Nursing Care Plan for ITP Idiopathic Thrombocytopenic Purpura

Idiopathic Thrombocytopenic Purpura

Definition

• Thrombocytopenia is a deficiency of platelets, which are part of the blood clotting.
• ITP is a bleeding state in the form of petechiae or ecchymosis in the skin / mucous membranes and other tissues with a decrease in platelet count due to an unknown cause. (ITP is most common in children at age 2-8 years), is more common in women.
• ITP or idiopathic thrombocytopenic purpura. Idiopathic means the cause is unknown. Thrombocytopenic means the blood does not have enough blood platelets (thrombocytes). Purpura means someone has bruises that many (redundant).

Etiology

• Hypersplenism.
• Virus infection.
• intoxication ; food / medicine.
• Chemicals.
• Effects of fission (radiation, heat).
• Lack of maturation factors (malnutrition).
• Disseminated intra- vascular coagulation CKID.
• Autoimmune.

Types of ITP :
1. Acute.

• Originally found thrombocytopenia in children.
• Platelet counts returned to normal within 6 months of diagnosis (spontaneous remission).
• There were no subsequent recurrence.

2. Chronic

• Thrombocytopenia lasting more than 6 months after diagnosis.
• Insidious onset.
• Platelet counts remained below normal for the disease.
• This form is mainly in adults.

3. Recurrent

• First thrombocytopenia.
• Recurrent relapses.
• Platelet counts returned to normal between the time of relapse.

Signs and Symptoms

• Prodormal period, fatigue, fever and abdominal pain.
• Spontaneously arising petechiae and ecchymoses on the skin.
• Epistaxis.
• Oral mucosal bleeding.
• Menorrhagia.
• Bruising.

Examination Support

• In laboratory tests found Platelets less than 10,000 / ml . Sometimes it can happen mild anemia caused by bleeding.
• Morphological examination of normal blood cells , except for a slightly enlarged platelets (megakaryocytes). Megakaryocytes are platelets produced in response to platelet destruction.
• Examination of normal leukocytes.
• In bone marrow examination were normal with normal or increased number of megakaryocytes
• Bleeding elongated period.

Nursing Assessment

1. Asymptomatic until the platelet count dropped below 20,000.
2. Signs of bleeding.
Petechiae occur spontaneously.
Ecchymosis occurs in areas of minor trauma.
Bleeding from the mucosa of the gums, nose, respiratory tract.
Menoragie.
Haematuria.
Gastrointestinal Bleeding.
4. Activity / rest.
Symptoms :
fatigue, weakness, general malaise.
Low tolerance for exercise.
Sign
tachycardia / tachypnea, dyspnea on activity / rest.
muscle weakness and decreased strength.
5. Circulation.
Symptoms :
history of chronic blood loss, such as chronic GI bleeding, heavy menstruation.
palpitations (tachycardia compensation).
Signs :
BP: systolic to diastolic steady improvement.
6. Integrity ego.
Symptoms : religious / cultural influence treatment options : refusal of blood transfusions.
Signs : Depression.
7. Elimination.
Symptoms : Haematemesis, stool with fresh blood, melena, diarrhea, constipation.
Signs : abdominal distension.
8. Food / liquids.
Symptoms :
Reduction in dietary input.
Nausea and vomiting.
Signs : poor skin turgor, disheveled, lost elasticity.
9. Neuro - sensory.
Symptoms :
Headache, dizziness.
Weakness, decreased vision.
Signs :
Epistaxis.
Mental : unable to respond (slow and shallow).
10. Pain / comfort .
Symptoms : Abdominal pain, headache.
Signs : tachypnea, dyspnea.
11. Breathing.
Symptoms : shortness of breath at rest and activity.
Signs : tachypnea, dyspnea.
12. Security
Symptoms : poor wound healing frequent infections, blood transfusions before.
Signs : petechiae, ecchymosis.