Last updated on December 28th, 2023
Here we will formulate sample Thrombocytopenia nursing care plans based on a hypothetical case scenario.
It will include three thrombocytopenia nursing care plans with NANDA nursing diagnoses, nursing assessment, expected outcome, and nursing interventions with rationales.
Thrombocytopenia Case Scenario
A 67-year-old man presents to the ED with complaints of a nosebleed that won’t stop. The patient reports a nosebleed that “started out of nowhere” and despite holding pressure on the nose, it has continued to bleed for 3 hours.
The patient vomited while in the ED and ~200 ml of bloody emesis is recorded. The patient also reports, “Lately I’ve noticed when I take my blood sugar, my finger bleeds for an unusually long period of time.”
The patient has a history of diabetes and stage 3 pancreatic cancer and is currently undergoing chemotherapy. His last chemotherapy session was 2 days ago.
Upon assessment, the patient is alert and oriented and follows commands appropriately.
The patient appears pale, various bruises are noted on his body, and petechiae are noted on the lower legs.
The patient’s temperature is 37.5 ˚C, heart rate is 110 BPM, blood pressure is 91/45 mmHg, respirations are 18 breaths per minute, and oxygen saturation is 99% on room air. His heart and lung sounds are clear upon auscultation.
The patient’s blood work reveals white blood cells of 3.3 K/mcL, hemoglobin of 8.1 g/dL, hematocrit of 31%, and platelets of 17,000 mm3. The patient is negative for HIV and an abdominal ultrasound shows no evidence of splenomegaly.
The patient is diagnosed with Thrombocytopenia.
#1. Thrombocytopenia Nursing Care Plan – Fluid volume deficit
Thrombocytopenia nursing assessment
Subjective Data:
- The patient reports bleeding from the nose for 3 hours.
Objective Data:
- The patient is hypotensive and tachycardic.
- He vomited ~200 ml of bloody emesis.
Thrombocytopenia nursing diagnosis
Fluid volume deficit related to prolonged bleeding and blood loss secondary to platelet deficiency as evidenced by hypotension and tachycardia.
Goal/desired outcome
Short-term goal: The patient will receive fluids and blood products as needed and the heart rate and blood pressure will return to normal.
Long-term goal: The patient will maintain normal hemoglobin, hematocrit, and platelet levels.
Thrombocytopenia nursing interventions – Fluid volume deficit
| Nursing Interventions | Rationales |
| Monitor vital signs. | Monitor heart rate and blood pressure to assess fluid status. Tachycardia and hypotension indicate low fluid volume. |
| Administer fluids. | Fluids should be administered to replace lost fluid volume from bleeding. |
| Administer blood as needed. | Transfusion of blood products may be required to support the patient until the underlying cause of thrombocytopenia can be addressed. Blood levels should be checked 2 hours after administration. Monitor for signs of a transfusion reaction. |
| Monitor intake and output (I&O). | Urine output, emesis, estimated blood loss, and IV fluid administration should be closely tracked to assess fluid status. |
| Assess physical markers of fluid status. | Physical indicators of fluid status are blood pressure, heart rate, CVP, skin turgor, dry skin, and dry mucous membranes. |
#2 Thrombocytopenia Nursing Care Plan – Risk for bleeding
Thrombocytopenia nursing assessment
Subjective Data:
- The patient reports bleeding from blood sugar sticks for an unusually long amount of time.
Objective Data:
- Significant bruises and petechiae are noted on the patient’s body.
- The patient’s hemoglobin, hematocrit, and platelets are low.
Thrombocytopenia nursing diagnosis
Risk for bleeding related to platelet deficiency secondary to chemotherapy as evidenced by bruises, petechiae, and prolonged bleeding time.
Goal/desired outcome
Short-term goal: By the end of the shift the patient’s nosebleed will cease and platelets will not decrease further.
Long-term goal: The patient will recognize the relationship between chemotherapy and platelets, and will take precautions to prevent bleeding.
