Nosebleeds

CanIcallmymom, BSN, RN · Apr 12, 2019

I have them stay in my office. If I don't, they want to constantly check it and rub it, and get blood everywhere. Almost every significant nose bleed that comes to my office, I swear they just let it drip down the hall the whole way to my office. And these are high schoolers.

k1p1ssk, BSN, RN · Apr 12, 2019

If they are younger (pre-k - 2nd grade) I usually keep them until the bleeding has stopped and start educating about nosebleed prevention and stoppage while they are sitting. I have them "manage" it by themselves if they are capable, which is usually the case by the second half of kindergarten...

Kids older than that, if it is simply that they blew their nose and a little blood came out or a quick nosebleed that doesn't "gush", I tell them they don't even need to come to me unless the bleeding cannot be stopped in class without making a mess... i.e. bleeding so much/so fast that it starts streaming down their face/into their hands.

At the beginning of the year, I was seeing a ton of kids that would run into my office yelling they had a nosebleed, and I think they would see a little blood and make the same exclamation in class and the teacher would assume the worse and send them down immediately. By educating them on what constitutes a "nurse-worthy" nosebleed, these types of visits have stopped almost all together.

OyWithThePoodles, RN · Apr 12, 2019

If it is just a little on the inside of the nare and not dripping I will tell them to clean up and head back. Otherwise I have them stay. I've had some that have lasted upwards of 20 minutes, it would stop, kid would wash their hands and it would drain again.

ETA: Most of the nosebleeds that come in think they have to lean their head back to get it to stop, which isn't a good idea, so I will educate on the proper way to sit, hold the nose, etc.

jnemartin, BSN, RN · Apr 12, 2019

6 minutes ago, k1p1ssk said:
"nurse-worthy" nosebleed

Haha! Yes, this is sort of why I brought this up!

Typically I give instruction and have them manage it in my office until the bleeding has stopped - but most often the bleeding has stopped by the time they arrive. The kids want to linger and I'm not sure why.

I have tried to think of all angles; of course they may be avoiding class, but they also may be embarrassed to have a nosebleed in class, or the teacher may be freaked out by a few drops of blood, and escalate the situation by demanding they run to the nurse.

Two situations made me rethink my approach. First was a 7th grader with a nosebleed that started after school and had stopped by the time she got to my office. She wanted to linger and, selfishly, I wanted to go home! Ultimately I observed her for 10 minutes (no bleeding) and sent her on her way with tissues. The second case was a 12th grader who had an extraordinarily long nosebleed - upwards of 40 minutes off and on. After about 20, I considered sending her back to class because she was missing so much instruction, but didn't want her to be embarrassed by bleeding in class.

It's that "season" now, and I'm considering changing up my approach of letting them stay so long. But I'm so interested to hear how everyone else manages!

jnemartin, BSN, RN · Apr 12, 2019

11 minutes ago, OyWithThePoodles said:
ETA: Most of the nosebleeds that come in think they have to lean their head back to get it to stop, which isn't a good idea, so I will educate on the proper way to sit, hold the nose, etc.

I had a student who asked if she could lie down. Um, no.

BrisketRN, BSN, RN · Apr 12, 2019

For big drippy nose bleeds if under 3rd grade I will don gloves and pinch that nose for 3-5 minutes until bleeding stops, I'll repeat the "no picking or blowing you nose today." If 3rd grade or over I'll have them stand over my bathroom sink and explain how to pinch their nose. If they can't get it to stop then I'll pinch for them. For the big nose bleeds a giant clot usually comes out, and I'd rather that happens in the nurse's office than in class or the hallway. I've also sent out the attached notice to all staff after a few incidences of our school looking like a crime scene.

Guidelines For Nosebleeds.pdf

jnemartin, BSN, RN · Apr 12, 2019

2 minutes ago, BiscuitRN said:
For big drippy nose bleeds if under 3rd grade I will don gloves and pinch that nose for 3-5 minutes until bleeding stops, I'll repeat the "no picking or blowing you nose today." If 3rd grade or over I'll have them stand over my bathroom sink and explain how to pinch their nose. If they can't get it to stop then I'll pinch for them. For the big nose bleeds a giant clot usually comes out, and I'd rather that happens in the nurse's office than in class or the hallway. I've also sent out the attached notice to all staff after a few incidences of our school looking like a crime scene.
Guidelines For Nosebleeds.pdf

Great resource! Simple and clear!

SaltineQueen · Apr 12, 2019

They stay. I'm K-3. I want to make sure it's really done & that their hands & clothes are cleaned up. Usually, it's just 10ish minutes.

Ever have a kid have such a bad nosebleed that it comes out their tear ducts? That's pretty startling the first time! ?

Queen of Icepacks, RN · Apr 12, 2019

I actually had one this year that we had to send to ER. Lost at least 2 units of blood. Gushing over my hand for over 20 minutes. I thought for sure that the ER would cauterize it but they didn't. It started bleeding again the next day.

NutmeggeRN, BSN · Apr 12, 2019

14 minutes ago, Queen of Icepacks said:
I actually had one this year that we had to send to ER. Lost at least 2 units of blood. Gushing over my hand for over 20 minutes. I thought for sure that the ER would cauterize it but they didn't. It started bleeding again the next day.

Von Willebrands??

RatherBHiking, BSN, RN · Apr 12, 2019

1 hour ago, CanIcallmymom said:
I have them stay in my office. If I don't, they want to constantly check it and rub it, and get blood everywhere. Almost every significant nose bleed that comes to my office, I swear they just let it drip down the hall the whole way to my office.

This is my kids except grade school. The more blood the more attention. I even have teachers bring me kids in as the kids hold their hand under their nose (not pinching) all the way from the playground or class dripping blood clear down the hall. ? I had to send an email to staff to not be stupid ( I did not say that but I thought it!) and have all kids PINCH their nose on the way here. Plus my grade school kids will not pinch for very long without letting go so most of the time I pinch if for them for 2 min straight without letting go and that usually stops it. I've since bought some disposable nose pinchers so I don't have to stand there and hold it myself. Then I make them wash their hands with strict instructions not to blow their nose the rest of the day.