Heavy or uncontrolled bleeding, signs of significant blood loss (tachycardia, hypotension, dizziness) require prompt reporting.
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse is assessing a newborn for Hirschsprung disease. Which finding in the first 48 hours of life is most suggestive of this disorder?
Answer: A. Failure to pass meconium within 24 to 48 hours of birth is a hallmark of Hirschsprung disease, caused by absence of ganglion cells in a segment of the distal colon. Frequent loose stools, projectile vomiting, and excessive meconium passage are not characteristic.
Question 2 of 3
A child is diagnosed with hand-foot-and-mouth disease. The nurse expects to find which characteristic lesions?
Answer: A. Hand-foot-and-mouth disease, caused by coxsackievirus, produces painful vesicular lesions in the mouth and on the palms and soles. It is usually self-limiting, and care focuses on hydration and comfort.
Question 3 of 3
A nurse is assessing a 78-year-old client. Which finding is a normal age-related change rather than a sign of disease?
Answer: A. Decreased skin elasticity and turgor is an expected aging change due to loss of subcutaneous tissue and collagen. Resting tachycardia, productive cough, and a new confusion onset are not normal aging and warrant evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is von willebrand disease?
Unlike hemophilia it is usually autosomal and affects both sexes. Bleeding is typically mucocutaneous: easy bruising, nosebleeds, gum bleeding, and heavy menstrual periods.
Key points to remember
- vWF mediates platelet adhesion to injured vessel walls and protects factor VIII from breakdown, so its loss impairs primary hemostasis.
- Most common pattern is mucosal bleeding: epistaxis, gingival bleeding, easy bruising, and menorrhagia in women.
- Bleeding time and PFA closure time are prolonged; aPTT may be prolonged if factor VIII is also low; platelet count is normal.
- Desmopressin (DDAVP) is the first-line treatment for many types because it releases stored vWF and factor VIII.
- vWF/factor VIII concentrates are used for severe disease or when DDAVP is ineffective; aminocaproic acid helps mucosal bleeding.
- Inheritance is most often autosomal dominant, so it affects males and females roughly equally.
Signs & symptoms
- Mucosal bleeds: epistaxis, gums
- Menorrhagia, easy bruising
- Prolonged bleed after surgery
Nursing priorities
- Control mucosal bleeding with direct pressure; for epistaxis have the client sit up and lean forward and apply pressure.
- Administer DDAVP or vWF-containing factor concentrate as prescribed before procedures or for active bleeding.
- Implement bleeding precautions and avoid IM injections, aspirin, and NSAIDs.
- Monitor for and quantify blood loss, especially menstrual bleeding, and assess for anemia.
- Hold pressure on venipuncture and injection sites longer than usual.
Labs & values
Patient teaching
- Avoid aspirin, NSAIDs, and other platelet-inhibiting medications; use acetaminophen for pain.
- Women with heavy periods may benefit from hormonal therapy; report excessive menstrual bleeding.
- Carry medical alert identification and notify dentists/surgeons before any procedure.
- Apply prolonged pressure to cuts and nosebleeds; keep DDAVP available if prescribed.
- Genetic counseling is appropriate as the condition is inherited.
Red flags: report now
- Heavy or uncontrolled bleeding, signs of significant blood loss (tachycardia, hypotension, dizziness) require prompt reporting.
- Never administer aspirin, NSAIDs, or antiplatelet agents.
- Sudden severe internal bleeding signs (abdominal pain, GI bleeding) warrant immediate evaluation.
References
Clinical references for this topic
