A nurse is caring for a client on a pediatric unit. The client is a 7-year-old male who is admitted with excessive bruising and complaints of joint pain. The nursing team is monitoring his symptoms closely due to his history of bleeding episodes. The client exhibits multiple bruises on legs and arms. Reports pain during movement, especially in the knees. No signs of active bleeding observed, but requires further evaluation. Joint pain reported at 6 out of 10. Client's gait is slightly altered, walking with a limp on the left side. Vital signs are within normal limits.
A nurse is caring for a 7-year-old child with hemophilia who presents with excessive bruising and joint pain. Based on this scenario, identify the anticipated nursing actions for the child's care. Select all that apply.

Rationale:

A. The patient is exhibiting acute hypocalcemia with neuromuscular irritability (tingling, muscle spasms, positive Chvostek/Trousseau signs) and cardiac manifestations (prolonged QT interval), which can lead to life-threatening arrhythmias. IV calcium gluconate provides rapid correction of serum calcium, making it the priority intervention in an emergency setting.

B. Magnesium may be needed if hypomagnesemia is present because it can contribute to hypocalcemia, but the immediate life-threatening issue is low calcium, not magnesium deficiency. Administering magnesium alone does not correct the urgent hypocalcemia.

C. Oral calcium is used for long-term management of hypocalcemia in hypoparathyroidism. In an acute, symptomatic emergency with cardiac involvement, oral calcium is too slow to correct the deficit and is not appropriate as the first-line intervention.

D. Thyroid function is not the acute concern in this scenario. While hypoparathyroidism may be related to thyroid or parathyroid surgery, immediate management of symptomatic hypocalcemia is the priority over diagnostic testing.

Rationale:

A. Gastrointestinal distress caused by NSAIDs like ketorolac is primarily due to gastric mucosal irritation, not potassium deficiency. A diet high in potassium does not prevent NSAID-related GI complications. Protective strategies include taking the medication with food or using gastroprotective agents if needed.

B. Ketorolac is a potent NSAID with a high risk of renal toxicity, gastrointestinal bleeding, and cardiovascular effects. It is generally not recommended for long-term or repeated use, and overlapping NSAIDs can increase the risk of adverse effects. The nurse should avoid concurrent NSAIDs unless explicitly prescribed.

C. Ketorolac can cause acute kidney injury, fluid retention, and electrolyte imbalances, even in patients without prior renal issues. Monitoring serum creatinine, BUN, and intake/output is essential to detect early renal compromise. This is especially important in patients with rheumatoid arthritis who may already be at risk due to chronic inflammation or other medications.

D. Taking ketorolac on an empty stomach increases the risk of gastric irritation and ulcers. NSAIDs should typically be taken with food or milk to minimize gastrointestinal adverse effects.