Epistaxis : Epistaxis Conducted by: Ms.Monika Clinical instructor Army college of nursing Définition : Définition Epistaxis is defined as acute hemorrhage from the nostril, nasal cavity, or nasopharynx. Patients with epistaxis commonly present with an elevated blood pressure. Epistaxis is more common in hypertensive patients Epistaxis is more prevalent in dry climates and during cold weather due to the dehumidification of the nasal mucosa by home heating systems. Etiology : Etiology Epistaxis may be the result of : Irritation Trauma Infection Foreign bodies Tumors EPISTAXIS MAY ALSO BE TE RESULT OF : Atherosclerosis Hypertension Treatment: chemotherapy or anticoagulants Others : Others Blowing the nose very hard Chemical irritants Direct injury to nose, including a broken nose Nose picking Repeated sneezing Upper respiratory infection Very cold or very dry air Pathopysiology : Pathopysiology The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes lining the inside of the nose, forming crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose. The lining of the nose is more likely to become dry and irritated from low humidity, allergies , colds , or sinusitis . nosebleeds occur more frequently in the winter when viruses are common and heated indoor air dries out the nostrils. A deviated septum, foreign object in the nose, or other nasal blockage can also cause a nosebleed. Medical management : Medical management 90% of nose bleed are anterior , Most occuring in children & Young adults. Anterior Epistaxis is initially treated by assissting the client to a sitting position. Apply pressure by pinching the anterior portion of the nose for a minimum of 5 to 10 mins. The application of ice compression to produce vasoconstriction may also reduce bleeding. If more definitive ,Treatment is necesary ,anterior epitaxis can usually be controlled by cauterization of the bleeding vessel with the application of silver nitrate. Cont…………..d: Cont…………..d cauterization is the process of destroying tissue using heat conduction from a metal probe heated by electric current. The procedure is used to stop bleeding from small vessels (larger vessels being ligated ) or for cutting through soft tissue. Cont………………..d: Cont………………..d If these measures donot stop the bleeding ,nasal packing may be inserted unilaterally or bilaterally. Antibacterial ointment is applied to half inch gauze ,which is then gently but firmly inserted into the anterior nasal cavities to apply pressure to the bleeding vessel. Nasal packing should remain for a minimum of 48 to 72 hours. 10% of nose bleed are posterior ,usually occuring in persons older than 50 years. Cont…………………….d: Cont…………………….d Insertion of posterior plug is very uncomfortable and mild analgesics may be required anxiety & discomfort. HOME CARE: HOME CARE Sit down and gently squeeze the soft portion of the nose between your thumb and finger (so that the nostrils are closed) for a full 10 minutes. Lean forward to avoid swallowing the blood and breathe through your mouth. apply cold compresses or ice across the bridge of the nose. Do NOT pack the inside of the nose with gauze. Lying down with a nosebleed is not recommended. You should avoid sniffing or blowing your nose for several hours after a nosebleed. Nursing management : Nursing management Client with a posterior plug & anterior nasal packing may be admitted to the hospital & monitored closely for hypoxia. The presence of posterior packing may alter consciousness & respiratory status ,especially in older adult. As hypertension is frequently a risk factor for epistaxis ,monitor the client’s blood pressure. Monitor the client closely for any manifestation of airway obstruction bleeding from the anterior . Prophylactic antibiotics are used to prevent infection & sinusitis. Surgical management: Surgical management If anterior & posterior packs fails to control epistaxis internal maxillary surgical artery ligation may be required. An incision is made in the gum line above the affected side. The artery that supplies the area of the bleeding is identified and metal clip or suture is used to ligate the artery. Nursing management of the surgical client: Nursing management of the surgical client The client is instructed to minimize activity for approximately 10 days ,such as avoiding strenuous exercise ,not blowing the nose ,sneezing with the mouth open The pt mouth should be rinsed with half strengthen hydrogen peroxide mixed with water for oral hygiene.