Planning of Nursing Care
- Prevent and control bleeding.
- Administer replacement therapy of factor VIII and IX as advised.
- Educate and support the patient and family.
Implementation of Nursing Care
Prevent and Control Bleeding
You as a nurse have to provide a safe and soothing environment to the child. The finger nails should be kept short to avoid scratching. Avoid using diaper pins (in infants) or use with caution. Provide soft toys without sharp comers. Soft tooth brushes should be used to clean teeth and child should be given soft foods.Child should not be unnecessarily restricted and should be given freedom but contact sports should be avoided. Bleeding from open wounds should be controlled by pressure bandage, cold compresses, and local use of thrombin, gelatin foam or fibrin. As far as possible cautery and suturing of wounds should be avoided.
Replacement Therapy
Fresh blood 15-20 ml/kg within six hours of collection should be used. Antihaemophilic globulin factor VIlI and IX available in the form of cryoprecipitate made from fresh plasma is also used in dosage of 100- 150 units kg/24 hours. It is your duty to administer or assist in administering fresh blood, plasma or cryoprecipitate, promptly and sufficiently to achieve and maintain a haemostatic level of factor VIII between 20 to 25per cent and watch for any untowerd reaction.
Provide Education and Support
After haemophilia is diagnosed in the child and when the parent learn about it they feel , depressed and somewhat guilty about this disease. Parent education regarding the disease can help them provide normal life to their affected child. This will help them to minimise the effect of disease on growth and development of the child. Your education will help them to relieve depression. Tell the parents to give the child same guidance as a normal child.
The parents and child are taught to identify the signs of bleeding and how to carry out their transfusion procedure. This prevents repeated hospitalisation and promotes their involvement in the self care of child.
When child is prone to spontaneous bleeding replacement factor is given prophylactically. Parents and child are educated and informed about cummunity support and resources for such diseases. Genetic counselling is given for child bearing families.