A nurse is caring for a child with hemophilia. Which of the following interventions should be included in your plan of care and teaching to the caregivers? Select all that apply.

Choice A rationale Children with hemophilia have a deficiency in a specific clotting factor (Factor VIII for Hemophilia A, Factor IX for Hemophilia B), which significantly impairs the coagulation cascade and places them at extremely high risk for life-threatening bleeds from trauma. Participation in high-impact or contact sports, such as football or hockey, must be strictly avoided to prevent spontaneous or injury-induced deep tissue, joint, or intracranial hemorrhage. Choice B rationale Due to the high risk of bleeding, any procedure that penetrates the muscle and potentially damages blood vessels, like intramuscular (IM) injections, should be minimized or avoided. Subcutaneous (SubQ) injections are preferred for necessary immunizations because they cause less trauma to blood vessels and have a lower risk of causing a deep hematoma, although firm pressure must still be applied afterward. Choice C rationale A joint injury, such as a knee hemarthrosis, is a common and serious complication of hemophilia, causing severe pain and swelling. Initial management involves RICE (Rest, Ice, Compression, Elevation). Immobilization of the affected joint is crucial to prevent further movement that could aggravate bleeding, reduce pain, and preserve joint function until the bleeding is controlled, usually with factor replacement therapy. Choice D rationale Pain management in a child with hemophilia must strictly avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as these medications inhibit platelet aggregation and increase the risk of bleeding. Acetaminophen is the analgesic of choice because it does not affect platelet function or increase bleeding risk, providing a safe option for managing mild to moderate pain, including that from hemarthrosis. Choice E rationale Epistaxis (nosebleeds) is a common bleeding episode in children with hemophilia. The appropriate initial intervention is to apply direct, continuous compression to the soft lower part of the nose for at least 10 minutes while tilting the head forward to prevent blood from flowing down the throat. Applying an ice pack to the bridge of the nose or the back of the neck causes vasoconstriction, which can help to slow the bleeding.