150826686 26249067-idiopathic-thrombocytopenic-purpura-case-study-txt

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By: Group 1-Section N By: Group 1-Section N

Identifying Data Name of Patient Sex Age Civil Status Nationality Religion
Address Date Admitted Time Informant Mode of Admission : : : : : : : : : Mr. M
Male 81 years old Married Filipino R.C. Tuleda, Camotes July 24, 2009
: Daughter : Wheelchair

Vital Signs on Admission Temperature Heart Rate Respiratory Rate Weight Height
Chief of Complaints : : : : : 37.9C 90 bpm 26 cpm 47kg 5 2
: excessive gum bleeding

. A case of Mr M, 81 y.o., male from Tudela Camotes, 3 weeks PTA pt. experience
episodes of gum bleeding. Pt s SO decided to take him to see a doctor and
advised to undergo laboratory exam. . On July 21, 2009, pt underwent Complete
Blood Count with a result of low platelet (15,000) and pt was given Hemonstan
and Cephalexin to relieve the bleeding. . On July 24, 2009 pt was admitted for
the first time at ECS by Dr. Guinocor with an admitting diagnose of gum bleeding
to consider THROMBOCYTOPENIA PURPURA

. Arthritis . Hypertension . Smoker

Laboratory Result Date Ordered Diagnostic/Laboratory Examination No. Result
Significance July 21, 2009 CBC- Platelet 140-440 10 x 3 cumm 15,000 May indicate
thrombocytopenia July 24, 2009 CBC - Hematocrit Male: 41-53% 27.3% May indicate
anemia July 24, 2009 CBC- RBC Male: 4.7-6.1 x 10 /L 3.71 May indicate
hemorrhagic infections and bleeding July 24, 2009 CBC- Hemoglobin Male: 14-18
mg/dl 8.4 May indicate excessive bleeding

Subjective Objective Communication Lima ka tuig na sya nga bungol as verbalized
by the daughter EENT Patient is sleeping during the assessment Oxygenation
Respiration Nag lisud sya ug ginhawa pm daughter as verbalized by the The
child's cycle per minute is 26 c
Circulation Heart Rhythm Wala man sa gi reklamo nga sakit sa tiil as Patient
manifested signs regular heart h rhythm or verbalized by the daughter pulse rate
of 90 bpm ( apical) Nutrition Nihugo sya mayo sukad sya nasakit as The patient
is not wearing any dentures. verbalized by the daughter. Elimination Bowel
Sounds Maglisod man siya ug kalibang unya gamay ra Bowel is graded as hypo 1-
2 /minute. The patient kayo siya ug hugaw as verbalized by the has no abdominal
distention. daughter. Urine color is light yellow, clear consistency with
aromatic odor Management of Health& Illness Ability to follow Treatments Not
applicable The patient religiously follow medications for bleeding and follows
Low Salt Diet per doctor's order.

Subjective Objective Skin Integrity Nang lagom man na iyang panit as verbalized
by the daughter. Patient has cold clammy skin. Peticheae seen distributed around
upper extremities. Bruises noted on Left Arm Activity/Safety LOC & Orientation
Nag sige lang sy aug higda sukad sya na admit Patient is sleeping during
assessmen t as verbalized by the daughter. Comfort/Sleep/Awake Other Signs of
Pain Magmata-mata siya ug gabie kay mag lisud man No signs of pain siya ug
ginhawa as verbalized by the daughter. Coping Observed non-verbal behavior The
wife is taking care of him in the hospital The patient is resting. The famil y
were discussing while the daughter is supporting financially. The on where to
look for blood for blood transfusion. daughter expressed difficulty in acquiring
blood and platelet.

Gum Bleeding - absent of clotting factor(platelets are destroyed). Purpura
-purple bruises that appears on theskin caused by bleeding under it or o n
themucos membrane (e.g. mouth) - bruises mean that bleeding has occured in small
vessels under the skin Dyspnea- decrease oxygenation in the blooddue to decrease
in blood volume becaus e of bleeding Petechiae - tiny red or purple spots on
theskin. Bleeding under the skin causes thepurple, brown, and red color of the
petechiae Gum Bleeding - absent of clotting factor(platelets are destroyed).
Purpura -purple bruises that appears on theskin caused by bleeding under it or o
n themucos membrane (e.g. mouth) - bruises mean that bleeding has occured in
small vessels under the skin Dyspnea- decrease oxygenation in the blooddue to
decrease in blood volume becaus e of bleeding Petechiae - tiny red or purple
spots on theskin. Bleeding under the skin causes thepurple, brown, and red color
of the petechiae

