Thrombocytopenia is diagnosed when platelet counts fall under 100,000 per milliliter of blood. This condition can also result in spontaneous hemorrhage if platelet counts drop below 20,000. Bleeding can be external or internal, with bleeding in the brain possibly leading to death. The exact cause of thrombocytopenia remains unknown, but the condition is classified as an autoimmune disorder. Many patients do not exhibit any symptoms, although some will present with complications.
Risk for Injury
Patients with thrombocytopenia are at high risk of sustaining serious injuries. Falling, minor scrapes, burns and bruises present a problem for these patients because of their risk for bleeding. The "risk for injury" nursing diagnosis for thrombocytopenia is generally an expected one, but every patient must be assessed on an individual level based on patient history, signs and symptoms.
Risk for Ineffective Protection
Patients with thrombocytopenia who suffer from secondary anemia or vertigo will have unique mobility issues because of their altered kinesthetic perception. They may need help ambulating or performing other activities of daily living. Patients will receive education on how to avoid injury and learn proper safety techniques.
Risk for Infection
Patients with thrombocypotenia are also at high risk for infection. As mentioned earlier, thrombocytopenia is classified as an autoimmune disorder, which means corticosteroids are administered to suppress the action of the immune system and the antibodies for platelets. This will leave the patient vulnerable to nosocomial infections. Extreme restrictions often are not placed on the patient during hospitalization, although this varies from patient to patient and standard precautions are used regardless. Patients are monitored closely for any signs of infection such as fever or elevated white blood cell count.
Risk for Disturbed Sensory Perception
The increased episodes of bleeding in patients with thrombocytopenia can cause secondary anemia. Menstruating female patients are at an increased risk of anemia due to excessive bleeding during menstrual cycles. Anemic patients may experience vertigo, or a feeling of dizziness. The nursing diagnosis of "risk for disturbed sensory perception" recognizes this tendency and addresses it through planning, intervention and evaluation.
Risk for Fluid Volume Deficit
Excessive bleeding, and diminishing platelet counts, may make "risk for fluid volume deficit" an appropriate nursing diagnosis for patients with thrombocytopenia. Patients with disorders that cause bleeding are often diagnosed with deficient fluid volume, or risk thereof, on the nursing care plan. These patients will often undergo platelet transfusion to prevent bleeding and rebuild platelet count.
- Medical-Surgical Nursing Care; Burke, LeMone, Mohn-Brown; 2003
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