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Idiopathic Thrombocytopenic Purpura

Tless are excellent red, rash-looking spots all aggravate 5-year old Stacey’s torso. “Must be from all the rolling and tumbling on the grass that she did yesterday, ” Stacey’s woman justified. Days passed by, and these rashes did not go separate, and Stacey was sensibility injudicious and inert most of the days. Capacious bruises showed on her legs, which fainthearted her woman extremely. “Not one mount component of ours has this malady, and I am very meticulous in caring for Stacey, ” her woman told the pediatrician.  Behind powerful blood tests and material exams, Stacey was diagnosed delay idiopathic thrombocytopenic purpura.

Description


Idiopathic Thrombocytopenia Purpura (ITP) has two dissimilar clinical syndromes, manifesting as an clever predicament in consequence and a constant predicament in adults.
ITP is a regulate guess-work characterized by an unprobable diminish in the enumeblame of platelets in the regulate.
  • Idiopathic thrombocytopenic purpura (ITP), so disclosed as primitive immune thrombocytopenic purpura and autoimmune thrombocytopenic purpura, is defined as unaffected thrombocytopenia delay typical annoyance essence and in the scantiness of other forces of thrombocytopenia.
  • ITP is a guess-work that can guide to unconcerned or undue bruising and bleeding.
  • Children commonly clear ITP behind a viral contagion and usually recaggravate capaciously delayout texture.

Pathophysiology


The bleeding ends from unusually low flattens of platelets — the cells that acceleration regulate clot.
  • ITP is primarily a malady of extensiond peripheral platelet damnation, delay most endurings having antibodies to inequitable platelet membrane glycoproteins.
  • Relative essence scarcity may subscribe to this predicament since studies showance that most endurings entertain either typical or diminished platelet genesis.
  • Acute ITP commonly follows an clever contagion and has a unbidden disentanglement delayin 2 months.
  • Chronic ITP persists longer than 6 months delayout a inequitable force.

Statistics and Incidences


Incidence blames of idiopathic thrombocytopenic purpura (ITP) are as follows:
  • An medium regard of the impingement in consequence is 50 contingencys per 1,000,000 per year.
  • New contingencys of constant mutinous ITP contain closely 10 contingencys per 1,000,000 per year
  • According to studies in Denmark and England, branchhood ITP arises in closely 10-40 contingencys per 1,000,000 per year.
  • A prospective, population-based examine in Norway implied an impingement of 53 per 1,000,000 in consequence younger than 15 years.
  • A examine in Kuhalt reported a higher impingement of 125 contingencys per 1,000,000 per year.
  • The lethargy blame from hemorrhage is closely 1% in consequence and 5% in adults.
  • Spontaneous release arises in further than 80% of contingencys in consequence.
  • Peak operation arises in consequence old 2-4 years.
  • Approximately 40% of all endurings are younger than 10 years.
  • In clever ITP (children), disposal is correspondent betwixt manlys (52%) and females (48%).

Causes


If the force of this immune reforce is obscure, the predicament is named idiopathic thrombocytopenic purpura. Idiopathic media “of obscure force.”
  • Increased breakdown of platelets. In community delay ITP, antibodies produced by the immune arrangement append themselves to the platelets, marking the platelets for damnation; the spleen, which accelerations the whole contention contagion, acknowledges the antibodies and ousts the platelets from the arrangement; the end of this contingency of misenthralled personality is a inferior enumeblame of circulating platelets than is typical.

Clinical Manifestations


Clinical features of idiopathic thrombocytopenic purpura (ITP):
ITP can end in unconcerned bruising, bleeding gums and interior bleeding. | Sanity Life Media
  • Petechiae. Petechiae show when capillaries bleed, leaking regulate into the husk.
  • Purpura. Easy or undue bruising or purpura is dominant; if annoyance essence megakaryocytes cannot extension genesis and obey a typical enumeblame of circulating platelets, thrombocytopenia and purpura clear.
  • Hemorrhage. Hemorrhagic bullae on mucous membranes, gingival bleeding, signs of GI bleeding, retinal hemorrhages, and appearance of intracranial hemorrhage, delay commoditiesiveial neurologic symptoms; the bleeding ends from unusually low flattens of platelets — the cells that acceleration regulate clot.
  • Noncorporal ill-humor. The operation of corporal ill-humor in endurings delay ITP is closely the similar as that in the non-ITP population (ie, 3% in adults, 12% in consequence); opposing the damnation of platelets by splenic macrophages, the ill-humor is typically not bounteous.
  • Spontaneous bleeding. Spontaneous bleeding amount when platelet calculate is close than 20,000/mm3.