Blood . Normally, 7-8% of human body weight is from blood. In adults, this
amounts to 4-5 quarts of blood. This essential fluid carries out the critical
functions of transporting oxygen and nutrients to our cells and getting rid of
carbon dioxide, ammonia, and other waste products. In addition, it plays a vital
role in our immune system and in maintaining a relatively constant body
temperature. Blood is a highly specialized tissue composed of many different
kinds of components. Four of the most important ones are red blood cells, white
blood cells, platelets, and plasma. . Red blood cells, or erythrocytes , are
relatively large microscopic cells without nuclei. Red blood cells normally make
up 40-50% of the total blood volume. They transport oxygen from the lungs to all
of the living tissues of the body and carry away carbon dioxide. The red cells
are produced continuously in our bone marrow from stem cells at a rate of about
2-3 million cells per second

Hemoglobin is the gas transporting protein molecule that makes up 95% of a red
blood cell. Each red blood cell has about 270,000,000 iron-rich hemoglobin
molecules. The red color of blood is primarily due to oxygenated red cells.

. White blood cells, or leukocytes exist in variable numbers and types but make
up a very small part of blood's volume. Leukocytes are not limited to blood.
They occur elsewhere in the body as well, most notably in the spleen, liver, and
lymph glands. Most are produced in our bone marrow from the same kind of stem
cells that produce red blood cells. Some white blood cells (called lymphocytes )
are the first responders for our immune system. They seek out, identify, and
bind to alien protein on bacteria, viruses, and fungi so that they can be
removed. Other white blood cells (called granulocytes and macrophages ) then
arrive to surround and destroy the alien cells. They also have the function of
getting rid of dead or dying blood cells as well as foreign matter such as dust
and asbestos.

. Platelets , or thrombocytes , are cell fragments without nuclei that work with
blood clotting chemicals at the site of wounds. They do this by adhering to the
walls of blood vessels, thereby plugging the rupture in the vascular wall. They
also can release coagulating chemicals which cause clots to form in the blood
that can plug up narrowed blood vessels. Recent research has shown that
platelets help fight infections by releasing proteins that kill invading
bacteria and some other microorganisms. In addition, platelets stimulate the
immune system. Individual platelets are about 1/3 the size of red cells. They
have a lifespan of 9-10 days. Like the red and white blood cells, platelets are
produced in bone marrow from stem cells.

. Plasma is the relatively clear liquid water (92+%), sugar, fat, protein and
salt solution which carries the red cells, white cells, platelets, and some
other chemicals. Normally, 55% of our blood's volume is made up of plasma. About
95% of it consists of water. As the heart pumps blood to cells throughout the
body, plasma brings nourishment to them and removes the waste products of
metabolism. Plasma also contains blood clotting factors, sugars, lipids,
vitamins, minerals, hormones, enzymes, antibodies, and other proteins.

. IS A DISEASE IN WHICH ANTIBODIES FORM AND DESTROY S THE BODY S PLATELET

Risk factors: AGE ( more common in children) SEX ( more common in young women)
Predisposing factors: PREVIOUS VIRAL INFECTION ( children) MEDICATIONS ( sulfa
drugs) IMMUNE DISORDER Unknown Etiology Formation of antibodies against
platelets Platelets recognized as foreign bodies Antibodies bind with antigen of
platelet membranes Platelets destroyed by macrophages Decreased number of
platelets SIGNS & SYMPTOMS Purpura Petechiae Hematomas Excessive Menstruation
For Women Blood In The Urine Or Stool Risk factors: AGE ( more common in
children) SEX ( more common in young women) Predisposing factors: PREVIOUS VIRAL
INFECTION ( children) MEDICATIONS ( sulfa drugs) IMMUNE DISORDER Unknown
Etiology Formation of antibodies against platelets Platelets recognized as
foreign bodies Antibodies bind with antigen of platelet membranes Platelets
destroyed by macrophages Decreased number of platelets SIGNS & SYMPTOMS Purpura
Petechiae Hematomas Excessive Menstruation For Women Blood In The Urine Or Stool

.INTRACEREBRAL HEMORRHAGE .GASTROINTESTINAL BLEEDING

A Diagnostic Exam/Laboratory Test: . CBC : determine that there are no blood
abnormalities other than low platelet count, and no physical signs except for
signs of bleeding. Despite the destruction of platelets by splenic macrophages,
the spleen is normally not enlarged. . Bleeding time -is prolonged . Bone Marrow
Examination -may be performed on patients over the age of 60 and those who do
not respond to treatment. Increase in the production of megakaryocytes. .
Tourniquet Test bp taken, cuff inflated half way bet. Systolic and diastolic
,left inflated for 5 minutes. (+) many petechiae. . Anti-platelet antibodies.

