UNIT1 EPISTAXIS PRESENTED BY Ms Pavithra K Lecturer

UNIT-1 EPISTAXIS PRESENTED BY: Ms. Pavithra K Lecturer, MSN dept

LEARNING OBJECTIVES At the end of the class students will be able to • define epistaxis • enlist the types of epistaxis • list down the causes of epistaxis • describe the patho-physiology of epistaxis • list down the clinical features of epistaxis • enumerate the management of epistaxis

INTRODUCTION • Nose bleed or nasal hemorrhage • Most often self limited • Serious and life threatening • Can occur in all age groups

DEFINITION • Epistaxis is defined as bleeding from the nostril, nasal cavity, or naso-pharynx due to the bursting of a blood vessel within the nose. • Epistaxis is a condition where there is active bleeding or acute hemorrhage from the nostril, nasal cavity or nasopharynx.

TYPES Anterior : • 90% of all cases • originating in the front of the nose • The most common site of anterior bleeding is in the nasal septum • Kiesselbach's plexus • Young population • Less severe and easy to control

Posterior : • originating from the back of the nose • Woodruffs plexus • Older population • The blood usually drains down the back of the throat instead of coming out the nostrils • Chance of aspiration of blood • Severe and difficult to control

ETIOLOGY Local causes • Spontaneous • Trauma – Finger nail trauma – Nose pricking – Blowing – Sneezing – Fracture of nasal bones – Barotrauma

• Foriegn bodies • Iatrogenic – Nasal canula, NG tube insertion, FESS • Inflammation/ Infection • Tumours – Polyps, malignant tumours • Telangiectasia • Higher altitude areas

SYSTEMIC CAUSES • Cardio vascular – Hypertension – Increased venous pressure • Coagulopathies – hemophilia – Thrombocytopenia • Drugs – Aspirin, warfarin, heparin

• Infection • Tuberculosis, syphillis • Connective tissue disorder • SLE • Vitamin C or K deficiency • Pregnancy

PATHOPHYSIOLOGY Etiology Increased pressure on the blood vessels Rupture Bleeding or hemorrhage

CLINICAL MANIFESTATIONS • Dark and bright red bleeding from one or both the nostrils • Trouble in breathing , smelling or talking if blood clots block nostrils • Headache • Confusion • Fainting • Dizziness • Weakness

DIAGNOSTIC EVALUATION • History collection • Nasal speculum examination • Nasal endoscopy • Angiography • CT scanning

MANAGEMENT Goals: • To arrest bleeding • To identify the cause • To prevent complications

FIRST AID • � Firmly pinch the entire soft part of the nose just above the nostrils. • � Sit and lean forward • � Breathe through the mouth. • Hold this position for 5 minutes. If bleeding continues, hold the position for an additional 10 minutes. • Trotter’s position

• Sit quietly keeping the head higher than the level of the heart. • Cold compression • Fluids

ASSESSMENT • • Type Duration and severity Amount of blood loss Nostrils – rt/lt Bleeding disorders Medical disorders Medications

MANAGEMENT • Packing • Anterior packing • Posterior packing

ANTERIOR PACKING • Bleeding is profuse • Ribbon gauze – 1 metre, 2. 5 cm wide • Liquid paraffin or petroleum jelly • Few centimetres of gauze is folded upon itself and inserted among the base of the nose or from front to back • Both nostrils • 48 -72 hrs

POSTERIOR PACKING • Posterior • Combination – anterior and posterior • Pack is prepared by tieing silk thread to a gauze rolled into cone shape. • It is inserted using catheter. • and tie the gauze cone and pull gently till the bleeding site • Then anterior packing is done

By foley’s catheter • Catheter is inserted into nose and brought through mouth • Inflate the balloon with air or water • gently pull the catheter till the bleeding site By epistaxis catheter • Both the baloons are inflated

Cauterization • Technique of burning a part of a body to close off bleeding area • Chemical or electrical • Silver nitrate

• Antibiotics – topical or oral – Cefotaxim, ceftriaxone • Analgesics – Diclo or tramadol • IV fluids – NS, DNS, RL • Blood transfusion

SURGICAL MANAGEMENT • Ligation of the blood vessels

NURSING MANAGEMENT • Identify the cause • Monitor for patient vital signs • Provide emesis basin to allow the patient to expectorate any excess blood. • Administer humidified oxygen by facemask • Stop anticoagulant therapy

• IV fluids • Trotters position or fowlers position • Administer medications • Blood tansfusion based on the blood loss • Aseptic measures to be followed during packing

NURSING DIAGNOSIS • Deficient fluid volume related to hemorrhage as evidenced by observation • Acute pain related to trauma as evidenced by pain scale score • Risk for Ineffective breathing pattern • Risk for Ineffective airway clearance • Risk for infection

CONCLUSION • Epistaxis also called acute hemorrhage or nose bleed is a medical condition in which bleeding occurs from the nasal cavity of the nostril. Nose bleed can occur due to a trauma to the nose, due to accident, or injury to the interior of the nose from pricking.

EVALUATION • • • What is Epistaxis List down the types of Epistaxis What are the causes of Epistaxis. Eneumerate the pathophysiology of Epistaxis Enlist the clinical features of Epistaxis. Explain the management of Epistaxis.

REFERENCE • Smeltzer – Brunner & Suddharth Textbook of Medical Surgical Nursing, Wolters kluwer publishers, 12 th edition 2009. • Black – Medical Surgical Nursing, Elsevier publishers, 8 th edition 2009. • Nettina – Lippincott manual of Nursing Practice, Wolters kluwer publishers, 7 th edition 2014. • Lewis – Medical Surgical Nursing, Elsevier publishers, 10 th edition, 2017