QUESTION SET ONE
◉ A nurse is suspecting their patient with hemophilia is bleeding
internally based on the assessment findings from GI, GU, and CNS.
What assessment findings lead them to this suspect and what
nursing interventions might be performed. Answer: GI: abdominal
pain, frank blood in stool or dark black stool, vomiting blood
~ NSG: guaiac stool
GU: abdominal or lower back pain, blood in urine
~NSG: perform urine dipstick for hematuria and encourage PO
fluids
CNS: headache, change in LOC, weakness, gait change
~NSG: neuro assessments
◉ Therapeutic management of a bleeding episode in a patient with
hemophilia. Answer: -Administer medications
~factor for moderate to severe hemophiliacs (prophylactic
treatment to prevent bleeding episodes with sever hemophilia)
~ Desmopressin Acetate (DDAVP) for mild to moderate Hemophilia
A patients
,-Administration of blood products (packed RBC or FFP)
-Nursing considerations
~Double check the factor or blood product transfusion with another
RN hemarthrosis
-For hemarthrosis (bleeding in joint): immobilize and elevate (RICE)
◉ Define Immune thrombocytopenic purpura (ITP). Answer: A
bleeding disorder characterized by increased destruction of
platelets in spleen
platelet destruction due to an antiplatelet antibody that destroys
platelets making this an autoimmune disorder
◉ A patient presents to the hospital with excessive bruising,
miniature petechiae, large areas of asymmetrical ecchymosis,
epistaxis, and marked thrombocytopenia but normal WBC, Hgb, and
Hct. What condition may this patient have?. Answer: Immune
thrombocytopenic purpura (ITP)
◉ True or false:
,Children with Immune thrombocytopenic purpura (ITP) require
immediate medical treatment.. Answer: FALSE!!!!
many children only require observation and reevaluation of labs. No
medical interventions are required
◉ A nurse is assessing if the patient and family understood her
instructions for their child with Immune thrombocytopenic purpura
(ITP). Which statement by the family needs further teaching?
"We can give our child aspirin, NSAIDS, or antihistamines if he has
any pain."
"We must prevent any serious traumas that may involve our child."
"We will watch for any signs of bleeding in our child.". Answer: DO
NOT GIVE THIS PATIENT ASPIRIN, NSAIDS, OR ANTIHISTAMINES!
All other options are correct
◉ A nurse is reviewing the orders in the chart for her patient with
Immune thrombocytopenic purpura (ITP). Would she follow the
orders or question what was put in?
, -Steroid therapy for 2-4 weeks
-IVIGs given once a day foe 3-5 days
-Possible platelet transfusion or splenomegaly if no improvement.
Answer: All these orders are accurate
◉ A nurse is educating a group of students on Immune
thrombocytopenic purpura (ITP). They responded with the
following education topics to teach the child and family. Which
options are correct?
-Pad the crib or bed and furniture
-Use a soft bristled toothbrush
-They can play in any sport they desire as long as they have the
correct padding equipment
-Follow up appointments for weekly platelet counts
-Signs and symptoms of infections because steroids may mask a
fever. Answer: All are correct EXCEPT they CANNOT play in any
contact sports because it can cause traumas
◉ What are 2 general medical treatments for hematological
disorders?. Answer: 1.Blood product transfusion
2.Hematopoetic stem cell transplantation (HSCT)