Idiopathic Thrombocytopenic Purpura

  1. General information
    1. Increased destruction of platelets with resultant platelet count of less than 100,000/mm3 characterized by petechiae and ecchymoses of the skin
    2. Exact cause unknown; may be an autoimmune mechanism; onset sudden, often preceded by a viral illness
    3. The spleen is the site for destruction of platelets; spleen is not enlarged
  2. Medical management
    1. Drug therapy: steroids and immunosuppressive agents
    2. Platelet transfusion
    3. Surgery: splenectomy
  3. Assessment findings
    1. Petechiae: spider-web appearance of bleeding under skin due to small size of platelets
    2. Ecchymosis
    3. Blood in any body secretions, bleeding from mucous membranes, nosebleeds
    4. Diagnostic tests: platelet count decreases, anemia
  4. Nursing interventions
    1. Control bleeding
      1. Administer platelet transfusions as ordered.
      2. Apply pressure to bleeding sites as needed.
      3. Position bleeding part above heart level if possible.
    2. Prevent bruising.
    3. Provide support to client and be sensitive to change in body image.
    4. Protect from infection.
    5. Measure normal circumference of extremities for baseline.
    6. Administer medications orally, rectally, or IV, rather than IM; if administering immunizations, give subcutaneously (SC) and hold pressure on site for 5 minutes.
    7. Administer analgesics (acetaminophen) as ordered; avoid aspirin.
    8. Provide care for the client with a splenectomy (see Splenectomy, in Unit 4).
    9. Provide client teaching and discharge planning concerning
      1. Pad crib and playpen, use rugs wherever possible.
      2. Provide soft toys.
      3. Sew pads in knees and elbows of clothing.
      4. Provide protective headgear during toddlerhood.
      5. Use soft Toothettes instead of bristle toothbrushes.
      6. Keep weight to low normal to decrease extra stress on joints.
      7. Use stool softeners to prevent straining.
      8. Avoid contact sports; suggest swimming, biking, golf, pool.