Report headache, confusion, vision changes, or altered consciousness suggesting intracranial bleeding.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client on a heparin drip should be monitored for heparin-induced thrombocytopenia. Which laboratory trend would most strongly suggest this complication?
Answer: B. Heparin-induced thrombocytopenia (HIT) is an immune reaction marked by a significant drop in the platelet count, often more than 50 percent from baseline, paradoxically increasing clotting risk. A falling platelet count is the key indicator and requires stopping all heparin. A rising platelet count, a stable hemoglobin, or an isolated rise in potassium do not indicate HIT.
Question 2 of 3
A client with leukemia has a platelet count of 18,000/mm3. Which instruction by the nurse requires correction because it increases the client's bleeding risk?
Answer: C. With severe thrombocytopenia, bleeding precautions include a soft toothbrush and electric razor, avoiding IM injections and rectal procedures, avoiding aspirin and NSAIDs, and applying prolonged pressure to puncture sites. Vigorous flossing causes gum trauma and bleeding and is contraindicated, so instructing the client to floss vigorously must be corrected.
Question 3 of 3
A client receiving chemotherapy has a platelet count of 9,000/mm3 and develops a sudden severe headache with confusion. What is the nurse's first action?
Answer: A. With profound thrombocytopenia, a sudden severe headache and altered mental status may indicate intracranial hemorrhage, a life-threatening emergency. The nurse should notify the provider immediately so urgent evaluation and platelet transfusion can occur. Administering oral analgesics, encouraging activity, or simply waiting would delay critical care.
Keep the streak going with more questions like these, each with a full rationale.
What is thrombocytopenia?
Causes include decreased production (marrow suppression, chemotherapy, leukemia), increased destruction (immune thrombocytopenia, heparin-induced), and sequestration in an enlarged spleen. It matters because spontaneous and prolonged bleeding can occur, with intracranial hemorrhage as the most feared outcome.
Key points to remember
- Platelet counts below 150,000/mm3 define thrombocytopenia; spontaneous bleeding risk rises sharply below 20,000.
- Petechiae, purpura, ecchymoses, and easy bruising are early skin signs.
- Mucosal bleeding shows as gum bleeding, epistaxis, hematuria, and prolonged bleeding from cuts.
- Heparin-induced thrombocytopenia (HIT) paradoxically causes clotting plus falling platelets.
- Immune thrombocytopenic purpura (ITP) results from antibody-mediated platelet destruction.
- Internal bleeding may present as melena, hematemesis, or neurologic changes.
Signs & symptoms
- petechiae, purpura, ecchymosis
- gum/nose bleed, hematuria
Nursing priorities
- Institute bleeding precautions: soft toothbrush, electric razor, no IM injections, no rectal temps/suppositories.
- Avoid aspirin, NSAIDs, and other antiplatelet agents.
- Apply firm, prolonged pressure to any puncture or bleeding site.
- Monitor for occult and overt bleeding, including stool, urine, and neurologic checks.
- Administer platelet transfusions or other therapies (steroids, IVIG) as prescribed.
Labs & values
Patient teaching
- Use a soft toothbrush and electric razor; avoid flossing aggressively, contact sports, and activities with fall risk.
- Do not take aspirin, ibuprofen, or other NSAIDs unless approved by the provider.
- Report bleeding that won't stop, black or bloody stools, blood in urine, or a severe headache right away.
Red flags: report now
- Report headache, confusion, vision changes, or altered consciousness suggesting intracranial bleeding.
- Report any active or uncontrolled bleeding, or a platelet count below the critical threshold.
- In suspected HIT, stop all heparin immediately and report it; never give platelets routinely in HIT.
References
Clinical references for this topic
