This document outlines the educational objectives related to epistaxis, including its definition, causes, clinical manifestations, and management strategies. Epistaxis, or nosebleed, commonly arises from the anterior nasal cavity due to ruptured blood vessels and can be categorized into anterior and posterior types. Management involves re-establishing hemostasis through various medical and nursing interventions, including pressure application, medication, and, if necessary, surgical procedures.

1. DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. Learning objectives
At the end of this lecture, the students should be
able to
• define epistaxis.
• enlist the causes epistaxis
• describe the clinical manifestations of epistaxis.
• discuss the management of epistaxis.
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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.
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4. 4

5. 5

6. EPISTAXIS (NOSEBLEED)
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.
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7. Most commonly, the site is the anterior septum,
• the anterior ethmoidal artery on
the forward part of the roof
• the sphenopalatine artery in
the posterosuperior region, and
• the internal maxillary
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8. Types of Epistaxis
1. ANTERIOR EPISTAXIS (Most common
and less severe and easy to control)
2. POSTERIOR EPISTAXIS ( Less common
more severe and difficult to control)
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9. Causes and risk factors
• trauma,
• infection, (rhinitis, sinusitis, fever)
• inhalation of illicit drugs,(cocaine)
• cardiovascular diseases, (HTN)
• tumor,
• thrombocytopenia
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10. • Rendu- Osler- Weber syndrome
• low humidity,
• a foreign body in the nose, and
• a deviated nasal septum.
• Additionally, vigorous nose blowing and
nose picking.
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12. Clinical features
• continuous and intermittent bleeding
• Hemoptysis or Hematemesis
• anxiety
• shock
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13. Investigations
• Haemogram
• Test for coagulation (CT & BT)
• Radiography
• CT scan
• Endoscopy
• Biopsy
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14. Medical Management
• Management of epistaxis depends on
the location of the bleeding site.
• A nasal speculum or headlight-to determine the
site of bleeding in the nasal cavity.
• Most nosebleeds - anterior portion of the nose.
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15. • Initial treatment may include applying direct
pressure.
• The patient sits upright with the head tilted
forward to prevent swallowing and aspiration of
blood 15

16. 16

17. Directed to pinch the soft outer portion - the
midline septum for 5 or 10 minutes.
If this measure is unsuccessful, additional
treatment is indicated.
• silver nitrate applicator and Gelfoam, or by
electrocautery.
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18. • Topical vasoconstrictors, such as adrenaline
(11,000),
• cocaine (0.5%), and phenylephrine may be
prescribed.
• If bleeding -posterior regions,
• cotton pledgets soaked in a vasoconstricting
solution may be inserted into the nose.
• Suction 18

19. When the origin of the bleeding cannot be
identified,
• the nose may be packed with gauze
impregnated with petroleum jelly or
• antibiotic ointment;
• a topical anesthetic spray and
• decongestant agent.
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20. • 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.
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22. Surgical management
• Ligation
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23. Nursing Management
• The nurse monitors the vital signs,
• assists in the control of bleeding
• Assuring the patient in a calm, efficient manner
that bleeding can be controlled can help reduce
anxiety.
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24. TEACHING PATIENTS SELF-CARE
• Discharge teaching
• avoiding forceful nose blowing,
• straining, high altitudes, and nasal trauma.
• Adequate humidification may prevent drying of
the nasal passages.
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25. 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.
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26. • If recurrent bleeding cannot be stopped,
the patient is instructed to seek additional
medical attention.
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27. Summary
So far we have discussed about definition,
causes, clinical manifestations, and
managements of epistaxis.

28. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th
edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.
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29. Thank You