26249067 idiopathic thrombocytopenic purpura case study

8/12/2019 26249067 Idiopathic Thrombocytopenic Purpura Case Study

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By: Group 1-Section N


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Identifying Data

Name of Patient : Mr. MSex : MaleAge : 81 years oldCivil Status : Married

Nationality : Filiino!eligion : !.C.Address : "uleda# CamotesDate Admitted : $uly % %''("ime :

Informant : Daug)ter

Mode of Admission : *)eel+)air


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A case of Mr M, 81 y.o., male from Tudela Camotes, !ee"s #TApt. e$perience episodes of %um &leedin%. #t's S( decided to ta"e)im to see a doctor and ad*ised to under%o la&oratory e$am.

(n +uly 1, , pt under!ent Complete Blood Count !it) a

result of lo! platelet /10, and pt !as %i*en 2emonstan andCep)ale$in to relie*e t)e &leedin%.

(n +uly 3, pt !as admitted for t)e first time at 4CS &y 5r.Guinocor !it) an admittin% dia%nose of %um &leedin% to consider

T26(MB(C7T(#4NA #96#96A


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Art)ritis

2ypertension

Smo"er


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Date Ordered Diagnostic/Laboratory Examination

No. Result Significance

July 21 2!!" CBC- Platelet 140-440 10 x 3cumm

15,000 May indicatethrombocytopenia

July 2# 2!!" CBC - Hematocrit Male:41-53

!"#3 May indicate anemia

July 2# 2!!" CBC- $BC Male:4#"-%#1 x 10 &'

3#"1 May indicatehemorrha(ic in)ection*

and bleedin(

July 2# 2!!" CBC- Hemo(lobin Male:14-1+ m(&dl

+#4 May indicateexce**ie bleedin(

Laboratory Result


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Subjective Objective

Communication'ima .a tui( na *ya n(a bun(ol/ a* erbalied

by the dau(hter

EENTPatient i* *leepin( durin( the a**e**ment

Oxygenationa( li*ud *ya u( (inha2a/ a* erbalied by thedau(hter

Respirationhe child* cycle per minute i* !% cpm

Circulationala man *a (i re.lamo n(a *a.it *a tiil/ a*erbalied by the dau(hter

Heart RhythmPatient mani)e*ted *i(n* re(ular hearth rhythm or

pul*e rate o) 60 bpm 7 apical8

Nutritionihu(o *ya mayo *u.ad *ya na*a.it/ a*erbalied by the dau(hter#

he patient i* not 2earin( any denture*#

Elimination

Ma(li*od man *iya u( .aliban( unya (amay ra.ayo *iya u( hu(a2/ a* erbalied by thedau(hter#

Bowel Sounds

Bo2el i* (raded a* hypo 1-! &minute# he patientha* no abdominal di*tention#9rine color i* li(ht yello2, clear con*i*tency 2itharomatic odor

Management of Health !llnessot applicable

"#ility to follow Treatmentshe patient reli(iou*ly )ollo2 medication* )or

bleedin( and )ollo2* 'o2 alt ;iet per doctor*order#


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Subjective Objective

S$in !ntegrityan( la(om man na iyan( panit/ a* erbalied

by the dau(hter#Patient ha* cold clammy *.in#Peticheae *een di*tributed around upperextremitie*#Brui*e* noted on 'e)t


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Gum Bleeding- absent of clotting factor(platelets are destroyed).

Purpura - purple bruises that appears on theskin caused by bleeding under it or on the

mucos membrane (e.g. mouth)

- bruises mean that bleeding has occured insmall vessels under the skin

Dyspnea- decrease oxygenation in the blooddue to decrease in blood volume because ofbleeding

Petechiae- tiny red or purple spots on theskin. Bleeding under the skin causes thepurple, brown, and red color of the petechiae


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Blood

Normally, -8; of )uman &ody !ei%)t is from &lood. n adults, t)isamounts to 3-0


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Hemoglobin is t)e %as transportin% protein molecule t)at ma"es up 0; ofa red &lood cell. 4ac) red &lood cell )as a&out ,, iron-ric))emo%lo&in molecules. T)e red color of &lood is primarily due too$y%enated red cells.


