Patient Care and Methodical Risk Reduction of Injury in Hemophilic Patients

Since any trauma can leas to a bleeding episode, all1. An adequate knowledge of the disease
persons caring for these children must be aware of2. sufficient emotional stability to accept the
their disorder. Hemophiliac children should wear Medicresponsibility
Alert identification, and older children should be3. a willingness to learn the venipuncture procedure
encouraged to recognize situations in which disclosing4. the ability to follow instructions and to monitor the
their condition is important. During procedures such astransfusion
dental extraction or injections, health personnel need to5. a willingness to accept the necessity of home care.
take special precautions to stop the bleeding.The nurse-skilled in veni-puncture techniques, if often
Unnecessary veni-punctures are avoided. A peripheralthe person who teaches families to administer
finger-stick is better for blood samples, and theantihemophilic factor concentrates.
subcutaneous route is substituted for intramuscularIn addition, the nurse must be familiar with the
injections. Hemophiliac children need to avoid salicylatesproperties of the concentrates and their preparation.
and any aspirin-containing compound. Aspirin inhibitsFor example, to hasten the missing process of
prothrombin synthesis, Acetaminophen is suitablereconstituting dried anti-hemophilic factor with diluents,
aspirin substitute, especially for use during control ofthe solution may be warmed or the vial gently rotated.
pain at home.Excessive heating or shaking of the container will result
Recognize and treat bleedingin loss of active anti-hemophilic factor. A filtered
Bleeding that occurs from a wound or close to the skinintravenous setup is usually supplied with the special
can be controlled bymembranes to filter any particles in the solution. If the
1. applying pressure to the area for at least 10 ti 15solution is not thoroughly mixed before administration,
minutes to allow clot formationthe filter will also remove the active factor.
2. immobilizing and elevating the area above the levelTransfusion reaction and viral hepatitis are potential
of the heart to decrease blood flow, andcomplications from replacement products. The nurse
3. applying cold to promote vasoconstriction.teaches the parents and/or child the signs of
By teaching parents and older children such measurestransfusion reactions or hepatitis and stresses the
beforehand, they can be prepared to initiate immediatenecessity of notifying a physician of their occurrence.
treatment before blood loss is excessive. Plastic bagsNot all children with hemophilia are eligible for or have
of ice and cryogel cold packs should be kept in thethe opportunity of a home-care program for their
freezer for such emergencies. However, suchhemophiliac children. Repeated hospitalizations are the
measures should not take the place of factorusual outcomes of bleeding episodes. Ideally, a core of
replacement.nurses should work with these children to maintain
The discovery of factor concentrates has greatlyconsistency of care during each hospitalization.
changed the outlook for these children. With scheduledBesides the physical goals of controlling bleeding and
infusions of the missing factor, bleeding can bepreventing disability, the nursing objectives should
prevented and the child can live a much more normal,include fostering independence and self-care, providing
unrestricted life. To foster maximum independence,an opportunity for the children to discuss their feelings
home-care programs that teach the parent and/orregarding the disease, and a continuous re-evaluation
child to administer the drug have been instituted.of those factors that may influence a bleeding episode.
Families with hemophilic child should have: