Pharmacology Skin Meds #3

Question

A client arrives to the emergency department with unrelieved epistaxis. Basic efforts to halt bleeding are ineffective, and the nurse anticipates which treatment to be used first to help control the bleeding?

Answers

  1. Silver nitrate
    • Rationale:

      This answer is correct because silver nitrate is a chemical substance placed in the nose by means of a swab in a client with epistaxis when other basic efforts, including pinching the nose, have been unsuccessful. The bleeding area is touched with the swab in an attempt to slow and stop bleeding. Silver nitrate is considered a “chemical cauterization” and is attempted first before electrical cauterization. Silver nitrate is less invasive but can be ineffective (compared to electrical cautery) for major nosebleeds since the c

  2. Hypertonic irrigation
    • Rationale:

      This answer is not correct because hypertonic solution irrigation will irritate the mucosa and increase bleeding. Silver nitrate is a chemical substance placed in the nose by means of a swab in a client with epistaxis when other basic efforts, including pinching the nose, have been unsuccessful.

  3. Normal saline irrigation
    • Rationale:

      This answer is not correct because normal saline solution irrigation will irritate the mucosa and increase bleeding. Silver nitrate is a chemical substance placed in the nose by means of a swab in a client with epistaxis when other basic efforts, including pinching the nose, have been unsuccessful.

  4. Cotton into the entrance of both nares.
    • Rationale:

      This answer is not correct because cotton in the nares of the client with epistaxis is not recommended. Packing gauze can be used with petroleum jelly or antibiotic ointment and may be in place for 2-6 days. Furthermore, cotton applicators soaked in a vasoconstricting solution like epinephrine may be used.

Overview

Silver nitrate is a chemical cauterization used to control bleeding in the nose when other basic efforts have been unsuccessful.

Explanation

The correct answer is A. Management of epistaxis may include cautery with silver nitrate or electrocautery. Selection B and C are incorrect as hypertonic irrigation will irritate the mucosa and increase bleeding. Selection D is incorrect. Cotton itself is not placed into the nose, but cotton applicators soaked in vasoconstricting solution like epinephrine may be used. Packing gauze may include petroleum jelly or antibiotic ointment and may be in place for 2-6 days.

Learning Outcomes

Silver nitrate is a chemical substance placed in the nose by means of a swab in a client with epistaxis when other basic efforts, including pinching the nose, have been unsuccessful. The bleeding area is touched with the swab in an attempt to slow and stop bleeding. Silver nitrate is considered a “chemical cauterization” and is attempted first before electrical cauterization. Silver nitrate is less invasive but can be ineffective for major nosebleeds since the chemical can come off of the skin. Electrical cauterization is a technique used to burn the blood vessel closed with an electrical current. This is most effective but most invasive, compared to chemical cautery through use of silver nitrate swabs.

Test Taking Tip

Be sure to choose the least invasive approach first, before most invasive, unless the condition is emergent and requires more invasive interventions.

Video Rationale