Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
NURSING CARE
Nursing Assessment
During a nursing assessment for epistaxis in children, the following factors should be evaluated:
1. History
Gather information about the child's medical history, including any previous episodes of
nosebleeds, family history of bleeding disorders, recent illnesses, allergies, trauma to the nose,
or any medications the child is taking.
2. Symptoms
Assess the severity and duration of the nosebleed. Determine if the bleeding is from one nostril or
both, and whether the bleeding is intermittent or continuous. Inquire about the frequency of
nosebleeds and any associated symptoms such as dizziness, lightheadedness, or fainting.
3. Vital signs
Measure the child's blood pressure, heart rate, and respiratory rate to assess for signs of
hypovolemia or hemorrhagic shock in severe cases of epistaxis.
4. Physical examination
Inspect the nasal cavity for any signs of bleeding, such as blood on tissue or clothing, and
determine the location of the bleeding. Assess for any abnormalities of the nose or nasal septum.
Check for signs of acute or chronic inflammation, such as redness, swelling, or discharge.
5. Bleeding disorders
Evaluate the child for any signs or symptoms of bleeding disorders, such as easy bruising,
prolonged bleeding after minor injuries, or excessive bleeding during dental procedures.
6. Coagulation profile
If recurrent or severe nosebleeds are present, a coagulation profile may be ordered to assess the
child's clotting factors and rule out underlying bleeding disorders.
7. Psychological impact
Assess the child's emotional state in response to the nosebleeds. Some children may experience
anxiety or fear due to the bleeding episodes, which may require appropriate support and
reassurance.
8. Education and prevention
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Provide education to the child and their parents or caregivers about prevention strategies for
nosebleeds, including proper nasal hygiene, avoidance of irritants, adequate humidification of
the environment, and instructions on conservative management and first aid techniques in case
of future nosebleeds.
Nursing Diagnosis
When assessing a child with epistaxis, the following nursing diagnoses may be applicable:
1. Risk for Impaired Gas Exchange: This diagnosis is appropriate if the child experiences heavy or
prolonged bleeding, which can lead to potential respiratory compromise, such as difficulty
breathing or decreased oxygen saturation.
2. Acute Pain related to mucosal injury and bleeding: This diagnosis is applicable if the child
experiences pain or discomfort during the episode of epistaxis.
3. Risk for Deficient Fluid Volume related to blood loss: This diagnosis is suitable for children who
experience significant blood loss during the episode, leading to a risk of hypovolemia and
dehydration.
4. Anxiety related to the fear of recurrent nosebleeds: This diagnosis is applicable if the child
experiences anxiety or fear due to the occurrence or anticipation of future nosebleeds.
5. Knowledge Deficit related to prevention measures and management of nosebleeds: This diagnosis
is appropriate if the child, parent, or caregiver lacks sufficient knowledge about preventive
measures for nosebleeds, as well as appropriate management techniques and when to seek
medical attention.
Planning
When planning nursing care for a child with epistaxis, the following goals and interventions may be
considered:
1. Goal: Ensure airway patency and adequate gas exchange.
● Monitor respiratory status, oxygen saturation, and vital signs.
● Position the child in an upright position to facilitate breathing.
● Administer supplemental oxygen if necessary.
● Initiate emergency management protocols if severe respiratory distress is present.
2. Goal: Relieve pain and discomfort.
● Provide comfort measures such as applying a cold compress to the bridge of the
nose.
● Administer analgesics as prescribed to alleviate pain.
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
● Offer distractions or diversion techniques to help the child cope with discomfort.
3. Goal: Minimize bleeding and prevent re-bleeding.
● Instruct the child and caregivers about proper nosebleed management techniques, such as
pinching the nostrils together and leaning forward to avoid swallowing
blood.
● Teach the child to avoid picking the nose or blowing the nose forcefully.
● Encourage the use of saline nasal sprays or nasal gel to keep the nasal mucosa moist and prevent
drying and irritation.
