Harding: Lewis’s Medical-Surgical Nursing, 12th Edition
NGN Case Study
Title: Thrombocytopenia
Scenario: The nurse is caring for a 30-year-old HIV positive type 1 diabetic male who was
admitted into the hospital today for a 4-day history of excessive bruising, frequent nose
bleeds, and bleeding gums. His platelet count is 30,000/µL. His admitting diagnosis is
immune thrombocytopenia. He is awake and alert and denies any pain or discomfort. Vital
signs are temperature 97.2, pulse 96 bpm, respirations 16 per minute, and blood pressure
118/60 mm Hg. He has several areas of purpura on his back and arms. He states his last
nosebleed was last night, which lasted 2 hours. He states that even though he uses a soft
toothbrush his gums bleed excessively each time he brushes his teeth.
NGN Item Type: Take Action
Use an X for the nursing actions listed below that are Indicated (necessary),
Contraindicated (could be harmful), or Nonessential (not necessary) for the client’s care
at this time. Only one selection can be made for each nursing action.
Nursing Action Indicated Contraindicated Nonessential
Apply direct
pressure for 5-10
minutes after each
insulin injection.
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NGN Case Study 35-2
Ask patient to blow
nose forcefully to
remove old clots.
Offer the patient a
razor blade for
shaving.
Closely monitor
hemoglobin and
hematocrit count.
Encourage the
patient to use an
incentive spirometer
to aid in lung
expansion.
Plan to administer
aspirin 81 mg each
day to prevent blood
clots.
Answers:
Nursing Action Indicated Contraindicated Nonessential
Apply direct X
pressure for 5-10
minutes after each
Copyright © 2023 by Elsevier, Inc. All rights reserved.
NGN Case Study 35-3
insulin injection.
Ask patient to blow X
nose forcefully to
remove old clots.
Offer the patient a X
razor blade for
shaving.
Closely monitor X
hemoglobin and
hematocrit count.
Encourage the X
patient to use an
incentive spirometer
to aid in lung
expansion.
Plan to administer X
aspirin 81 mg each
day to prevent blood
clots.
Rationale:
Type 1 diabetics must be treated with subcutaneous insulin. As in this patient’s case, when
subcutaneous injections cannot be avoided, a small gauge needle should be used, and direct
pressure applied to the injection site for at least 5-10 minutes after the injection. Hemoglobin
Copyright © 2023 by Elsevier, Inc. All rights reserved.
NGN Case Study 35-4
and hematocrit should be closely monitored along with the patient’s platelet counts. When
monitored together, they provide vital information about potential or actual bleeding. The nose
should be gently patted with a tissue when needed. Forceful blowing can cause more bleeding
from the nose. For a nosebleed, the patient should keep his head up and apply firm pressure to
the nostrils and bridge of the nose. Ice can also be applied to the bridge of the nose and the
nape of the neck if needed to stop the bleeding. Patients with thrombocytopenia should only
use electric razors, which cause less skin irritation and cuts. Aspirin has an antithrombotic
action by inhibiting platelet aggregation. Inhibition of platelet aggregation further increases
the chance for hemorrhage in a patient already at risk due to low platelet counts. Although use
of an incentive spirometer is useful to ensure adequate lung expansion in patients at risk for
atelectasis, their use is not related to thrombocytopenia risk factors.
Cognitive Skill: Matrix
Copyright © 2023 by Elsevier, Inc. All rights reserved.
