Epistaxis: Nursing Process (ADPIE)

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Notes

Transcript

Contributors

Evan Debevec-McKenney

Jessica Reynolds, MS

Ethan Porter is a 10-year-old student who was brought to the school nursing office by his gym teacher with a nosebleed.

Ethan was newly diagnosed with von Willebrand disease, and about 5 minutes ago, his nose suddenly started bleeding while he was running the track outside in gym class.

Epistaxis, or nose bleed, is caused by ruptured blood vessels in the nasal mucosa.

Up to 90% of epistaxis is anterior epistaxis where bleeding occurs in the anterior nasal cavity and the blood typically comes out of the nares.

Posterior epistaxis occurs in the superior or posterior nasal cavity so the blood usually goes down the throat.

In the anterior nasal cavity, numerous arteries in the face connect together to form the Kiesselbach’s plexus, also known as Little's area.

This blood vessel rich area is located on the nasal septum and is covered by a thin mucus membrane that offers little protection so dryness, irritation or even minor trauma, like nose picking, can lead to bleeding.

An intranasal mass and foreign bodies can also be causes.

The most common sign is visible bleeding, usually from one nostril.

After having the person gently blow their nose to clear blood clots, the nasal cavity is typically assessed with a light source and a nasal speculum to look for signs of active bleeding, excoriation, or scabbing.

Posterior epistaxis occurs further back in the nose, and the most common site is where blood vessels come together in the lateral wall of the nasal cavity to form the Woodruff’s plexus.

Since it’s located deeper in the nasal cavity, more severe head and nasal trauma can cause this type of epistaxis.

It is more serious than anterior epistaxis because the bleeding is often more severe and blood can go down the pharynx, esophagus and trachea.

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