Epistaxis and its surgical and nursing management

epitaxis- its types, causes, sign and symptoms, diagnostic evaluation, surgical management and nursing management and its complication.it consist of images that will help in easy understanding of the topic. language is also easy to understand.

1. EPISTAXIS SUBMITTED TO: MRS. BIJAYATA SHARMA ASSOCIATE PROFESSOR SUBMITTED BY: MS. BHARTI SHARMA M.SC (N) 2 ND YR SGRRCON

2. Introduction: Epistaxis is common in children. In infant almost 30% of children have this problem. From 0 to 5 year old have epistaxis is 56%, from 6 to 10 yr old children have 64%.

3. definition: When one or two small veins in the nose erupt the resulting condition is nose bleed or epistaxis Bleeding occur usually from anterior- inferior portion of the cartilaginous nasal septum due to run capillary vasculature in this zone known as little area or kiesselbach’s plexus.

4. Types of epistaxis : Recurrent Epistaxis: - in recurrent nose bleeds, the episode of bloods happens only at certain periods of time. Recurrent nosebleed can be occur in seasonal pattern. Its most happen when the weather get hot and dry. Constant Epistaxis :- this is type of nosebleed that happens for a longer period of time. The bleeding is continuously occur.( 45min)

5. Cont…. Sudden epistaxis :- These are nosebleeds which could happen anytime of the day, regardless of the activity of the child. Whether the child resting or playing. Chronic epistaxis :- condition that are continuously experienced for more then 6month. Chronic bleeding happen as result of a chronic disease this include, Chronic liver or kidney disease, vascular malformation, long term use medication.

6. Cont… Heavy nosebleed:- heavy nosebleeds pertain to episodes where there is a significant amount of blood coming out of the nose. Only this type is seen immediate first aid treatment must be employed.

7. Causes:- The common causes in children are:- Major trauma Nose pricking Foreign body in the nose Nasal injury Nasal polyp Rhinitis Nasal diphtheria Nasopharyngeal tumors Nasal spray abuse Hot summer month

8. Cont…. Other systemic causes:- Leukemia Hemophilia Ingestion of aspirin Vitamin K deficiency Ca deficiency Nephritis Solar radiation Acute infections Thrombocytopenia

9. Sign & symptoms:- Bleeding usually starts from one nostrils. In case of heavy bleeding, it may fill up both the nostrils and overflow the nasopharynx . In certain cases, blood may drip back from the nose through the throat to stomach.

10. Complication:- Hypotension Shock Anemia Secondary infection

11. Diagnostic evaluation:- Complete blood count Coagulation studies Angiography Endoscopy MRI X ray

12. Management:- First aid measures:- Keep the patient quiet Place the patient in a sitting position, leaning forward, semifowler position. Apply direct pressure by pinching the entire soft lower portion of the nose for 10 to 15min. Apply icepack to the nose and check area. Loosing clothes and giving reassurance. Partially insert a small gauze pad into the nose.

13. Cont…. Bleeding nostril and apply digital pressure if bleeding continues. Take medical treatment if bleeding dose not stop.

14. Medical management:- Identification of bleeding site by a nasal speculum or headlight. Application of a vasoconstrictive agent. Cauterization Nasal packing

15. Cont…. Anterior nasal bleeding:- Silver nitrate application gelform Electrocauterization Topical vasoconstrictor adrenaline(1:100) creaine (0.5%) phenylephrine Posterior nasal bleeding:- Posterior nasal packing impregnate with a vaso constricting solution.

16. Cont….. Cotton tempon Suction to remove the blood clots Radiologic embolization of the artery Ligation of the internal maxillary artery.

17. Nursing management Monitor vital signs. Assisting in the control of bleeding . Provide tissue paper and cotton. To instruct child to avoid aspiration of blood. Nasal packing may alter respiration status so closely monitor respiratory rate, heart rate, rhythm, LOC Instruct the child to avoid vigarous nasal blowing, strenous activity, or lifting straining for4-6 weak.

18. Cont… Also instructed to avoid nasal blowing or picking nose after nosebleed, Instructions to be given to the parents to apply lubricant to nasal septum twice daily to reduce dryness. Advice to were loose garments

19. Thank you