursing interventions and rationales.
Thrombocytopenia is defined as a low platelet count and an increased risk of bleeding. Usually, thrombocytopenia is a side effect of another disease process like leukemia, some immune disorders, or even medications. Thrombocytes are essential to the body because as they clump together to form clots and seal blood vessels when injury or damage occurs. If bleeding does occur, it can be internal or external. Many factors influence the development of thrombocytopenia, such as cancers, autoimmune diseases, infections, surgery, alcohol use disorder, and also certain medications. The condition can be inherited or acquired. Generally, a low platelet count develops when the bone marrow fails to produce enough thrombocytes, or the bone marrow makes enough for the body, destroys them, or uses them too quickly, or when the spleen holds on to too many platelets. The desired outcome is to increase platelet production and availability, minimize the risk of excessive bleeding and to treat that underlying cause.
Let’s take a look at some of the subjective and objective data that your patient with thrombocytopenia may present with. Remember, subjective data are going to be things that are based on your patient’s opinions or feelings. This might include bruising easily, or bleeding gums with brushing, although patients might even be asymptomatic or have no symptoms at all.
Objective data includes petechiae or purpura, abnormal vaginal bleeding, epistaxis, or a platelet count on CBC of less than a hundred thousand.
Let’s take a look at the nursing interventions when caring for a patient with thrombocytopenia. Assess for signs of internal and external bleeding, including blood in the urine or stool, bleeding of the mucous membrane, such as the gums, and the skin. Observe the skin for petechiae, purpura, or open wounds. Bleeding can be minimal, it can be non-existent, or it can be severe. So, even though platelets are low, administering platelets may not be indicated if there are no signs of active bleeding.
Treatment is going to depend on the cause of the thrombocytopenia. Immunosuppressants may be given if the underlying cause is auto-immune, Androgens may be given to males only, because of the possibility of unwanted hair growth that would occur in females. Vinca alkaloids may also be given if other measures have failed. So NSAIDS, such as ibuprofen and aspirin can increase the risk of bleeding and should be avoided. If pain relief is necessary, recommend acetaminophen or non-pharmacological alternatives. Decreased platelets does not always indicate bleeding in the patient, but it may lead to excessive bleeding if injury occurs, so teach your patient about bleeding precautions. Patients should use only electric razors. Needle sticks should be limited. They should use a soft toothbrush and provide safety devices like non-skid shoes and socks to prevent injury. It’s important to teach your patient to avoid high-risk activities that could cause injury like contact sports to reduce the risk of bleeding.
Alcohol should be avoided, or at least limited because alcohol slows the production of platelets. Also like I mentioned earlier, NSAIDS can increase the likelihood of bleeding, so they should be avoided. increase the intake of green leafy vegetables as they are high in vitamin K, which helps to promote clotting. Finally, removing the spleen may be necessary to treat thrombocytopenia, and if this is the case, it increases the risk for infection in the patient, so teach the patient to monitor for fever, rash, and other signs of infection.
Okay, guys, here is a look at the completed care plan for thrombocytopenia. We love you guys. Now, go out and be your best self today and as always, happy nursing!
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