Assessment and Diagnostic Findings


Diagnosis of idiopathic thrombocytopenic purpura conceives:
  • Laboratory studies. Isolated thrombocytopenia on a total regulate cell calculate (CBC) is the key laboratory finding; the colorless regulate cell (WBC) calculate and hemoglobin flatten typically are typical, unclose cutting hemorrhage has arisered; on peripheral spatter, verily hercules platelets applaud immanent thrombocytopenia.
  • Imaging studies. A CT scan of the topic is necessitated if regard exists in-reference-to intracranial hemorrhage.

Medical Management


Treatment may conceive a enumeblame of approaches, such as medications to boost platelet calculate or surgery to oust ill-humor (splenectomy).
  • Prehospital solicitude. Prehospital solicitude focuses on the ABCs (airway, subsisting, prevalence), which conceive providing oxygen, powerful cutting hemorrhage, and initiating intravenous (IV) introduceys to obey hemodynamic stability; airway administer may be inevitable for a capacious intracranial hemorrhage.
  • Emergency division solicitude. Life-threatening bleeding requires usual important solicitude interventions; in the enduring delay disclosed ITP, high-dose parenteral glucocorticoids and IV immunoglobulin (IVIg), delay or delayout platelet transfusions, are alienate.
  • Consultations. Consult a hematologist for abettance in confirming the idiosyncrasy or, in the enduring delay disclosed ITP, arranging disposition and follow-up solicitude, if alienate.

Pharmacologic Management

Glucocorticoids and intravenous immunoglobulin (IVIg) are the mainstays of medical therapy for idiopathic thrombocytopenic purpura (ITP).
  • Glucocorticoids. These agents are used to bargain idiopathic and acquired autoimmune guess-works; they entertain been showancen to extension platelet calculate in ITP.
  • Blood products. Administration of IVIg may temporarily extension platelet calculates in some consequence and adults delay ITP; think IVIg if the aspect requires a quick, provisoed mount in platelet calculate.
  • Thrombopoeitic. These agents straightway embitter annoyance essence platelet genesis.

Nursing Management


Nursing solicitude for a branch delay idiopathic thrombocytopenia purpura conceive:

Nursing Assessment

Assessment in a branch delay ITP conceive the forthcoming:
  • History. Medications can be a despicable etiology for inducing thrombocytopenia, and endurings should entertain their medications solicitudelargely reviewed; one examine used three dissimilar methods to muniment garbages that may be associated delay garbage-induced immune thrombocytopenia (DITP).
  • Physical exam. Address betray factors for extensiond bleeding, such as GI malady, CNS malady, urologic malady, or erratic lifestyle, as these may determine the aggressiveness of skillful-treatment.

Nursing Diagnoses

Based on the rate grounds, the elder nursing diagnoses for idiopathic thrombocytopenis purpura are:

Nursing Solicitude Planning and Goals

The elder nursing solicitude pur-posening goals for idiopathic thrombocytopenic purpura are:
  • Patient or solicitudegivers assume measures to bar bleeding and acknowledge signs of bleeding that want to be reported forthcoming a timelinessout-delay to a sanity solicitude functional.
  • Patient does not test bleeding as appearanced by typical regulate constraining, perpetual hematocrit and hemoglobin flattens and desired ranges for coagulation profiles.
  • Patient offscourings operating of injuries.
  • Patient extensions daily enthusiasm, if commoditiesiveial.
  • Patient offscourings operating of contagion, as appearanced by typical material signs and scantiness of signs and symptoms of contagion.
  • Early acknowledgment of contagion to admit for quick texture.

Nursing Interventions

Nursing interventions for a branch delay ITP are:
  • Prevent bleeding. Review laboratory ends for coagulation standing as alienate: platelet calculate, prothrombin spell/international typicalized harmony (PT/INR), activated specific thromboplastin spell (aPTT), fibrinogen, bleeding spell, fibrin suspension products, vitamin K, activated coagulation spell (ACT); and initiate the at-betray enduring and solicitudegivers about precautionary measures to bar construction trauma or disintegration of the typical clotting mechanisms.
  • Prevent damnification. Thoroughly yield enduring to surroundings; put flatter unencumbered delayin gain and inform how to flatter for abettance; tally to flatter unencumbered forthcoming a timelinessout-delay; eschew use of restraints; obtain a physician’s regulate if restraints are wanted; and eject or percolate all commoditiesiveial hazards in the ground such as razors, medications, and matches.
  • Prevent contagion. Wash hands and inform enduring and SO to bathe hands precedently touch delay endurings and betwixt procedures delay the enduring; advance introducey inassume of 2,000 to 3,000 mL of introduce per day, unclose contraindicated; applaud the use of soft-bristled toothbrushes and stool softeners to cover mucous membranes; and if contagion arises, inform the enduring to assume antibiotics as prescribed; acquaint enduring to assume the bountiful passage of antibiotics smooth if symptoms rectify or diminish.

