The nurse is caring for a child who has haemophilia. He is admitted with a bleeding episode. Which of the following should the nurse expect will be given to stop the bleeding?

1. A

   Cryoprecipitate

2. B

   Packed cells

3. C

   Heparin

4. D

   Whole blood

Appeared in: UPUMS Nsg.Officer-2024

Explanation

• Haemophilia is a bleeding disorder caused by a deficiency in specific clotting factors, most commonly Factor VIII (Haemophilia A).
• The primary goal of treatment during an acute bleed is to replace the deficient clotting factor to allow for clot formation and stop the bleeding.
• Cryoprecipitate is a blood product prepared from plasma and is a concentrated source of several clotting factors, including Factor VIII, fibrinogen, and von Willebrand factor.
• Administering cryoprecipitate provides the necessary Factor VIII to correct the deficiency and control the bleeding episode in a patient with Haemophilia A.

Why Other Options Were Wrong

• Option B: Packed red blood cells are used to restore oxygen-carrying capacity by replacing lost red cells. They do not contain significant amounts of the clotting factors needed to address the underlying cause of bleeding in haemophilia.
• Option C: Heparin is an anticoagulant, meaning it prevents blood clotting. Administering heparin to a patient with a bleeding disorder like haemophilia is strictly contraindicated as it would severely worsen the bleeding and could be life-threatening.
• Option D: While whole blood contains all blood components, including clotting factors, the factors are present in a low concentration. A large volume would be needed to provide a therapeutic dose of Factor VIII, creating a significant risk of circulatory overload, especially in a child.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of acute bleeding episodes in haemophilia to guide bedside assessment, documentation, and the next nursing action.
• While cryoprecipitate is the correct answer among the choices, nurses should be aware that recombinant factor concentrates (e.g., recombinant Factor VIII) are the current standard of care for haemophilia. They are preferred due to their purity and zero risk of transmitting blood-borne viruses.
• A critical nursing responsibility is to monitor for signs of transfusion reactions and for the effectiveness of the treatment (i.e., cessation of bleeding). Accurate administration and documentation are vital.
• The development of 'inhibitors' (antibodies against the replacement factor) is a serious complication of haemophilia treatment. Nurses should be aware of this risk, as it renders standard factor replacement ineffective.

How to Approach the Question

• First, identify the patient's diagnosis from the stem: a child with haemophilia experiencing a bleeding episode.
• Recall the pathophysiology of haemophilia: it is a deficiency of a specific clotting factor (usually Factor VIII or IX).
• Determine the therapeutic goal: to stop the bleeding by replacing the missing clotting factor.
• Analyze each option based on its composition and function:
• Does it contain clotting factors?
• Is it a concentrated source?

Concept Tested & Keywords

• Concept Tested: Management of acute bleeding episodes in haemophilia.
• Stem keywords: haemophilia, child, bleeding episode
• Lead-in keywords: expect will be given
• Clinical cues: The patient is a child with a known diagnosis of haemophilia.
• Clinical cues: The patient is actively bleeding, requiring intervention to achieve hemostasis.

Question ID

QAl9ExVWx2iRqZrxFmbMR

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 373-375

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 138-140

E6 Gynecology Williams p. 9-33