An 8-year-old with severe hemophilia A presents with painful right knee swelling after a fall. Which is the nurse priority intervention?
1Perform an arthrocentesis to aspirate blood from the joint to relieve pressure and pain
2Administer factor VIII concentrate or, given inhibitor history, a bypassing agent immediately✓ Correct answer
3Administer a nonsteroidal anti-inflammatory drug like ibuprofen to manage joint pain and swelling
4Apply a warm compress to the affected knee for 15 to 20 minutes to reduce muscle spasm
Explanation
Acute hemarthrosis in severe hemophilia is treated with factor concentrate FIRST — within minutes — before imaging or analgesia, to limit joint damage. With known factor VIII inhibitor, bypassing agents (FEIBA or recombinant factor VIIa) are used because additional factor VIII will be neutralized. RICE (rest, ice, compression, elevation) follows factor replacement. Heat increases bleeding. Aspiration is avoided in routine hemarthrosis. Aspirin and NSAIDs inhibit platelets and worsen bleeding — acetaminophen is preferred for analgesia.