A nurse is developing a plan of care for a 4-year-old child who has hemophilia and is experiencing acute hemarthrosis. Which of the following interventions should the nurse include in the plan?
A.
Have the child perform passive range-of-motion exercises.
B.
Administer aspirin as needed for pain.
C.
Place ice packs on the affected joints.
D.
Position the lower extremities below the level of the heart.
The Correct Answer and Explanation is:
The correct answer is:
C. Place ice packs on the affected joints.
Explanation:
Hemophilia is a genetic disorder that affects the blood’s ability to clot, leading to prolonged bleeding. One of the most common complications of hemophilia in children is hemarthrosis, which refers to bleeding into a joint space. This condition can cause pain, swelling, and limited range of motion in the affected joints, typically the knees, elbows, or ankles. Immediate and effective management of acute hemarthrosis is essential to prevent long-term joint damage and alleviate pain.
C. Place ice packs on the affected joints is the correct intervention because applying ice helps reduce swelling and provides pain relief by constricting the blood vessels (vasoconstriction), which helps slow down bleeding into the joint. The cold also helps decrease inflammation in the area, offering comfort and reducing the risk of further bleeding. In conjunction with rest and elevation, ice packs are part of the RICE (Rest, Ice, Compression, Elevation) protocol commonly used to manage joint and soft tissue injuries, including those caused by hemophilia.
Now, let’s discuss why the other options are incorrect:
- A. Have the child perform passive range-of-motion exercises is incorrect because, during an acute episode of hemarthrosis, any movement of the joint can increase pain and potentially worsen bleeding. Joint rest is essential during the acute phase to allow healing and prevent further injury. Once the bleeding is controlled, and under the guidance of a healthcare provider or physical therapist, range-of-motion exercises can be introduced to prevent stiffness and preserve joint function.
- B. Administer aspirin as needed for pain is incorrect because aspirin has anticoagulant properties, which can worsen bleeding. Hemophilia patients should avoid medications that impair platelet function, such as aspirin. Instead, pain management should include alternatives like acetaminophen, which does not have an effect on bleeding risk.
- D. Position the lower extremities below the level of the heart is incorrect because this position can increase blood flow to the joints, exacerbating swelling and bleeding. The affected joint should be elevated above the heart to reduce blood flow and minimize bleeding.
In conclusion, using ice packs (option C) is a key intervention for managing acute hemarthrosis in children with hemophilia, helping to control pain and swelling without increasing the risk of further bleeding.