Epistaxis

Subject: Medical and Surgical Nursing II (Theory)

Overview

Bleeding from the nose, or epistaxis, is a common ailment. Although it rarely poses a life-threatening threat, it may still give parents of young children cause for serious concern. The majority of nosebleeds are harmless, spontaneous, and self-limiting, but some can be recurrent. Additional unusual causes are noted. According to the location where the bleeding originates, epistaxis can be divided into anterior and posterior bleeds. Usually, bleeding happens when the mucosa erodes, exposing the vessels, which then break. A perforated tympanic membrane can cause bleeding through the nares and blood to trickle into the oropharynx, blood in the auditory canal, blood in the corners of the eyes, and other signs and symptoms. Pinch your nares together and maintain the pressure for five to ten minutes. If there is no improvement, pack nose for ten minutes with gauze that has been soaked in a vasoconstrictor and lots of petroleum jelly. In extreme cases, a Naso stat is inserted, a foley catheter device that uses a balloon to directly compress the site. Using a facemask, give a patient wearing posterior packing humidified oxygen.

Epistaxis

Epistaxis, or bleeding from the nose, is a common condition. Even though it seldom presents a life-threatening threat, it can nonetheless create severe concern in parents of small children. Although most nosebleeds are benign, spontaneous, and self-limiting, some can be recurrent. Other peculiar causes are noted.

Epistaxis can be classified as anterior or posterior bleeds depending on where the bleeding starts.

Etiology

Local Causes:

  • Nasal trauma,
  • Allergic, chronic or infectious infection,
  • Chemical irritants,
  • Medication,
  • Drying of the basal mucosa from low humidity,
  • Deviation of nasal septum or septal perforation,
  • Bleeding polyp or the septum or lateral nasal wall,
  • Neoplasm of the nose or sinuses,
  • Vascular malformation,
  • Tumors of nasopharynx.

Systematic Causes:

  • Hemophilia,
  • Hypertension,
  • Leukemia,
  • Liver disease,
  • Medications like aspirin, anticoagulation, anti-inflammatory,
  • Platelet dysfunction,
  • Thrombocytopenia.

Signs and Symptoms:

  • Bleeding through the nares and blood trickling into the oropharynx.
  • Blood in the auditory canal if the tympanic membrane is perforated.
  • Blood in the corners of the eyes.
  • Laboratory and diagnostic study findings:
  • Nasal inspection with a bright light and speculum may locate the source of bleeding.

Investigation

  • CBC with platelets count, PT/PTT and bleeding time.
  • Ct scan or x-ray of the sinus and nasal area to search for neoplasm of the nasopharynx and sinuses.
  • Consider biopsy of suspicious areas or Naso laryngoscopy, especially in smokers.

Treatment

Initial First Aid Treatment

  • In order to stop posterior blood leakage, tilt your head forward.
  • Pinch your nares together and maintain the pressure for five to ten minutes.
  • If there is no improvement, pack nose for ten minutes with gauze that has been soaked in a vasoconstrictor and lots of petroleum jelly.
  • In extreme cases, a Naso stat is inserted, a foley catheter device that uses a balloon to deliver the harshest compression to the site.
  • To prevent hypovolemic shock, resuscitation with intravenous fluids or possibly blood transfusion may be required.

Medical and Surgical Management:

  • Direct pressures: When blood clots, the flow of blood usually ceases, and this can be aided by applying direct pressure by squeezing the soft, fleshy area of the nose.
  • It has been demonstrated that the local use of a vasoconstriction agent shortens the bleeding period in benign cases of epistaxis.
  • Caution: Medical assistance may be required to control bleeding if these easy steps fail. First, this may involve packing a nostril with ribbon gauze or an absorbent bandage or chemical cautery of any bleeding vessels (called anterior nasal packing). The most typical method for doing chemical cauterization is local administration of a silver nitrate compound to any apparent bleeding arteries.
  • stowing the nose
  • a bleeding point being ligated.

