EPISTAXIS.pptx
- 1. BY: M R S . A R U N A P A T E L N U R S I N G T U T O R A M B A J I N U R S I N G C O L L E G E EPISTAXIS (NOSE BLEEDING)
- 3. Introduction •Bleeding from inside the nose is called epistaxis •Fairly common and is seen in all age groups. “Epistaxis refers to nose bleed or hemorrhage from the nose”. • It‘s mostly commonly originates in the anterior portion of the nasal cavity.
- 4. Definition •A hemorrhage from the nose, referred to as epistaxis, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
- 5. Types of Epistaxis 1. ANTERIOR EPISTAXIX (Most common and less severe and easy to control) 2. POSTERIOR EPISTAXIX ( Less common more severe and difficult to control)
- 6. Causes of Epistaxis •There are a variety of causes associated with epistaxis, including: trauma, infection, inhalation of illicit drugs, cardiovascular diseases, blood dyscrasias, nasal tumors, low humidity, a foreign body in the nose, and a deviated nasal septum. •Additionally, vigorous nose blowing and nose picking have been associated with epistaxis.
- 7. Pathophysiology and Etiology 1. Local causes: a) Dryness leading to crust formation-bleeding occurs with removal of crusts by nose picking, rubbing, or blowing. b) Trauma – direct blows c) Infections (Acute: viral rhinitis, nasal diphtheria, acute sinusitis.) d) Foreign bodies (Non-living: any neglected foreign body)
- 8. d. Atmospheric changes. High altitudes, sudden decompression (Caisson’s disease). e. Deviated nasal septum (DNS). 2. Systemic causes are less common : a)Hypertension b) arteriosclerosis c) renal disease d) Bleeding disorders e) Idiopathic f) Liver disease- hepatic cirrhosis g) Disorders of blood and blood vessels- Aplastic anemia, leukemia, thrombocytopenic and vascular purpura, hemophilia, Christmas disease, scurvy, vitamin K deficiency.
- 9. Diagnostic Evaluation 1. History : including amount of blood loss, duration of blood loss medications history ,Side of nose from where bleeding is occurring and any known bleeding tendency in the patient or family. 2. Care full inspection with nasal speculum to determine site of bleeding ( its very important to determine which site of bled first.) 3. Laboratory investigations to exclude blood dyscrasias and coagulopathy.
- 10. Medical Management client with epistaxis Management of epistaxis depends on the location of the bleeding site. A nasal speculum or headlight may be used to determine the site of bleeding in the nasal cavity. Most nosebleeds originate from the anterior portion of the nose. Initial treatment may include applying direct pressure.
- 11. First aid •Little’s area- pinching the nose with thumb and index finger for about 5 minutes- compression of vessels. •Trotter’s method- patient is made to sit, leaning a little forward over a basin to spit any blood, and breathe quietly from mouth- cold compresses should be applied to nose to cause reflex vasoconstriction.
- 14. If this measure is unsuccessful, additional treatment is indicated. In anterior nosebleeds, the area may be treated with a silver nitrate applicator and Gelfoam, or by electrocautery. • Topical vasoconstrictors, such as adrenaline or cocaine (0.5%), and phenylephrine may be prescribed. If bleeding is occurring from the posterior regions, cotton pledgets soaked in a vasoconstricting solution may be inserted into the nose to reduce the blood flow and improve the examiner’s view of the bleeding site.
- 15. 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. When the origin of the bleeding cannot be identified, the nose may be packed with gauze impregnated with petrolatum jelly or antibiotic ointment; a topical anesthetic spray and decongestant agent may be used prior to inserting the gauze packing, or a balloon-inflated catheter may be used. •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 because of the risk of iatrogenic sinusitis and toxic shock syndrome.
- 16. Nursing Management 1. The nurse monitors the vital signs, assists in the control of bleeding, and provides tissues and an emesis basin to allow the patient to expectorate any excess blood. It is not uncommon for patients to be anxious in response to a nosebleed. 2. Monitor vital sings & assist with control of bleeding. Assess for changes in BP and pulse indicative of hypovolemia. 3. Assuring the patient in a calm, efficient manner that bleeding can be controlled can help reduce anxiety. 4. Instructs to the client to avoid blowing or picking nose after a nose bleed. 5. Discharge teaching includes reviewing ways to prevent epistaxis: avoiding forceful nose blowing, straining, high altitudes, and nasal trauma (including nose picking). 6. Monitor the client with posterior packing for hypoxia. 7. Adequate humidification may prevent drying of the nasal passages. 8. The nurse instructs the patient how to apply direct pressure to the nose with the thumb and the index finger for 15 minutes in the case of a recurrent nosebleed. If recurrent bleeding cannot be stopped, the patient is instructed to seek additional medical attention.
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