A nurse is creating a teaching plan for a client who has thrombocytopenia. Which of the following instructions should the nurse include? (Select all that apply.)

Choice A rationale Brushing teeth with a soft toothbrush is crucial for clients with thrombocytopenia because their platelet count is reduced (normal range 150,000-450,000/µL), impairing the blood's clotting ability. A soft toothbrush minimizes mechanical trauma to the oral mucosa, preventing gingival bleeding and subsequent blood loss. This prophylactic measure significantly reduces the risk of iatrogenic hemorrhage in a compromised hemostatic system. Choice B rationale Blowing the nose gently is recommended to prevent epistaxis (nosebleeds). In thrombocytopenia, fragile capillaries combined with a low platelet count make the nasal mucosa highly susceptible to bleeding from minor trauma. Gentle blowing reduces the pressure exerted on these delicate vessels, thereby minimizing the risk of rupture and subsequent hemorrhage, which can be difficult to control. Choice C rationale Limiting fruit consumption is not a standard instruction for thrombocytopenia. While some fruits contain salicylates that can theoretically affect platelet function, the amount is usually not clinically significant enough to warrant restriction unless specific contraindications exist. The primary focus for these clients is on preventing physical trauma and managing medication interactions that impair platelet function. Choice D rationale Using a straight-edge razor to shave is contraindicated for clients with thrombocytopenia due to the high risk of nicks and cuts. Even minor skin abrasions can lead to significant and prolonged bleeding because of impaired hemostasis. An electric razor is strongly recommended as a safer alternative to minimize the risk of skin trauma and subsequent hemorrhage. Choice E rationale Lubricating lips with water-soluble ointment helps prevent cracking and dryness, which can lead to bleeding. Dry, chapped lips are prone to fissures and micro-trauma, creating potential sites for hemorrhage in individuals with thrombocytopenia. Water-soluble ointment provides a protective barrier and maintains moisture, reducing the likelihood of such complications.