A nurse is developing a plan of care for a 4-year-old child who has hemophilia and is experiencing acute hemarthrosis of the knee. Which of the following interventions should the nurse include in the plan?

Choice A rationale Performing passive range of motion exercises on an acutely affected joint with hemarthrosis can exacerbate bleeding and cause further damage to the joint capsule and surrounding tissues. The goal is to minimize movement to allow the bleeding to stop and the joint to heal, preventing long-term joint destruction and chronic arthropathy. Gentle, active range of motion may be initiated later, after the acute phase. Choice B rationale Applying heat to a joint experiencing an acute bleed, or hemarthrosis, is contraindicated because vasodilation will occur. The increased blood flow to the area would intensify the bleeding into the joint space, increasing swelling, pain, and the risk of permanent joint damage. Cold therapy, or cryotherapy, is the appropriate intervention to promote vasoconstriction and reduce bleeding. Choice C rationale Elevating the affected limb above the level of the heart uses gravity to reduce blood flow to the injured joint. This action decreases the pressure within the blood vessels, which helps to slow or stop the bleeding into the joint space (hemarthrosis), thereby reducing swelling, pain, and potential long-term damage to the cartilage and bone. Choice D rationale Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with antiplatelet properties. It irreversibly inhibits cyclooxygenase (COX) enzymes, preventing the production of thromboxane A2, which is essential for platelet aggregation. In a child with hemophilia, administering aspirin would inhibit the little clotting ability they have, increasing the risk of prolonged and severe bleeding.