Thrombocytopenia
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Included In This Lesson
Study Tools For Thrombocytopenia
Bleeding Precautions (Mnemonic)
Thrombocytopenia Pathochart (Cheatsheet)
Clotting Cascade Anticoagulants Cheatsheet (Cheatsheet)
Detailed Clotting Cascade (Image)
Clotting Cascade (Image)
Petichiae and Purpura (Image)
Oral Petichiae due to Thrombocytopenia (Image)
Bone Marrow Biopsy (Image)
63 Must Know Lab Values (Book)
Heparin Induced Thrombocytopenia (HIT) (Picmonic)
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Outline
Pathophysiology:
This can occur for either unknown reasons or autoimmune. Platelets are destroyed by the body (autoimmune) or are decreased for unknown reasons.
Overview
- Decrease in circulating platelets (<100,000/mL)
- Often far less before treatment (<40,000/mL)
Nursing Points
General
- Causes
- Decreased production
- Aplastic Anemia
- Increased destruction
- Autoimmune Disorders
- Medication induced
- Heparin-Induced
- Decreased production
Assessment
- Abnormal Labs
- ↓ Platelet count
- ↓ Hgb, Hct
- Monitor CBC
- Bleeding
- Petechiae
- Epistaxis
- GI bleeding
- Hematemesis
- Melena
- Occult blood in stool
- Hematuria
- Hemoptysis
Therapeutic Management
- Platelet transfusions
- Bleeding precautions
- Avoid invasive procedures
- Soft bristled toothbrush
- Avoid medications that interfere with coagulation (i.e. Aspirin, Heparin)
- Diagnosis made via bone marrow aspiration
Nursing Concepts
- Clotting
- Monitor for signs of bleeding
- Educate patient on bleeding precautions
- NO invasive procedures unless medically necessary
- IV starts, NG Tube, Foley
- Central Lines
- Assess all current lines for bleeding
Patient Education
- Bleeding precautions
- No straight blade razors – electric only
- Soft-bristle toothbrush
- Report bleeding to provider
- Avoid injury/falls
- Do NOT take Aspirin or other anticoagulants without permission from primary care provider
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Thrombocytopenia
Transcript
Okay, guys, in this lesson we’re going to review nursing implications of thrombocytopenia. Let’s break down this word. Thrombocyte is another word for platelets. And any time you see -penia you should think lack of or too little.
So, Thrombocytopenia is a lack of platelets – by definition it’s platelets less than 100,000, but usually we see much lower than that, like less than 40,000. There are a couple of general causes – either decreased production, increased destruction, or medication induced. An example of decreased production would be like in aplastic anemia where the bone marrow stops producing blood cells altogether. Increased destruction can happen in some autoimmune diseases like lupus, and medications like heparin can induce a severe thrombocytopenia in patients.
So we’ll see decreased platelet counts. Like I said, less than 100,000, but usually we don’t start treating until less than 40,000 or so. Now, we know that platelets are responsible for the clotting process, right? So if we have too few platelets in our system, we’re going to see bleeding. This isn’t usually AS severe as something like DIC, but they will ooze from all their IV sites, and will probably have petechiae or purpura on their skin like you see here. They could have epistaxis or nosebleeds. GI bleeding could cause hematemesis, melena, or occult blood in the stool. They could even have hematuria or blood in their urine or hemoptysis which is coughing up blood. Anything that would normally cause bleeding will simply cause more bleeding than usual because of the low platelets.
We could possibly do a bone marrow aspiration from one of the major flat bones to confirm diagnosis of what’s causing the thrombocytopenia, but usually our lab values are enough. When their platelets are low enough, we’ll give them platelet transfusions. Key thing to note here is that platelets have to be blood type compatible just like red blood cells, so make sure you’re checking the blood compatibility chart. We will also avoid any antiplatelet meds like aspirin or whatever med that caused the thrombocytopenia in the first place. If they do get heparin-induced thrombocytopenia, we consider that an allergy to heparin and that patient should not receive heparin ever again. And then, we want to put the patient on bleeding precautions. This means no straight blade razors – only electric razors. We use soft-bristle toothbrushes only. We want to monitor for any kind of bleeding and avoid falls or injury as much as possible. It’s possible for a patient to go home with thrombocytopenia, so make sure the patient understands these precautions as well.
The top priority nursing concept for a patient with thrombocytopenia is clotting. I know that seems obvious, but it’s important that we monitor for bleeding, monitor lab values, transfuse platelets, and institute bleeding precautions.
So, let’s recap. Thrombocytopenia is decreased platelets, below 100,000. This means the patient will struggle to form a clot if needed. So we’ll see signs of bleeding like petechiae, nose bleeds, or blood from other places – remember any time you see hemat or hemo think blood – so hematuria, hematemesis, hemoptysis, or GI bleeding. We want to replenish their platelets with transfusions and by avoiding antiplatelet meds, and we institute bleeding precautions. We want to monitor for bleeding and make sure we educate our patients on what to do and what to report to their provider.
So that’s it for thrombocytopenia. Check out the rest of the resources in this lesson to learn more. Now, go out and be your best self today. And, as always, happy nursing!
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Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)