Nursing Care Plans for Thrombocytopenia with Examples

Introduction

Thrombocytopenia is a condition in which a person has a low blood platelet count. This condition means a person has fewer than 150,000 platelets per microliter of circulating blood. Platelets are colourless blood cells that facilitate blood clotting. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.

Thrombocytopenia might occur due to a bone marrow disorder such as leukemia or an immune system problem. Or it can be a side effect of taking certain medications. It affects both children and adults.

Thrombocytopenia can be mild and cause few signs or symptoms. In rare cases, the number of platelets can be so low that dangerous internal bleeding occurs. Treatment options are available.

This blog post discusses nursing care plans for thrombocytopenia together with the diagnosis, causes, symptoms and interventions with elaborate examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Symptoms of Thrombocytopenia

Thrombocytopenia signs and symptoms may include:

1. Easy or excessive bruising (purpura)
2. Blotches and bruises – A person might have large areas of bleeding under the skin that don’t turn white when you press on them. You also might see what look like the bruises you get from a bump or being hit. They could be blue or purple and change to yellow or green over time. These are caused from the inside by the sudden leaking from tiny blood vessels. The medical name for these is purpura.
3. Prolonged bleeding from cuts
4. Bleeding from your gums or nose
5. Blood in urine or stools
6. Hefty menstrual flows
7. Fatigue
8. Enlarged spleen

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Causes of Thrombocytopenia

Platelets live about 10 days in the body, making it renew the platelet supply continually by producing new platelets in the bone marrow.

Thrombocytopenia rarely is inherited. Several medications or conditions can cause it. Whatever the cause, circulating platelets are reduced by one or more of the following:

Trapped platelets

The spleen is a small organ about the size of a fist situated just below the rib cage on the left side of the abdomen. Normally, the spleen works to fight infection and filter unwanted material from the blood. An enlarged spleen, which a number of disorders can cause, can harbour too many platelets, which decreases the number of platelets in circulation.

Decreased production of platelets

Platelets are produced in the bone marrow. Factors that can decrease platelet production include:

• Leukemia and other cancers
• Some types of anemia
• Viral infections, such as hepatitis C or HIV
• Chemotherapy drugs and radiation therapy
• Heavy alcohol consumption

Increased breakdown of platelets

Some conditions can cause the body to use up or destroy platelets faster than they’re produced, leading to a shortage of platelets in the bloodstream. Examples of such conditions include:

Pregnancy – Thrombocytopenia caused by pregnancy is usually mild and improves soon after childbirth.

Immune thrombocytopenia – Autoimmune diseases like lupus and rheumatoid arthritis cause this type. The body’s immune system mistakenly attacks and destroys platelets. If the exact cause of this condition isn’t known, it’s called idiopathic thrombocytopenic purpura. This type more often affects children.

Bacteria in the blood – Severe bacterial infections involving the blood (bacteremia) can destroy platelets.

Thrombotic thrombocytopenic purpura is a rare condition that occurs when small blood clots suddenly form throughout the body, using up large numbers of platelets.

Hemolytic uremic syndrome – This rare disorder causes a sharp drop in platelets, destruction of red blood cells and impairs kidney function.

Medications – Certain medications can reduce the number of platelets in the blood. Sometimes a drug confuses the immune system and causes it to destroy platelets. Examples include heparin, quinine, sulfa-containing antibiotics and anticonvulsants.

Complications of Thrombocytopenia

Dangerous internal bleeding can occur when your platelet count falls below 10,000 platelets per microliter. Though rare, severe thrombocytopenia can cause bleeding into the brain, which can be fatal.

Diagnosis of Thrombocytopenia

Physical examination

If a doctor suspects a low platelet count, they will first do a physical exam. The doctor will check a patient’s body for unusual bruising or evidence of petechiae (small red and purple dots), which is a sign of capillary bleeding that often accompanies a low platelet count.

The doctor may also feel the abdomen to check for an enlarged spleen or liver.

Medical history

A doctor may also ask about the following:

• A family history of bleeding disorders
• Medications taken
• Herbal supplements taken
• Patient’s eating patterns
• Alcohol intake and IV drug use
• Current sex protection methods

Tests

Multiple blood, bone marrow, and ultrasound tests can help a doctor diagnose this condition and determine the underlying cause. The tests are discussed below.

Blood tests

A doctor will need to do a complete blood count (CBC) test to diagnose low platelet count. This test is often performed with a simple blood draw in the arm.

A CBC test looks at the number of blood cells in the blood. It will tell a doctor if the platelet count is lower than it should be. A typical platelet count will range between 150,000 and 450,000 platelets per millilitre of blood.

A doctor may also choose to perform a blood smear test, which looks at the blood under a microscope to see how the platelets look.

A patient’s blood may also be tested for platelet antibodies. These are proteins that destroy platelets. Platelet antibodies can be produced as a side effect of certain drugs, such as heparin, or for unknown reasons.

Blood-clotting tests may also be ordered, including partial thromboplastin time and prothrombin time. Certain chemicals are added to a blood sample to determine how long it takes the blood to clot.

Ultrasound

If a doctor suspects that a patient’s spleen is enlarged, they may order an ultrasound. This test uses sound waves to make a picture of the spleen.

Bone marrow aspiration and biopsy

A bone marrow test may also be performed. There are two types of bone marrow tests: a biopsy and an aspiration. In some cases, both tests may be performed at the same time.

A small amount of bone marrow is removed from one of the bones

 during a bone marrow aspiration.

A sample of the core bone marrow is removed in a bone marrow biopsy, usually from the hipbone.

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Treatment of Thrombocytopenia

The treatment options for a low platelet count can vary. A doctor or specialist will determine the appropriate treatment for low platelet counts based on the underlying cause and severity of the condition.