Pharmacologic: . corticosteroids, azathioprene(imuran) production of anti-
platelet used to inhibit immune system
. IVIg (steroids) -intravenous steroids (methylpredinisolone or prednisone)
intravenous immunoglobulin (IVIg) or a combination . Anti-D -A relatively new
strategy in treatment with anti-D, but the patient must be Rh-positive .
Steroid-sparing agents -dangerously low platelet counts, and a poor response to
other treatments, IVIg treatment Immunosuppresants like mycophenolate mofetil
and azathioprine are becoming more popular for their effectiveness for pre-
splenectomy. . Vincristine, a chemotherapy agent -Extreme cases (very rare,
especially in children) may require the infusion of, to stop the immune system
from destroying platelets. However, vincristine, a vinca alkaloid, has
significant of side effects and its use in treating ITP must be approached with
caution.

Pharmacologic: . Thrombopoietin Receptor Agonists . Romiplostim (trade name
Nplate) . Eltrombopag (if joint pain-no salicylates and ibuprofen) .
Experimental and novel agents . Dapsone (also called Diphenylsulfone, DDS, or
Avlosulfon) . The off-label use of rituximab, a chimeric monoclonal antibody
against the B cel l surface antigen CD20, has been shown in preliminary studies
to be an effective alternative to splenectomy in some patients. . Promising
results have been reported in a small phase II study of the experiment al kinase
inhibitor tamatinib fosdium . Platelet transfusion -Alone for emergency . H.
pylori eradication DIET

Medications: . -Ranitidine 50mg IVTT every 8 hours . -Tranexamic Acid 500 mg
IVTT every 12 hours . -Lactulose 30cc HS . -Ceftazidime IVTT every 8 hours
ANST(-) . -Salbutamol 1 neb now . -Furosemide 1 amp IVTT now Laboratory exam: .
-Urinalysis . -Complete Blood Count . -Stool Examination . -Hematologic
Examination Others: . -PNSS 1 liter @ 30gtts/min

Name of Drug Generic (Brand) Date ordered Classifica tion Dose FreqRoute
Mechanism of Action SpecificIndication Side Effects NursingImplication lactulose
laxatives Increases water content and softens the stool. Lowers the pH of the
colon, which inhibits the diffusion of ammonia from the colon into the blood,
thereby reducing blood ammonia levels Treatment of chronic constipation in
adults and geriatric patients. Adjunct in the management of portal-systemic
(hepatic) encephalopathy (PSE) GI: belching, Cramps, distention,
flatulence,diarr hea, ENDO: hyperglycemia BEFORE: -assess patient for abdominal
distention, presence of bowel sounds,and normal pattern of bowel function
-Assess color, consistency, and amount of stool produced. DURING:

-Mix with fruit juice, water, milk or carbonated citrus beverage to improve
flavor AFTER: -Encourage patients to use other forms of the diet, increasing
fluid intake, and increasing mobility -Caution patient that this medication may
cause belching, flatulence or abdominal cramping Name of DrugGeneric (Brand)
Date ordered Classifica tion Dose FreqRoute Mechanism of Action
SpecificIndication Side Effects NursingImplication lactulose laxatives Increases
water content and softens the stool. Lowers the pH of the colon, which inhibits
the diffusion of ammonia from the colon into the blood, thereby reducing blood
ammonia levels Treatment of chronic constipation in adults and geriatric
patients. Adjunct in the management of portal-systemic (hepatic) encephalopathy
(PSE) GI: belching, Cramps, distention, flatulence,diarr hea,

ENDO: hyperglycemia BEFORE: -assess patient for abdominal distention, presence
of bowel sounds,and normal pattern of bowel function -Assess color, consistency,
and amount of stool produced. DURING: -Mix with fruit juice, water, milk or
carbonated citrus beverage to improve flavor AFTER: -Encourage patients to use
other forms of the diet, increasing fluid intake, and increasing mobility
-Caution patient that this medication may cause belching, flatulence or
abdominal cramping

