Tuesday, March 11, 2008

EPISTAXIS


DESCRIPTION

Ø The most common causes of which are

nose picking and injury

ETIOLOGY

Ø Epistaxis may be spontaneous or may

result from trauma (usually nose picking)

Ø It also may be be associated with chemical

irritation, acute or chronic infection (such as

rhinitis or sinusitis), purpura, leukemia and

other blood dyscrasias, hypertension,

anticoagulant therapy, or deviated septum.

PATHOPHYSIOLOGY

Ø In children, epistaxis usually originated in the

anterior nose and tends to be mild. In adults,

it tends to originate in the posterior nose and

be more severe.

Ø Slight to moderate epistaxis usually causes

no complications; however, severe bleeding

(persisting longer than 10 minutes after

pressure is applied) may cause blood up to

1 L/hr

ASSESSMENT FINDINGS

Ø Clinical manifestation may include:

1. Bleeding through the nares, blood tricking

into the oropharynx

2. Blood in the corner of eyes (through the

lacrimal ducts)

3. Blood in the auditory canal if the tympanic

membrane is perforated

Ø Diagnostic Findings:

1. Nasal inspection with a bright and speculum

may locate the source of bleeding.

2. Artery legation may be required for anterior

posterior packs fail to control epistaxis.

NURSING INTERVENTIONS

Ø Instruct client to minimize activity for

approximately 10 days, such as avoiding

strenuous exercises, not blowing the nose;

sneezing with the mouth open; and not

lifting; stooping, or straining.

TREATMENT MODALITIES

Important step to prevent nosebleed include:

Ø Avoiding picking the nose

Ø Bleeding usually can be controlled at home by

pinching the sides of the nose together for 5 to

10 minutes

Ø Icepacks to the nose

Ø Putting wads of tissue paper in the nostrils

Ø And placing the head in various position are not

effective

NURSING MANAGEMENT

Ø Interventions to control bleeding, as follow:

1. Instruct patient to sit upright, breathe through

the mouth, and refrain from talking.

2. Instruct patient to compress the soft outer

portion of the nares against the septum for 5

to 10 minutes.

3. Instruct patient to avoid nose blowing during

or after the episode.

METHODS OF PREVENTION

Ø If pressure does not control bleeding, insert

anterior packing or posterior pack as

appropriate. Keep scissors and hemostat on

hand to cut the string and remove the

packing in the event of airway obstruction.

Ø Monitor bleeding: inspect for blood trickling into the posterior pharynx; observe for hemoptysis, hematemesis.

Ø Frequent swallowing or belching; instruct the patient not to swallow but to spit out any blood.

Ø If indicated, provide information regarding electrocautery.

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