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White blood cells, or leukocytes e$ist in *aria&le num&ers and types&ut ma"e up a *ery small part of &lood?s *olume. @eu"ocytes are notlimited to &lood. T)ey occur else!)ere in t)e &ody as !ell, mostnota&ly in t)e spleen, li*er, and lymp) %lands. Most are produced in our&one marro! from t)e same "ind of stem cells t)at produce red &loodcells. Some !)ite &lood cells /called lymp)ocytes are t)e first

responders for our immune system. T)ey see" out, identify, and &ind toalien protein on &acteria, *iruses, and fun%i so t)at t)ey can &eremo*ed. (t)er !)ite &lood cells /called %ranulocytes andmacrop)a%es t)en arri*e to surround and destroy t)e alien cells. T)eyalso )a*e t)e function of %ettin% rid of dead or dyin% &lood cells as !ellas forei%n matter suc) as dust and as&estos.


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Platelets , or thrombocytes, are cell fra%ments !it)out nuclei t)at!or" !it) &lood clottin% c)emicals at t)e site of !ounds. T)ey do t)is&y ad)erin% to t)e !alls of &lood *essels, t)ere&y plu%%in% t)e rupturein t)e *ascular !all. T)ey also can release coa%ulatin% c)emicals !)ic)cause clots to form in t)e &lood t)at can plu% up narro!ed &lood*essels. 6ecent researc) )as s)o!n t)at platelets )elp fi%)t infections&y releasin% proteins t)at "ill in*adin% &acteria and some ot)ermicroor%anisms. n addition, platelets stimulate t)e immune system.ndi*idual platelets are a&out 1 t)e si=e of red cells. T)ey )a*e alifespan of -1 days. @i"e t)e red and !)ite &lood cells, platelets areproduced in &one marro! from stem cells.


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Plasma is t)e relati*ely clear li


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S A 5S4AS4 N 2C2 ANTB(54S >(6M AN554ST6(7'S T24 B(57'S #@AT4@4T


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6is" factors:

AG4 / more common in

c)ildren

S4D / more common in

youn% !omen

#redisposin% factors:

#64E(9S E6A@

N>4CT(N

/ c)ildren

M45CAT(NS / sulfa dru%s

MM9N4 5S(6546

9n"no!n 4tiolo%y

>ormation of anti&odies a%ainst platelets

#latelets reco%ni=ed as forei%n &odies

Anti&odies &ind !it) anti%en of platelet

mem&ranes

#latelets destroyed &y macrop)a%es

5ecreased num&er of platelets

SGNS F S7M#T(MS

#urpura

#etec)iae

2ematomas

4$cessi*e Menstruation >or omen

Blood n T)e 9rine (r Stool


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NT6AC464B6A@ 24M(662AG4

GAST6(NT4STNA@ B@445NG


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A Diagnostic Exam/Laboratory Test

CBC : determine t)at t)ere are no &lood a&normalities ot)er t)anlo! platelet count, and no p)ysical si%ns e$cept for si%ns of

&leedin%. 5espite t)e destruction of platelets &y splenic macrop)a%es,t)e spleen is normally not enlar%ed.

Bleedin% time - is prolon%ed

Bone Marro! 4$amination - may &e performed on patients o*er t)e a%e of and t)ose !)o do not respond to treatment. ncrease in t)eproduction of me%a"aryocytes.

Tourni


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Pharmacologic

corticosteroids, a=at)ioprene/imuran H used to in)i&it immune systemproduction of anti-platelet

E% /steroids - intra*enous steroids /met)ylpredinisolone orprednisone intra*enous immuno%lo&ulin /E% or a com&ination

Anti-5 - A relati*ely ne! strate%y in treatment !it) anti-5, &ut t)epatient must &e 6)-positi*e

Steroid-sparin% a%ents - dan%erously lo! platelet counts, and a poorresponse to ot)er treatments, E% treatment mmunosuppresants li"emycop)enolate mofetil and a=at)ioprine are &ecomin% more popular fort)eir effecti*eness for pre-splenectomy.

