NOSE BLEEDING

Epistaxis (Nosebleed)

Epistaxis is a hemorrhage from the nose caused by the rupture
of tiny, distended vessels in the mucous membrane of any area
of the nasal passage. The anterior septum is the most common
site. Risk factors include infections, low humidity, nasal
inhalation of illicit drugs, trauma (including vigorous nose
blowing and nose picking), arteriosclerosis, hypertension,
nasal tumors, thrombocytopenia, aspirin use, liver disease, and
hemorrhagic syndromes.

Medical Management
A nasal speculum, penlight, or headlight may be used to identify
the site of bleeding in the nasal cavity. The patient sits
upright with the head tilted forward to prevent swallowing
and aspiration of blood and is directed to pinch the soft outer
portion of the nose against the midline septum for 5 or
10 minutes continuously.

Alternatively, a cotton tampon may
be used to try to stop the bleeding. Suction may be used to
remove excess blood and clots from the field of inspection.
Application of anesthetics and nasal decongestants (phenylephrine,
one or two sprays) to act as vasoconstrictors may be
necessary. Visible bleeding sites may be cauterized with silver
nitrate or electrocautery (high-frequency electrical current).
If the origin of the bleeding cannot be identified, the nose
may be packed with gauze impregnated with petrolatum jelly or
antibiotic ointment. The packing may remain in place for
48 hours or up to 5 or 6 days if necessary to control bleeding.
Antibiotics may be prescribed to prevent and manage infection.
Nursing Management
• Monitor vital signs, airway, and breathing, and assist in control
of bleeding.
• Provide tissues and an emesis basin for expectoration of
blood.
• Reassure patient in a calm, efficient manner that bleeding
can be controlled.
• Once bleeding is controlled, instruct the patient to avoid
vigorous exercise for several days and to avoid hot or spicy
foods and tobacco.