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Symptoms and Nursing Care for Hemophilia
Christian de Castro
National University
Hemophilia is a blood coagulation disorder caused by deficiencies of clotting factors characterized
by recurrent bleeding into muscles and joints (Rodriguez et. al 2011). The author also added that severity
of bleeding symptoms depends on the degree of factor deficiency. Based on the study of Santagostino et.
al (2002), bleeding may occur at various sites but the most prominent features are muscle hematomas and
recurrent hemarthroses leading to arthropathy. Moreover, Taylor (2004) stated that frequent and
prolonged episodes of bleeding into susceptible joints leads to arthritis, which in turn is responsible for
most of the pain and long term physical disability. In particular, Dolan et. al (2012) stated that elbows,
knees and ankles are the joints most susceptible to acute hemarthroses. According to Santagostino et. al
(2002), severely affected patients bleed frequently and spontaneously. Furthermore, Taylor, (2004) added
that if bleeds occur in internal organs or in the head, it may be life threatening.
According to Rodriguez-Merchan et. al (2011), the goal of comprehensive care is to address acute
management of bleeding episodes, long term management of arthropathy and other significant
complications, while Santagostino et. al (2002) added that early recognition and treatment can often stop
the bleeding before tissue damage occurs. Since hemophilia causes bleeding problems, Santagostino et. al
(2002) suggests that low impact sporting activities should be encouraged to promote muscle
strengthening, while Dolan, et. al (2012) emphasized safety issues such as removal of dangerous toys
with sharp edges, square coffee tables and playground equipment. However, overprotection of children
with hemophilia should be avoided to allow normal emotional and social growth (Santagostino et. al
(2002). Furthermore, the author recommends that routine vaccines should be given subcutaneously rather
than intramuscularly to avoid hematoma. Santagostino et. al (2002) also added that patients with
hemophilia need regular dental care and vigorous brushing and professional cleaning, the same as it is for
children with no hemophilia. With regards with pain management, according to Dolan, et. al (2012)
immobilization and use of ice may be helpful in the relief and inflammation, while the author emphasized
that paracetamol is recommended for mild-moderate pain, and opiates may be necessary for severe pain.
BIBLIOGRAPHY
Dolan, G., Cruz, J., Steinhagen-Thiessen, E., Kessler, E., Haaning, C., Lemm, J., Altisent, C., Guerrero,
C., Hermans, C., Riske, B., Bolton-Maggs, B. 2012. Advances in Hemophilia Care: Report of Two
Symposia at the Hemophilia 2010 World Congress. Advances in Therapy 29(1): 1-16.
Rodriguez-Merchan, E., Carlos, V., Leonard, A. 2011. Comprehensive Care on Hemophilia. Current and
Future Issues in Haemophilia Care 2(1): 10-17.
Santagostino, E., Gringeri, A., Mannucci, P. 2002. State of Care for Hemophilia in Pediatric Patients.
Pediatric Drugs 4(3): 149-157.
Taylor, G. 2004. Challenges for social work in hemophilia care. Health & Social Work 29(2): 149-52.
Zhang, X., Chen, S., Yoo, S., Chakrabarti, S., Zhang, T., Ke, T., Oberti, C., Yong, S., Fang, F., Li, L.,
Fuente, R., Wang, L., Chen, Q., & Wang, Q. (2008). Mutation in nuclear pore component NUP155 leads
to atrial fibrillation and early sudden cardiac death. Cell 135(6): 1017-1027.
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Treatments for Severe Acute Respiratory Syndrome (SARS)
Jane Doe
National University
Antiviral Drug Therapy
According to Lai (2005), although there are various known therapies to help cure SARS, it is still unknown
which treatment method is considered the best. The author specifies the different forms of antiviral treatment such
as ribavirin, human interferons, traditional chinese medicine, and immunoglobulin. Koren et. al (2003) states that in
a study that took place in Toronto and Hong Kong, patients were given high doses of ribavirin with either the
extensive oral drug oseltamivir or corticosteroids and there was improvement on the progress of recovery in
ventilation, fever, heart rate, and overall. However, in one study, 49% of patients suffering from SARS showed
drastically lowered hemoglobin proving that the drug had many negative effects such as anemia (Lai 2005).
