Primary Nursing Diagnosis

Risk of injury related to increased bleeding tendency

OUTCOMES. Risk control; Safety behavior: Fall prevention; Knowledge: Personal safety; Safety status: Physical injury; Knowledge: Medication; Safety behavior: Home physical environment

INTERVENTIONS. Bleeding precautions; Bleeding reduction; Fall prevention; Environmental management; Safety; Health education; Surveillance; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

Treatment for ITP is primarily pharmacologic. Because the risk of hemorrhage occurs early in the course of acute ITP, therapy is focused on a rapid, sustained elevation in platelet counts. Children with non-life-threatening bleeding are not generally given transfused platelets because the antiplatelet antibody found in their serum is directed against both autologous and transfused platelets.

If the patient fails to respond within 1 to 4 months or needs a high steroid dosage, splenec-tomy is usually considered. Splenectomy is effective because the spleen is a major site of antibody production and platelet destruction; research suggests that splenectomy is successful 85% of the time. In the face of life-threatening bleeding, such as intracranial or massive GI hemorrhages, a splenectomy is indicated.

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