-
Deviated Septum
- Deflection of normally straight nasal septum
- Concern = air movement, epistaxis, and infection
- Treat with nasal allergy control or surgery
-
Nasal Fracture
- Unilateral, Bilateral, Complex
- S/S: depend on severity (ecchymosis, edema, bleeding)
- Need to check for clear drainage * determine whether drainage is nasal secretion or CSF by checking for glucose - CSF contains glucose & nasal secretions should not
- Ice to face, surgery
-
Nursing & Collaborative Management: Nasal Surgery
- Respiratory status:
- * Positioning: want to support drainage - HIGH FOWLER'S or SEMI-FOWLER'S
- * Assess airway: pulse ox, respirations, auscultate lung sounds, look for accessory muscle use, labored breathing, anxiety/restlessness
- Pain management: agents such as morphine (* keep in mind respiratory depression)
- Hemhorrage:
- * check for frequent swallowing
- * avoid Valsalva maneuvers - laxatives .. increases intracranial pressure
- * sneeze with mouth open .. closed mouth increases intracranial pressure
- * avoid blowing nose
- Edema
- Ecchymosis
- Antibiotics
-
Epistaxis - Measures to Control Bleeding
- If tubes are used ... observe for respiratory distress, humidified oxygen, bedrest, pain management, hydration & oral care
- Prevent bleeding after tubes are removed:
- * nasal salin & humidification
- * AVOID: vigorous nose blowing, NSAIDs or Aspirin, strenuous activity
-
Rhinitis
- Inflammation and infection of the nose and paranasal sinuses
- Typically does not interfere with a person's ability to maintain oxygenation or adequate tissue perfusion
- Inflammation of the nasal mucosa caused by a variety of sources
- Allergic rhinitis
- Acute viral rhinitis ("common cold")
-
Allergic Rhinitis ("hay fever, allergies")
- Triggered by a sensitivity reaction to airborne allergens
- "Seasonal" or "Chronic"
-
Acute Viral Rhinitis ("Common Cold")
- Viruses invade upper respiratory system
- Spread by droplet
- Increased in the winter months
- Risk factors: overcrowding/staying indoors, compromised immune system, stress
- Manifestations similar to those of allergic rhinitis - usually no fever with allergic
-
Clinical Manifestations of Acute Rhinitis
- Nasal irritation, sneezing
- Post-nasal tickling
- Copious secretions
- Obstructed nasal passages
- Watery eyes
- Elevated temperature
- Headache
-
Nursing & Collaborative Management of Acute Viral Rhinitis
- Rest, fluids, diet, analgesics
- Treated symptomatically
- Antihistamine and decongestant therapy (* warn about sedation with histamines)
- Recognize symptoms of secondary bacterial infection (if left untreated may turn into a sinus infection)
- Prevention: avoid crowds, good hand washing, no sharing of cups, etc.
-
Sinusitis
- Exit (ostia) from sinus is narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa
- Secretions build up behind the obstruction
- Excellent medium for growth of organisms, leading to infection
-
Acute Sinusitis: Etiology
- * all cause inflammation and retention of secretions
- Upper respiratory infection
- Allergic rhinitis
- Swimming
-
Chronic Sinusitis: Etiology
- Acute sinusitit - irreversible loss of normal ciliated epithelium lining the sinus cavity
- Allergies
- Polyps
-
Acute Manifestations of Sinusitis
- Pain over affected sinus
- Purulent nasal drainage
- Nasal obstruction
- Congestion
- Fever
- Malaise
- Dental Pain
- Headaches * will cause discomfort with change of position
-
Sinusitis Physical Exam (acute)
- Pain/tenderness upon palpation of sinus
- Edematous mucosa
- Enlarged turbunates
- Change in headache change?
-
Management (acute) of Sinusitis
- Control underlying cause (i.e., allergies)
- Antibiotics * avoided unless absolutely necessary
- Decongestants
- Nasal corticosteroids (* teach patient to look down when using nasal sprays)
- Avoid antihistamines (* using antihistamines can over dry the area, restricting drainage)
- Increase fluids
- Humidifier
- Nasal cleaning techniques
- Avoid smoking and exposure to smoke
-
Pharyngitis
- "Sore throat"
- Inflammation fo the mucus membranes of the pharynx
- Often occurs with rhinitis and sinusitis
- Caused by: bacteria, viruses, trauma, dehydration, irritants, alcohol
- Group A beta-hemolytic Streptococcus - most common strain of bacterial that causes infection
- Most adults experience viral pharyngitis
- Late fall and spring
- Important to treat if bacterial - to prevent complications such as Rheumatic fever
-
Manifestation of Pharyngitis
- Throat pain
- Odynophagia
- Dysphagia
- Hyperemia
- Possible exudate
- Fever
- Often difficult to distinguish viral from bactrial without a culture
- Bacterial - usually abrupt onset
-
Pharyngitis: Diagnosis & Collaborative Care
- Diagnosis: Rapid stress test, throat cultures
- Supportive therapy: fluids, rest, analgesics, warm gargles
- Antibiotics for bacterial infection
- Should be re-evaluated if no improvement after 3 days
- ENTIRE does of antibiotics MUST BE COMPLETELY FINISHED
- Return to work or school after taking 24 hours of antibiotics and afebrile for 24 hours
- If bacterial - change toothbrush
|
|
