So the treatment.
This is determined on a child's age,
the health and their prior medical history
It also depends on the extent of the disease.
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.
Not all children with ITP require
treatment, remember this can self-resolve.
Observation and prevention of serious bleeding complications
may be the preferred course of action until it goes away.
There are two mainstay
treatments, the first is steroids.
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.
Another option is IVIG and this is
a protein that contains antibodies.
It's infused intravenously and it's
gonna slow the destruction of platelets.
This is a quicker option, this will work in 24-48 hours
and we usually do this on our inpatient children with ITP.
Other less common treatments,
you can do a medication change.
So there are medications associated with
ITP and if medication is a suspected cause,
you will want to stop that medication.
If a patient has an infection that's
causing more platelet destruction, you're gonna treat that infection.
A splenectomy. Older children with chronic
ITP will need the removal of their spleen.
So you're gonna try to stop the menstrual cycle in
adolescent patients to control their excessive bleeding.
And finally, an infusion of platelets.
We also want to prevent bleeding.
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.
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.
In ITP, the prognosis is usually very favorable.
Once the body stops making antibodies that
attack the platelets, the disorder will resolve.
Serious complications are rare and these usually
occur when the platelet count is less than 5,000.
This includes the risk for fatal intracranial
hemorrhage and the risk for serious GI bleeding.
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.
You're going to be looking to
see if it's going up for going down.
You're also gonna monitor clotting studies in your patient but
remember the clotting factors are normal in these patients.
You're gonna prevent injury, you
want to put the call light within reach.
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.
Avoid the use of restraints and this is important
because this can cause extra bleeding on the skin.
And you want to eliminate
other hazards such as razors.
These patients again we'll be doing
soft oral care including soft toothbrushes.
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.