Thrombocytopenia Sherpath

A patient diagnosed with immune thrombocytopenic purpura (ITP) will be undergoing a splenectomy. A family member asks why this procedure is necessary. Which response by the nurse is appropriate?

"Removal of the spleen will stop the unwarranted destruction of your platelets." *Since ITP is autoimmune in nature, a person with chronic ITP may benefit from the removal of the spleen since it is a major source of autoantibody production.

The nurse should include which statement regarding over-the-counter (OTC) medications when teaching a patient with thrombocytopenia?

"There are certain medications that should be avoided altogether, including aspirin." *There are certain medications that should be avoided. Aspirin is one since it can increase the risk of bleeding in a thrombocytopenic patient.

A patient is diagnosed with thrombotic thrombocytopenic purpura (TTP) and asks the nurse what to expect regarding treatment. Identify the treatments the nurse should review in the order that they would be administered.

1) The first step in treating thrombotic thrombocytopenic purpura is to treat the underlying causes such as infection. Infection would be treated with antibiotics. 2) If treating the cause did not address the problem, plasmapheresis or plasma exchange would be performed. 3) Rituximab may be used for patients refractory to plasma exchange. 4) Finally, splenectomy may be considered in patients who are refractory to plasma exchange or immunosuppression.

In which patient with thrombocytopenia would a platelet transfusion be appropriate?

A patient with immune thrombocytopenic purpura (ITP) with a platelet count <10, 000/μL *A patient with ITP and a platelet count <10,000 will receive a platelet transfusion. Usually ITP can be treated effectively with steroids, but if this treatment fails and the platelet level falls, the patient will need a transfusion.

A nurse is caring for a patient with a history of thrombocytopenia. The patient has several complications while in the hospital and needs to be on bedrest for several days. The nurse understands that one main goal is to prevent bleeding in this patient. Which intervention needs to be considered for this patient who needs additional bed rest at home?

Avoid herbal medications and supplements *To prevent bleeding complications in this patient, it will be important for the nurse to instruct the patient and caregiver to avoid taking herbal medications.

A patient presents with symptoms of thrombocytopenia and a platelet count of 50,000/µL. To differentiate thrombocytopenia from a myeloproliferative disorder, which diagnostic study would the nurse anticipate being prescribed for this patient?

Bone marrow biopsy *A bone marrow biopsy may be necessary to rule out leukemia, aplastic anemia, and other myeloproliferative disorders and can be used to differentiate thrombocytopenia from other myeloproliferative disorders.

A patient presents to the emergency department with drug-induced thrombotic thrombocytopenic purpura (TTP). The patient is currently on aspirin and clopidogrel. The patient is complaining of a fever and severe discomfort in the left lower quadrant. The nurse should anticipate which treatment plan from the primary health care provider to care for this patient?

Discontinue clopidogrel *This patient is experiencing a drug-induced TTP, so the nurse would expect the health care provider to remove the offending agent(s), including clopidogrel.

On day five post-op, a patient's laboratory blood results reveal a platelet count of 95,000/μL. The patient has been prophylactically treated with heparin for the past five days for deep vein thrombosis. Which treatment orders should the health care team anticipate to manage this patient?

Discontinue the heparin *This patient has developed heparin-induced thrombocytopenia (HIT) and heparin will need to be discontinued. If not already indicated in the patient's electronic health record, it should be noted that this patient should never receive heparin in the future.

A patient diagnosed with metastasizing cancer has a history of immune thrombocytopenic purpura (ITP) controlled with prednisone. Which information will need to be covered in the education plan for this patient?

Information on chemotherapy since some drugs will cause thrombocytopenia *Some chemotherapy drugs can lead to thrombocytopenia, and therefore, the patient will need education on this therapy.

A patient presents to the clinic with possible immune thrombocytopenic purpura (ITP) due to a rash on the upper legs and arm and is also recovering from a bad case of strep throat. The patient has no significant medical history. The nurse should anticipate which medication will be administered to this patient?

PrednisoneThis patient is presenting with signs of ITP. *Many cases will resolve on their own, but if needed, the best medication for this patient would be a low-dose steroid.

The nurse is reviewing a patient's chart and the patient is found to have a decreased platelet count (60,000/µL). How can the nurse determine the type of thrombocytopenia the patient is experiencing?

Prior medical history *Heparin-induced thrombocytopenia (HIT) occurs in response to heparin administration, and thrombotic thrombocytopenic purpura (TTP) may follow drug toxicity, pregnancy or preeclampsia, infection, or known autoimmune disorder. Therefore, the patient history can help differentiate the type of thrombocytopenia.

A patient with a history of chronic immune thrombocytopenic purpura (ITP) comes to the nurse for dietary advice. As a health care provider, you understand that an important goal for this patient is to reduce mouth soreness and irritation. Which intervention would be helpful for this patient?

Soft, bland food *A diet of soft, bland foods will be most helpful to patients and help prevent mouth discomfort and irritation.

A nurse is caring for a patient newly diagnosed with thrombocytopenia who is an active sports player and has a number of bruises. Which intervention should the nurse implement to improve the chances of a desired patient outcome?

Teach the patient about harmful effects that vigorous exercise can cause and encourage walking instead. *Teaching the patient about the harmful effects of vigorous exercise and encouraging them to walk would be a good intervention, since this is teaching them to avoid causative factors.

A nurse is caring for a young adult female patient with thrombocytopenia. Which statements about the patient's menstrual cycle should the nurse include during patient education?

Teach the patient about the importance of avoiding tampons. *Encouraging the patient to use pads instead of tampons will be helpful for monitoring blood loss. If the patient is using a large number of pads, then she should be encouraged to contact the health care provider. Encourage the patient to use pads and count the number of pads used. *Encouraging the patient to use pads will be helpful for monitoring blood loss. If the patient is using a large number of pads, then she should be encouraged to contact the health care provider.

A 44-year-old patient presents to the emergency department with a fever, blood clots, and history of an abnormal enzyme deficiency. The patient has not taken any medications in the past month. Why is this patient also likely to experience pain with the condition?

This patient is presenting with signs of thrombotic thrombocytopenic purpura (TTP). *This patient is presenting with signs of TTP that include fever (without an identifiable cause) and history of an enzyme deficiency (ADAMTS13) needed to break down von Willebrand factor. TTP patients need to be monitored for microthrombi that can cause ischemia and pain.

A patient presents with thrombocytopenia secondary to heparin administration. The nurse should assess the patient for which potential complication(s)?

Venous thrombosis *Venous thrombosis is the major clinical complication of heparin-induced thrombocytopenia and can lead to further life-threatening complications. Altered cognitive status *Neurologic abnormalities, resulting in altered cognitive status, can occur as part of thrombotic stroke. This is a complication of heparin-induced thrombocytopenia.

Patient was diagnosed with thrombocytopenia and states he was born with it. What type of thrombocytopenia is this?

pancytopenia *this is inherited thrombocytopenia

A patient is diagnosed with thrombocytopenia. Which symptoms would the nurse expect to observe in a patient with thrombocytopenia?

petechiae, tachycardia, abdominal pain, hypotension