● Advise the child and caregivers to maintain adequate humidity in the environment, especially
during dry seasons.
● Educate the child about strategies to prevent or reduce exposure to irritants, such as smoke or
dust.
4. Goal: Provide education and support.
● Educate the child and caregivers about the underlying causes and risk factors for
epistaxis.
● Teach preventive measures, such as proper nasal hygiene and the avoidance of
trigger factors.
● Provide written instructions for home care management of nosebleeds.
● Offer emotional support to the child and caregivers to alleviate anxiety related to recurrent
nosebleeds.
5. Goal: Collaborate with the healthcare team.
● Communicate any abnormalities or concerns identified during
the nursing
assessment to the healthcare provider for further evaluation or intervention.
● Collaborate with other healthcare professionals, such as an otolaryngologist (ENT specialist), for
specialized evaluation or treatment if recurrent or severe epistaxis
persists.
Nursing Interventions
When it comes to nursing interventions for epistaxis in children, there are several evidence-
based strategies that can be implemented. Proper management of epistaxis in children involves both
immediate interventions during an episode and long-term measures to prevent recurrence.
Immediate interventions during an episode of epistaxis may include:
1. Positioning: Help the child sit upright and lean forward slightly. This position helps minimize
swallowing of blood and reduces the risk of aspiration.
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
2. Pressure and Compression: Instruct the child to pinch their nostrils together just below the bony
part of the nose and apply gentle pressure for 10-15 minutes. Encourage them to breathe through
the mouth during this time.
3. Cold Compress: Applying a cold compress or ice pack wrapped in a cloth to the bridge of the nose
can help constrict blood vessels and reduce bleeding.
4. Humidification: Increasing humidity in the surrounding environment can help prevent drying and
irritation of the nasal mucosa. This can be achieved using a humidifier or by placing a bowl of water
near a heat source.
Long-term preventive measures may include:
1. Nasal Moisturization: Advise the child to use saline nasal sprays or petroleum jelly to keep the nasal
mucosa moist and prevent drying and irritation.
2. Nasal Hygiene: Teach the child to avoid picking the nose or blowing the nose forcefully, as these
actions can aggravate the nasal lining and increase the risk of
epistaxis.
3. Avoidance of Trigger Factors: Educate the child and parents on identifying and avoiding triggers
that may contribute to nosebleeds, such as exposure to dry air, irritants (e.g., smoke, dust), certain
medications, or nasal trauma.
MEDICAL AND SURGICAL MANAGEMENT
Medical Management
The medical management of epistaxis in children typically involves a combination of conservative
measures and, in some cases, more invasive interventions. Here's an outline of medical management
strategies:
1. Initial Management:
● Positioning: Instruct the child to sit upright and lean forward to prevent blood from flowing
down the throat, reducing the risk of aspiration.
● Direct Pressure: Apply firm pressure to the soft lower part of the nose, just above the nostrils,
for approximately 10-15 minutes to stop the bleeding.
● Nasal Packing: If bleeding persists, nasal packing with absorbable materials (e.g., petroleum
gauze, nasal tampons) may be necessary to achieve
hemostasis.
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
2. Treatments:
● Topical Vasoconstrictors: Application of topical vasoconstrictors such as oxymetazoline or
phenylephrine can help constrict blood vessels and control bleeding. These agents are
typically administered via nasal spray or soaked cotton pledgets.
● Topical Hemostatic Agents: Products containing agents like thrombin or fibrin glue may be
applied topically to promote clot formation and stop
bleeding.
3. Cauterization:
● Chemical Cautery: Silver nitrate sticks or electrocautery can be used for chemical or thermal
cauterization of bleeding vessels in the nasal mucosa.
● Surgical Cautery: If conservative measures fail, surgical cauterization under local or general
anesthesia may be performed, particularly for recurrent or refractory cases.
