Nursing Care Management
The earlier a bleeding episode is recognized, the more effectively it can be treated. Signs that indicate internal bleeding are especially important to recognize. Children are aware of internal bleeding and are reliable in telling the examiner where an internal bleed is. In addition to the manifestations described(see BOX 26-5), the nurse maintains a high level of suspicion when a child with hemophilia demonstrates signs such as headache, slurred speech, loss of consciousness (from cerebral bleeding), and black tarry stools (from GI bleeding).
Prevent Bleeding. The goal of prevention of bleeding episodes is directed toward decreasing the risk of injury. Prevention of bleeding episodes is geared mostly toward appropriate exercises to strengthen muscles and joints and to allow age-appropriate activity. During infancy and toddlerhood the normal acquisition of motor skills creates innumerable opportunities for falls, bruises, and minor wounds. Restraining the child from mastering motor development can foster more serious long-term problems than allowing the behavior. However, the environment should be made as safe as possible, with close supervision during playtime to minimize incidental injuries.