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

Choice A rationale Passive range-of-motion exercises are contraindicated during an acute hemarthrosis episode. Movement can exacerbate bleeding within the joint and cause further pain and damage to the synovial tissue and cartilage. The scientific rationale is to immobilize the affected joint to stop the bleeding and allow the clotting factors to work effectively. Gentle range of motion is only introduced later, during the rehabilitation phase. Choice B rationale Administering aspirin is a dangerous and contraindicated choice for a child with hemophilia. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1 (COX-1) and COX-2 enzymes, thereby increasing the risk of bleeding. This can worsen the hemarthrosis. Acetaminophen or non-aspirin NSAIDs like ibuprofen are preferred for pain management in these patients. Choice C rationale Placing ice packs on the affected joints is the correct scientific intervention. Cold application, or cryotherapy, causes vasoconstriction, which helps to slow or stop the bleeding into the joint space. This reduces swelling, inflammation, and pain associated with hemarthrosis. The RICE acronym (rest, ice, compression, elevation) is a scientifically validated acute management strategy for joint bleeds in hemophilia. Choice D rationale Positioning the lower extremities below the level of the heart is scientifically incorrect. The affected extremity should be elevated above the level of the heart. Elevation uses gravity to reduce blood flow to the joint, which helps to decrease swelling, pain, and bleeding. Placing the extremity below the heart would increase blood flow and exacerbate the hemarthrosis, increasing intra-articular pressure and pain.