According to Enserink (2004), Albert Osterhaus and his team disclosed information on evidence that the antiviral
drug, Interferon-α, could possibly help treat SARS if administered to the patient immediately. The author also
mentions that they tested the drug on cynomolgus macaques and the damage to their lungs was reduced immensely
by 80% since the drug blocks further reproduction of viruses and activate a patient’s immune system. Jia and Gao
(2003) state that there were several clinical findings on the effectiveness of traditional chinese medicine (TCM)
such as a speedy recovery of lung inflammation, the reduction of corticosteroid use, and reduction of death rates
among SARS patients. However, the author also explains how TCM is slow acting and shouldn’t be considered as
the only form of medical care. In 2005, Lai mentioned that intravenous immunoglobulin, a hyper immune globulin,
isn’t considered to be highly effective since patients are at risk of venous thrombosis. However, the author states
that pentaglobin is safe and effective for treating corticosteroid resistance.
Ventilation Therapy
Yam et. al (2003), states that 50-85% of patients with SARS needed oxygen supplementation. According to
Han et. al (2004), acute lung injury (ALI), acute respiratory failure (ARF), and acute respiratory distress syndrome
(ARDS) arise in 20% of patients suffering from SARS putting them at a higher risk for fatality. Noninvasive
Ventilation (NIV) is a form of therapy known to treat ARF and ARDS in patients with SARS (Yam et. al 2003).
These authors also state that NIV can decrease intubation rate. According to Lai (2005), Noninvasive Positive
Pressure Ventilation (NPPV), is a form of NIV that’s administered through a tight facemask or nasal mask by
providing positive airway pressure to help treat respiratory failure. NPPV is controversial since it can possibly
spread the virus but is also necessary for oxygen loss (Han et. al 2004). Yam et. al (2003), state that Mechanical
Ventilation is used for patients who are not successful in enduring NIV. The plateau pressure, the pressure applied
in positive pressure ventilation, is decreased and made to be less than 30 cm of water due to barotrauma (Lai 2005).
Immunomodulatory Therapy
According to Rong-chang (2006), in a study of 127 patients who survived out of 152 critical cases due to
the use of steroids, had less hospitalization days and had a 95% chance of being discharged earlier than usual. Lai
(2005), states that corticosteroid use in high doses and for an extended period of time can cause negative side
effects such as the development of hyperglycemia, hypokalemia, hypertension, gastrointestinal hemorrhage, and
even nosocomial infections. However, low doses of corticosteroids that are given to the patient early enough is
beneficial by improving mortality and organ dysfunction, and length of stay in the hospital decreases. (BrunBuisson et. al 2011).
Bibliography
Brun-Buisson, C., Richard, J. M., Mercat, A., Thiébaut, A.,C.M., & Brochard, L. 2011. Early corticosteroids in
severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. American Journal of Respiratory and
Critical Care Medicine 183(9): 1200-6.
Enserink, M. 2004. Interferon shows promise in monkeys. Science 303(5662): 1273-5.
Han, F., Jiang, Y. Y., Zheng, J. H., Gao, Z. C., & He, Q. Y. 2004. Noninvasive positive pressure ventilation
treatment for acute respiratory failure in SARS. Sleep and Breathing 8(2): 97-106.
Jia, W. and Gao, W. 2003. Is traditional Chinese medicine useful in the treatment of SARS?. Phytother Res.
17: 840–841.
Koren, G., King, S., Knowles, S., & Philips, E. 2003. Ribavirin in the treatment of SARS: A new trick for an old
drug? Canadian Medical Association.Journal 168(10): 1289-92.
Lai, S. T. 2005. Treatment of severe acute respiratory syndrome. European Journal of Clinical Microbiology and
Infectious Diseases 24(9): 583-91.
Rong-chang, C., Xiao-ping, T., Shou-yong, T., Bi-ling, L. 2006. Treatment of severe acute respiratory syndrome
with glucosteroids: The guangzhou experience. Chest 129(6): 1441-52.
Yam, L. Y., Rong Chang Chen, L. Y., & Nan Shan Zhong, L. Y. 2003. SARS: Ventilatory and intensive care.
Respirology 8: S31-S35.