A client has been admitted for immune thrombocytopenic purpura. The client has not responded to corticosteroid treatment. The priority nursing intervention for this client would include which of the following treatment measures?
A) Place the client in isolation, so the skin rashes will not spread to other clients.
B) Insert an intravenous catheter, so immune globulin can be administered in a timely manner.
C) Insert a Foley catheter to monitor hourly urine output.
D) Prepare a surgical permit for an emergency splenectomy.
Ans: B
Feedback:
The decision to treat ITP is based on the platelet count and the degree of bleeding. Corticosteroids are used as initial therapy; other effective initial treatment includes intravenous immune globulin. However, this treatment is expensive, and the beneficial effect may last only 1 to 2 weeks. Because the spleen is the major site of antibody formation and platelet destruction, splenectomy is the traditional second-line treatment for persons who relapse or do not respond to medications. Isolation is not required; it is not contagious. The client may require a Foley if he does not respond to the immune globulin and must undergo surgery.
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