4. Systemic Medications:
● Tranexamic Acid: Oral or intravenous tranexamic acid, an antifibrinolytic agent, may be
considered in cases of recurrent or severe epistaxis, especially in patients with underlying
bleeding disorders.
● Desmopressin (DDAVP): In patients with von Willebrand disease or mild hemophilia,
desmopressin may be administered intravenously or intranasally to temporarily increase
plasma levels of von Willebrand factor and factor VIII, promoting hemostasis.
5. Preventive Measures:
● Nasal Moisturization: Use of saline nasal sprays or nasal gels to keep the nasal mucosa moist
and reduce the risk of mucosal irritation and bleeding.
● Humidification: Employing humidifiers in indoor environments to maintain adequate humidity
levels and prevent nasal dryness.
● Avoidance of Nasal Trauma: Educate children and caregivers about the importance of avoiding
nasal trauma, such as nose picking or vigorous blowing of the nose.
6. Referral and Consultation:
● Referral to an otolaryngologist or hematologist may be warranted for further evaluation and
management, particularly in cases of recurrent, severe, or refractory epistaxis or suspicion of
an underlying bleeding disorder.
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
Surgical Management
1. Cauterization:
● Chemical Cautery: Application of silver nitrate sticks for chemical cauterization of
bleeding vessels in the nasal mucosa.
● Electrocautery: Use of electrically heated instruments for thermal cauterization of
bleeding vessels, particularly useful for targeting specific bleeding points.
2. Nasal Packing:
● Anterior Nasal Packing: Placement of nasal packs (e.g., absorbable gelatin sponge, nasal
tampons) into the anterior nasal cavity to apply pressure and tamponade bleeding
vessels.
● Posterior Nasal Packing: Placement of balloon catheters or specialized packing materials
into the posterior nasal cavity in cases of posterior
epistaxis.
3. Nasal Surgery:
● Septoplasty: Surgical correction of deviated nasal septum or nasal septal perforations
contributing to recurrent epistaxis.
● Endoscopic Sinus Surgery: Functional endoscopic sinus surgery (FESS) for underlying sinus
disease or nasal polyps associated with epistaxis.
● Nasal Fracture Reduction: Reduction of nasal fractures in cases of traumatic
epistaxis.
4. Embolization:
● Transarterial Embolization (TAE): Minimally invasive procedure involving selective
catheterization and embolization of bleeding arteries, often the branches of the internal
maxillary artery, in refractory or severe cases of
epistaxis.
5. Ligation:
● Ligation of Nasal Arteries: Surgical ligation of specific nasal arteries, such as the
sphenopalatine artery, in cases of refractory epistaxis not responsive to other
interventions.
6. Adenoidectomy:
Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
● Surgical removal of the adenoids in children with recurrent epistaxis associated with
adenoid hypertrophy or chronic adenoiditis.
REFERENCES
● Lee, S., & Hur, D. G. (2020). Pediatric Epistaxis. Korean Journal of Otorhinolaryngology-Head and
Neck Surgery, 63(1), 8-15.
● Nosebleed (Epistaxis) in children. (2023, November 6). Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/nosebleeds
● Phn, A. C. R. B. (2022, December 31). Epistaxis Nursing Diagnosis and Nursing Care Plan. Retrieved
from https://nursestudy.net/epistaxis-nursing-diagnosis/
● Stanford Medicine Children’s Health. (n.d.). Retrieved from
https://www.stanfordchildrens.org/en/topic/default?id=epistaxis-nosebleeds-in-ch ildren-90-
P02052
● Tunkel, D. E., Anne S. (2019). Epistaxis in children: Management. UpToDate. Retrieved from
https://www.uptodate.com/contents/epistaxis-in-children-management
● Vieira, F., Allen, J., Liang, J., & Bizaki, A. J. (2020). Epistaxis management. In StatPearls [Internet].
StatPearls Publishing.
● Villines, Z. (2019, February 25). When to see a doctor if a child has a nosebleed. Retrieved from
https://www.medicalnewstoday.com/articles/324536
