Epistaxis

1. EPISTAXIS

2. DEFINITION
It is defined as bleeding from the nose it is
common and found in all age groups

3. CLASSIFICATION
 Anterior epistaxis – when blood flows out
from the front of the nose with the patient in
sitting position
 Posterior epistaxis – mainly the blood flows
back in to the throat patient swallow it and
later have a coffee coloured vomitus and it
expelled out through the vomiting.

4. ETIOLOGY
• Trauma
• Finger nail trauma
• Injury to nose
• Intra nasal surgery
• Fractures to the skull
• Chronic mose picking
• Infections
• Viral infections
• Sinusitis
• T.B

5. FOREIGN BODIES
 Leech
 Food piece
 Coins
 Tumour of the nose
 Atmospheric pressure changes in the altitudes
 Dns
General causes
Hyper tension
Anemia
Leuckemia
Haemophilia

6. CLINICAL MANIFESTATIONS
 Recurrent episodes of bleeding
 Nasal obstruction
 Mouth breathing
 Hypotension
 Increased pulse rate

7. DIAGNOSTIC EVALUATION
 Sinus x-ray
 CBC
 Rhinoscopy
 Nasopharyngoscopy

8. MANAGEMENT
Assessment
1. Mode of onset
2. Duration and frequency of bleeding
3. Amount of blood loss
4. Any known bleeding tendency in the
patient or the family
5. History of drug intake

9. GENERAL TREATMENT
 First aid
 Cauterization
 Anterior nasal packing
 Posterior nasal packing

10. FIRST AID
Initial treatment of epistaxis is the
application of the pressure by pinching the
anterior portion of the nose for a minimum
of 8-10 mins

14. CAUTERIZATION
Application of ice compress produces
vasoconstriction may decrease bleeding, if
this initial method is don’t stop bleeding
nasal packing may be necessary.

15. ANTERIOR NASAL PACKING
For the client with anterior epistaxis anterior
nasal packing should be done. For this use
ribbon gauze soaked with liquid paraffin.
Pack can be removed after 24 hrs if bleeding
has stopped sometimes it has been repeated
for 2-3 days

17.  Sit up and lean forward
 Using thumb & index finger, squeeze soft part
of nose (this is between end of nose and the
bridge of nose)
 Continue holding until bleeding stops
 Ask the patient to take breath through nose.
 If bleeding continues, hold for another 10
minutes
 If the patient is a child, divert attention by
TV/stories
 Avoid picking, blowing or rubbing nose for the
next 3 days
 Place an ice pack on the bridge of nose

18. GENERAL MEASURES OF EPISTAXIS
 Make the patient sit up with a back rest and
record any blood loss taking place through
vomiting
 Check the vital signs
 Blood transfusion may be done if needed
 Antibiotics may be given to prevent
infection
 Mild sedation may be given
 Administer the oxygen if needed
 Treat the patient for any local or general
cause

19. Reference
 Ansari Javed .Text book of medical and surgical nursing-I.
3rd ed. Punjab: P V books (p) Ltd;2017. p 93-95
 Lewis, Herhamper, Diralosen, Brien O, Bacher, Medical
surgical nursing, 7th Ed. Philadelphia: Mosby publications;
2009.p .421-422
 https://en.wikipedia.org/wiki/epistaxis .
Thank you