Page 907 - Saunders Comprehensive Review For NCLEX-RN

1. Monitor for bleeding and maintain bleeding

precautions.
2. Prepare to administer factor VIII concentrates, either
produced through genetic engineering (recombinant)
or derived from pooled plasma, as prescribed.
3. DDAVP (1-deamino-8-d-arginine vasopressin), a
synthetic form of vasopressin, increases plasma factor
VIII and may be prescribed to treat mild hemophilia.
4. Monitor for joint pain; immobilize the affected
extremity if joint pain occurs.
5. Assess neurological status (child is at risk for
intracranial hemorrhage).
6. Monitor urine for hematuria.
7. Control joint bleeding by immobilization, elevation,
and application of ice; apply pressure (15 minutes) for
superficial bleeding.
8. Instruct the child and parents about the signs of
internal bleeding.
9. Instruct parents in how to control the bleeding.

10. Instruct parents regarding activities for the

child, emphasizing the avoidance of contact sports
and the need for protective devices while learning to
walk; assist in developing an appropriate exercise
plan.
11. Instruct the child to wear protective devices

such as helmets and knee and elbow pads when
participating in sports such as bicycling and skating.
III. von Willebrand’s Disease
A. Description
1. von Willebrand’s disease is a hereditary bleeding
disorder that is characterized by a deficiency of or a
defect in a protein termed von Willebrand factor.
2. The disorder causes platelets to adhere to damaged
endothelium; the von Willebrand factor protein also
serves as a carrier protein for factor VIII.
3. It is characterized by an increased tendency to

bleed from mucous membranes.
B. Assessment

1. Epistaxis
2. Gum bleeding
3. Easy bruising

907