Name of DrugGeneric (Brand) Date ordered Classifica tion Dose FreqRoute
Mechanism of Action SpecificIndication Side Effects NursingImplication
SULCRALFATE Gastrointestin al/ Hepatobiliary drugs Forms a complex by binding
with positively charged proteins, that adheres to ulcer site. This selectively
forms a protective coat that protect the lining against peptic acid,pepsin and
bile salt Duodenal and Gastric ulcers, chronic gastritis CONTRAINDICATI ONS: Not
intended for IV administration Constipation, diarrhea, nausea, gastric
discomfort,, indigestion, dry mouth,rash, pruritus, back pain, dizziness,
drowsiness, vertigo BEFORE: -Obtain patients history and drug history as well as
hypersensitivity -Monitor gastric pH (>5 should be maintained; blood in stools
-Monitor patient for

severe, persistent constipation DURING: -Give on empty stomach 1 hr before meals
and at bedtime. -do not crush or chew tablets AFTER: -Instruct patient to take
medication in empty stomach -Caution patient to avoid antacids within 30 mins of
drug or 1 hr after this drug Sources:PPD Nursing Drug Guide 2007 Edition , pages
SULCRALFATE Gastrointestin al/ Hepatobiliary drugs Forms a complex by binding
with positively charged proteins, that adheres to ulcer site. This selectively
forms a protective coat that protect the lining against peptic acid,pepsin and
bile salt Duodenal and Gastric ulcers, chronic gastritis CONTRAINDICATI ONS: Not
intended for IV administration Constipation,

diarrhea, nausea, gastric discomfort,, indigestion, dry mouth,rash, pruritus,
back pain, dizziness, drowsiness, vertigo BEFORE: -Obtain patients history and
drug history as well as hypersensitivity -Monitor gastric pH (>5 should be
maintained; blood in stools -Monitor patient for severe, persistent constipation
DURING: -Give on empty stomach 1 hr before meals and at bedtime. -do not crush
or chew tablets AFTER: -Instruct patient to take medication in empty stomach
-Caution patient to avoid antacids within 30 mins of drug or 1 hr after this
drug Sources:PPD Nursing Drug Guide 2007 Edition , pages

TRANEXAMIC ACID Cardiovascular Drugs Inhibits breakdown of fibrin clots. It acts
primarily by blocking the binding plasminogen and plasmin to fibrin; direct
inhibition of plasmin occurs only to a limited degree. Treatment and prophylaxis
of hemorrhage associated with excessive fibrinolysis. Prophylaxis of hereditary
angioedema. CONTRAINDICATI ON: Hypersensitivity Patients with active
intravascular clotting because of the risk of thrombosis. Severe Renal
insufficiency Patients with microscopic hematuria Gastrointestin al disturbances
Hypotension, particularly after rapid IV administration. Thrombotic

complications have been reported. Instances of transient disturbance of color
vision associated with its use. BEFORE: Assess patients history, if with active
intravascular clotting, predisposed to thrombosis; hemorrhage due to
disseminated intravascular coagulation Monitored anticoagulant cover Perform eye
examination Perform liver function tests Obtain prothrombin time of the patient
DURING: Maybe mixed with most solutions but not with penicillin's AFTER: Should
not be used in patients with active intravascular clotting Possibility for skin
reaction such as a wide spread, patchy rash with associated blisters. Advice
patient to report visual abnormalities to the physician. Name of DrugGeneric
(Brand) Date ordered Classifica tion Dose FreqRoute Mechanism of Action
SpecificIndication Side Effects NursingImplication TRANEXAMIC ACID
Cardiovascular

Drugs Inhibits breakdown of fibrin clots. It acts primarily by blocking the
binding plasminogen and plasmin to fibrin; direct inhibition of plasmin occurs
only to a limited degree. Treatment and prophylaxis of hemorrhage associated
with excessive fibrinolysis. Prophylaxis of hereditary angioedema.
CONTRAINDICATI ON: Hypersensitivity Patients with active intravascular clotting
because of the risk of thrombosis. Severe Renal insufficiency Patients with
microscopic hematuria Gastrointestin al disturbances Hypotension, particularly
after rapid IV administration. Thrombotic complications have been reported.
Instances of transient disturbance of color vision associated with its use.
BEFORE: Assess patients history, if with active intravascular clotting,
predisposed to thrombosis; hemorrhage due to disseminated

intravascular coagulation Monitored anticoagulant cover Perform eye examination
Perform liver function tests Obtain prothrombin time of the patient DURING:
Maybe mixed with most solutions but not with penicillin's AFTER: Should not be
used in patients with active intravascular clotting Possibility for skin
reaction such as a wide spread, patchy rash with associated blisters. Advice
patient to report visual abnormalities to the physician.

