EPISTAXIS

OVERVIEW AND PATHOPHYSIOLOGY

Epistaxis is the medical term for nosebleed. Any trauma to the face can cause
bleeding which may profuse. Nosebleeds can occur spontaneously when the nasal
membranes dry out, crust and crack, as is common in dry climates or during winter
months. Nosebleeds can be divided into primary or secondary. Primary nosebleeds are
idiopathic and spontaneous. Secondary bleeds have clear and definite causes like
trauma or anticoagulation use.

Due to external trauma, foreign bodies, blaring of

nose, picking of nose

Allergic rhinitis or sinusitis

Result in strain of emotional excitement or physical

exercise may be enough to start nose bleeding

A circulatory renal or emotional condition that

produces elevated BP may cause nasal hemorrhage

It leads to rheumatic fever, a blood dyscrasia or an

infection
SYMPTOMS
 Severe bleeding from the nostrils associated with faint and weak
 Excessive blood loss include; dizziness, weakness, confusion and fainting

CAUSES
 Trauma
 Exposure to warm, dry air for prolonged periods of time
 Nasal and sinus infections
 Allergic rhinitis
 Nasal foreign body (object stuck in the nose)
 Vigorous nose blowing
 Nasal surgery
 Deviated or perforated nasal septum
 Cocaine use
 Medications side effects
 Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and
inherited blood clotting disorders
 Vascular malformations
 High blood pressure

RISKS FACTORS
 Dry weather and low humidity
 Oxygen dependence
 Septal deviation

COMPLICATIONS
 Sinusitis
 Septal hematoma/perforation
 External nasal deformity
 Mucosal pressure necrosis
 Vasovagal episode
 Balloon migration
 Aspiration
PREVENTION
 Avoid picking the nose and keep fingernails short
 Blow the nose as little as possible
 Keep home humidified
 Wear headguard during activities where nose or head could get injured
NURSING INTERVENTIONS
Nursing Diagnosis Nursing Intervention Rationale
Ineffective airway  Assess airway for - Maintaining patent
clearance related to patency. airway is always the
excessive or thick first priority,
secretions secondary to especially in cases
allergy like trauma, acute
neurological
decompensation or
cardiac arrest.

 Auscultate lungs for - Abnormal breath

presence of normal
or adventitious
breath sounds.
sounds can be
heard as fluid and
mucus accumulate.
This may indicate
ineffective airway
clearance.

 Assess respirations. - A change in the

Note quality, rate, usual respiration
pattern, depth, may mean
flaring of nostrils, respiratory
dyspnea on compromise. An
exertion, evidence increase in
of splinting, use of respiratory rate and
accessory muscles, rhythm may be
and position for compensatory
breathing. response to airway
obstruction.

 Note for changes in Increasing lethargy,

mental status. confusion, restlessness
and irritability can be initial
signs of cerebral hypoxia.
Lethargy and somnolence
are late signs.
 Note for changes in - Increased work of
HR, BP, and breathing can lead
temperature. to tachycardia and
hypertension.
Retained secretions
may be a sign of an
existing infection or
inflammatory
process manifested
by fever.

 Assess hydration - Airway clearance is

status; skin turgor, impaired with poor
mucous membranes hydration and
and toungue subsequent
secretion
thickening.