A client with hemophilia has a nosebleed. Which nursing action is most appropriate to control the bleeding?
A. Place the client in a sitting position with the head hyperextended
B. Pack the nares tightly with gauze to apply pressure to the source of bleeding
C. Pinch the soft lower part of the nose for a minimum of 5 minutes
D. Apply ice packs to the forehead and back of the neck
Correct Answer: C. Pinch the soft lower part of the nose for a minimum of 5 minutes
The client should be positioned upright and leaning forward, to prevent aspiration of blood. Usual sites of external bleeding may include the bleeding in the mouth from a cut, bite, or from cutting or losing a tooth; nosebleeds for no obvious reasons; heavy bleeding from a minor cut, or bleeding from a cut that resumes after stopping for a short time. Hemophiliacs do not bleed faster or more frequently. Instead, they bleed longer due to a deficiency of clotting factor. Clients are often aware of bleeding before clinical manifestation. Bleeding can be life-threatening to these clients.
Option A: Direct pressure to the nose stops the bleeding. Apply manual or mechanical pressure if active bleeding is noted. If spontaneous or traumatic bleeding is evident, monitor vital signs.
Option B: If a pack is necessary, the nares are loosely packed. Controlling bleeding is a nursing priority. Nasal packing should be avoided, because the subsequent removal of the packing may precipitate further bleeding.
Option D: Ice packs should be applied directly to the nose as well. Assess for any signs of bruising and bleeding (note the extent of bleeding). Assess for prolonged bleeding after minor injuries.