ER epistaxis POLICY OF CARE

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Information about ER epistaxis POLICY OF CARE
Health & Medicine

Published on February 17, 2014

Author: gamsoli

Source: slideshare.net

Description

Emergency department policy for supplying care to epistaxis patient, is among tens of others to reach an implementation of health care quality improvement

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A EPISTAXIS 14 - September - 2012 Prepared By Dr Gamal Soliman 1

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A DEFINITION It is a hemorrhage from the nose caused by rupture of tiny, distended vessels in the mucus membrane of any area of the nose. 14 - September - 2012 Prepared By Dr Gamal Soliman 2

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A OBJECTIVE 1. To control nose bleeding 2. To assess etiology 14 - September - 2012 Prepared By Dr Gamal Soliman 3

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A POLICY 1. Assessment of patients includes: 1.1 Airway status 1.2 Nasal bleeding 1.3 Site of bleeding 14 - September - 2012 Prepared By Dr Gamal Soliman 4

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A POLICY 1. Assessment of patients includes: 1.1 Airway status 1.2 Nasal bleeding 1.3 Site of bleeding 14 - September - 2012 Prepared By Dr Gamal Soliman 5

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 2. Vital signs are monitored and recorded. 3. Gloves must be worn throughout the procedure. 4. The nurse assists physician during the procedure. 14 - September - 2012 Prepared By Dr Gamal Soliman 6

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 5. Suction is done to remove excess blood and clots from the site of infection. 6. Causes of nose bleeding includes: 6.1 Local – Dryness leading to crust formation, trauma. 6.2 Systemic –hypertension, arteriosclerosis, renal disease bleeding disorders. 6.3 Posterior bleeds are more difficult to control. 14 - September - 2012 Prepared By Dr Gamal Soliman 7

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A MATERIALS & EQUIPMENT 1. Suction 2. Nasal pack tray – 3 sizes posterior packs 2.1 #12 RR catheter 2.2 (2) dental bolster 2.3 Scissors 2.4 Mayo clamp 3. Anterior nasal pack – Nasal speculum 3.1 Flashlight or ENT headlight 3.2 Packing forcep 3.3 2 x 2 gauze 14 - September - 2012 Prepared By Dr Gamal Soliman 8

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 4. Goose neck lamp with head mirror 5. Gloves 6. Suction 7. Emesis basin with tissue 8. Bowel of water 14 - September - 2012 Prepared By Dr Gamal Soliman 9

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A PROCEDURE RATIONALE 1. Monitor vital signs and record. 1. As data baseline 2. Wash hands and wear gloves. 2. To reduce transmission or microorganism. 3. Inspect with nasal speculum 3. To determine site of bleeding. 14 - September - 2012 Prepared By Dr Gamal Soliman 10

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 4. Collect blood for laboratory analysis 4. To exclude blood dyscrasia. 5. Explain the procedure to the patient instruct to breath gently. 5. To reduce anxiety and gain cooperation. 14 - September - 2012 Prepared By Dr Gamal Soliman 11

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 6. Pressure to the soft portion of the nose 5-10 minutes. If the patient is a child or not able to do it, the nurse will apply pressure on the nasal septum for 5-10 minutes. 6. Breathing through the mouth will prevent swallowing of blood. 14 - September - 2012 Prepared By Dr Gamal Soliman 12

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A PROCEDURE RATIONALE 7. Place the patient in an upright position leaning forward. 7. To reduce venous pressure. 8. Assist the physician during the Procedures. 8. To detect blood dyscrasias. 9. Provide IV access and draw blood for laboratory analysis. 14 - September - 2012 Prepared By Dr Gamal Soliman 13

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 9. To identify bleeding site. 10. Insert a cotton pledget soaked with a vaso-constricting agent into each nostril and removed after 5-10 minutes. If bleeding continues, nasal packing maybe applied. 10. To apply pressure over the large area. 14 - September - 2012 Prepared By Dr Gamal Soliman 14

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 11. Provide tissue and emesis basin 11. To allow patient expectorate any excess blood. 12. Assure the patient that the bleeding be can controlled. 12. Help reduce anxiety. 13. Teach the patient to aavoid forceful nose blowing, straining, high altitudes, and nasal trauma. 13. To prevent epistaxis. 14 - September - 2012 Prepared By Dr Gamal Soliman 15

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 16. 16. Document the procedure in the nurse's notes. To determine patients response to treatment. 17. Expedite admission, if required. 14 - September - 2012 Prepared By Dr Gamal Soliman 16

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A DISCUSSION 14 - September - 2012 Prepared By Dr Gamal Soliman 17

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 18

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 19

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 20

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 21

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 22

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 23

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 24

S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A 14 - September - 2012 Prepared By Dr Gamal Soliman 25

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