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)
2.
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.
12.
13.
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.
