Headache, confusion, or neurologic changes may indicate intracranial hemorrhage, the most feared complication; report immediately.
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse reviews a white blood cell count of 22,000/microliter. Which condition is most consistent with this result?
Answer: A. WBC of 22,000 is elevated (normal 5,000-10,000). Leukocytosis most often reflects an active infection or inflammatory process as the body mounts an immune response.
Question 2 of 3
An older adult with pneumonia may not show a typical fever. Which atypical presentation of infection should the nurse watch for in older adults?
Answer: A. Older adults often present atypically with new confusion, functional decline, falls, or decreased appetite rather than a high fever, because of a blunted immune and thermoregulatory response. A high spiking fever with rigors is the classic, not atypical, presentation.
Question 3 of 3
A nurse caring for a client with a healing wound wants to support tissue repair through nutrition. Which nutrient is most essential for collagen synthesis and wound healing?
Answer: A. Protein is essential for collagen synthesis, fibroblast proliferation, and immune function during wound healing; protein deficiency delays healing. Vitamin C and zinc also support healing, but adequate protein intake is the foundational requirement for tissue repair.
Keep the streak going with more questions like these, each with a full rationale.
What is immune thrombocytopenic purpura?
It often follows a viral infection in children (usually self-limiting) and is more chronic in adults. The spleen sequesters and destroys the antibody-coated platelets. Hallmark findings are petechiae, purpura, easy bruising, and mucosal bleeding.
Key points to remember
- Autoantibodies coat platelets, which are then destroyed by the spleen, dropping the platelet count.
- Skin findings include petechiae, purpura, and ecchymoses; mucosal bleeding (gums, nose) is common.
- Platelet count is low (often <50,000, sometimes <20,000); PT and aPTT are normal.
- First-line treatment includes corticosteroids and IV immunoglobulin (IVIG); anti-D may be used in Rh-positive clients.
- Splenectomy is considered for chronic or refractory disease because the spleen is the main site of platelet destruction.
- Bleeding risk rises sharply as platelets fall, with spontaneous bleeding likely below about 20,000/mm3.
Signs & symptoms
- Petechiae, purpura, ecchymoses
- Epistaxis, gum/mucosal bleeding
Nursing priorities
- Implement bleeding precautions: soft toothbrush, electric razor, no IM injections, fall prevention.
- Monitor platelet counts and assess skin and mucous membranes for new petechiae, purpura, or active bleeding.
- Administer corticosteroids or IVIG as prescribed and monitor response.
- Apply prolonged pressure to puncture sites and avoid invasive procedures when possible.
- Assess for signs of internal bleeding, including neurologic changes suggesting intracranial hemorrhage.
Labs & values
Patient teaching
- Avoid aspirin, NSAIDs, and activities with a high injury risk; use acetaminophen for pain.
- Use a soft toothbrush and electric razor; blow the nose gently and avoid straining.
- Report any new bruising, petechiae, bleeding, black stools, blood in urine, or headache.
- If taking corticosteroids, do not stop abruptly and watch for infection and elevated glucose.
- Wear medical alert identification and prevent falls and bumps.
Red flags: report now
- Headache, confusion, or neurologic changes may indicate intracranial hemorrhage, the most feared complication; report immediately.
- Never give aspirin, NSAIDs, or other antiplatelet/anticoagulant medications.
- Active or uncontrolled bleeding with a very low platelet count requires urgent intervention.
References
Clinical references for this topic
