Chapter 30 Diseases of the Nose Certain images and/or photos in this presentation are the copyrighted property of ArtToday, Inc. and are being used with permission under license. These images and/or photos may not be copied or downloaded without permission from ArtToday, Inc. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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Epistaxis Air enters the body through the nose or the mouth. The nose warms, moistens, and filters the air that we breathe in. The nasal mucosa is supplied with many blood vessels that lie close to the surface where they can be injured and bleed.

Causes of Epistaxis Traumatic Causes Medical Causes Foreign body Nose picking Facial and nasal surgery Facial trauma Dry, heated, indoor air Dry, hot, low-humidity climates Allergies Sinusitis Hypertension Bleeding disorders Upper respiratory infection Chemical irritants Vitamin K deficiency Use of drugs that thin the blood Causes of a nosebleed, also called epistaxis, can be caused by trauma or medical conditions. Although the most common cause of epistaxis is nose picking, in many cases the cause of the bleeding is unknown.

Assessment Findings and Symptoms Bleeding from the nose Possible vomiting Localized pain or tenderness may be present Typical assessment findings and symptoms associated with epistaxis include bleeding from the nose, which can range from a trickle to a strong flow of blood. Significant bleeding can result in an airway obstruction if the patient is unresponsive. Vomiting may be present if the patient swallowed blood. Localized pain or tenderness may be present, particularly if nasal bleeding was caused by trauma.

Emergency Care

Anterior Nosebleed Bleeding vessel in front part of nose Usually easy to control Pinch fleshy part of nostrils together for 15 min Most nosebleeds come from a bleeding blood vessel in the front of the nose. This is called an anterior nosebleed and is usually easy to control. Do not put anything in the nose to try to control bleeding. If the patient can help you, have her sit up and lean her head forward. This helps to keep blood from draining into the back of the patient’s throat. If the patient cannot sit up, have her lie down with her head raised. Tell the patient to breathe through her mouth. Pinch the fleshy part of the patient’s nostrils together with your thumb and two fingers for 15 minutes.

Posterior Nosebleed Bleeding vessel in back part of nose Occurs most often in older adults Difficult to control Rapid transport Treat for shock if present Some nosebleeds come from a bleeding blood vessel in the back of the nose. This type of nosebleed is called a posterior nosebleed. A posterior nosebleed occurs most often in older adults. This type of nosebleed is difficult to control, and the patient can develop shock. A patient with a posterior nosebleed needs rapid transport to the hospital. Treat for shock if present.

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