DescriptionIdiopathic Thrombocytopenia Purpura (ITP) has two ununited clinical syndromes, manifesting as an clever mood in posterity and a continuous mood in adults.
- Idiopathic thrombocytopenic purpura (ITP), also disclosed as pristine immune thrombocytopenic purpura and autoimmune thrombocytopenic purpura, is defined as unmixed thrombocytopenia delay usual scourge essence and in the omission of other reasons of thrombocytopenia.
- ITP is a quackery that can manage to facile or overmuch bruising and bleeding.
- Children continually amplify ITP succeeding a viral contamination and usually regain easily delayout discoursement.
PathophysiologyThe bleeding fruits from unusually low equalizes of platelets — the cells that acceleration lineage clot.
- ITP is comprehensively a illness of acceptiond peripheral platelet perdition, delay most unrepinings having antibodies to favoring platelet membrane glycoproteins.
- Relative essence scarcity may conduce to this mood gone studies demonstration that most unrepinings possess either usual or mixed platelet formation.
- Acute ITP continually follows an clever contamination and has a self-originated analysis delayin 2 months.
- Chronic ITP persists longer than 6 months delayout a favoring reason.
Statistics and IncidencesIncidence reprimands of idiopathic thrombocytopenic purpura (ITP) are as follows:
- An middle price of the stroke in posterity is 50 rollts per 1,000,000 per year.
- New rollts of continuous unmanageable ITP involve closely 10 rollts per 1,000,000 per year
- According to studies in Denmark and England, cadethood ITP supervenes in closely 10-40 rollts per 1,000,000 per year.
- A prospective, population-based examine in Norway implied an stroke of 53 per 1,000,000 in posterity younger than 15 years.
- A examine in Kuhalt reported a eminent stroke of 125 rollts per 1,000,000 per year.
- The non-existence reprimand from hemorrhage is closely 1% in posterity and 5% in adults.
- Spontaneous remission supervenes in past than 80% of rollts in posterity.
- Peak efficacy supervenes in posterity elderly 2-4 years.
- Approximately 40% of all unrepinings are younger than 10 years.
- In clever ITP (children), division is correspondent betwixt viriles (52%) and females (48%).
CausesIf the reason of this immune reforce is unrecognized, the mood is individualized idiopathic thrombocytopenic purpura. Idiopathic resources “of uncertain reason.”
- Increased breakdown of platelets. In herd delay ITP, antibodies produced by the immune intention annex themselves to the platelets, marking the platelets for perdition; the spleen, which accelerations the matter conflict contamination, owns the antibodies and carrys the platelets from the intention; the fruit of this rollt of miscaptured unity is a inferior enumerate of circulating platelets than is usual.
Clinical ManifestationsClinical features of idiopathic thrombocytopenic purpura (ITP):
- Petechiae. Petechiae vindication when capillaries bleed, leaking lineage into the bark.
- Purpura. Easy or overmuch bruising or purpura is dominant; if scourge essence megakaryocytes cannot acception formation and defend a usual enumerate of circulating platelets, thrombocytopenia and purpura amplify.
- Hemorrhage. Hemorrhagic bullae on mucous membranes, gingival bleeding, signs of GI bleeding, retinal hemorrhages, and sign of intracranial hemorrhage, delay likely neurologic symptoms; the bleeding fruits from unusually low equalizes of platelets — the cells that acceleration lineage clot.
- Nontangible hypochondria. The efficacy of tangible hypochondria in unrepinings delay ITP is closely the corresponding as that in the non-ITP population (ie, 3% in adults, 12% in posterity); resisting the perdition of platelets by splenic macrophages, the hypochondria is usually not comprehensive.
- Spontaneous bleeding. Spontaneous bleeding supervene when platelet calculate is less than 20,000/mm3.
Assessment and Diagnostic FindingsDiagnosis of idiopathic thrombocytopenic purpura embodys:
- Laboratory studies. Isolated thrombocytopenia on a exhaustive lineage cell calculate (CBC) is the key laboratory finding; the snowy lineage cell (WBC) calculate and hemoglobin equalize typically are usual, intrinsic exact hemorrhage has supervenered; on peripheral coat, actually hercules platelets propose ingenerate thrombocytopenia.
- Imaging studies. A CT scan of the summit is involuntary if sympathy exists concerning intracranial hemorrhage.
Medical ManagementTreatment may emorganization a enumerate of approaches, such as medications to boost platelet calculate or surgery to carry hypochondria (splenectomy).
- Prehospital custody. Prehospital custody focuses on the ABCs (airway, safe, prevalence), which emorganization providing oxygen, guiding exact hemorrhage, and initiating intravenous (IV) clears to defend hemodynamic stability; airway restrain may be compulsory for a comprehensive intracranial hemorrhage.
- Emergency section custody. Life-threatening bleeding requires ordinary precarious custody interventions; in the unrepining delay disclosed ITP, high-dose parenteral glucocorticoids and IV immunoglobulin (IVIg), delay or delayout platelet transfusions, are expend.
- Consultations. Consult a hematologist for defendion in confirming the singularity or, in the unrepining delay disclosed ITP, arranging distillation and follow-up custody, if expend.
Pharmacologic ManagementGlucocorticoids and intravenous immunoglobulin (IVIg) are the mainstays of medical therapy for idiopathic thrombocytopenic purpura (ITP).
- Glucocorticoids. These agents are used to disline idiopathic and artificial autoimmune quackerys; they possess been demonstrationn to acception platelet calculate in ITP.
- Blood products. Administration of IVIg may temporarily acception platelet calculates in some posterity and adults delay ITP; attend IVIg if the predicament requires a swift, specific melt in platelet calculate.
- Thrombopoeitic. These agents straightway inflame scourge essence platelet formation.
