Assess patency by occluding one nostril at a time and having the patient breathe through the other.
For epistaxis, note whether it is anterior or posterior, estimate the volume, and apply firm continuous pressure to the soft part of the nose with the patient leaning forward, timing the pressure.
Inspect the nares and the external nose and, where visible, the anterior mucosa for a bleeding source, dryness, or crusting.
Palpate over the frontal and maxillary sinuses for tenderness where sinusitis is suspected.
Inspect the skin under and around the cannula — the nares, the columella, and behind the ears — for pressure marks and breakdown.
Confirm the current anticoagulant or antiplatelet regimen and measure the blood pressure when epistaxis is present.
Assess humidification and mucosal moisture where the patient is on oxygen or reports dryness.
For a large-volume, posterior, or uncontrolled bleed, escalate rather than continuing a full exam.
