Question

Michelle Chaney, age 20, is admitted to the medical-surgical unit with a diagnosis of idiopathic thrombocytopenia purpura (ITP). A college student, she noted bruising on her body and excessive bleeding when brushing her teeth and went to the college health nurse. The nurse referred her to a healthcare provider, who assessed her laboratory data and made the initial diagnosis of idiopathic thrombocytopenia purpura (ITP). Michelle is 5 feet, 2 inches tall, and weighs 118 pounds. Her vital signs are T 99°F, P 88, R 22, and BP 110/60. Her history includes the usual childhood illnesses and a history of hypertension and heart disease in her father's extended family. She takes no regular medications but reports taking an over-the counter vitamin supplement. She is a non-smoker.

1. Michelle is placed on an oral glucocorticoid, prednisone, 20 mg orally three times each day. What positive outcome does the nurse anticipate that Michelle will have, and how will this be assessed?

Answer 1

In immune thrombocytic purpura -----

Immune thrombocytic usually happens when immune system mistakenly attacks and destroy to the platelet. Platelets is cell fragment and help to blood clot.

Purpura means that the illness produces red and purple rash which increase bleeding under to the skin.

In adults this may be triggerd by infection with HIV, hepatitis and some bacteria ( H.pylori) that causes stomach ulcer.

LABORATORY TESTS :

1.Complete blood count

This measures the number of red blood cells, white blood cells and platelets.

2.Blood smear

This test mainly shows how your platelets look under the microscope.

3.Bone marrow test

##In case of Michelle chaney her laboratory tests is done and finding shows ITP.

MEDICATION :

In this case oral glucocorticoid is given.

##In case of Michelle chaney she takes oral medication prednisone ( 20 mg ) three times per day.

NURSING ASSESSMENT :

1.History taking

Medication is a common etiology for a thrombocytopenia. Take the history about use of past medication.

2.Physical Examination

• Risk for increasing bleeding such as any GI disease, CNS disease.
• Sign of any bleeding
• Sign of infection
• Check the vital sign mainly BP (BP within normal limit)

##In case of Michelle chaney brushing her body and excessive bleeding when brushing on her teeth. Blood pressure within normal limit . (BP 110/60 )

HEALTH EDUCATION :

• Avoid contact sports which may risk increase bleeding.
• Watch sign for any infection.
• Use caution with over the counter medication.

##In case of chaney she used vitamin supplements over the counter.