A nurse is caring for a client in a pediatric unit. The child has been experiencing frequent nosebleeds and easy bruising. The family expresses concern about the child's unusual bleeding patterns following minor injuries

Based on the following clinical scenario, determine if the nursing actions regarding the potential diagnosis of hemophilia are anticipated or contraindicated.

Rationale:

A. This is the most critical and first-line priority in managing DIC. DIC is not a primary disease but a complication of conditions such as sepsis, trauma, malignancy, or obstetric emergencies (e.g., placental abruption). The widespread activation of the clotting cascade will continue unless the trigger is removed. For example, administering antibiotics for sepsis or delivering the placenta in obstetric cases directly addresses the root cause. Without this step, supportive treatments alone will be ineffective.

B. Beta blockers are used to manage conditions such as hypertension, arrhythmias, or heart failure. They have no role in correcting the coagulation abnormalities seen in DIC. They do not affect platelet consumption, clotting factor depletion, or fibrinolysis. Therefore, this option is inappropriate and incorrect.

C. Although it may seem counterintuitive in a condition associated with bleeding, heparin can be used in selected cases of DIC, particularly when thrombotic manifestations predominate (e.g., digital ischemia, organ dysfunction from microthrombi, or chronic DIC). Heparin works by inhibiting further clot formation, thereby reducing consumption of clotting factors and platelets. However, it is used cautiously and is generally avoided in patients with severe active bleeding. This makes it a situational but appropriate intervention.

D. Patients with DIC are at high risk for hypovolemia and shock due to bleeding and capillary leakage. Isotonic fluids like lactated Ringer’s help maintain intravascular volume, blood pressure, and organ perfusion. Adequate fluid resuscitation is essential to prevent complications such as acute kidney injury and multi-organ failure. This is a key supportive therapy.

E. In DIC, clotting factors are rapidly consumed, leading to coagulopathy and bleeding. FFP contains all clotting factors and is administered to replace depleted factors, correct prolonged PT/INR and aPTT, and help control bleeding. It is especially indicated in patients with active bleeding or those at high risk for bleeding.

Rationale:

A. While both rheumatoid arthritis (RA) and osteoarthritis (OA) can cause joint swelling, RA typically involves symmetric joint inflammation affecting multiple joints, particularly the small joints of the hands and feet, whereas OA is more localized and asymmetric. Thus, localized swelling alone does not distinguish RA from OA.

B. A hallmark of RA is prolonged morning stiffness lasting more than 30–60 minutes, which eases with movement and activity. In contrast, OA typically causes brief morning stiffness (<30 minutes) that may worsen with activity. The duration of morning stiffness and its improvement with activity is a key distinguishing characteristic of RA.

C. While RA can cause pain at rest due to inflammation, this feature alone is not specific enough to distinguish RA from OA. OA pain is often activity-related but can also occur at rest in advanced stages.

D. RA frequently leads to joint deformities, such as ulnar deviation, swan-neck, and boutonniere deformities, especially in the small joints. OA can also cause deformities, but these are usually due to bony overgrowths (Heberden’s and Bouchard’s nodes). Therefore, stating no deformities occur is inaccurate for RA.