Discharge And Home Healthcare Guidelines

PREVENTION. To prevent exacerbations, teach the patient and family to monitor for an increase in shortness of breath or edema. Tell the patient to restrict fluid intake to 2 to 2.5 L per day and restrict sodium intake as prescribed. Teach the patient to monitor daily weights and report weight gain of more than 4 pounds in 2 days.

MEDICATIONS. Be sure the patient and family understand all medications, including effect, dosage, route, adverse effects, and the need for routine laboratory monitoring for drugs such as digoxin.

COMPLICATIONS OF HF. Tell the patient to call for emergency assistance for acute shortness of breath or chest discomfort that is not alleviated with rest.

400 Hemophilia

DRG Category: 397 Mean LOS: 5.0 days Description: MEDICAL: Coagulation Disorders

I I emophilia refers to a group of congenital coagulation disorders that are characterized by a deficiency or malfunction of specific clotting factors. Hemophilia A, or classic hemophilia, is caused by a defect in factor VIII (antihemophilic factor). Hemophilia B, or Christmas disease, is caused by a defect in factor IX (plasma thromboplastin component, or Christmas factor). Hemophilia A is more common, occurring once per 5000 to 10,000 live male births, contrasted with hemophilia B, which occurs once per 30,000 live male births. Hemophilia C, or factor XI (plasma thromboplastin antecedent) deficiency, is even more rare, accounting for less than 5% of hereditary coagulopathies. The mortality rate for persons with hemophilia is twice that of the healthy male population, and for severe hemophilia, the rate is almost six times higher.

Of patients who have hemophilia, 85% have hemophilia A, which is classified by levels of factor VIII. Severe hemophiliacs have less than 1% activity and have bleeding episodes that require factor VIII therapy several times per month. Moderate hemophiliacs have 1% to 5% activity and have varying need for factor VIII therapy, whereas mild hemophiliacs have greater than 5% activity and require intervention only after trauma or surgery.

Persons with hemophilia are able to form a platelet plug but are unable to form a stable clot. Clinical manifestations and complications of hemophilia are usually secondary to recurrent bleeding. Complications from subcutaneous and intramuscular hematomas are caused by compression of nerves or other structures, resulting in peripheral neuropathies, pain, compromised airway, muscle atrophy, ischemia, and gangrene. Hemarthrosis, or bleeding into the joint or synovial cavity, is a common complication that often results in joint deformities. Life-threatening hemorrhage may result from minor injuries.

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