Eincristine, a c)emot)erapy a%ent -4$treme cases /*ery rare, especiallyin c)ildren may re


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Pharmacologic

T)rom&opoietin 6eceptor A%onists -

6omiplostim /trade name Nplate

4ltrom&opa%/if Joint pain- no salicylates and i&uprofen

4$perimental and no*el a%ents

5apsone /also called 5ip)enylsulfone, 55S, or A*losulfon T)e off-la&el use of ritu$ima&, a c)imeric monoclonal anti&ody a%ainst t)e B cell

surface anti%en C5, )as &een s)o!n in preliminary studies to &e an effecti*ealternati*e to splenectomy in some patients.

#romisin% results )a*e &een reported in a small p)ase study of t)e e$perimental"inase in)i&itor tamatini& fosdium

#latelet transfusion - Alone for emer%ency

H! "ylorieradication

54T


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Name ofDrug

$eneric%&rand'

Dateordered

(lassification

Dose)re*

Route

+ec,anismof -ction

Secificndication

SideEffects

Nursingmlication

lactulose la$ati*es ncreases !atercontent and

softens t)e stool.@o!ers t)e p2 oft)e colon, !)ic)in)i&its t)ediffusion ofammonia fromt)e colon into t)e&lood, t)ere&yreducin% &loodammonia le*els

Treatment ofc)ronic

constipation inadults and%eriatricpatients.AdJunct in t)emana%ement ofportal-systemic/)epaticencep)alopat)y/#S4

G: &elc)in%,Cramps,

distention,flatulence,diarr)ea,4N5(:)yper%lycemia

B4>(64:-assess patient for

a&dominal distention,presence of &o!elsounds,and normalpattern of &o!elfunction-Assess color,consistency, andamount of stoolproduced.596NG:

-Mi$ !it) fruit Juice,!ater, mil" orcar&onated citrus&e*era%e to impro*efla*orA>T46:-4ncoura%e patients touse ot)er forms of t)ediet, increasin% fluidinta"e, and increasin%

mo&ility-Caution patient t)att)is medication maycause &elc)in%,flatulence ora&dominal crampin%


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Name ofDrug

$eneric%&rand'

Dateordered

(lassification

Dose)re*

Route

+ec,anismof -ction

Secificndication

SideEffects

Nursingmlication

S9@C6A@>AT4 Gastrointestinal

2epato&iliarydru%s

>orms a comple$&y &indin% !it)

positi*ely c)ar%edproteins, t)atad)eres to ulcersite. T)isselecti*ely formsa protecti*e coatt)at protect t)elinin% a%ainstpepticacid,pepsin and

&ile salt

5uodenal andGastric ulcers,

c)ronic %astritis

C(NT6AN5CAT(NS:Not intendedfor E

administration

Constipation,diarr)ea,

nausea, %astricdiscomfort,,indi%estion, drymout),ras),pruritus, &ac"pain, di==iness,dro!siness,*erti%o

B4>(64:-(&tain patients

)istory and dru%)istory as !ell as)ypersensiti*ity-Monitor %astric p2 /L0s)ould &e maintained&lood in stools-Monitor patient forse*ere, persistentconstipation

596NG:-Gi*e on emptystomac) 1 )r &eforemeals and at &edtime.-do not crus) or c)e!ta&lets

A>T46:-nstruct patient tota"e medication in

empty stomac)-Caution patient toa*oid antacids !it)in mins of dru% or 1 )rafter t)is dru%

Sources:##5 Nursin%5ru% Guide 4dition a es


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Name ofDrug

$eneric%&rand'

Dateordered

(lassification

Dose)re*

Route

+ec,anismof -ction

Secificndication

SideEffects

Nursingmlication

T6AN4DAMC AC5 Cardio*ascular5ru%s

n)i&its&rea"do!n of

fi&rin clots. tacts primarily &y&loc"in% t)e&indin%plasmino%en andplasmin to fi&rindirect in)i&itionof plasmin occursonly to a limitedde%ree.

