Hemophilia case study PDF

Preview

Summary

Hemophilia case study ...

Description

543-109 Complex Health Alterations I Case Study: Hemophilia John Paul Simmons is a 2 year old boy who is seen in the clinic after his mother noticed several severe bruises on his shins, knees and elbows. He has been limping as well, favoring his right leg. His left knee appears to be quite swollen and warm to the touch, and he cries if the knee is touched. The physician examines the child and has some blood work done. His exam noted the following information: Vital signs: Temperature 98.8 F, BP 90/56, HR 136, R 24 Mentation: alert, appears in distress and is restless; mother notes normal sleep/activity/eating patterns up until today. Lungs: clear throughout all lung fields, oxygen saturation 99% on room air Heart: Presence of innocent murmur, grade 2 Abdomen: distended, somewhat taut, is tender upon palpation, normal bowel sounds present in all quadrants, normal urine and bowel habits Left knee is swollen, warm to the touch, very tender to touch, and very difficult to bend. Other extremities appear normal. Lab resultsWBC: 8 K/ul RBC: 3.9 M/ul Hemoglobin: 9.0 g/dL Hematocrit: 28% Platelet count: 200,000/ul Prothrombin time: 12.2 seconds Partial Thromboplastin time: 40 seconds Factor 8 Assay: 4% of normal level After the lab results are available, the physician tells the mother that he is concerned about the possibility of classic hemophilia. Complete the following: 1. Explain the pathophysiology behind abnormal assessment findings for the patient (1 point) The mechanisms behind hemophilia all work together to facilitate healing when the blood vessel is injured. The first thing that happens in the blood vessels constrict to limit the amount of blood that could be lost. The circulating platelets will move to form a plug at the site of the injury. Then the blood goes under coagulation. Through this process, it allows the platelet plugs to be established and forms a surface. In the assessment, the left knee is swollen and warm to the touch. There are several severe bruises as well and this is common because the blood gets trapped. The abnormal

assessment of the excessive bleeding is actually considered normal for the patient.

2. Review the lab values and describe how the abnormal labs fit into the scenario (in other words, WHY is the lab result high or low in the scenario…how it relates to the patient’s medical problem) (2 points) The white blood cell count is within the normal limits. The red blood cell count normal range is 4.7-6.1. The count is at 3.9 and since the patient did have bleeding, that would be the reason why it is a little low. The normal hemoglobin range is 13.8-17.2. The count is 9.0 because the patient had bleeding and that is normal to see a lower hemoglobin level with excess bleeding. The normal hematocrit range is 38.3-48.6%. The count is 28% because they are prone to blood clots and since the patient has the bruising and bleeding, that is why the level is lower than normal. The platelet count is within normal limits. The prothrombin time is 11 to 13.5 seconds is within normal limits. The normal range of PTT is 60-70 seconds. The count is at 40 seconds, which means it is low and that is because the blood is taking longer to clot than normal. The normal range of factor 8 assay is 50 to 150%. The count is at 4% of normal level. If a patient’s count comes back less than 50% it means that they have hemophilia. This is dependent on how much of a risk to bleed you have by the percentage.

3. Identify 1 priority nursing diagnosis (include the diagnosis, along with “related to” and “as evidenced by”) (1 point) Impaired physical mobility related to pain and discomfort in left leg as evidenced by decreased ability to move. 4. At least two (2) outcomes or goals for the diagnosis. Make sure they are specific and measurable (1 point)

Child will maintain optimal physical mobility by performing range of motion exercises, focusing on the affected leg twice daily until discharge from hospital. Child will walk four times a day to help regain strength and movement on affected leg until discharge from hospital. 5. Describe at least four (4) nursing interventions for the diagnosis (2 points) The nurse will help provide passive range of motion exercises with client. This will help gain joint movement and optimal muscle strength which is needed to get better. The nurse will assist and monitor the client’s progression to get to active exercise as tolerated. These non-weight bearing exercises will help facilitate range of motion and this will help prevent the rebleed. The nurse will have the client referred to physical and occupational therapy. This will help gain the strength and joint movement to promote independence. The nurse will assess the patient’s pain to monitor and control pain levels. It is important to assess the pain levels, so the patient is overdoing it on the affected leg, but rather control the pain from the start. 6. Describe priority teaching that needs to be done prior to discharge (1 point) Regular dental evaluation is recommended, regarding proper oral hygiene, dental care. Encourage appropriate exercise. Advise not to play in contact and collision sports. Avoid blood thinning medications the prevent blood from clotting like heparin and warfarin. Avoid certain pain medications like acetaminophen that can trigger bleeding. Make sure to do first aid treatment for minor cuts. Make sure your child is vaccinated.

Make sure you are specific in your descriptions. Once you have completed the assignment, submit it to the assignment tab AND the discussion board for the appropriate topic (in this case, Hemophilia). Grading: 8 points for the care plan; 2 points for your responses on the discussion boards. You must respond to at least 2 care plans on each topic in order to receive any points for this assignment!...