Chapter 72: Nasal Trauma Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child’s nose and displacement of the septum. What is the most important intervention initially?

a. Applying ice to the injured site to prevent airway occlusion b. Immobilizing the child’s head and neck and call 911 c. Placing nasal packing in both nares to stop the bleeding d. Turning the child’s head to the side to prevent aspiration of blood

ANS: B a. Computerized tomography (CT) scan of facial structures b. Ice packs to reduce facial swelling c. Surgery to reduce the nasal fracture

Nasal trauma resulting in loss of consciousness and possible neck injury are emergencies. The provider should take cervical spine precautions and call 911 for transport to an emergency room. The other interventions may be performed once the child’s head and neck are stable.

2. A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary initially?

NURSINGTB.COM d. Urgent drainage of the mass

ANS: D a. Assessment of tetanus vaccination b. Ice, head elevation, and analgesia c. Immediate nasal reduction surgery d. Involvement of social services

A rounded bluish or purplish mass indicates a septal hematoma and must be drained urgently for cosmetic purposes to prevent loss of nasal cartilage caused by loss of blood supply to this area. This patient has no signs of facial fractures, so this exam may be deferred. Ice packs are part of ongoing management, but not a priority. The nasal fracture may be reduced within the first 3 to 5 days after injury.

3. An alert, irritable 12-month-old child is brought to the emergency department by a parent who reports that the child fell into a coffee table. The child has epistaxis, periorbital ecchymosis, and nasal edema. Nares are patent, and the examiner palpates instability and point tenderness of the nasal septum. The orbital structures appear intact. What is an urgent action for this patient?

ANS: D

Young children and infants generally do not engage in activities that cause the high impact needed to cause a nasal fracture and nasal structures, which have more cartilage than adults, are at much lower risk of fracture. Child abuse must be suspected in this case. Assessment of tetanus status and application of symptomatic treatment may be ongoing but are not urgent. Nasal reduction surgery may be deferred for several days.