Epistaxis, commonly known as nosebleed, is a frequent medical condition that nurses encounter in both emergency and primary care settings. While most cases are benign and self-limiting, proper nursing assessment and intervention are crucial for optimal patient outcomes. This comprehensive guide explores the nursing diagnoses, care plans, and evidence-based interventions for managing patients with epistaxis.
Understanding Epistaxis
Epistaxis occurs in approximately 60% of the general population, with about 6% requiring medical intervention. The condition is classified into two main types:
Anterior Epistaxis
- Occurs in the front portion of the nasal septum (Kiesselbach’s plexus)
- Accounts for 90% of all nosebleeds
- Generally easier to control
- Often responds well to direct pressure
Posterior Epistaxis
- Originates deeper in the nasal cavity
- More common in older adults
- Usually requires medical intervention
- Associated with higher risk of complications
Risk Factors and Causes
Several factors contribute to the development of epistaxis:
Age-Related Factors:
- Children (2-10 years): Due to nose picking and trauma
- Adults (45-65 years): Related to medication use and vascular conditions
- Elderly: Increased risk due to vascular diseases
Medical Conditions:
- Hypertension
- Coagulation disorders
- Liver disease
- Thrombocytopenia
Environmental Factors:
- Low humidity
- Temperature changes
- Altitude changes
- Chemical irritants
Medications:
- Anticoagulants
- Antiplatelet agents
- Nasal sprays
- NSAIDs
Nursing Care Plans for Epistaxis
Below are five essential nursing care plans for managing patients with epistaxis, each tailored to address specific aspects of patient care.
1. Risk for Ineffective Breathing Pattern
Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to epistaxis and posterior blood flow as evidenced by difficulty breathing through nose and presence of blood in posterior pharynx.
Related Factors:
- Bleeding into the posterior pharynx
- Anxiety
- Position-related compromised airway
- Blood clot formation
Nursing Interventions and Rationales:
- Position patient upright with head slightly forward
Rationale: Prevents blood aspiration and allows visualization of bleeding - Monitor respiratory rate and oxygen saturation
Rationale: Early detection of respiratory compromise - Maintain patent airway
Rationale: Ensures adequate oxygenation - Prepare suction equipment
Rationale: Ready for immediate intervention if needed
Desired Outcomes:
- The patient maintains a patent airway
- Oxygen saturation remains >95%
- No signs of respiratory distress
2. Risk for Deficient Fluid Volume
Nursing Diagnosis Statement:
Risk for Deficient Fluid Volume related to active bleeding as evidenced by decreased blood pressure and increased heart rate.
Related Factors:
- Active epistaxis
- Anticoagulation therapy
- Underlying bleeding disorders
- Prolonged bleeding time
Nursing Interventions and Rationales:
- Monitor vital signs every 15 minutes during active bleeding
Rationale: Early detection of hemodynamic instability - Establish IV access and initiate fluid replacement
Rationale: Ensure adequate circulation - Track blood loss volume
Rationale: Assess severity and need for transfusion - Monitor CBC and coagulation studies
Rationale: Evaluate blood loss and clotting function
Desired Outcomes:
- Stable vital signs
- Adequate urine output
- Normal skin turgor
- No signs of shock
3. Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to tissue trauma and pressure from nasal packing as evidenced by verbal reports of discomfort and facial grimacing.
Related Factors:
- Nasal tissue trauma
- Pressure from interventions
- Inflammation
- Nasal packing
Nursing Interventions and Rationales:
- Assess pain using the appropriate scale
Rationale: Establish a baseline and monitor the effectiveness of interventions - Administer prescribed pain medication
Rationale: Provide comfort and reduce anxiety - Apply a cold compress to the bridge of the nose
Rationale: Reduce inflammation and discomfort - Position patient comfortably
Rationale: Minimize pressure and promote comfort
Desired Outcomes:
- The patient reports decreased pain
- Demonstrates improved comfort
- Uses effective pain management strategies
4. Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about epistaxis management as evidenced by incorrect demonstration of nose-pinching technique.
Related Factors:
- Limited exposure to the condition
- Misunderstanding of management techniques
- Anxiety interfering with learning
- Language barriers
Nursing Interventions and Rationales:
- Assess current knowledge level
Rationale: Identify learning needs - Demonstrate proper nose-pinching technique
Rationale: Ensure correct application of pressure - Provide written instructions
Rationale: Reinforce verbal teaching - Review prevention strategies
Rationale: Reduce recurrence risk
Desired Outcomes:
- Correctly demonstrates first-aid techniques
- Identifies warning signs requiring medical attention
- Verbalizes understanding of prevention strategies
5. Risk for Anxiety
Nursing Diagnosis Statement:
Risk for Anxiety related to the acute bleeding episode as evidenced by expressed concern and increased vital signs.
Related Factors:
- Visible bleeding
- Fear of recurrence
- Lack of control
- Previous negative experiences
Nursing Interventions and Rationales:
- Maintain calm demeanor
Rationale: Reduce patient anxiety - Provide clear, concise explanations
Rationale: Increase understanding and control - Teach relaxation techniques
Rationale: Help manage anxiety - Include family in education
Rationale: Enhance support system
Desired Outcomes:
- Demonstrates reduced anxiety levels
- Uses effective coping strategies
- Verbalizes understanding of the condition
Prevention and Education
Essential patient education topics include:
- Proper nose-blowing technique
- Avoiding nose picking
- Using humidifiers in dry environments
- Proper use of prescribed medications
- Recognition of warning signs
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Beck R, Sorge M, Schneider A, Dietz A. Current Approaches to Epistaxis Treatment in Primary and Secondary Care. Dtsch Arztebl Int. 2018 Jan 8;115(1-02):12-22. doi: 10.3238/arztebl.2018.0012. PMID: 29345234; PMCID: PMC5778404.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Janapala, R. N., Tran, Q. K., Patel, J., Mehta, E., & Pourmand, A. (2022). Efficacy of topical tranexamic acid in epistaxis: A systematic review and meta-analysis. The American Journal of Emergency Medicine, 51, 169-175. https://doi.org/10.1016/j.ajem.2021.10.043
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Tabassom A, Dahlstrom JJ. Epistaxis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435997/
