| The primary therapy for hemophilia is preventing | | | | as safe as possible to minimize the incidental |
| spontaneous bleeding by replacement of the | | | | injuries and maintaining close supervision during |
| missing factor. | | | | playtime. |
| Vigorous therapy is instituted to prevent chronic | | | | For older children, the family usually needs |
| crippling effects, from joint bleeding. If | | | | assistance in preparing for school. A nurse who |
| replacement therapy is begun immediately, local | | | | knows the family can be instrumental in discussing |
| measures such as Ice applications and splinting are | | | | the situation with the school nurse and in jointly |
| seldom needed. Local application of epsilon | | | | planning an appropriate schedule of activity. Since |
| aminocapronic acid prevents clot destruction; | | | | almost all hemophiliac persons are boys. The |
| however, its use is limited to mouth or trauma | | | | physical limitations in regard to active sports are a |
| surgery. | | | | difficult adjustment. Encouraging the pursuit of |
| A regular program of exercise and physical | | | | intellectual and/or creative endeavors from early |
| therapy is an important aspect of management. | | | | childhood helps foster a life-style that is fulfilling |
| Treatment without delay results in more aspect | | | | and less conflicting than one focused on unrealistic |
| of management. Treatment without delay results | | | | goals. Using the group approach with hemophiliac |
| in more rapid recovery and a decreased likelihood | | | | children is often very successful because within |
| of complications; therefore, most hemophiliac | | | | the group, they can find acceptance, healthy |
| children over 3 years of age. The child learns the | | | | competition, and a sense of camaraderie. Such a |
| procedure for self-administration between ages 9 | | | | setting may be the first time that these children |
| and 12. Home treatment is highly successful, and | | | | have felt a sense of belonging; even with their |
| the rewards, in addition to the immediacy of | | | | sibling relationships, they commonly see |
| treatment, are less disruption of family life, fewer | | | | themselves as outsiders. |
| school of work days missed, and enhancement of | | | | Since the mucous membranes bleed easily, the |
| the child's independence. | | | | young child is given food that is easily masticated. |
| Nursing considerations | | | | For the older child, food choices need not be |
| The objectives for nursing care can be divided | | | | limited as long as he understands the necessity of |
| into immediate meeds and long-term goals. | | | | chewing thoroughly and eating slowly. Dental care |
| Obviously the most immediate consideration is | | | | is very important and may require some |
| control of bleeding episodes. However, the | | | | readjustment in terms of daily hygiene. For |
| ultimate adjustment and prognosis for the | | | | example, the nurse can recommend the use of a |
| hemophiliac person rely heavily on the family's | | | | Water Pik, softening the toothbrush in warm |
| ability to cope with the disorder, to provide | | | | water before brushing, or using a sponge-tipped |
| effective methods of control and prevention, and | | | | disposable toothbrush available in many |
| t temper child-rearing practices with judicious | | | | drugstores. A regular toothbrush should be soft |
| protection from injury while fostering | | | | bristled and small in size. Adolescents also need to |
| independence and development. | | | | be advised of the dangers of shaving with razor |
| Prevent bleeding by decreasing risk of injury | | | | blade and encouraged to use an electric shaver. |
| Prevention of bleeding through control of behavior | | | | Diet is also an important consideration, since |
| is no easy task. During infancy and 'toddler-hood' | | | | excessive body weight can increase the strain on |
| the normal acquisition of motor skills creates | | | | affected joints, especially the knees and |
| innumerable opportunities for falls, bruises and | | | | predispose to hemarthrosis. Since limited activity is |
| minor wounds. Restraining the child from | | | | frequently the result of a more sedentary |
| mastering motor development can herald more | | | | life-style and occasional periods of bed rest aster |
| serious long-term problems than allowing the | | | | tissue bleeding, calories need to be supplied in |
| behavior. However, the environment can be made | | | | accordance with energy requirements. |