EPISTAXIS

Nealeth Nanquil

DEFINITION
The definition of a nosebleed is simply
bleeding from the blood vessels in the
nose. The medical term for nosebleed is
epistaxis
Nosebleeds are common due to the
location of the nose on the face, and the
large amount of blood vessels in the nose.

Two Categories of Epistaxis

Nosebleeds are categorized based on
where they originate, and are described as
either anterior (originating from the front of
the nose) or posterior (originating from the
back of the nose).

Signs and Symptoms

Dizzy
Nausea
Vertigo
Restless
Confuse
Syncope

Most common causes of

Nosebleed:
Anterior
1. Blowing Your Nose Too Hard
2. A Cold or Flu
3. Nasal Decongestants
4. Sinusitis
5. Picking Your Nose
6. Hot or Cold Weather
7. Allergies
8. High Altitude
9. Deviated Septum
10. Liver Disease
11. Alcohol and Drug Use

 Posterior
1. Certain Medications
2. Hypertension
3. Blood Disorders
4. Hardened Arteries
5. Tumors
6. Blow to the head
7. Nasal Surgery
8. Vitamin K Deficiency
9. Chemical irritants

 Epistaxis may result from the rupture of

tiny vessels in the anterior nasal septum;
this occurs most frequently in children and
adolescence. In adults it occurs more
commonly in men than in women; may be
severe in elderly persons; may be
accompanied by respiratory distress,
apprehension, restlessness, vertigo, and
nausea; and lead to syncope

Labs/Diagnosis:
The diagnosis of a nosebleed is generally
self-evident and apparent upon seeing the
patient, though some individuals may not
have any active bleeding by the time they
arrive to seek medical care.
To examine the nose, the health care
practitioner will place medications into the
nostrils (usually with a cotton ball) in order
to numb the inside of the nose and
constrict the blood vessels in that area.

Continuation
Laboratory tests are usually not needed.
For severe nosebleeds, however, a blood
count may be checked to assess the
degree of blood loss.
If there are concerns about malignancy or
other less common causes of nosebleeds,
further blood tests and/or imaging studies
may be considered.

Medications
Topical Vasoconstrictors
Topical vasoconstrictors act on alpha-adrenergic receptors in the nasal
mucosa, causing vessels to constrict.
Oxymetazoline
Anesthetics
When anesthetics are used concomitantly with vasoconstrictors, their
anesthetic effect is prolonged and the pain threshold increased.
Lidocaine
Antibiotic Agents
Antibiotic ointments help prevent local infection and provide local
moisturization.
Mupirocin ointment
Cauterizing Agents
Cauterizing agents coagulate cellular proteins, which can in turn reduce
bleeding.
Silver Nitrate

Nursing Diagnosis:
Risk for Ineffective Breathing Pattern or Ineffective Airway
Clearance
Interventions:
Assess the sound or the depth of breathing and chest movement.
Rational: Decreased breath sounds may lead to atelectasis, Ronchi,
and wheezing showed accumulation of secretions.
Note the ability to remove mucous / coughing effectively
Rational: bright lumpy or bloody sputum may result from damage to
lungs or bronchial injury.
Position Fowler's or semi-Fowler position.
Rational: Positioning helps maximize lung expansion and reduce
respiratory effort.
Clean secretions from the mouth and trachea
Rational: To prevent obstruction / aspiration.

How to prevent epistaxis?

Most nosebleeds occur during the winter in cold, dry
climates. If a person is prone to nosebleeds, use a
humidifier in the home. Petroleum jelly (Vaseline),
antibiotic ointment, or a saline nasal spray also may be
used to keep the nasal passages moist.
Try not to pick or blow the nose too vigorously.
If the nosebleed is related to an underlying medical
condition (for example, liver disease or a chronic sinus
condition), follow the health care practitioner's
instructions to keep these medical problems under
control

Home Management:
Remain calm.
Sit up straight and lean slightly forward.
Lean your head forward. Tilting your head back will only cause you
to swallow the blood.
Use your thumb and forefinger to firmly pinch the soft part of your
nose shut. The nose consists of a hard, bony part and a softer part
made of cartilage. Nosebleeds usually occur in the soft part of the
nose. Spraying the nose with a medicated nasal spray (such
as Afrin) before applying pressure may help stop a nosebleed. You
will have to breathe through your mouth.
Spit out any blood in the mouth. Swallowing blood may make the
affected individual vomit.

Continuation
Keep pinching for a full 10 minutes. Use a clock to time the 10
minutes. It can seem like a long time. Resist the urge to peek after a
few minutes to see if your nose has stopped bleeding.
Check to see if your nose is still bleeding after 10 minutes. If it is,
hold it for 10 more minutes. Most nosebleeds will stop after 10 to 20
minutes of direct pressure.
Put a thin layer of a saline- or water-based nasal gel, such as
NasoGel, or an antiseptic nasal cream inside your nose. Do not
blow your nose or put anything else inside your nose for at least 12
hours after the bleeding has stopped.
Rest quietly for a few hours.

Go to the hospital if the person with

the nosebleed:
is still bleeding after pinching the nose for 10 to 20
minutes;
is having repeated episodes of nosebleeds over a short
time or if a large amount of blood is lost;
feels dizzy or light-headed, or feels that they are going to
pass out;
has a rapid heartbeat or trouble breathing;
is vomiting blood;
has a rash or temperature greater than 101.4 F (38.5 C);
or
if a health care practitioner instructs you to go to a
hospital's emergency department.

Nurses Responsibility
Administers first aid.
Assists in cauterization and nasal packing.
Checks BP, pulse, and RR every half hour until bleeding
subsides and continues to check every 4 hours.
Limits activities, avoids serving milk and hot liquids.
Encourages expectoration rather than swallowing of
blood.
Reports symptoms of Respiratory distress, vertigo, and
bleeding.
Before the patient is discharged the nurse provides
instruction on the prevention of epistaxis by using
vaporizer and applying a water soluble gel with a cotton
swab gently to the mucous membrane.

Cauterize
To burn tissues by thermal heat, including
steam, hot metal, or solar radiation;
electricity; or another agent such as ; laser
pr dry ice, usually with the objective of
destroying damaged or diseased tissues,
preventing infections, or coagulating blood
vessels.

Cauterize

Balloon Nasal Packing

Anterior Nasal Packing