Patient with platelet count of 3?

Nurses General Nursing

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Quick question. I received a 30 something year old patient with a diagnosis of TTP. Her hemoglobin was within normal limits but her platelets was 3. She was agile and mobile. I would label her a standby assist due to the wires in ICU. As I was giving report to the receiving nurse, she asked me how she voided. I told her on a bedside commode. She scolded me and was upset that I hadn't placed her on strict bedrest.

I understand that a fall in this particular case would be very bad. But she is no more a fall risk than a patient with chest tubes and drains. I mean we are getting patients into chairs who are on ventilators and ECMO. In addition, she had "up ad lib" orders.

I wanted to hear others opinions. What would you do?

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Specializes in ICU/community health/school nursing.

I would probably have wanted confirmation of the platelet result. I mean...three? How did she look? They used to tell us "treat the patient not the test result." Also up ad lib versus bedrest are doctor's orders.

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Specializes in oncology, MS/tele/stepdown.

Standby assist and someone stays with her until she's back in bed, bed alarm at all times. That's what we did with our patient who had a plt count of 1. I don't really get why this patient can't sit in a chair with a chair alarm either.

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Specializes in Medsurg.

Wow that's a crazy value. We put our ventilator patients with all types of comorbidities in gerichairs every-day. We are (like I'm sure you are) very attentive and hyper vigilant to their current clinical status.

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7 hours ago, ruby_jane said:

I would probably have wanted confirmation of the platelet result. I mean...three? How did she look? They used to tell us "treat the patient not the test result." Also up ad lib versus bedrest are doctor's orders.

Sorry, I forgot to mention she has a diagnosis of TTP. The platelet before that was 9. So I trust the result.

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5 hours ago, Snatchedwig said:

Wow that's a crazy value. We put our ventilator patients with all types of comorbidities in gerichairs every-day. We are (like I'm sure you are) very attentive and hyper vigilant to their current clinical status.

I agree. It was standby assist every time. Despite the orders saying up ad lib. Thank you

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7 hours ago, ruby_jane said:

I would probably have wanted confirmation of the platelet result. I mean...three? How did she look? They used to tell us "treat the patient not the test result." Also up ad lib versus bedrest are doctor's orders.

She seemed fine. No lethargy, dizziness or weakness.

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Specializes in Oncology, OCN.

I work Oncology so plt count of 9 isn’t crazy on my unit. By standard protocol they are listed as high falls but a lot refuse bed alarms and walk laps independently around the unit. We only enforce falls precautions on them if they’ve been unsteady/light headed etc. I’ve had a pt with a plt count of 0, gave 2 units of plts and they went all the way up to 2.

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Specializes in oncology, MS/tele/stepdown.
12 hours ago, Quota said:

I work Oncology so plt count of 9 isn’t crazy on my unit. By standard protocol they are listed as high falls but a lot refuse bed alarms and walk laps independently around the unit. We only enforce falls precautions on them if they’ve been unsteady/light headed etc. I’ve had a pt with a plt count of 0, gave 2 units of plts and they went all the way up to 2.

Onc makes you completely rethink what a "normal" lab value is lol.

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Specializes in Medsurg.
2 hours ago, Swellz said:

Onc makes you completely rethink what a "normal" lab value is lol.

Amen lol. I would be having a fit on my unit going home stressed

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Specializes in Medical Hematology/Oncology/Stem Cell Transplant.

I work Heme/Onc so I’m not surprised about that result. We used to have this pt with ITP and a Plt of 2 his whole life, even after a clinical trial stem cell transplant! He’s so refractory that even after Plt transfusion his plt count actually drops. But anyway, they should be a high fall risk, so yes to stand by assist, and eyes on all the time; no bedrest is needed though cause we don’t want them to lose all those muscles either! We used to have a pt with a plt of 3 that fell in the bathroom and did not tell anyone about it until we found a nice giant bruise on his hip; needless to say it didn’t look good.

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Specializes in Medical Hematology/Oncology/Stem Cell Transplant.
On 8/7/2019 at 9:47 AM, Swellz said:

Onc makes you completely rethink what a "normal" lab value is lol.

Literally! I used to have the lab call me about a “critical” result of Hb of 7.8 on my chemo pt, and I told him that’s actually pretty darn good ? if Hb is still above 7 then I’m good with it ?

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