Question

The nurse is caring for a child newly diagnosed with hemophilia. Which would the nurse omit when writing a discharge plan? A. The child needs to wear a medic-alert bracelet. B. Avoid drugs containing aspirin and NSAIDs. C. Apply heat if bleeding in the joint occurs. D. Rectal temperatures should not be done.

Short answer

A. Wear a medic-alert bracelet. B. Avoid drugs containing aspirin and NSAIDs. C. Apply heat if bleeding in the joint occurs. D. Rectal temperatures should not be done. Answer: C. Apply heat if bleeding in the joint occurs. Explanation: Option C is incorrect, as applying heat to a joint bleed can increase blood flow and worsen bleeding. A child with hemophilia should avoid applying heat to a bleeding joint. Instead, ice or a cold pack should be applied to manage a joint bleed efficiently.

Step-by-step solution

Understand the question

Read the question carefully to make sure we understand what it's asking. The nurse is caring for a child newly diagnosed with hemophilia and needs to create a discharge plan. We have to identify which of the options (A, B, C, D) should be omitted from the discharge plan based on what we know about hemophilia.

Analyze each option

Break down each choice (A, B, C, D) and think about whether it is appropriate or not for a discharge plan for a child with hemophilia. A. The child needs to wear a medic-alert bracelet. - This seems important, as it allows medical personnel to be aware of the child's condition in an emergency. B. Avoid drugs containing aspirin and NSAIDs. - Aspirin and NSAIDs can increase the risk of bleeding in patients with hemophilia, so avoiding them would be appropriate advice. C. Apply heat if bleeding in the joint occurs. - This advice seems counterintuitive for a bleeding disorder. Heat will likely increase blood flow, and thus increase bleeding. We need to check whether this is correct or not. D. Rectal temperatures should not be done. - Rectal temperatures can cause trauma and increase the risk of bleeding, so this is sound advice.

Identify the incorrect advice

Based on our analysis, it seems that option C (Apply heat if bleeding in the joint occurs) is the most likely to be incorrect, as it does not seem like appropriate advice for a bleeding disorder. We can double-check with sources on hemophilia management to confirm that heat application is not recommended for joint bleeding.

Confirm the answer

Upon researching hemophilia management, it is confirmed that applying heat to a bleed increases blood flow and may worsen bleeding. Instead, the recommended practice to manage a joint bleed is to apply ice or a cold pack to decrease blood flow and reduce swelling. Therefore, the nurse should omit option C from the discharge plan.

Key concepts

Pediatric Nursing

Pediatric nursing encompasses various aspects of health care for children, from infancy through adolescence. It's crucial for pediatric nurses to create a caring and supportive environment while being aware of the unique challenges faced by younger patients. In the case of children with hemophilia, the nurse's role includes not only providing medical care but also offering emotional support and guidance to families.

For children newly diagnosed with hemophilia, there are specific considerations that pediatric nurses must address. Safety is paramount; the nurse must educate the family on how to create a safe home environment to prevent injuries that could lead to bleeding episodes. For instance, engaging in non-contact sports and using protective gear during activities can be crucial advice.

Importance of Clear Communication

Communication with both the child and their family is vital. Pediatric nurses use age-appropriate language and teaching tools, such as visual aids, to help explain the child's condition and the necessary precautions to take. Additionally, nurses must ensure that the child's psychosocial needs are met, as chronic illnesses like hemophilia can impact a child's mental health and self-esteem.

Hemophilia Management

Hemophilia management requires a comprehensive approach to prevent and control bleeding episodes. Apart from avoiding trauma and injury, several precautions must be observed. People with hemophilia, especially children, are counseled against taking medications like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), which can exacerbate bleeding.

Proactive Strategies

Proactive strategies include administering clotting factor concentrates, which can be given on a routine schedule to prevent bleeds (prophylaxis) or to stop a bleeding episode when it occurs (on-demand). It's also essential for patients and families to be familiar with recognizing early signs of a bleed, particularly in joints and muscles, and know how to respond effectively.Regarding exercise and physical activity, it is encouraged with modifications. Activities that strengthen muscles and protect joints are beneficial, and it is critical to avoid those that pose a high risk of injury. Healthcare professionals also recommend wearing medical alert identification to ensure prompt and proper treatment in case of an emergency.

Patient Education

Patient education is a cornerstone of effective disease management, especially for lifelong conditions like hemophilia. It involves teaching patients and their families about the disease, its treatments, and how to manage various aspects of their health. Educated patients are more likely to follow their treatment plans, recognize symptoms of complications, and know when to seek medical help.

Elements of Educational Planning

In a discharge plan, clear instructions on what to avoid and what actions to take during certain situations are critical. For instance, advice such as not performing rectal temperatures is important due to the risk of trauma and bleeding. Instead, alternative methods for temperature measurement should be taught. Counselling on first aid for minor bleeds and the correct application of pressure and cold packs to manage joint bleeds should also be included. Above all, patient education must be continuous and updated as the child grows and their life circumstances change.