Cefuroxime Antibiotic Cephalosporins (second generation) Bactericidal: inhibits
synthesis of bacterial cell wall, causing cell death Parenteral: dermatologic
infections caused by S. Aureus, S. Pyogens, E. coli, kleibsiella, enterobacter
Contraindicatio ns and cautions: Contraindicated with allergy to cephalosporins
and penicillins GI: nausea, vomiting, diarrhea, anorexia, abdominal pain,
flatulence Hematologic: Bone marrow depression, (decreased WBC,decreased
platelets, decreased hct) Parenteral drug: BEFORE: Avoid alcohol while taking
this drug and for 3 days after because severe reactions often occur

DURING: You may experience these side effects: stomach upset or diarrhea AFTER:
Report severe diarrhea, difficulty of breathing, unusual tiredness or fatigue,
pain at injection site. Name of DrugGeneric (Brand) Date ordered Classifica tion
Dose FreqRoute Mechanism of Action SpecificIndication Side Effects
NursingImplication Cefuroxime Antibiotic Cephalosporins (second generation)
Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death
Parenteral: dermatologic infections caused by S. Aureus, S. Pyogens, E. coli,
kleibsiella, enterobacter Contraindicatio ns and cautions: Contraindicated with
allergy to cephalosporins and penicillins GI: nausea, vomiting, diarrhea,
anorexia, abdominal pain, flatulence Hematologic: Bone marrow depression,
(decreased

WBC,decreased platelets, decreased hct) Parenteral drug: BEFORE: Avoid alcohol
while taking this drug and for 3 days after because severe reactions often occur
DURING: You may experience these side effects: stomach upset or diarrhea AFTER:
Report severe diarrhea, difficulty of breathing, unusual tiredness or fatigue,
pain at injection site.

Metronidazole Antibiotic AntiBacterial Amebicide Antiprotozoal Bactericidal:
Inhibits DNA synthesis in specific (obligate) anaerobes, causind cell death;
antiprotozoaltrichomonacidal, amebicidal: Biochemical mechanism of action is not
known. Indications: Acute infection with susceptible anaerobic bacteria
Contraindication s: Contraindicated with hypersensitivity to metronidazole CNS:
headache, dizziness, ataxia, vertigo, fatigue, GI: unpleasant metallic taste,
anorexia, nausea, vomiting, diarrhea, GI upset, cramps BEFORE:

Take the drug with food if GI upset occurs. Do not drink alcohol DURING: You may
experience these side effects: dry mouth with strange metallic taste, frequent
mouth care, sucking sugarless candies may help); nausea, vomiting, diarrhea (eat
frequent meals). AFTER: Report for severe GI upset, dizziness, unusual fatigue,
or weakness, fever, chills. Name of DrugGeneric (Brand) Date ordered Classifica
tion Dose FreqRoute Mechanism of Action SpecificIndication Side Effects
NursingImplication Metronidazole Antibiotic AntiBacterial Amebicide
Antiprotozoal Bactericidal: Inhibits DNA synthesis in specific (obligate)
anaerobes, causind cell death; antiprotozoaltrichomonacidal, amebicidal:
Biochemical mechanism of action is not known. Indications: Acute infection with
susceptible anaerobic

bacteria Contraindication s: Contraindicated with hypersensitivity to
metronidazole CNS: headache, dizziness, ataxia, vertigo, fatigue, GI: unpleasant
metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps BEFORE:
Take the drug with food if GI upset occurs. Do not drink alcohol DURING: You may
experience these side effects: dry mouth with strange metallic taste, frequent
mouth care, sucking sugarless candies may help); nausea, vomiting, diarrhea (eat
frequent meals). AFTER: Report for severe GI upset, dizziness, unusual fatigue,
or weakness, fever, chills.

Assessment Nursing diagnosis Nursing goal Nursing Intervention Rationale Outcome
Criteria Evaluation S= Naglisud siya ug ginhawa as stated by pt s S.O. O= seen
pt lying in bed,asleep. = c ongoing IVF of PNSS,1 L at KVO rate infusing well at
left arm = c Oxygen inhalation via nasal prong at 2-3L/min = pallor of skin &
mucous membrane = c bluish skin discoloration on left & right upper arms =
difficulty breathing at rest, noted = productive cough observed = fine crackles
heard upon auscultation = c resp. rate of 26 cpm -tachypnea Impaired Gas
Exchange r/t decreased oxygencarrying capacity of blood due to bleeding
Scientific base: A change in the pt s respiratory rate or pattern may be one of
the earliest indicators of the need for oxygen therapy. The change in
respiratory rate may result from hypoxemia which is a decrease in the arterial
tension in the blood manifested by difficulty breathing,

cyanosis and cool extremities. Hypoxemia usually leads to hypoxia, which is a
decrease in O2 supply to the tissues. After 30 mins to 1 hour of nursept
interventions, patient will be able to demonstrate improved ventilation/
oxygenation. Independent: 1.Promote frequent position changes such as SemiFowler
s,side-lying & deep breathing coughing exercises 2. Assess patient s v/s and
evaluate for any adverse effects of CO2 toxicity (such as difficulty breathing
3.Encourage adequate rest & limit activities within patient s tolerance 4.
Ensure patient to maintain adequate fluid intake at least 12 L/day,unless
contraindicated and regular output -Promotes lung expansion & drainage of
retained secretions. -Excess CO2 blood gas levels may cause respiratory
obstruction as a result of long-term use of oxygen therapy -helps limit oxygen
requirements & consumption -mobilization of secretions & output prevents fluid
overload Assessment Nursing diagnosis Nursing goal Nursing Intervention

