A 16-year-old has been admitted to the hospital for advanced osteosarcoma with metastasis to the lungs. His prognosis is poor. He is continuing to require oxygen and needs to remain in the hospital for monitoring. The adolescent is very frustrated and states that he doesn't want to stay in the hospital and wants to be with his friends. Which of the following is the best option?

A. Appropriate dose of aspirin and rest: Aspirin is an antiplatelet medication that can worsen bleeding in individuals with hemophilia. It should be avoided. Rest alone is not sufficient in this situation.

B. Immobilization of the leg and a dose of ibuprofen: Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding. Immobilizing the leg may help prevent further injury, but it does not address the underlying bleeding issue or provide the necessary clotting factor.

C. Heating pad and administration of factor VIII concentrate: While the administration of factor VIII concentrate is appropriate, the use of a heating pad is not advisable, as it can potentially worsen bleeding by dilating blood vessels in the area.

D. Pressure on the site and administration of the required clotting factor.

Hemophilia is a bleeding disorder in which the blood doesn't clot properly. When a hemophilic child has a significant bruise or bleeding, it is crucial to administer the specific clotting factor that they are deficient in (Factor VIII or IX) to stop the bleeding. Applying pressure to the site can also help control bleeding.

In summary, option D is the priority because it directly addresses the bleeding issue in the child with hemophilia by applying pressure to the site and administering the necessary clotting factor. This is crucial in preventing further bleeding and complications.

A. Checking urine for glucose and protein is not directly related to the care of a child with a VP shunt. The focus is on monitoring the child for signs of complications related to the shunt.

B. Administering narcotics for pain control may be indicated if the child is in pain, but it is not the primary action and should be determined based on the child's pain assessment.

C. Testing cerebrospinal (CSF) fluid leakage for protein is not typically a nursing responsibility in the immediate postoperative period. Leakage of CSF should be reported to the healthcare provider, and diagnostic tests would be conducted by medical staff as needed.

D. Monitor for increased temperature.

Monitoring for an increased temperature is essential because postoperative fever could be an early sign of infection or complications related to the VP shunt. Infection and shunt malfunction are potential risks in the postoperative period.