NURSING CARE PLAN ON PLATELET DISORDERS

SCENARIO:

MR. ARJUN AGED 13 YEARS BROUGHT TO THE CASUALITY ACCOMP AINED BY SIGNIFICANT FAMILY MEMEBER. EXPLAINED THAT PATIENT HAD DIZZINESS, MORE
BLEEDING FROM TRAUMA SITE, .WHEN PATIENT IS BROUGHT TO THE CLINIC PATIENT IS CONSCIOUS.PATIENT COMPLAINED THAT FROM TWO HOURS HE HAD BLEEDING AND NO
CLOT FORMATION OR STOPAGE OF BLEEDING.

ON ASSESSMENT PATIENT HAD ELEVATED HEART RATE 102 BEATS PER MINUTE ,DYSPNEA WITH EXERTION ,RESTLESSNESS ,PALE, BLOOD COOL EXTRIMITIES, PRESSURE
RECORDED AS 60/100 MM OF HG .AND ALSO PATIENT IS IN HYPOVOLEMIC SHOCK .

NURSING GOAL PLANNING/ IMPLEMENTATION RATIONALE EVALUATION

ASESSMENT DIAGNOSIS
Risk for bleeding To prevent Assess the patient’s vital signs and perform a focused Anticoagulants put the patient at risk for Patient reported normal
related to low bleeding and physical assessment, looking for any signs of bleeding. bleeding. Early signs of bleeding include platelet count.
Sub data : patient platelet count increase gum bleeding, epistaxis, and unexplained
complaints of bleeding platelet count bruises. Low blood pressure, low
from nose, gums, and temperature and dizziness may result from
skin bruises, petechie. http://youtu.be/UqFp1AvrAuE excessive bleeding.

Obj data : on observation

of lab reports, WBC
count is less and To measure the risk of bleeding by knowing
PLATELLETS count is Obtain blood samples and monitor platelet counts as the platelet counts and coagulation levels of
less. well as coagulation levels (INR PT, AND PTT ). the patient.

To check for the need for platelet

Administer blood or platelet transfusion as prescribed. transfusion, if the platelet level is low and
immediate correction is warranted platelet or
whole blood transfusion is administered.

Prepare the patient spleenectomy as indicated. This is mostly recommended in cases of

splenomegaly. If it is the cause of
thrombocytopenia.
 Assess the vital signs particularly blood pressure level Patient reported normal
Fluid volume To increase Hypovolemia due to bleeding may lower fluid volume.
Sub data : patient deficit related to fluid volume blood pressure levels and put the patient at
complaints of weight blood volume risk for hypertensive episodes that leads to
loss, dry skin. loss secondary to shock
bleeding as Commence a fluid balance chart, monitoring the input
evidence by and output of the patient. Include episodes of vomiting, To monitor patients fluid volume accurately
Object data : on Low platelet gastric suctioning and other gastric losses in the I/O
observation patient is count charting
thin, dry skin and sunken
eyes.
Start intravenous therapy as prescribed electrolytes may
need to be replaced intravenously. Encourage oral fluid To replenish the fluids and electrolytes lost,
intake of at least 200 ml/ day if not contraindicated and to promote better blood circulation
around the body
Educate the patient or guardian on how to fill out a fluid
balance chart at bedside. To help the patient or the guardian take
ownership of the patients care, encouraging
them to drink more fluids as needed or report
any changes to the nursing team
Administer blood transfusion as prescribed.
To increase the platelet count and
http://youtu.be/N2bjlunGVBk hemoglobin level and treat
thrombocytopenia, anemia and hypovolemia
related to bleeding.

Patient reported normal

increased activity
To promote Assess the patient energy level and fatigability, as well tolerance.
Activity as is her usual activities of daily living ( ADL’S)
Subjective data : patient intolerance activity
complaints of difficulty related to Fatigue tolerance
in doing works, related to post level
weakness, fatigue. surgical removal
of spleen Place the bed in the lowest position. Place the call bell
Objective data : on secondary to with in reach. If there’s any ( and keep the visual aids
observation patient feels thrombocytopenia and patients phone and other devices with in reach.
tired, unable to do and
activities. spleenomegaly as Promote adaequate lighting in the patients room.
evidenced by
verbalization of
Advise the patient to wear sun glasses especially when
lack of energy
going out doors.
the patient to rate fatigue level (mild, moderate, severe
fatigue ).
Assess the patients activities of daily living, as well as
actual and perceived limitations to physical activities,
ask for any exercise that he/ she used to do or wants to
try.
Encourage progressive activity through self- care and
exercise as tolerated. Explain the ned to reduce sendary
activites such as watching television and using social
media in long periods. Alternate periods of physical
activity with rest and sleep. Encourage the patient to
follow a low cholesterol, high caloric diet. Refer to the
dietitian as needed.
To explore the patients energy levels and
how these can effect ( ADL’S ). To gain
useful information before modifying patient
environment.
To prevent or minimize the injury of the
patient.
To promote safety measures and support to
the patients in doing. (ADL’S) optimally.
To reduce the glare and help and protect the
eyes.
To create a base line of activity levels.
Degree of fatiagibility, and mental status
related to fatigue and activity intolrence.
To gradually increase the patient’s tolerance
to physical activity.
http://yputu.be/R8JMfbYW2p4
To increase energy levels.
Patient reported normal
anxiety levels