If the condition is mild, a doctor may choose to monitor a patient.

If the low platelet count is more severe, a patient may need medical treatment.

Treatment options may include:

1. Blood or platelet transfusions
2. Changing medications that are causing a low platelet count
3. Prescribing steroids, immune globulin, or other medicines that suppress your immune system
4. Spleen removal surgery

Management of Thrombocytopenia

If a patient is at risk of developing a low platelet count, scheduling regular doctor’s visits will help pay attention to potential signs and symptoms.

The patient should let the doctor know about any supplements or medications they are taking.

The patient should avoid activities like contact sports that put you at risk for bleeding injuries or talk to a doctor about safety measures when possible.

If a patient’s spleen has been removed, they should watch for potential signs of infection — as the removal of the spleen can increase the risk — and seek medical attention if they start to feel ill or have a fever.

Screening and Prevention of Thrombocytopenia

There are many reasons that a doctor may screen for low platelet count. In some cases, a routine blood test may indicate low levels.

If a patient is at risk of developing a low platelet count due to an underlying condition or medical history, the healthcare professional may recommend taking prevention measures. These may include:

1. Avoiding activities with a high risk of bleeding or bruising (i.e., contact sports)
2. Limiting alcohol consumption
3. Making dietary changes
4. Stopping or switching medications that affect platelets, including aspirin and ibuprofen
5. Getting certain types of vaccinations
6. Avoiding toxic chemicals

Nursing Care Plans for Thrombocytopenia Based on Nursing Diagnosis

Nursing Care Plan 1: Diagnosis -Risk for Bleeding related to low platelet count

Desired Outcome

To prevent any bleeding episode and improve platelet count.

Interventions	Rationales
Assess the patient’s vital signs and perform a focused physical assessment, looking for any signs of bleeding.	Anticoagulants put the patient at risk for bleeding. Early signs of bleeding include gum bleeding, epistaxis, and unexplained bruises. Low blood pressure, low temperature, and dizziness may result from excessive bleeding.
Obtain blood samples and monitor platelet counts as well as coagulation levels (INR, PT, and PTT).	To measure the risk of bleeding by knowing the patient’s platelet counts and coagulation levels. To check for the need for platelet transfusion.
Administer blood or platelet transfusion as prescribed.	A platelet or whole blood transfusion is administered if the platelet level is too low and immediate correction is warranted.
Prepare the patient for splenectomy as indicated.	This is mostly recommended in cases of splenomegaly if it is the cause of thrombocytopenia.

Nursing Care Plan 2: Diagnosis – Fluid Volume Deficit related to blood volume loss secondary to bleeding

Evidenced by:

• Hematemesis
• Low platelet count
• HB of 70
• Skin pallor
• A blood pressure level of 85/58
• Lightheadedness

Desired Outcome

The patient will have an absence of bleeding, a hemoglobin (HB) level of over 100, blood pressure level within normal range, full level of consciousness, and normal skin colour.

Interventions	Rationales
Assess vital signs, particularly blood pressure level.	Hypovolemia due to bleeding may lower blood pressure levels and put the patient at risk for hypotensive episodes that lead to shock.
Commence a fluid balance chart, monitoring the input and output of the patient. Include episodes of vomiting, gastric suctioning, and other gastric losses in the I/O charting.	To monitor the patient’s fluid volume accurately.
Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously.     Encourage oral fluid intake of at least 2000 mL per day if not contraindicated.	To replenish the fluids and electrolytes lost and promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at the bedside.	To help the patient or the guardian take ownership of the patient’s care, encourage them to drink more fluids as needed, or report any changes to the nursing team.
Administer blood transfusion as prescribed.	To increase the platelet count and hemoglobin level and treat thrombocytopenia, anemia and hypovolemia related to bleeding.

Nursing Care Plan 3: Diagnosis – Risk for Injury related to abnormal blood profile

Desired Outcome

The patient will be able to prevent injury by means doing activities that can be done without spending too much energy and by modifying the environment to adapt to the current capacity.

Intervention	Rationale
Assess the patient’s energy level and fatigability, as well as their usual activities of daily living (ADLs).	To explore the patient’s energy levels and how these can affect ADLs. To gain useful information before modifying the patient’s environment.
Place the bed in the lowest position. Place the call bell within reach (if there’s any), and keep the visual aids, patient’s phone, and other devices within reach.	To prevent or minimize injury of the patient.
Promote adequate lighting in the patient’s room.	To promote safety measures and support to the patient in doing ADLs optimally.
Ensure that the floor is free of objects that can cause the patient to slip or fall.	To promote safety measures and support to the patient in doing ADLs optimally.
Advise the patient to wear sunglasses, especially when going outdoors.	To reduce glare and help protect the eyes.

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Nursing Care Plan 4: Diagnosis – Fatigue related to post-surgical removal of spleen secondary to thrombocytopenia and splenomegaly

Evidenced by:

• Verbalization of lack of energy
• Verbalization of tiredness
• Generalized weakness

Desired Outcome

Post-surgery, the patient will verbalize improved energy levels and will demonstrate active participation in necessary and desired activities.

Interventions	Rationales
Ask the patient to rate fatigue level (mild, moderate, or severe fatigue).     Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that they used to do or wants to try.	To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with rest and sleep.	To gradually increase the patient’s tolerance to physical activity.
Encourage the patient to follow low cholesterol, high caloric diet. Refer to the dietitian as needed.	To increase energy levels.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.	To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to the physiotherapy / occupational therapy team as required.	To provide more specialized care for the patient in terms of helping them build confidence in increasing daily physical activity.

References

• ncbi.gov
• scholar.google.com