Thrombocytopenia nursing interventions – Risk for bleeding
| Nursing Interventions | Rationales |
| Closely monitor CBC. | Monitor blood count levels closely for decreasing hemoglobin, hematocrit, or platelet counts. Recheck blood levels 2 hours after transfusion of blood products. |
| If needed, administer glucocorticoids or intravenous immunoglobulin (IVIG). | Depending on the cause of the thrombocytopenia, glucocorticoids or IVIG may be administered to prevent the body from forming antibodies that destroy platelets. These medications are generally used for immune thrombocytopenia. |
| Institute bleeding precautions. | Needlesticks should be minimized and pressure should be applied until hemostasis occurs. The patient should be educated on bleeding precautions as well, including using a soft toothbrush and an electric razor. |
| If needed, administer thrombopoietin receptor agonists. | Depending on the cause of the thrombocytopenia, thrombopoietin receptor agonists (such as romiplostim and eltrombopag) may be administered to increase platelets. These medications are generally used for chronic or immune thrombocytopenia. |
| Monitor for signs and symptoms of bleeding. | Signs of symptoms of bleeding include ecchymosis, petechiae, nosebleeds, bleeding from the gums, GI bleeding, or intracranial hemorrhage. |
| Avoid the use of aspirin or NSAIDs. | Aspirin and NSAIDs increase the risk of bleeding and are dangerous to give to patients with thrombocytopenia. |
#3 Thrombocytopenia Nursing Care Plan – Risk for injury
Thrombocytopenia nursing assessment
Subjective Data:
- The patient reports prolonged bleeding times.
Objective Data:
- The patient’s nose has been bleeding for 3 hours.
- His platelets are 17,000 mm3.
Thrombocytopenia nursing diagnosis
Risk for injury related to increased risk of bleeding as evidenced by critically low platelets and prolonged bleeding.
Goal/desired outcome
Short-term goal: By the end of the shift the patient will remain free from injuries and falls.
Long-term goal: The patient will experience no complications such as GI bleeding or intracranial hemorrhage.
Thrombocytopenia nursing interventions – Risk for injury
| Nursing Interventions | Rationales |
| Perform neurological checks. | A patient with thrombocytopenia is at risk for intracranial hemorrhage. The patient should be monitored for signs of intracranial hemorrhage including headache, decreasing levels of consciousness, unequal pupils, slurred speech, or paralysis on one side of the body. |
| Institute fall precautions. | The patient could suffer serious injuries from a fall due to the increased risk of bleeding. The patient should be advised to call for help getting out of bed. Bed alarms and non-skid socks are other fall precautions. |
| Prepare for plasmapheresis. | Plasmapheresis is a procedure in which the plasma is removed from the body and replaced with new plasma. |
| Prepare for a possible splenectomy. | A splenectomy is sometimes indicated for steroid-refractory or immune thrombocytopenia. |
Conclusion
To conclude, here we have formulated a scenario-based sample nursing care plan for Thrombocytopenia. Prioritized nursing diagnosis includes risk for bleeding, risk for injury, and fluid volume deficit.
Additionally, these sample thrombocytopenia nursing care plans comprise nursing assessment, NANDA nursing diagnosis, goal, and interventions with rationales.
Recommended Readings & References
Ackley, B., Ladwig, G., Makic, M., Martinez-Kratz, M., & Zanotti, M. (2020). Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). Elsevier.
Comer, S. and Sagel, B. (1998). CRITICAL CARE NURSING CARE PLANS. Skidmore-Roth Publications.
Doenges, M., Moorhouse, M., & Murr, A. (2013). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales (13th ed.). F. A. Davis Company.
Herdman, T., Kamitsuru, S. & Lopes, C. (2021). NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Thieme.
Swearingen, P. (2016). ALL-IN-ONE CARE PLANNING RESOURCE (4th ed.). Elsevier/Mosby.
