• assess airway/breathing frequently
• monitor for edema, pain
• assess swallowing frequency (Freq swallowing may indicate bleeding)
• monitor for CSF leaks
• Teach pts to avoid Valsalva maneuvers, sniffing or blowing of nose, and NSAIDs/ASA
• Utilize humidifier to prevent drying of the mucous membranes

observe for edema and bleeding

check vitals q4h until pt is discharged

assess how often the pt swallows

use a penlight to examine the throat for bleeding

• position the pt upright and leaning forward to prevent blood from entering the stomach and possible aspiration
• reassure the patient and attempt to keep him or her quiet to reduce anxiety and blood pressure
• apply direct lateral pressure to the nose for 5 minutes, and apply ice or cool compresses to the nose and face if possible
• maintain standard precautions
• if nasal packing is necessary, loosely pack both nares with gauze or nasal tampons
• to prevent rebleeding from dislodging clots, instruct the pt not to blow the nose for several hours after the bleeding stops
• seek medical assistance if these measures are ineffective or if the bleeding occurs frequently

• pain
• lump in the mouth, throat, or neck
• difficulty swallowing
• folor changes in the mouth or tongue to red, white, gray, dark brown, or black
• oral lesion or sore that does not heal in 2 weeks
• persistent or unexplained oral bleeding
• numbness of the mouth, lips, or face
• change in the fit of dentures
• burning sensation when drinking citrus juices or hot liquids
• persistent, unilateral ear pain
• hoarseness or change in voice quality
• persistent or recurrent sore throat
• shortness of breath
• anorexia and weight loss

• hoarseness
• a breathy, weak voice
• aspiration of food

• stridor
• airway obstruction
• it's a medical emergency