Treatment andprop)yla$is of

)emorr)a%eassociated !it)e$cessi*efi&rinolysis.#rop)yla$is of)ereditaryan%ioedema.

C(NT6AN5CAT(N:

2ypersensiti*ity#atients !it)acti*eintra*ascularclottin% &ecauseof t)e ris" oft)rom&osis.Se*ere 6enalinsufficiency#atients !it)

microscopic)ematuria

Gastrointestinal distur&ances

2ypotension,particularlyafter rapid Eadministration.T)rom&oticcomplications)a*e &eenreported.nstances oftransient

distur&ance ofcolor *isionassociated !it)its use.

B4>(64:Assess patients

)istory, if !it) acti*eintra*ascular clottin%,predisposed tot)rom&osis)emorr)a%e due todisseminatedintra*ascularcoa%ulationMonitoredanticoa%ulant co*er

#erform eyee$amination#erform li*er functiontests(&tain prot)rom&intime of t)e patient596NG:May&e mi$ed !it)most solutions &ut not!it) penicillin?s

A>T46:S)ould not &e used inpatients !it) acti*eintra*ascular clottin%#ossi&ility for s"inreaction suc) as a!ide spread, patc)yras) !it) associated&listers.Ad*ice patient to

report *isuala&normalities to t)e) sician.


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Assessment Nursing diagnosis Nursing Nursing !ationale 5ut+ome 6valuation


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Assessment Nursing diagnosis Nursinggoal

NursingIntervention

!ationale 5ut+omeCriteria

6valuation

S ONa%lisud siya u%%in)a!aPas stated &y pt'sS.(.( seen pt lyin% in

&ed,asleep. c on%oin% E> of#NSS,1 @ at QE(rate infusin% !ell atleft arm c ($y%enin)alation *ianasal pron% at-@min pallor of s"in F

mucous mem&rane c &luis) s"indiscoloration onleft F ri%)t upperarms difficulty&reat)in% at rest,noted producti*e cou%)o&ser*ed fine crac"les)eard uponauscultation c resp. rate of cpm - tac)ypnea

mpaired Gas4$c)an%e rtdecreased o$y%en-carryin% capacity of&lood

due to &leedin%

S+ientifi+ 0ase:A c)an%e in t)e pt'srespiratory rate orpattern may &e oneof t)e earliestindicators of t)eneed for o$y%ent)erapy. T)e c)an%e

in respiratory ratemay result from)ypo$emia !)ic) is adecrease in t)earterial tension int)e &lood manifested&y difficulty&reat)in%,cyanosis and coole$tremities.2ypo$emia usuallyleads to )ypo$ia,!)ic) is a decreasein ( supply to t)etissues.

After mins to1 )our of nurse-pt inter*entions,patient !ill &ea&le to

demonstrateimpro*ed*entilationo$y%enation.

Indeendent:1.#romote freo!ler's,side-lyin% F

deep &reat)in%cou%)in% e$ercises. Assess patient's *sand e*aluate for anyad*erse effects ofC( to$icity /suc) asdifficulty &reat)in%

.4ncoura%e ade


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Assessment Nursing diagnosis Nursinggoal

NursingIntervention


6valuation

T)is conditionmay occur as aresult of t!ofactors: from

inade


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Assessment Nursingdiagnosis

Nursinggoal

NursingIntervention


6valuation

0. diminis)edcrac"les )eard uponauscultation

1.Goal !aspartially met,as patient s)o!edsi%ns ofpro%ressi*ely

)ealt)y s"in colorF mucousmem&rane. Goal !aspartially met as pts)o!ed diminis)edappearance of&luis) s"indiscoloration on )isri%)t F left upper

arms

Assessment Nursing Nursing Nursing !ationale 5ut+ome 6valuation


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Nursinggoal

NursingIntervention


6valuation

. Goal !aspartially met aspatient no lon%er)ad difficulty&reat)in% at rest

due to use ofo$y%en in)alationat @min *ia nasalpron% and !it) arespiratory rate of

3. Goal !as met aspatient !as a&le tocou%) outsecretions

effecti*ely.0. Goal !aspartially met aspatient still )adcrac"les )eardupon auscultation



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Nursinggoal

NursingIntervention


6valuation

S H O ma% si%e la%pamin)ud a"un% tiildon% O as *er&ali=ed&y t)e patient.

