Case Studies

Case 14: A person with epistaxis (Part 16 Ear, nose and throat)

Mrs Dolores Cotton is aged 69 years and lives with her husband in a semi-detached house on the outskirts of a village. The couple live quietly as Mrs Cotton is rather frail. Her past medical history includes left ventricular failure due to hypertension and she has received anti-hypertensive therapy and digoxin. In the last month Mrs Cotton has felt unwell and thinks this is related to her medication, so she has decided to have a rest from it. One day she develops a severe headache and two hours later starts to have a seizure. Her husband becomes anxious and contacts the GP. The doctor examines her and advises urgent transfer to hospital for treatment, as simple measures fail to arrest the haemorrhage. Mr Cotton travels with his wife in the ambulance and notices that she is getting paler and is sweating.

On arrival at the accident and emergency department the following observations are made:

• Nose bleeding profusely
• Skin pale, cold and clammy
• Pulse rate raised, 120 beats per minute
• Blood pressure 150/90 mmHg
• Respirations difficult to count as she is spitting out blood

To decrease venous congestion the nurse helps Mrs Cotton to lean forward so that the blood may run straight from the nose into a bowl. The doctor attempts to find the bleeding point, with the help of his head mirror, a good light source and suction. He finds it impossible to discover the bleeding point so prepares to pack the nasal cavity and commences an intravenous infusion.

The nasal pack is inserted into the bleeding nostril. She is prescribed a sedative and antibiotics and the doctor arranges for Mrs Cotton to be transferred to the ear, nose and throat ward. Mrs Cotton is prescribed oxygen therapy.

• 1. What are the reasons why a person may require a blood transfusion? What are the roles and responsibilities of the nurse before, during and after a blood transfusion?

• 2. What is the first aid treatment for person with an epistaxis?

• 3. What advice is given to people who are taking anticoagulant therapies?

• 4. How does the nurse ensure that the administration of oxygen is safe and effective?

Consider this situation, where Mrs Cotton's condition deteriorates and she is losing a large amount of blood. Her pulse rate is 145 beats per minute, her blood pressure is 86/60 mm/Hg, she is pale cold and clammy and she has not passed urine in the last two hours. What nursing interventions need to be instigated to reduce the potential complications associated with hypovolaemic shock?