thrombocytopenia

Thrombocytopenia Nursing Diagnosis Interventions and Care Plans

Thrombocytopenia NCLEX Review Care Plans

Nursing Study Guide on Thrombocytopenia

Thrombocytopenia is a medical condition characterized by low levels of platelets in the blood.

It can happen because of reduced production of platelets in the bone marrow, destruction of platelets, or dilution of platelets in the bloodstream.

Platelets, also known as thrombocytes, are small colorless blood cells that are responsible for the body’s clotting ability.

Their primary function is to stop bleeding by a process known as coagulation, which means clumping together to make a “plug” and sticking on the source of bleeding.

They are produced in the bone marrow together with the red and white blood cells. Once made, they live up to eight to ten days.

The normal level of platelets in the blood stream is between 150,000 to 400,000 platelets per microliter.

Levels below this range can cause problems in the human body.

Signs and Symptoms of Thrombocytopenia

The signs and symptoms of thrombocytopenia are mostly related to bleeding. This condition can presents as follows:

  • Epistaxis or nosebleed.
  • Bleeding gums
  • Hemoptysis – coughing of blood
  • Hematemesis – vomiting of blood
  • Hematuria or passing of blood in urine
  • Hematochezia -the presence of fresh red blood in the stool
  • Melena  -passage of dark, tarry stool.
  • Metromenorrhagia in women –irregular and persistent uterine bleeding
  • Post-partum hemorrhage in women
  • Excessive post-surgical bleeding in minor and major surgeries
  • Bleeding after aspirin intake
  • Spontaneous bruising
  • Petechial rash
  • Fatigue
  • Enlarged spleen

Causes of Thrombocytopenia

Thrombocytopenia can result from different conditions or as a side effect of medications.

The three main explanations in the reduction of platelets level are:

  1. Trapped platelets in the spleen. About a third of the body’s platelets are housed in the spleen. Any condition that causes enlargement of the spleen can cause it to trap more platelets than usual, hence affecting the number of platelets in the blood circulation. Enlargement of spleen can be seen in cirrhosis and splenomegaly. 
  2. Reduction in platelet production. Conditions that affect the function of the bone marrow can also cause low platelet count. Leukemia and other cancers, some types of anemia, hepatitis, HIV and other viral illnesses, chemotherapy and radiation therapy, and heavy alcohol consumption can cause suppression in the bone marrows ability to produce blood products including platelets. 
  3. Increased destruction of platelets. Platelets have a lifespan of 8-10 days. However, there are some conditions that cause the breakdown of platelets sooner than they should. These conditions include:
    • Pregnancy. Pregnancy usually causes mild thrombocytopenia which settles immediately after birth.
    • Immune thrombocytopenia. This is commonly referred to as idiopathic thrombocytopenic purpura. It is an autoimmune condition where the body  attacks its own platelets. The cause is still unknown.
    • Bacterial infection. Severe bacterial infection affecting the blood or bacteremia can cause the destruction of platelets in the blood.
    • Thrombotic thrombocytopenic purpura. It is a condition characterized by the sudden formation of small blood clots throughout the body causing the use of most of the platelets in circulation.
    • Hemolytic uremic syndrome. This condition is characterized by the inflammation of the small blood vessels in the kidneys, leading to kidney failure. The damage to the small blood vessels causes the formation of blood clots causing the destruction of red blood cells and platelets.
    • Medication. Some medications can reduce platelet levels. Examples are heparin, quinine, anticonvulsants, and antibiotics that have a sulfa component.

Complications of Thrombocytopenia

Bleeding often results from low platelet count. It can range from mild to severe depending on how low the platelet count is.

In cases where the platelet levels fall below 10,000 platelets per microliter, severe bleeding in the brain may occur.

Diagnosis of Thrombocytopenia

  • Physical examination – to check the presence of the signs and symptoms of thrombocytopenia; the skin will be assessed for presence of bruising and questions will be asked regarding the presence of bleeding
  • Blood test – complete blood count is a procedure that involves taking a sample of the patient’s blood to count the number of platelets present

Depending on the presenting signs and symptoms, further tests may be requested to determine the primary cause of thrombocytopenia.

Treatment of Thrombocytopenia

  1. Close monitoring. In mild cases, thrombocytopenia will not require treatment as the bone marrow is expected to create new thrombocytes. In more severe cases, treatment will be required depending on what caused the low platelet count.
  2. Blood or platelet transfusion. If the platelet level is too low and immediate correction is warranted, platelet or whole blood transfusion is administered.
  3. Medication. If the low levels of platelets are due to immune system, corticosteroid is usually prescribed to slow down the destruction of platelets.
  4. Surgery. This is mostly recommended in cases of splenomegaly if it is the cause of thrombocytopenia.
  5. Plasmapheresis. Also known as plasma exchange, this procedure involves the removal of plasma from the body of the patient and replacing it with new plasma fluid.  In rare cases of thrombotic thrombocytopenic purpura, plasma exchange is usually required.

Nursing Care Plans for Thrombocytopenia

Nursing Care Plan 1

Nursing Diagnosis: Risk for Bleeding related to low platelet count

Desired Outcome: To prevent any bleeding episode and improve platelet count.

InterventionsRationales
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 platelet counts and coagulation levels of the patient.
To check for the need for platelet transfusion.
Administer blood or platelet transfusion as prescribed.If the platelet level is too low and immediate correction is warranted, platelet or whole blood transfusion is administered.
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

Nursing Diagnosis: Fluid Volume Deficit related to blood volume loss secondary to bleeding as evidenced by hematemesis, low platelet count, HB of 70, skin pallor, blood pressure level of 85/58, and 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 color

InterventionsRationales
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 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 to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.To help the patient or the guardian take ownership of the patient’s care, encouraging 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

Nursing 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 environment to adapt to current capacity.

InterventionRationale
Assess the patient’s energy level and fatiguability, as well as his/her 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 aides and 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.

Nursing Care Plan 4

Nursing Diagnosis: Fatigue related to post surgical removal of spleen secondary to thrombocytopenia and splenomegaly, as evidenced by verbalization of lack of  energy, verbalization of tiredness, and generalized weakness

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

InterventionsRationales
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 he/she 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 in 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 a 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 physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Other possible nursing diagnoses:

  • Activity Intolerance
  • Risk for Infection

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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