The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia. Which instructions should the clinic nurse provide to the student? Select all that apply.

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Hemophilia is a bleeding disorder caused by a deficiency in coagulation proteins, increasing the risk for bleeding. The nurse should avoid procedures that can cause bleeding (eg, intramuscular injections, rectal temperature measurement). Vaccinations are administered subcutaneously whenever possible to prevent intramuscular hematoma (Option B). The smallest gauge needle is used, and firm, continuous pressure is applied at the site for 5 minutes (Option D). (Option A) Children with hemophilia should avoid aspirin and nonsteroidal anti-inflammatory drugs due to the risk of bleeding. Acetaminophen is recommended for pain relief. (Options C and E) Firm pressure should be held on the site without rubbing or massaging due to the risk of bleeding and hematoma formation. Superficial bleeding can be controlled using ice packs, which promote vasoconstriction. Applying a warm compress would cause vasodilation and prolong bleeding. Educational objective: Procedures that can cause bleeding (eg, intramuscular injections) are avoided in children with hemophilia. Vaccinations are administered subcutaneously when possible, and the smallest gauge needle is used. Firm pressure is applied to the injection site for 5 minutes, often using ice. Nonsteroidal anti-inflammatory agents including aspirin are avoided due to the risk of bleeding.

The Clinic Nurse Supervises a Student Nurse Who Is Preparing