Pharmacologic Highlights

Conquer Low Platelets

Treating  Thrombocytopenia

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Medication or Drug Class

Dosage

Description

Rationale

Intravenous Immune globulin (IVIG)

2 days

Prednisone 1-2 mg/kg PO qd; methylpred-nisolone 1-2 g IV for 3 days

Increases antibody titer and antigen-antibody reaction; provides passive immunity against infection and induces rapid but short-term increases in platelet count

Decrease inflammatory response; glucocorticoids are highly controversial therapy for children. Chronic ITP requires a slow steroid taper over several months

Other Therapy: Alternative treatments Include Immunosuppression agents such as cyclophosphamide (Cytoxan) and vincristine sulfate. Plasmapheresis has been attempted with limited success.

Independent

Many children are managed as outpatients with frequent outpatient visits for therapeutics and platelet counts. If the platelet count is less than 15,000 mm3, the condition may be considered serious enough to warrant hospitalization. Institute safety precautions to prevent injury and the resultant bleeding and to assist with ambulation. Protect areas of hematoma, petechiae, and ecchymoses from further injury. Avoid intramuscular injections, but if they are essential, apply pressure for at least 10 minutes after the intramuscular injection and for 20 minutes after venipuncture. Avoid nasotracheal suctioning, if possible, to prevent bleeding. If a child is being managed as an outpatient, discuss the home environment with the parents or caregivers. Encourage the parents to set up one or two rooms at home (such as the child's bedroom and the family room) as a protected environment. Pad all hard surfaces and corners with pillows and blankets and remove obstructions, furniture, and loose rugs.

Teach the patient and significant others about the nature of this disorder and necessary self-assessments and self-care activities. Teach the patient to report any signs of petechiae and ecchymoses formation, bruising, bleeding gums, and other signs of frank bleeding. Encourage the patient to stand unclothed in front of a mirror once a day to check for areas of bruising. Headaches and any change in level of consciousness may indicate cerebral bleeding and, therefore, need to be reported to the healthcare workers immediately. Teach the signs and symptoms of blood loss, such as pallor or fatigue. Demonstrate correct mouth care for the patient and significant others by using a soft toothbrush to avoid mouth injury. Recommend electric shavers for both men and women. Teach the patient to use care when taking a rectal temperature to prevent rectal perforation. Recommend care when clipping fingernails or toenails. If any bleeding does occur, instruct the patient to apply pressure to the area for up to 15 minutes or to seek help. Teach the patient to avoid aspirin, ibuprofen in any form, and other drugs that impair coagulation, with particular attention to over-the-counter remedies.

514 Infective Endocarditis

Provide a private, quiet environment to discuss the patient's or parents' concerns. The period of diagnosis is an anxious one, and parents need a great deal of emotional support. If the child is managed at home, parents need an opportunity to express their fears.

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