A patient with haemophilia is brought to the emergency department after injuring his knee. The nurse should anticipate the need to administer?

Appeared in: RAK Nursing Officer - 2019

Explanation

Haemophilia A is a genetic disorder characterized by a deficiency in clotting Factor VIII.
Acute injury in a patient with haemophilia can lead to severe bleeding into joints (hemarthrosis), which is a medical emergency.
The definitive treatment is to replace the deficient clotting factor as quickly as possible to facilitate clot formation and stop the hemorrhage.
Factor VIII concentrate provides a specific, high-dose replacement, which is the standard of care for active bleeding in Haemophilia A.

Option A: Haemophilia is a clotting factor deficiency, not a disorder of platelet number or function. Therefore, platelet transfusion is not indicated.
Option B: While Fresh Frozen Plasma (FFP) contains Factor VIII, it is not concentrated. Specific factor concentrates are the standard of care because they are more effective and require a smaller volume. FFP is considered an outdated therapy for haemophilia except in rare emergencies.
Option D: Administering red blood cells (RBCs) treats the symptom of blood loss (anemia) but does not address the underlying cause of the bleeding (the clotting factor deficiency). The priority is to stop the bleed first.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Management of acute bleeding in a patient with haemophilia in acute care settings.
Nurses must recognize that for haemophilia patients, even minor trauma can cause a major bleeding event. Prompt assessment and anticipation of administering factor concentrate is a critical nursing responsibility.
A key patient safety intervention is to avoid medications that can increase bleeding risk, such as aspirin and other NSAIDs. Acetaminophen is a safer alternative for pain management.
Intramuscular (IM) injections should be strictly avoided in patients with haemophilia as they can cause large, painful hematomas at the injection site.

How to Approach the Question

First, identify the patient's core diagnosis from the question stem: 'a patient with haemophilia'.
Next, recall the underlying pathophysiology of haemophilia, which is a deficiency of a specific clotting factor (most commonly Factor VIII).
Analyze the clinical situation: The patient has an acute 'knee injury', which implies active bleeding or risk of severe bleeding (hemarthrosis).
Connect the pathophysiology to the treatment goal: The priority is to correct the clotting factor deficiency to stop the bleeding.
Evaluate the options based on this goal. Factor VIII concentrate directly replaces the missing factor. Rule out options that treat different conditions (platelets for thrombocytopenia, RBCs for anemia) or are less effective (FFP).

Concept Tested & Keywords

Concept Tested: Management of acute bleeding in a patient with haemophilia.
Stem keywords: haemophilia, emergency department, knee injury
Lead-in keywords: anticipate the need to administer
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Negative lead-in flag: false

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Practise the full RAK Nursing Officer - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.