Nursing Clinical Practice Guide
Clinical Scenario: You are a nurse in a pediatric ED. A frantic mother brings in her 7-year-old son, whose shirt is stained with blood. He is crying and has blood actively dripping from his right nostril. He says he was playing and bumped his nose on a table.
Nursing Intervention Strategy:- 1Assessment & Immediate ActionQuickly don gloves. Calmly instruct the child, "Let's sit up here on the bed. I want you to lean forward a little, just like this." Use a calm, reassuring tone for both child and parent. Pinch the soft part of his nose firmly with your thumb and index finger. Instruct him to breathe through his mouth. Apply pressure for a full 10 minutes without releasing to check. Provide an emesis basin for any drips.
- 2Ongoing Monitoring & CareAfter 10 minutes, release pressure gently. If bleeding continues, reapply pressure for another 10 minutes. Assess for signs of significant blood loss (tachycardia, pallor, dizziness). Obtain vital signs. Apply a cold pack wrapped in a towel to the bridge of the nose to aid vasoconstriction.
- 3Patient Education and DischargeOnce bleeding stops, educate the child and parent: "For the next 24 hours, don't blow your nose hard, pick your nose, or do any rough play. If it starts again, just sit up, lean forward, and pinch like we did here for 10 minutes." Discuss using a humidifier and saline nasal spray if the air is dry.
Patient Safety and Precautions: Never leave a child with active epistaxis unattended. Monitor closely for airway compromise. Be aware of potential underlying causes like clotting disorders (e.g., hemophilia) or hypertension, especially in older patients, though less common in children.
Nursing Procedure & Medication Flow
Epistaxis First Aid Procedure:
1. Ensure personal protective equipment (PPE - gloves).
2. Position: Upright, head tilted slightly forward.
3. Action: Apply direct, continuous pressure to the soft part (ala) of the nose for 5-10 minutes.
4. Adjunct: Apply ice pack to nasal bridge.
5. Instruct patient to breathe through mouth and spit out any blood in the mouth.
6. After bleeding stops, avoid straining, nose blowing, or strenuous activity.If Medical Intervention is Needed: Prepare for provider to administer topical vasoconstrictors (e.g., phenylephrine spray) or apply silver nitrate for cautery. Assist with anterior nasal packing if ordered. Monitor for re-bleeding and provide analgesia if packing causes discomfort.
A Word from Your Senior Nurse
"In the hustle of the ED, a simple nosebleed can seem minor, but doing the right thing first makes all the difference. That forward-leaning position isn't just a textbook step—it's what keeps a scared kid from choking on blood. Always pair your skilled hands with a calm voice. Remember, your confidence reassures both the patient and the family. On the NCLEX, they love to test these 'first action' priorities, so know your ABCs (Airway, Breathing, Circulation) and how they apply to every scenario, even a bloody nose!"