Fractures of the Nose - Upper Respiratory Airway

FRACTURES OF THE NOSE

The location of the nose makes it susceptible to injury by a wide variety of causes. In fact, nasal fractures are more common than those of any other bone in the body. Fractures of the nose usually result from a direct assault. As a rule, no serious consequences re-sult, but the deformity that may follow often gives rise to ob-struction of the nasal air passages and to facial disfigurement.

Clinical Manifestations

The signs and symptoms of a nasal fracture are bleeding from the nose externally and internally into the pharynx, swelling of the soft tissues adjacent to the nose, and deformity.

Assessment and Diagnostic Findings

The nose is examined internally to rule out the possibility that the injury may be complicated by a fracture of the nasal septum and a submucosal septal hematoma. Because of the swelling and bleeding that occur with a nasal fracture, an accurate diagnosis can be made only after the swelling subsides.

Clear fluid draining from either nostril suggests a fracture of the cribriform plate with leakage of cerebrospinal fluid. Because cerebrospinal fluid contains glucose, it can readily be differenti-ated from nasal mucus by means of a dipstick (Dextrostix). Usu-ally, careful inspection or palpation will disclose any deviations of the bone or disruptions of the nasal cartilages. An x-ray may re-veal displacement of the fractured bones and may help rule out extension of the fracture into the skull.

Medical Management

As a rule, bleeding is controlled with the use of cold compresses. The nose is assessed for symmetry either before swelling has oc-curred or after it has subsided. The patient is referred to a spe-cialist, usually 3 to 5 days after the injury, to evaluate the need to realign the bones. Nasal fractures are surgically reduced 7 to 10 days after the injury.

Nursing Management

The nurse instructs the patient to apply ice packs to the nose for 20 minutes four times each day to decrease swelling. The patient who experiences bleeding from the nose (epistaxis) because of in-jury or for unexplained reasons is usually frightened and anxious. The packing inserted to stop the bleeding may be uncomfortable and unpleasant, and obstruction of the nasal passages by the pack-ing forces the patient to breathe through the mouth. This in turn causes the oral mucous membranes to become dry. Mouth rinses will help to moisten the mucous membranes and to reduce the odor and taste of dried blood in the oropharynx and nasopharynx.