Rationale Outcome Criteria Evaluation S= Naglisud siya ug ginhawa as stated by
pt s S.O. O= seen pt lying in bed,asleep. = c ongoing IVF of PNSS,1 L at KVO
rate infusing well at left arm = c Oxygen inhalation via nasal prong at 2-3L/min
= pallor of skin & mucous membrane = c bluish skin discoloration on left & right
upper arms = difficulty breathing at rest, noted = productive cough observed =
fine crackles heard upon auscultation = c resp. rate of 26 cpm -tachypnea
Impaired Gas Exchange r/t decreased oxygencarrying capacity of blood due to
bleeding Scientific base: A change in the pt s respiratory rate or pattern may
be one of the earliest indicators of the need for oxygen therapy. The change in
respiratory rate may result from hypoxemia which is a decrease in the arterial
tension in the blood manifested by difficulty breathing, cyanosis and cool
extremities. Hypoxemia usually leads to hypoxia, which is a decrease

in O2 supply to the tissues. After 30 mins to 1 hour of nursept interventions,
patient will be able to demonstrate improved ventilation/ oxygenation.
Independent: 1.Promote frequent position changes such as SemiFowler s,side-lying
& deep breathing coughing exercises 2. Assess patient s v/s and evaluate for any
adverse effects of CO2 toxicity (such as difficulty breathing 3.Encourage
adequate rest & limit activities within patient s tolerance 4. Ensure patient to
maintain adequate fluid intake at least 12 L/day,unless contraindicated and
regular output -Promotes lung expansion & drainage of retained secretions.
-Excess CO2 blood gas levels may cause respiratory obstruction as a result of
long-term use of oxygen therapy -helps limit oxygen requirements & consumption
-mobilization of secretions & output prevents fluid overload

Criteria Evaluation This condition may occur as a result of two factors: from
inadequate O2 supply or from inadequate O2 delivery.One type of hypoxia
associated with blood disorders such as bleeding is Anemic hypoxia.This is a
result of decreased effective Hgb concentration which causes a decrease in the
O2-carrying capacity of the blood. Reference: Med-Surgical Nursing. Brunner,Vol
1 Page 723-724 5. Provide fluids with electrolytes if decreased appetite 6.
Explain to pt & family about disease process & mgt of symptoms 7. Assist pt to
develop strategies for monitoring therapeutic regimen Dependent: 1.Suction
secretions as indicated 2.Adjust O2 levels if patient shows adverse effects as
indicated. -Provide supplemental fluid & calories if not met by adequate food
intake -pt will be able to identify successful mgt techniques & improve

coping skills -promotes early recognition of changes for proactive response -to
maintain airway -to detect any developing complications usually from prolonged
O2 therapy After 30 mins of nurse-pt interventions, pt has able to progressively
demonstrate improved oxygenation as evidenced by the following: 1.reduced pallor
of skin & mucous membrane 2. diminished appearance of bluish skin discoloration
on left & right upper arms 3.no longer showed difficulty breathing at rest
4.able to cough out secretions effectively Assessment Nursing diagnosis Nursing
goal Nursing Intervention Rationale Outcome Criteria Evaluation This condition
may occur as a result of two factors: from inadequate O2 supply or from
inadequate O2 delivery.One type of hypoxia associated with blood disorders such
as bleeding is Anemic hypoxia.This is a result of decreased effective Hgb
concentration which causes a

decrease in the O2-carrying capacity of the blood. Reference: Med-Surgical
Nursing. Brunner,Vol 1 Page 723-724 5. Provide fluids with electrolytes if
decreased appetite 6. Explain to pt & family about disease process & mgt of
symptoms 7. Assist pt to develop strategies for monitoring therapeutic regimen
Dependent: 1.Suction secretions as indicated 2.Adjust O2 levels if patient shows
adverse effects as indicated. -Provide supplemental fluid & calories if not met
by adequate food intake -pt will be able to identify successful mgt techniques &
improve coping skills -promotes early recognition of changes for proactive
response -to maintain airway -to detect any developing complications usually
from prolonged O2 therapy After 30 mins of nurse-pt interventions, pt has able
to progressively demonstrate improved oxygenation as evidenced by the following:
1.reduced pallor of skin & mucous membrane 2. diminished appearance of bluish
skin discoloration on left

