Caring For A Senior With Idiopathic Thrombocytopenia Purpura (ITP) May Require Special Skills
Pegasus skilled caregivers in Saugus and elsewhere are familiar with Idiopathic Thrombocytopenia Purpura (ITP). They understand that it has potentially dangerous complications in the elderly. Will you need special skills to care for a senior with ITP during your career as a home healthcare nurse?
Medical science has renamed ITP from Idiopathic to Immune Thrombocytopenia Purpura as the cause is now known. As the new name implies, it’s an autoimmune disorder. In most cases of ITP, the immune system produces antibodies that attach to platelets.
ITP Destroys Platelets
Those platelets are then destroyed by the body, leaving a deficiency of platelets in the blood. The blood no longer forms necessary clots. That’s led to informal descriptions of ITP as a bleeding disorder or low platelet count.
Acute ITP is the most common type. It’s mainly a childhood disorder that usually lasts for about six months. It rarely needs treatment and usually does not recur.
Chronic ITP primarily affects adults. It can be short-lived or last a lifetime. Your ITP patients are more likely to be female than male.
A few instances of ITP are due to T-cells, rather than antibodies, attacking the platelets. Rogue T-cells are also an immune system malfunction. Causes of all ITP can include other autoimmune diseases as well as:
- Allergies to medications
- Leukemia
- Lymphoma
- Pregnancy
- Viral or chronic infections
The cause is unknown in some cases. ITP is not contagious.
Symptoms Of ITP
Your patient may exhibit any of the following symptoms:
- Bleeding in the mouth
- Bruises without a known cause
- Nosebleeds
- Tiny dots under the skin (petechiae)
- Unexplained blood in urine, feces, or vomit
If there’s been a head injury of any kind, there could be life-threatening bleeding in the head.
Your one-on-one care as a home health nurse enables you to observe your patient’s symptoms in the early stages. Some symptoms wouldn’t necessarily be noticeable in a clinical setting until too late to avert a crisis.
Your senior patients may have one or more comorbidities. They may or may not be taking medications for those. Some may be cognitively impaired, and you must rely on family caregivers for information.
Symptoms of their comorbidities may be the same as ITP. Or the symptoms may mask an impending ITP crisis. Unfortunately, not everyone can reliably describe their symptoms or may dismiss them.
It can be a challenge, but it’s essential that you evaluate all symptoms for cause. You should know your ITP patient’s medical history and diagnosis. It’s also crucial that you are aware at all times of their platelet count.
For example, patients may be taking anticoagulants for cardiovascular issues. Individuals frequently see different healthcare professionals, so their heart doctor may not know they have ITP. You may be the only professional who has complete information.
Treatment For ITP
Treatment depends on the severity of ITP and other health conditions. Some patients may only need to be monitored. As you gain their trust, they’ll confide bleeding or other issues they may hide from others.
You have evaluated their medications. However, that isn’t enough, as far too many individuals self-treat. It can take time and present a challenge, but you need to know their OTC drugs, herbs, and supplements.
Many of those affect platelets. That can affect dosages of anticoagulants such as Warfarin. Individuals with ITP may be experiencing unnecessary bleeding.
Once you sort things out, you can coordinate appropriate ITP treatment with the patient and healthcare providers. It’s an opportunity to make a difference in someone’s life that isn’t available in clinical settings.
Treatment can include:
- Immune globulin injections: usually reserved for critical situations, such as excessive bleeding.
- Medications to decrease the destruction of platelets: these can reduce the effect of vaccinations and have numerous side effects or interactions with other drugs.
- Medications to increase platelet productions: carry the risk of blood clots.
- Platelet transfusion: sometimes necessary during surgery or medical emergencies.
- Steroids: these generally are not suitable for long-term use.
A splenectomy may be necessary in the most severe cases. That increases the individual’s risk of infection. Your special care includes vigilance in monitoring your patient’s reactions to any treatment.
Complications Of Untreated ITP
You may have patients who resist treatment. Some find the side effects of treatment worse than the ITP.
Discuss the potential complications of untreated ITP with them. These include:
- Anemia
- Fatigue
- Increased risk of infection
- Internal bleeding, including brain hemorrhages
- Limited activities to minimize or prevent bruises
- Prolonged bleeding from wounds
- Reduced life expectancy
You may be able to coax them into making dietary changes and eventually accepting treatment.
Coffee is a known anti-platelet beverage, and wine is a natural blood thinner. Both should be consumed in moderation, if at all, by ITP patients. Your Pegasus team includes a dietitian who can help them learn which foods are helpful and which to avoid.
Pegasus is a licensed Home Care Organization and a Joint Commission Accredited Home Health Care organization. Our skilled caregivers in Saugus and our other locations are devoted to keeping individuals safe and independent in their home. As a nurse-owned and -operated organization, we value and support our career home health care nurses.
