Ah, the joys of the school nursing profession! Where else can you experience the thrill of a lice outbreak while simultaneously soothing math test tummy troubles? School nurses have seen it all as seasoned professionals – from the truly worrisome to the laughably benign. Yet, even with years of experience, some injuries demand a closer look. Nasal injuries – those playground collisions and gym class mishaps – can leave you pondering, "Is this just a bloody nose, or something more?"

School nurses know kids are magnets for bumps, bruises, and the occasional face-plant. In fact, accidental falls are the leading cause of nasal injuries in elementary school children. Fortunately, most of those precious little noses are more cartilage than bone, acting like built-in shock absorbers. This means you're less likely to encounter an actual fracture in the younger set. However, as children grow, sports-related injuries take center stage, and the potential for a nasal fracture increases, particularly in adolescents.

Let's break down (no pun intended!) the signs and symptoms that should raise your school nursing intuition antennae when evaluating nasal injuries:

• Obvious Deformity: If the nose appears twisted, flattened, crooked, or otherwise misshapen, it's a pretty clear sign of a potential fracture.
• The Painful Truth: While a simple bloody nose might cause discomfort, a fracture will result in significant pain and tenderness over the nasal bones.
• Swelling and Bruising: These are common after any trauma to the nose, but in the case of a fracture, you might see more pronounced swelling around the nose and even bruising under the eyes (aka raccoon eyes.)
• Breathing Trouble: If a student has difficulty breathing through their nose, it could signal a fracture or a septal hematoma, a collection of blood within the nasal septum that appears as a bulge or discoloration and requires immediate attention.
• The Creepy Crunch: Crepitus, that unsettling crackling sound or crunching sensation, is typically more indicative of a more serious injury, although many children with nasal fractures don't present with any hypermobility or crepitus.

When a nose takes a hit, it's time to "nose" what to do:

• First Things First: To control any bleeding, provide continuous compression (10 minutes) to the nares while having the student sit upright, leaning forward slightly, and encourage the student to breathe through their mouth.
• The Chill Factor: Apply a cold pack for up to 20 minutes every hour to help stop bleeding, minimize swelling, and alleviate discomfort.
• Tame The Ouch: Over-the-counter pain medications, such as acetaminophen or ibuprofen, can be used to manage pain if administered within the scope of practice and in compliance with school policies.
• Look Beyond The Nose: Nasal injuries can often occur alongside other facial injuries. Check for signs of trauma to the eyes, mouth, teeth, and jaw. And remember, any impact strong enough to potentially fracture or injure facial bones may also lead to concussions or other brain injuries.
• When In Doubt, Refer Out: When you suspect a nasal fracture, septal hematoma, or uncontrolled bleeding, don't hesitate to send the student for further evaluation. Timely intervention is essential to ensure proper healing and prevent long-term complications.
• The Reassurance Route: A calm and reassuring demeanor can go a long way in easing the student's (and parent's) anxiety. Generally, x-rays are not helpful for nasal injuries, and correction or further treatment is often delayed until swelling has subsided.

Nasal injuries, while often minor, require careful evaluation to ensure that no serious complications are overlooked. With every nose assessment, you're sniffing out trouble and making sure every student receives the nose-to-toe care they deserve.