& right upper arms 3.no longer showed difficulty breathing at rest 4.able to
cough out secretions effectively

Criteria Evaluation 5. diminished crackles heard upon auscultation 1.Goal was
partially met, as patient showed signs of progressively healthy skin color &
mucous membrane 2. Goal was partially met as pt showed diminished appearance of
bluish skin discoloration on his right & left upper arms Assessment Nursing
diagnosis Nursing goal Nursing Intervention Rationale Outcome Criteria
Evaluation 5. diminished crackles heard upon auscultation 1.Goal was partially
met, as patient showed signs of progressively healthy skin color & mucous
membrane 2. Goal was partially met as pt showed diminished appearance of bluish
skin discoloration on his right & left upper arms

Criteria Evaluation 3. Goal was partially met as patient no longer had
difficulty breathing at rest due to use of oxygen inhalation at 2L/min via nasal
prong and with a respiratory rate of 4. Goal was met as patient was able to
cough out secretions effectively. 5. Goal was partially met as patient still had
crackles heard upon auscultation Assessment Nursing diagnosis Nursing goal
Nursing Intervention Rationale Outcome Criteria Evaluation 3. Goal was partially
met as patient no longer had difficulty breathing at rest due to use of oxygen
inhalation at 2L/min via nasal prong and with a respiratory rate of 4. Goal was
met as patient was able to cough out secretions effectively. 5. Goal was
partially met as patient still had crackles heard upon auscultation

Criteria Evaluation S mag sige lag paminhud akung tiil dong as verbalized by the
patient. O -Seen patient lying on bed sleeping with i.v at the right arm. -Blue
discoloration of skin. -Bloody gums noted. -pale color skin noted. -Pale color
skin noted. ineffective tissue perfusion related to decrease circulating blood
volume due to bleeding Scientific base: ITP is an autoimmune disorder the
antibodies destroy the platelets lowering the platelet count,sometimes to
dangerous levels, at which time symptoms such as bruising, nosebleeds, or
hemorrhaging may appear. After 1-2 hours of nursing intervention the patient
will be able to demonstrate increased perfusion. -Teach patient assist about
passive ROM exercise. -Elevate lower limbs as appropriate. -Elevate head of bed
during sleep.

-Encourage diet rich in iron such as chicken liver or other organ meat if not
contraindicated. -Provide increase fluid intake. -Encourage patient to take
adequate rest period of time. -Provide patient and family teaching of disease
process and techniques in managing associated symptoms. -Enhance circulation and
venous return. -To reduce edema. -To increase gravitational blood flow. -To
increase blood level. -To facilitate blood circulation throughout the body. -To
decrease metabolic and oxygen need, enhancing oxygenation in blood. -Promote
patient s coping skills in self care management. After 2 hours of patient nurse
intervention the patient showed the following signs : -Patient verbalized
reduced sensation of numbness in the legs. -Decreased blood stain in the gums.
-Manifest signs of relief and comfort. Assessment Nursing diagnosis Nursing

goal Nursing Intervention Rationale Outcome Criteria Evaluation S mag sige lag
paminhud akung tiil dong as verbalized by the patient. O -Seen patient lying on
bed sleeping with i.v at the right arm. -Blue discoloration of skin. -Bloody
gums noted. -pale color skin noted. -Pale color skin noted. ineffective tissue
perfusion related to decrease circulating blood volume due to bleeding
Scientific base: ITP is an autoimmune disorder the antibodies destroy the
platelets lowering the platelet count,sometimes to dangerous levels, at which
time symptoms such as bruising, nosebleeds, or hemorrhaging may appear. After 1-
2 hours of nursing intervention the patient will be able to demonstrate
increased perfusion. -Teach patient assist about passive ROM exercise. -Elevate
lower limbs as appropriate. -Elevate head of bed during sleep. -Encourage diet
rich in iron such as chicken liver or other organ meat if not

contraindicated. -Provide increase fluid intake. -Encourage patient to take
adequate rest period of time. -Provide patient and family teaching of disease
process and techniques in managing associated symptoms. -Enhance circulation and
venous return. -To reduce edema. -To increase gravitational blood flow. -To
increase blood level. -To facilitate blood circulation throughout the body. -To
decrease metabolic and oxygen need, enhancing oxygenation in blood. -Promote
patient s coping skills in self care management. After 2 hours of patient nurse
intervention the patient showed the following signs : -Patient verbalized
reduced sensation of numbness in the legs. -Decreased blood stain in the gums.
-Manifest signs of relief and comfort. -

