Emergency department policy for supplying care to epistaxis patient, is among tens of others to reach an implementation of health care quality improvement

1. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
EPISTAXIS
14 - September - 2012
Prepared By Dr Gamal Soliman
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2. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITION
It is a hemorrhage from the nose caused by
rupture of tiny, distended vessels
in the mucus membrane of any area of the
nose.
14 - September - 2012
Prepared By Dr Gamal Soliman
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3. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To control
nose bleeding
2. To assess
etiology
14 - September - 2012
Prepared By Dr Gamal Soliman
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4. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Assessment of
patients includes:
1.1 Airway status
1.2 Nasal bleeding
1.3 Site of bleeding
14 - September - 2012
Prepared By Dr Gamal Soliman
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5. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Assessment of
patients includes:
1.1 Airway status
1.2 Nasal bleeding
1.3 Site of bleeding
14 - September - 2012
Prepared By Dr Gamal Soliman
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6. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. Vital signs are monitored and
recorded.
3. Gloves must be worn
throughout the procedure.
4. The nurse assists physician
during the procedure.
14 - September - 2012
Prepared By Dr Gamal Soliman
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7. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. Suction is done to remove excess blood and
clots from the site of infection.
6. Causes of nose bleeding includes:
6.1 Local – Dryness leading to crust formation,
trauma.
6.2 Systemic –hypertension, arteriosclerosis, renal
disease bleeding
disorders.
6.3 Posterior bleeds are more difficult to control.
14 - September - 2012
Prepared By Dr Gamal Soliman
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8. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS & EQUIPMENT
1. Suction
2. Nasal pack tray – 3 sizes
posterior packs
2.1 #12 RR catheter
2.2 (2) dental bolster
2.3 Scissors
2.4 Mayo clamp
3. Anterior nasal pack –
Nasal speculum
3.1 Flashlight or ENT
headlight
3.2 Packing forcep
3.3 2 x 2 gauze
14 - September - 2012
Prepared By Dr Gamal Soliman
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9. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
4. Goose neck lamp
with head mirror
5. Gloves
6. Suction
7. Emesis basin with
tissue
8. Bowel of water
14 - September - 2012
Prepared By Dr Gamal Soliman
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10. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE RATIONALE
1. Monitor vital signs and record.
1. As data baseline
2. Wash hands and wear gloves.
2. To reduce transmission or microorganism.
3. Inspect with nasal speculum
3. To determine site of bleeding.
14 - September - 2012
Prepared By Dr Gamal Soliman
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11. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
4. Collect blood for laboratory analysis 4. To
exclude blood dyscrasia.
5. Explain the procedure to the patient
instruct to breath gently. 5. To reduce anxiety
and gain cooperation.
14 - September - 2012
Prepared By Dr Gamal Soliman
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12. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6. Pressure to the soft portion
of the nose 5-10 minutes.
If the patient is a child or not able to do it,
the nurse will apply pressure
on the nasal septum for 5-10 minutes.
6. Breathing through the mouth will prevent swallowing of
blood.
14 - September - 2012
Prepared By Dr Gamal Soliman
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13. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE RATIONALE
7. Place the patient in an upright position
leaning forward. 7. To reduce venous pressure.
8. Assist the physician during the Procedures.
8. To detect blood
dyscrasias.
9. Provide IV access and draw blood for
laboratory analysis.
14 - September - 2012
Prepared By Dr Gamal Soliman
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14. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
9. To identify bleeding site.
10.
Insert a cotton pledget soaked with
a vaso-constricting agent
into each nostril and removed
after 5-10 minutes. If bleeding continues,
nasal packing maybe applied.
10. To apply pressure over the large area.
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Prepared By Dr Gamal Soliman
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15. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
11. Provide tissue and emesis basin
11. To allow patient expectorate any excess
blood.
12. Assure the patient that the bleeding be can
controlled.
12. Help reduce anxiety.
13. Teach the patient to aavoid forceful nose blowing,
straining, high altitudes, and nasal trauma.
13. To prevent epistaxis.
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Prepared By Dr Gamal Soliman
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16. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
16.
16.
Document the procedure
in the nurse's notes.
To determine patients response to treatment.
17. Expedite admission, if required.
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Prepared By Dr Gamal Soliman
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17. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DISCUSSION
14 - September - 2012
Prepared By Dr Gamal Soliman
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18. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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19. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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20. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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21. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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22. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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23. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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24. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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25. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
14 - September - 2012
Prepared By Dr Gamal Soliman
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