RN Nursing · Thrombocytopenia · Practice question
A 42-year-old patient with immune thrombocytopenic purpura (ITP) is admitted with a platelet count of 18,000/uL. The patient reports bleeding gums when brushing teeth and scattered petechiae on the lower extremities. Vital signs are stable. Which nursing intervention is the priority?
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Encourage ambulation to prevent venous stasis
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Administer aspirin for discomfort
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Apply warm compresses to extremities
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✓
Initiate bleeding precautions
Answer & explanation
Correct: Initiate bleeding precautions
With a platelet count of 18,000/µL, this patient is at extreme risk for spontaneous and potentially life-threatening hemorrhage. Normal platelet count ranges from 150,000 to 400,000/µL; counts below 20,000/µL carry serious risk of internal bleeding, including intracranial hemorrhage. Initiating bleeding precautions — which include using a soft toothbrush, avoiding IM injections and invasive procedures, instructing the patient to avoid straining, and monitoring for signs of internal bleeding — is the priority intervention to prevent harm. Encouraging ambulation to prevent venous stasis is appropriate for other conditions but increases fall and injury risk in a severely thrombocytopenic patient. Aspirin inhibits platelet aggregation and is absolutely contraindicated when platelets are this low, as it would further impair what little clotting ability remains. Applying warm compresses does not address the hemorrhagic risk and has no therapeutic basis for ITP. Safety and bleeding precautions must be established immediately to protect the patient from a preventable hemorrhagic event.
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- A 42-year-old patient with immune thrombocytopenic purpura (ITP) is admitted with a platelet count of 18,000/µL. The patient reports bleeding gums when brushing teeth and scattered petechiae on the lower extremities. Vital signs are stable. Which nursing intervention is the priority?