Nursing Prioritization Delegation Assignment Q 51
You are supervising an RN who was pulled from the medical-surgical floor to the emergency department. The nurse is providing care for a patient admitted with anterior epistaxis (nosebleed). Which of these directions would you clearly prove to the RN? Select all that apply.
A. Position the patient supine and turned on his side.
B. Apply direct lateral pressure to the nose for 5 minutes.
C. Maintain universal body substances precautions.
D. Apply ice or cool compresses to the nose.
E. Instruct the patient not to blow the nose for several hours.
Correct Answers: B, C, D, and E.
Epistaxis (nasal bleeding) is relatively common but rarely fatal. Anterior bleeding is usually managed by digital pressure, gentle chemical cauterization, or nasal packing. Posterior bleeding, which is less common, is characterized by massive bleeding that’s initially bilateral; this bleeding may be more difficult to control.
Option A: Have the patient sit upright with her head tilted forward, and instruct her to apply direct external digital pressure to the nares with her index finger and thumb. The correct position for a patient with an anterior nosebleed is upright and leaning forward to prevent blood from entering the stomach and avoid aspiration. All of the other instructions are appropriate according to best practice for emergency care of a patient with an anterior nosebleed.
Option B: Tell her to breathe through her mouth while she holds firm pressure on the soft flesh of her nose for at least 10 minutes. If bleeding persists, cotton pledgets soaked in a vasoconstrictor and anesthetic will be placed in the anterior nasal cavity, and direct pressure should be applied at both sides of the nose.
Option C: Put on protective gear, including gown, gloves, and face shields. Provide an emesis basin and tissues. Tell her to spit blood into the basin if necessary. This helps prevent nausea and vomiting and lets you estimate the amount of bleeding.
Option D: Cooling the nape of the neck is said to induce reflex constriction of the mucosal vessels of the nose, but there is no general agreement in the literature on the benefit of an ice pack as an adjuvant treatment of epistaxis.
Option E: The nasal packing will be left in place for 3 to 5 days. Instruct the patient to avoid exerting herself, forcefully blowing her nose, or bending over. She should also avoid NSAIDs, alcoholic beverages, and smoking for 5 to 7 days. Tell her to apply water-soluble ointment to her lips and nostrils while packing is in place and to use a cool-mist room humidifier. Advise her to take steps to prevent constipation and straining, which increases the risk of bleeding.