Anxiety related to To revlive Identify and acknowledge patient’s perception of threat

Sub data : patient disease condition
complaints of lack of as evidenced by
information, tense, and facial tension.
and situation. Encourage expressions of, and do not deny
anxiety Coping with the pain and emotional trauma
levels by feelings of, anger, grief, sadness, fear.
of an thrombocytopenia is difficult. Patient
explaining may fear death and/or be anxious about
anxiety. about http://youtu.be/pqo3PDHR924 immediate environment. Ongoing anxiety
condition. (related to concerns about impact of heart
attack on future lifestyle, matters left
unattended or unresolved, and effects of
Obj data : on observation illness on family) may be present in varying
patient is depressed, degrees for some time and may be
stress. manifested by symptoms of depression.

Research into survival rates between type A

Note presence of hostility, withdrawal, and/or denial
(inappropriate affect or refusal to comply with medical
regimen).
and type B individuals and the impact of
denial has been ambiguous; however, studies
show some correlation between degree
or expression of anger or hostility and an
increased risk for death.

Maintain confident manner (without false reassurance).
Observe for verbal and nonverbal signs of anxiety
(restlessness, changes in vital signs), and stay with
patient. Intervene if patient displays destructive
behavior.
Patient and SO can be affected by the
anxiety/uneasiness displayed by health team
members. Honest explanations can alleviate
anxiety.
Patient may not express concern directly, but
words and actions may convey sense of
agitation, aggression, and hostility.
Intervention can help patient regain control
of own behavior.

Accept but do not reinforce use of denial. Avoid
confrontations.
Denial can be beneficial in decreasing
anxiety but can postpone dealing with the
reality of the current situation. Confrontation
can promote anger and increase use of
denial, reducing cooperation and possibly
impeding recovery.
Orient patient and/or SO to routine procedures and
expected activities. Promote participation when possible. anxiety for patient.
Answer all questions factually. Provide consistent
information; repeat as indicated.
Encourage patient and SO to communicate with one
another, sharing questions and concerns.
Provide privacy for patient and SO.
Provide rest periods and/or uninterrupted sleep time,
quiet surroundings, with patient controlling type, amount Can provide reassurance that feelings are
of external stimuli.
Support normality of grieving process, including time
Predictability and information can decrease
Accurate information about the situation
reduces fear, strengthens nurse-patient
relationship, and assists patient and SO to
deal realistically with situation. Attention
span may be short, and repetition of
information helps with retention
Sharing information elicits support and
comfort and can relieve tension of
unexpressed worries.
Allows needed time for personal expression
of feelings; may enhance mutual support and
promote more adaptive behaviors.
Conserves energy and enhances coping
abilities.
normal response to situation and/or perceived
changes.
 necessary for resolution.
Encourage independence, self-care, and decision making
within accepted treatment plan.
Increased independence from staff promotes
self-confidence and reduces feelings of
abandonment that can accompany transfer
from emergency unit and/or discharge from
hospital.

http://youtu.be/3POEndv8ovo

Encourage discussion about postdischarge expectations.

Helps patient and/or SO identify realistic
goals, thereby reducing risk of
discouragement in face of the reality of
limitations of condition and/or pace of
recuperation.

Administer anti anxiety and hypnotics as indicated: Promotes relaxation and rest and reduces
alprazolam (Xanax), diazepam (Valium), lorazepam feelings of anxiety.
(Ativan), flurazepam (Dalmane).
Patient reported
knowledge improved
about the medical
Deficient To provide treatment and health
Sub data : patient knowledge information condition.
complaints of fear, related to lack of about
tension and lack of information condition
knowledge about regarding disease and improve
condition condition as knowledge
Assess patient or SO level of knowledge and ability and Necessary for creation of individual
evidence by levels. instruction plan.
questioning. desire to learn.

Obj data : on observation

patient is asking
questions frequently,
facial tension Be alert to signs of avoidance (changing subject away
from information being presented or extremes of
behavior).
http://youtu.be/cEbkO_Ag3P0
Present information in varied learning formats:
programmed books, audiovisual tapes, question and
answer sessions, group activities.
Reinforce explanations of risk factors, dietary and/or
activity restrictions, medications, and symptoms
requiring immediate medical attention.Encourage
identification and reduction of individual risk factors
(smoking/alcohol consumption, obesity).
Reinforces expectation that this will be a
“learning experience.” Verbalization
identifies misunderstandings and allows for
clarification.
Natural defense mechanisms, such as anger
or denial of significance of situation, can
block learning, affecting patient’s response
and ability to assimilate information.
Changing to a less formal or structured style
may be more effective until patient and SO is
ready to accept or deal with current situation.
Using multiple learning methods enhances
retention of material.