Criteria Evaluation S: Nagdugo iyahang lagus , as stated by the SO. O: -received
pt sleeping with IVF PNSS 1liter at 30gtts/min infusing well on left arm
-petechea .5cm distributed in the upper extremities -bluish pigment on the right
arm -blood stained sputum due to gum bleeding -constipation Risk for injury,
hemorrhage related to altered clotting factor Scientific base: After 4-8hrs of
nursing intervention,pt will: -modify environment as indicated to enhance safety
-demonstrate behaviors, lifestyle changes to reduce risk factors and protect
self from injury -verbalize understanding of individual factors that contribute
to possibility of injury -Perform thorough assessment regarding safety issues
when planning for client care -ascertain knowledge

of safety needs/injury prevention and motivation -note clients
age,gender,developm ental stage,decisionmaking ability,level of competence
-assess clients muscle strength, gross and fine motor coordination -failure to
accurately assess and intervene or refer these issues can place the client at
needless risk and creates negligence issues for the healthcare practitioner -to
prevent injury in home,community, and work setting -affects clients ability to
protect self and others, and influences choice of interventions and teaching -to
identify risk for falls Assessment Nursing diagnosis Nursing goal Nursing
Intervention Rationale Outcome Criteria Evaluation S: Nagdugo iyahang lagus , as
stated by the SO. O: -received pt sleeping with IVF PNSS 1liter at 30gtts/min
infusing well on left arm -petechea .5cm distributed in the upper extremities
-bluish pigment on the right arm -blood stained sputum due to gum bleeding
-constipation Risk for injury, hemorrhage

related to altered clotting factor Scientific base: After 4-8hrs of nursing
intervention,pt will: -modify environment as indicated to enhance safety
-demonstrate behaviors, lifestyle changes to reduce risk factors and protect
self from injury -verbalize understanding of individual factors that contribute
to possibility of injury -Perform thorough assessment regarding safety issues
when planning for client care -ascertain knowledge of safety needs/injury
prevention and motivation -note clients age,gender,developm ental
stage,decisionmaking ability,level of competence -assess clients muscle
strength, gross and fine motor coordination -failure to accurately assess and
intervene or refer these issues can place the client at needless risk and
creates negligence issues for the healthcare practitioner -to prevent injury in
home,community, and work setting -affects clients ability to protect self and
others, and influences choice of interventions and

teaching -to identify risk for falls

Criteria Evaluation -provide healthcare within a culture of safety *maintain bed
in lowest position with wheels locked *place assistive devices within reach
*instruct client/SO to request assistance as needed *monitor environment fro
potentially unsafe conditions and modify as needed -provide information
regarding disease/condition that may result in increased risk of injury
-identify interventions/safety devices -to prevent errors resulting in client
injury, promote client safety, and model safety behaviors for client/SO -to
promote safe physical environment and individual safety After 4-8hrs of nursing
intervention,pt will be able to demonstrate the following: -less petechea -less
bluish pigment -less incidence of blood stained sputum due to gum bleeding
Assessment Nursing diagnosis

Nursing goal Nursing Intervention Rationale Outcome Criteria Evaluation -provide
healthcare within a culture of safety *maintain bed in lowest position with
wheels locked *place assistive devices within reach *instruct client/SO to
request assistance as needed *monitor environment fro potentially unsafe
conditions and modify as needed -provide information regarding disease/condition
that may result in increased risk of injury -identify interventions/safety
devices -to prevent errors resulting in client injury, promote client safety,
and model safety behaviors for client/SO -to promote safe physical environment
and individual safety After 4-8hrs of nursing intervention,pt will be able to
demonstrate the following: -less petechea -less bluish pigment -less incidence
of blood stained sputum due to gum bleeding

. Based from Nursing Diagnosis Priority Problem 1 Exchange Goals of Care .
Improving airway patency . Promoting rest and conserving energy . Promoting
fluid intake . Maintaining nutrition . Promoting patient s knowledge .
Maintaining and managing potential complications
Impaired Gas

. Based from Nursing Diagnosis Priority Problem 2 tissue perfusion Goals of Care
Ineffective
. Promote adequate circulation . Maintain optimal nutrition . Ensure hydration
and fluid intake . Provide rest & adequate sleep . Promote patient and family
knowledge (patient education)

150826686 26249067-idiopathic-thrombocytopenic-purpura-case-study-txt

150826686 26249067-idiopathic-thrombocytopenic-purpura-case-study-txt

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150826686 26249067-idiopathic-thrombocytopenic-purpura-case-study-txt