Purpura

Subject: Child Health Nursing

Overview

Due to excessive bleeding or a lack of plasma coagulation factor, purpura is a type of bleeding condition. It is characterized by uncontrollable bleeding into the skin or mucosa, which can appear as ecchymosis (large superficial bleeding) or petechiae (little pinpoint bleeding). The most typical signs and symptoms of purpura include significant bleeding following minor surgery or tooth extraction as well as bleeding from the mucosa of the nose, mouth, gastrointestinal tract, and genitourinary system. 85–95% of patients recover within 6 months. The care rate after splenectomy may be 75%. A common therapeutic option for extreme bleeding is a blood + platelet transfusion. Transfusions of blood and platelets are part of supportive therapy for the prevention and treatment of bleeding events. When patients don't improve after receiving IV-IgG treatment and steroids, a splenectomy is performed.

Purpura

Due to excessive bleeding or a lack of plasma coagulation factor, purpura is a type of bleeding condition. Its hallmark is spontaneous bleeding into the skin or mucosa, which appears as ecchymosis or petechiae (tiny pinpoint hemorrhages) (large superficial hemorrhage). It is frequently accompanied by a platelet shortage, either quantitatively or qualitatively, or by vascular integrity flaws (dysfunction of hemostasis).

Classification

  • Thrombocytopenic purpura: platelet count is decreased.
  • Non- thrombocytopenic purpura: defect in platelet functions.

Causes

  • Decreased platelet production
  • Increased platelet destruction
  • Abnormality of spleen
  • Platelet dilution during red blood cell transfusion after bleeding

Sign and symptoms

  • Petechiae occur spontaneously
  • Bleeding from the mucosa of the nose, gastrointestinal tract, genitourinary system, etc.
  • Heavy bleeding occurs after minor surgery, tooth extraction.
  • Easy bruising following minor trauma.
  • Splenomegaly may occur in one-fourth of the cases.
  • Haematuria

Diagnosis

  • Blood examination: prothrombin time, platelet count, Hb, hematocrit levels.
  • History taking and physical examination
  • History of the previous infection, x-ray exposure, use of sprays, exposure to toxins or insecticides.
  • Bone marrow study

Management

  • Blood + platelet transfusion in severe bleeding.
  • Life-threatening bleeding should be managed with a specialized approach.
  • Identification of the exact cause and specific management.
  • Steroid therapy may be used in some cases.
  • Supportive management includes blood and platelets transfusion to prevent and treat bleeding episodes.
  • Anti-Rh therapy to control the acute bleeding episodes to increase platelet count before surgery.
  • Intravenous immunoglobulin IgG is administered with 2 gm/kg of total dose to protect platelets antibody.
  • Splenectomy is done for the patients not responding to steroids and IV-IgG therapy.

Prognosis

Recovery in 85-95% cases within 6 months. The care rate may be 75% following splenectomy.

Nursing management

  • Detailed history, physical examination, ordering of diagnostic tests, and review of the results are used to determine the patient's condition.
  • Avoiding using a hard toothbrush, intramuscular injections, tourniquets, trauma, nose pricking, and rectal operation will help to reduce bleeding.
  • changing one's diet to avoid constipation.
  • Restricting exercise and activities to avoid unintended harm.
  • Taking steps to avoid infection and anaphylaxis during the transfusion of blood or blood products.
  • Quick monitoring of vital signs.
  • Follow the chart for input and output in order.
  • Examine the feces for menstrual bleeding, occult blood, etc.
  • Teaching the child's parents not to blow their noses, not to use NSAIDs or aspirin, not to expose themselves to trauma, etc.
  • Teaching about home-based cases, particularly those involving bleeding, the need for medical assistance, and ongoing follow-up.
  • Emotional and psychological assistance for the child and the parents.
  • Carefully instruct the caregivers about nutrition.
  • Education about personal hygiene.
  • Expiration date, pint, color, etc. must be carefully examined during blood transfusion. also negative impacts.
  • Proper instruction regarding home care and follow-up.

 
Things to remember
  • Purpura is a form of bleeding disorders due to prolonged bleeding time or plasma coagulation factor deficiency.
  • It is often associated with a quantitative or qualitative deficiency in platelet, or due to defects of vascular integrity (dysfunction of hemostasis).
  • The classification of purpura are  Thrombocytopenic purpura: platelet count is decreased and Non- thrombocytopenic purpura.
  • Blood + platelet transfusion in severe bleeding.
  • Anti-Rh therapy to control the acute bleeding episodes to increase platelet count before surgery.
  • Recovery in 85-95% cases within 6 months. The care rate may be 75% following splenectomy.
Videos for Purpura
Purpura
Questions and Answers

Due to excessive bleeding or a lack of plasma coagulation factor, purpura is a type of bleeding condition. It is characterized by spontaneous bleeding into the skin or mucous, which appears as ecchymosis or petechiae (tiny pinhole hemorrhages) (large superficial hemorrhage). It is frequently accompanied by a platelet deficiency, either quantitatively or qualitatively, or by vascular integrity flaws.

  • Thrombocytopenic purpura: A lower platelet count occurs.
  • Non-thrombocytopenic purpura: A functional platelet defect.

 

85–95% of patients recover within 6 months. The care rate after splenectomy may be 75%.

 

Management:

  • Transfusion of blood and platelets for serious bleeding.
  • An expert strategy should be used to treat bleeding that poses a life-threatening concern.
  • precise cause-and-effect determination and management.
  • In some circumstances, steroid treatment may be employed.
  • Transfusions of blood and platelets are part of supportive therapy for the prevention and treatment of bleeding events.
  • Before surgery, anti-Rh treatment is used to reduce acute bleeding episodes and boost platelet count.
  • To protect platelets antibodies, 2 gm/kg of total dosage of intravenous immunoglobulin IgG is given.
  • When patients don't improve after receiving IV-IgG treatment and steroids, a splenectomy is performed.

Nursing management:

  • Detailed history, physical examination, ordering of diagnostic tests, and review of the results are used to determine the patient's condition.
  • Avoiding using a hard toothbrush, intramuscular injections, tourniquets, trauma, nose pricking, and rectal operation will help to reduce bleeding.
  • changing one's diet to avoid constipation.
  • restricting exercise and activities to avoid unintended harm.
  • Taking steps to avoid infection and anaphylaxis during the transfusion of blood or blood products.
  • quick monitoring of vital signs.
  • Follow the chart for input and output in order.
  • Examine the feces for menstrual bleeding, occult blood, etc.
  • teaching the child's parents not to blow their noses, not to use NSAIDs or aspirin, not to expose themselves to trauma, etc.
  • teaching about home-based cases, particularly those involving bleeding, the need for medical assistance, and ongoing follow-up.
  • emotional and psychological assistance for the child and the parents.
  • Carefully enlighten the caregivers on nutrition.
  • education about personal hygiene.
  • Expiration date, pint, color, etc. must be carefully examined during blood transfusion. also negative impacts.
  • a suitable education regarding follow-ups and home care.

 

© 2021 Saralmind. All Rights Reserved.