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.
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.
Increase platelet production and availability, minimize risk of excessive bleeding, treat underlying cause
Thrombocytopenia Nursing Care Plan
- Easily bruises
- Bleeding gums when brushing teeth
** Patients may be completely asymptomatic **
- Petechiae or purpura
- Abnormal vaginal bleeding
- 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
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
- 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.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nrsng.com/cornell