itp and epistaxis

causes of anemia

1. decreased rbc production

2. increased rbc loss

3. increased rbc destrution

immune thrombocytopenic purpura

most comonly occuring thrombocytopenia of childhood 

itp onset

2-5 years of age

how does itp arise

development of antibodies against multiple platelet antigens leading to destruction of platelets and reduced platelet production

characteristics of ITP

1. thrombocytopenia

2. purpura

3. normal bone marrow

4. normal or increased number of immature platelets adn eosinophils

5. signs of internal bleeding inc cerebral hemorrhage

thrombocytopenia

excessive destruction of platelets

purpura

discoloration caused by petechiae beneath the skin

two forms of ITP

1. acute (resolves within 6 months)

2. chronic (longer than 6 months)

how does acute ITP start

1. recent viral infections

2. immune disorders

3. med response

how long does acute ITP normally last

1-2 weeks

how long does thrombocytppenia normally take to resolve

6 months

diagnosis of ITP

1. cbc with differential count

2. coagulation studies

what is NEVER done to diagnose ITP

bone marrow biospy/aspiration

what to expect from cbc with differential for ITP

significant reduction in platelet levels, normal/elevated esionophils, elevated esr and crp

what to expect from coagulation studies for ITP

prolonged clotting times

therapeutic management of ITP

1. assess s&s of bleeding

2. activity restrictions

3. corticosteroids

4. IVIG

5. Andi-D antibody

why put kids on activity restrictions

to reduce risk of injury

why put kids on corticosteroids

to reduce inflammatory process

signs of internal bleeding

1. hemiarthrosis

2. gums

3. ocular bleed

4. hematuria

5. melena

hemiarthrosis

bleeding over bony prominences

IVIG parameters

1. take baseline vitals

2. establish patent IV

3. how fast infusion can run

4. policy on the unit

when do you give IVIG

for moderate bleeding

only group of people that can get anti-d antibody

children that are Rh+

what do you need to give anti-d antibody

blood type and screen within 48 hours

continuous monitorign for anti-d antibody

every 48 hours

how many lines are going for anti-d antibodies

2 iv lines, one of them is normal saline

therapeutic management during anti-d infusion

vitals 5, 20, 60 minutes

s&s that can occur during or after infusion

1. fever 

2. chills

3. hematuria

4. headache

what do you do if you see s&s during/after infusion

call prescriber for order and give benadryl and IV solu-cortef, and watch for one additional hour (9 instead of *)

how many hours are you monitoring while adminstering anti-d

8 hours, maintain patent IV line

when is platelet transfusion given

only for life-threatening hemorrhage or if child requires surgery

splenectomy

in children that have chronic ITP unresponsive to treatment and those with an increased risk of severe hemorrhage

management after splenectomy

prophylactic antiobiotics before and after surgery (at least 3 years after), childs hould be greater than 5 years old

prognosis of ITP

not many complications of acute, chronic can be managed by treatment or splenectomy if severe

supportive care for ITP

1. assess and monitor for signs of bleeding

2. monitor for signs of side effects of ordered therapies

3. health education to child and family

health education for ITP

1. avoid contact sports

2. prevent abd and head injuries through safety equipment and avoidign activities that can cause the stuff

3. teach child and family how to montior for signs of bleeding at homea nd to return for re assessment if bleeding occurs

epistaxis

recurrent or severe episodes may indicate nderlying disease

nursing care for epistaxis

1. remain calm

2. have child sit up and lean forward

3. apply continuous pressure by holding tup of nose with thumb and forefinger for at least 10-15 minutes

4. do not insert anyting into nose or blow nose

5. apply ice or cold cloth to bridge of nose if bleeding persists

6. cool mist humidification

7. further evaluation

what could hcp do for nosebleed

pack the nose with topocal tranexamic acid-soaked gauze, investigate further

places family should look for ITP bleeding

urine, stool, gums, signs of internal bleeding

when might the nose need to be cauterized

if nosebleeds past 15 minutes after tranexamic acid