A patient arrives at an Emergency OPD with active bleeding from the nose. Which of the following actions would the nurse perform to prevent further bleeding?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

The correct action is to advise the patient to pinch the soft part of the nose.
This maneuver applies direct, continuous pressure to Kiesselbach's plexus, a highly vascular area on the anterior nasal septum where most nosebleeds originate.
Compressing these blood vessels is the most effective first-aid measure to promote hemostasis (stop bleeding) and allow a stable clot to form.

Option A: Sneezing violently increases intranasal pressure, which can dislodge any forming clots and exacerbate the bleeding.
Option B: While positioning the patient upright is a crucial part of management to prevent aspiration of blood, it is not the primary action that stops the bleeding. Direct pressure is the hemostatic intervention.
Option C: Instructing the patient to blow their nose is contraindicated as it will dislodge any fragile clots that are beginning to form, thereby restarting or worsening the bleeding.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing First-aid management of epistaxis (nosebleed) in acute care settings.
Knowing the correct first-aid for epistaxis is a fundamental nursing skill essential in emergency departments, schools, and community health settings to manage a common and often frightening event.
A critical nursing instruction is to have the patient lean forward, not backward. Leaning back can cause blood to drain into the pharynx, leading to nausea, vomiting, or aspiration.
What if? If the patient reports they are taking an anticoagulant medication (e.g., warfarin, apixaban), the nurse should instruct them to apply pressure for a longer duration (at least 15-20 minutes) and recognize a higher likelihood of needing further medical intervention like nasal packing or cautery.

How to Approach the Question

First, identify the core clinical problem presented in the stem: a patient with an active nosebleed (epistaxis).
Next, understand the question's goal: to identify the nursing action that will 'prevent further bleeding,' which means stopping the current hemorrhage.
Recall the basic principles of hemostasis: bleeding is stopped by pressure, which allows for clot formation.
Evaluate each option against this principle:
Does sneezing or blowing the nose apply controlled pressure? No, it increases pressure and dislodges clots.
Does raising the head apply pressure? No, it's a positioning maneuver to prevent complications like aspiration.

Concept Tested & Keywords

Concept Tested: First-aid management of epistaxis (nosebleed).
Stem keywords: active bleeding, nose, Emergency OPD, prevent further bleeding
Lead-in keywords: perform
Clinical cues: The patient presenting with active bleeding from the nose indicates an ongoing case of epistaxis that requires immediate first-aid intervention.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 42-44

Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.