Evaluation

Goals are met as appearanced by:
  • Patient or solicitudegivers took measures to bar bleeding and acknowledged signs of bleeding that want to be reported forthcoming a timelinessout-delay to a sanity solicitude functional.
  • Patient did not test bleeding as appearanced by typical regulate constraining, perpetual hematocrit and hemoglobin flattens and desired ranges for coagulation profiles.
  • Patient remained operating of injuries.
  • Patient extensiond daily enthusiasm, if commoditiesiveial.
  • Patient remained operating of contagion, as appearanced by typical material signs and scantiness of signs and symptoms of contagion.
  • Early acknowledgment of contagion admited for quick texture.

Documentation Guidelines

Documentation in a branch delay ITP conceive the forthcoming:
  • Baseline and forthcoming rate findings to conceive signs and symptoms.
  • Individual cultural or devout restrictions and personal preferences.
  • Plan of solicitude and people complicated.
  • Teaching pur-pose.
  • Client’s defenses to informings, interventions, and forces performed.
  • Attainment or advance toward the desired consequence.
  • Long-term wants, and who is under obligation for forces to be assumen.

Practice Quiz: Idiopathic Thrombocytopenic Purpura


Here’s a 5-item satire for Idiopathic Thrombocytopenic Purpura (ITP) examine guide:

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Practice Quiz: Idiopathic Thrombocytopenic Purpura

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1. Which of the forthcoming garbages would be regulateed by the physician to rectify the platelet calculate in a manly client delay idiopathic thrombocytopenic purpura (ITP)? A. Acetylsalicylic piercing (ASA) B. Corticosteroids C. Methotrexate D. Vitamin K 1. Answer: B. Corticosteroids.
  • Option B: Corticosteroid therapy can diminish antiwhole genesis and phagocytosis of the antibody-coated platelets, cherishing further functioning platelets.
  • Option C: Methotrexate can force thrombocytopenia.
  • Options A and D: Vitamin K is used to bargain an undue anticoagulate narrate from warfarin aggravateload, and ASA diminishs platelet composition.
2. Nurse Hannah is administering a steroid to a branch diagnosed delay idiopathic thrombocytopenic purpura (ITP); which of the forthcoming should the encourage instructor? A. Infection B. Anemia C. Bleeding D. Bruising 2. Answer: A. Infection.
  • Option A: Steroids may aid immunosuppression, making the branch further sensitive to contagions.
  • Option B: Anemia is not alike to the guess-work or medication.
  • Options C and D: Bleeding and bruising are acknowledged as a end of the guess-work, not the steroid therapy.
3. Mr. and Mrs. Robertson’s son was diagnosed delay idiopathic thrombocytopenic purpura. They should be cognizant that the garbage to be eschewed is: A. Acetaminophen B. Aspirin C. Codeine D. Morphine 3. Answer: B. Aspirin.
  • Option B: Aspirin exerts an antiplatelet force and hence may extension platelet damnation in ITP.
  • Options A, C, and D: Acetaminophen, codeine, and morphine entertain no movables on platelets and, hence, are not contraindicated.
4. Corticosteroids are commoditiesive era-hors of the whole’s exasperating defense. Which of the forthcoming predicaments or forces do they era-h? A. Cushing syndrome B. Pain receptors C. Immune defense D. Neural transmission 4. Answer: C. Immune defense.
  • Option C: Corticosteroids era-h eosinophils, lymphocytes, and probable killer cells, inhibiting the probable exasperating course in an vitiated or injured sunder of the whole.
  • Option A: Excessive corticosteroid therapy can guide to Cushing’s syndrome.
  • Options B and D: Corticosteroids do not era-h the asceticism receptors and neural transmission.
5. A client is receiving a platelet transfusion. The encourage determines that the client is gaining from this therapy if the client exhibits which of the forthcoming? A. Close common febrile issues B. Increased flatten of hematocrit C. Close issues of bleeding D. Increased flatten of hemoglobin 5. Answer: C. Close issues of bleeding.
  • Options C: Platelet transfusions may be loving to bar bleeding when the platelet calculate falls down.
  • Options A: A discard in the febrile issue earn betide behind the transfusion of agranulocytes.
  • Options B and D: An extensiond flatten of hemoglobin and hematocrit earn betide behind the transfusion of red regulate cells.

See Also


Related topics to this examine guide:

Further Reading


Recommended media and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Important Components of Nursing Care

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