( - Seen patientlyin% on &edsleepin% !it) i.* att)e ri%)t arm. - Bluediscoloration ofs"in.

- Bloody %umsnoted. - pale color s"innoted.- #ale color s"innoted.

ineffecti*e tissueperfusion related todecrease circulatin%&lood *olume due to&leedin%

Scientific &ase:

T# is an autoimmunedisorder t)eanti&odies destroyt)e plateletslo!erin% t)e plateletcount,sometimes to

dan%erous le*els, at!)ic) timesymptoms suc) as&ruisin%, nose&leeds,or )emorr)a%in% mayappear.

After 1- )oursof nursin%inter*ention t)epatient !ill &ea&le to

demonstrateincreasedperfusion.

-Teac) patient assista&out passi*e 6(Me$ercise.

-4le*ate lo!er lim&s

as appropriate.

-4le*ate )ead of &eddurin% sleep.

-4ncoura%e diet ric)in iron suc) asc)ic"en li*er or ot)eror%an meat if not

contraindicated.

- #ro*ide increasefluid inta"e.

- 4ncoura%e patientto ta"e ade


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Nursinggoal

NursingIntervention


6valuation

S: ONa%du%o iya)an%la%us O, as stated &yt)e S(.

(: -recei*ed ptsleepin% !it) E>#NSS 1liter at%ttsmin infusin%!ell on left arm

-petec)ea .0cmdistri&uted in t)eupper e$tremities

-&luis) pi%ment ont)e ri%)t arm

-&lood stainedsputum due to %um&leedin%

-constipation

6is" for inJury,)emorr)a%erelated to alteredclottin% factor

Scientific &ase:

After 3-8)rs ofnursin%inter*ention,pt!ill:

-modifyen*ironment asindicated toen)ance safety

-demonstrate&e)a*iors,lifestyle c)an%esto reduce ris"factors and

protect self frominJury

-*er&ali=eunderstandin% ofindi*idualfactors t)atcontri&ute topossi&ility ofinJury

-#erform t)orou%)assessment re%ardin%safety issues !)enplannin% for clientcare

-ascertain "no!led%eof safety needsinJurypre*ention andmoti*ation

-note clientsa%e,%ender,de*elopmental sta%e,decision-ma"in% a&ility,le*el ofcompetence

-assess clients musclestren%t), %ross andfine motorcoordination

-failure to accuratelyassess and inter*eneor refer t)ese issuescan place t)e clientat needless ris" and

creates ne%li%enceissues for t)e)ealt)carepractitioner

-to pre*ent inJury in)ome,community,and !or" settin%

-affects clientsa&ility to protect selfand ot)ers, andinfluences c)oice ofinter*entions andteac)in%

-to identify ris" forfalls



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Nursinggoal

NursingIntervention


6valuation

-pro*ide )ealt)care!it)in a culture ofsafetyRmaintain &ed inlo!est position !it)

!)eels loc"edRplace assisti*ede*ices !it)in reac)Rinstruct clientS( tore


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Based from Nursin% 5ia%nosis #riority #ro&lem 1 H mpaired Gas4$c)an%e

oals of Care

mpro*in% air!ay patency

#romotin% rest and conser*in% ener%y

#romotin% fluid inta"e

Maintainin% nutrition

#romotin% patient's "no!led%e

Maintainin% and mana%in% potential complications


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26249067 idiopathic thrombocytopenic purpura case study

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