Nursing ManagementNursing custody for a cadet delay idiopathic thrombocytopenia purpura embody:
Nursing AssessmentAssessment in a cadet delay ITP emorganization the forthcoming:
- History. Medications can be a vulgar etiology for inducing thrombocytopenia, and unrepinings should possess their medications custodyeasily reviewed; one examine used three ununited methods to instrument refuses that may be associated delay refuse-induced immune thrombocytopenia (DITP).
- Physical exam. Address expose factors for acceptiond bleeding, such as GI illness, CNS illness, urologic illness, or exempt lifestyle, as these may individualize the aggressiveness of superintendence.
Nursing DiagnosesBased on the tribute basis, the main nursing diagnoses for idiopathic thrombocytopenis purpura are:
- Risk for bleeding related to abated platelet calculate.
- Risk for damnification related to abusual lineage mark.
- Risk for petty defendion related to altered kinesthetic discernment.
- Risk for contamination related to reservation of the immune intention by steroids.
Nursing Custody Planning and GoalsThe main nursing custody intentionning goals for idiopathic thrombocytopenic purpura are:
- Patient or custodygivers catch measures to checkmate bleeding and own signs of bleeding that deficiency to be reported instantly to a vigor custody administrative.
- Patient does not trial bleeding as signd by usual lineage constraining, unwavering hematocrit and hemoglobin equalizes and desired ranges for coagulation marks.
- Patient debris exempt of injuries.
- Patient acceptions daily spectre, if manageable.
- Patient debris exempt of contamination, as signd by usual life-supporting signs and omission of signs and symptoms of contamination.
- Early memory of contamination to yield for apt discoursement.
Nursing InterventionsNursing interventions for a cadet delay ITP are:
- Prevent bleeding. Review laboratory fruits for coagulation condition as expend: platelet calculate, prothrombin span/international usualized homogeneity (PT/INR), activated specific thromboplastin span (aPTT), fibrinogen, bleeding span, fibrin suspension products, vitamin K, activated coagulation span (ACT); and admonish the at-expose unrepining and custodygivers encircling precautionary measures to checkmate construction trauma or dissension of the usual clotting mechanisms.
- Prevent damnification. Thoroughly consent unrepining to surroundings; put allure buoyant delayin gain and admonish how to allure for defendion; tally to allure buoyant instantly; dodge use of restraints; allure a physician’s ordain if restraints are deficiencyed; and elucidate or ooze all likely hazards in the margin such as razors, medications, and matches.
- Prevent contamination. Wash hands and admonish unrepining and SO to absterge hands precedently continuity delay unrepinings and betwixt procedures delay the unrepining; permit clear incatch of 2,000 to 3,000 mL of instil per day, intrinsic contraindicated; applaud the use of soft-bristled toothbrushes and stool softeners to defend mucous membranes; and if contamination supervenes, admonish the unrepining to catch antibiotics as prescribed; teach unrepining to catch the ample line of antibiotics roll if symptoms reform or delaydraw.
EvaluationGoals are met as signd by:
- Patient or custodygivers took measures to checkmate bleeding and ownd signs of bleeding that deficiency to be reported instantly to a vigor custody administrative.
- Patient did not trial bleeding as signd by usual lineage constraining, unwavering hematocrit and hemoglobin equalizes and desired ranges for coagulation marks.
- Patient remained exempt of injuries.
- Patient acceptiond daily spectre, if manageable.
- Patient remained exempt of contamination, as signd by usual life-supporting signs and omission of signs and symptoms of contamination.
- Early memory of contamination yielded for apt discoursement.
Documentation GuidelinesDocumentation in a cadet delay ITP emorganization the forthcoming:
- Baseline and succeeding tribute findings to emorganization signs and symptoms.
- Individual cultural or holy restrictions and idiosyncratic preferences.
- Plan of custody and living-souls confused.
- Teaching intention.
- Client’s exculpations to admonishings, interventions, and forces done.
- Attainment or advance toward the desired end.
- Long-term deficiencys, and who is under obligation for forces to be catchn.
Idiopathic Thrombocytopenic Purpura Practice Exam
- Option C: Corticosteroids check eosinophils, lymphocytes, and regular killer cells, inhibiting the regular exasperating regularity in an vitiated or injured deal-out of the matter.
- Option A: Excessive corticosteroid therapy can manage to Cushing’s syndrome.
- Options B and D: Corticosteroids do not check the aversion receptors and neural transmission.
- Option A: Steroids may exalt immunosuppression, making the cadet past tender to contaminations.
- Option B: Anemia is not united to the quackery or medication.
- Options C and D: Bleeding and bruising are ownd as a fruit of the quackery, not the steroid therapy.
Acetylsalicylic harsh (ASA)
- Option B: Corticosteroid therapy can abate antimatter formation and phagocytosis of the antibody-coated platelets, retaining past functioning platelets.
- Option C: Methotrexate can reason thrombocytopenia.
- Options A and D: Vitamin K is used to disline an overmuch anticoagulate recite from warfarin overload, and ASA abates platelet confusion.
Less continual febrile occurrences
Increased equalize of hematocrit
Less occurrences of bleeding
Increased equalize of hemoglobin
- Options C: Platelet transfusions may be fond to checkmate bleeding when the platelet calculate falls down.
- Options A: A delaydraw in the febrile occurrence allure bechance succeeding the transfusion of agranulocytes.
- Options B and D: An acceptiond equalize of hemoglobin and hematocrit allure bechance succeeding the transfusion of red lineage cells.
- Option B: Aspirin exerts an antiplatelet force and for-this-reason may acception platelet perdition in ITP.
- Options A, C, and D: Acetaminophen, codeine, and morphine possess no chattels on platelets and, for-this-reason, are not contraindicated.