Nursing Managment

  • Monitor for patient vital signs assists in the control of bleeding.
  • Provides tissues and emesis basin to allow the patient to expectorate any excess blood.
  • Administer humidified oxygen by facemask to a patient with posterior packing.
  • Assuring the patient in a calm, efficient manner that bleeding can be controlled can help reduce anxiety.

Reference

  • Dhingra PL. Diseases of ear, nose and throat. $th ed: Reed Elsevier India (P) Limited:2007
  • MedicineNet. 1996. 2017 medicinenet.com/script/main/art.asp?articlekey=3290
  • Medscape. 1994. 2017 emedicine.medscape.com/article/863220-overview
  • Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.
  • Shrivastav R, Rakesh P. An illustrated Textbook of ear, nose, throat and head and neck surgery. 1st ed. Lalitpur Nepal: UPS publisher; 2008
  • Williams and Wilkins, The Lippincott manual of Nursing practice, 7th edition, International student edition, 2001.
Things to remember
  • Bleeding from the nose, or epistaxis, is a frequent ailment. Although it seldom poses a life-threatening hazard, it may nonetheless give parents of young children cause for serious anxiety.
  • The majority of nosebleeds are harmless, spontaneous, and self-limiting, but others might be chronic. Additional unusual reasons are identified.
  • According to the location where the bleeding begins, epistaxis can be separated into anterior and posterior bleeds.
  • Usually, bleeding happens when the mucosa erodes, exposing the vessels, which then break.
  • A perforated tympanic membrane can cause bleeding through the nares and blood to trickle into the oropharynx, blood in the auditory canal, blood in the corners of the eyes, and other signs and symptoms.
  • Pinch your nares together and maintain the pressure for five to ten minutes.
  • If there is no improvement, compress nose for ten minutes with gauze that has been soaked in a vasoconstrictor and plenty of petroleum jelly.
  • In extreme cases, a Naso stat is inserted, a foley catheter device that uses a balloon to directly compress the site.
  • Using a facemask, give a patient wearing posterior packing humidified oxygen.
Questions and Answers

Epistaxis, or nose bleeding, is a common complaint. It is rarely fatal, but it can cause significant concern, particularly among parents of small children. The majority of nosebleeds are harmless, self-limiting, and spontaneous, but some can be recurring. Many unusual causes are also mentioned.

Etiology

Local causes:

  1. Nasal trauma
  2. Allergic, chronic or infectious infection
  3. Chemical irritants
  4. Medication
  5. Drying of the basal mucosa from low humidity
  6. Deviation of nasal septum or septal perforation
  7. Bleeding polyp or the septum or lateral nasal wall
  8. Neoplasm of the nose or sinuses
  9. Vascular malformation
  10. Tumors of nasopharynx

Systematic causes:

  1. Hemophilia
  2. Hypertension
  3. Leukemia
  4. Liver disease
  5. Medications like aspirin, anticoagulation, anti-inflammatory
  6. Platelet dysfunction
  7. Thrombocytopenia

Initial first aid treatment:

  1. Tilt head forward to prevent posterior blood drainage.
  2. Apply continuous pressure by pinching nares together for 5-10 minutes.
  3. If no improvement, pack nose with vasoconstrictor-soaked gauze and a heavy coat of petroleum jelly for 10 minutes.
  4. In severe cases, a nasostat is inserted, a foley catheter device which provides the direst compression to the site via a balloon.
  5. Resuscitation with IV fluids or possibly blood transfusion may be necessary for severe blood loss to prevent hypovolemic shock.

Medical and surgical management:

  1. Application of direct pressures: The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure applied by pinching the soft fleshy part of the nose.
  2. The local application of a vasoconstriction agent has been shown to reduce the bleeding time in benign cases of epistaxis.
  3. Cautry: If These simple measures do not work then medical intervention may be needed to stop bleeding. In the first instances, this can take the form of chemical cautery of any bleeding vessels or packing of a nose with ribbon gauze or an absorbent dressing (called anterior nasal packing). Chemical cauterization is most commonly conducted using local application of silver nitrate compound to any visible bleeding vessels.
  4. Nasal packing
  5. Ligation of a bleeding point.

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