Immune Thrombocytopenia (ITP): Management (Pediatric Nursing)

00:01 So the treatment.

00:02 This is determined on a child's age, the health and their prior medical history It also depends on the extent of the disease.

00:09 You also want to think about, how is your patient going to tolerate certain medications, procedures and therapies and you want to talk about this with the patient and their family and and see what you guys can do together.

00:21 Not all children with ITP require treatment, remember this can self-resolve.

00:26 Observation and prevention of serious bleeding complications may be the preferred course of action until it goes away.

00:32 There are two mainstay treatments, the first is steroids.

00:36 These are used for a few reasons, first they're gonna prevent bleeding, they're gonna decrease the rate of the platelet destruction and they're gonna help increase the platelet count within two to three weeks.

00:46 Another option is IVIG and this is a protein that contains antibodies.

00:51 It's infused intravenously and it's gonna slow the destruction of platelets.

00:55 This is a quicker option, this will work in 24-48 hours and we usually do this on our inpatient children with ITP.

01:03 Other less common treatments, you can do a medication change.

01:06 So there are medications associated with ITP and if medication is a suspected cause, you will want to stop that medication.

01:13 If a patient has an infection that's causing more platelet destruction, you're gonna treat that infection.

01:19 A splenectomy. Older children with chronic ITP will need the removal of their spleen.

01:25 Hormone therapy.

01:26 So you're gonna try to stop the menstrual cycle in adolescent patients to control their excessive bleeding.

01:32 And finally, an infusion of platelets.

01:36 We also want to prevent bleeding.

01:39 You need to make the environment safe so you want to pad the crib, potentially have a child wear a helmet and do protective padding and clothing when the platelet count is really low You're gonna want to restrict contact sports in these patients, they shouldn't be going for bike rides or participating in rough play when their platelet count is really low.

01:57 You're going to avoid giving certain medications to these patients including NSAIDS and that's ibuprofen, naproxen, etcetera because they can interfere with the body's ability to control bleeding.

02:07 In ITP, the prognosis is usually very favorable.

02:11 Once the body stops making antibodies that attack the platelets, the disorder will resolve.

02:16 Serious complications are rare and these usually occur when the platelet count is less than 5,000.

02:22 This includes the risk for fatal intracranial hemorrhage and the risk for serious GI bleeding.

02:27 So what should the nurse do if taking care of a patient with ITP? Well you want to review the lab results regularly and this includes keeping a tight watch on the platelet count.

02:37 You're going to be looking to see if it's going up for going down.

02:39 You're also gonna monitor clotting studies in your patient but remember the clotting factors are normal in these patients.

02:46 You're gonna prevent injury, you want to put the call light within reach.

02:49 If a patient has to climb over a railing and climb over a table to get to the call light to call for help, they risk injury in falling.

02:56 Avoid the use of restraints and this is important because this can cause extra bleeding on the skin.

03:01 And you want to eliminate other hazards such as razors.

03:04 These patients again we'll be doing soft oral care including soft toothbrushes.

03:09 Prevent infection.

03:10 This is strict hand hygiene, encourage hydration, use the soft bristled toothbrushes so that the mucosa stays intact and you can administer stool softeners to your patient to protect their mucous membranes.