Nose Flashcards
Patient has these issues what would you suspect?
(1) Acute, unilateral bleeding from the anterior nasal cavity (most common)
(2) High blood pressures (normally controlled after treatment of acute bleeding)
Epistaxis
What type of labs would you run for an Epistaxis patient?
Labs that provide assessment of bleeding parameters
- Coagulation tests such as
1) Prothrombin time (PT)
2) Activated partial thromboplastin time (aPTT)
3) Thrombin time (TT)
What is the best treatment for most cases of Anterior epistaxis?
- Direct pressure by compression of the nares continuously for 15 minutes
- Venous pressure is reduced in the sitting position, and slight leaning forward lessens the swallowing of blood.
What med would you give for most cases of
anterior epistaxis, and why?
Short-acting topical nasal decongestants
-Phenylephrine, 0.125–1% solution, one or two sprays
(acts as vasoconstrictor)
IF the nose bleed does not easily subside what you do first?
Nose exam
-Illumination and suction to locate the bleeding site
Treatment
“Epistaxis Does not readily subside”
What meds/ procedures would you perform
-Oxymetazoline (Afrin)
12 Hour Nasal Relief Spray: 0.05% (15 mL, 30 mL), Instill 2 to 3 sprays into each nostril twice daily for 3 days.
-topical Lidocaine (vasoconstrictor)
Dose: 2-5 ml placed on cotton or soaked into a nasal tampon
- Cauterize with silver nitrate, diathermy, or electrocautery
- Apply a Petroleum-based ointment as a moisture barrier
Treatment
Anterior cavity Epistaxis
“If inaccessible”
Hemostatic sealant, pneumatic nasal tamponade, or anterior PACKING may suffice
a) With several feet of lubricated iodoform
b) Packing systematically placed in the floor of the nose
Treatment
Posterior cavity Epistaxis
“If inaccessible”
- Hospitalization for monitoring and stabilization is indicated
- Surgical ligation of the nasal arterial supply
- Endovascular embolization of the internal maxillary artery or facial artery
- Posterior pack
When nose packing is in place for at lease 5 days what should you administer and why?
Anti-staphylococcal antibiotics, to reduce the risk of toxic shock syndrome developing.
Cephalexin (Keflex)
Dose: 500mg PO QID for 7 days
-OR-
Clindamycin
Dose: 150mg PO QID for 7 days
True/False
Your pt can continue vigorous exercise immediately after having a nosebleed
FALSE
They should avoid straining and vigorous exercise for several days.
What are some complications for Epistaxis?
(1) Vasovagal syncope
(2) Extreme hemorrhage
What can your pt do at home to help reduce risk of reoccurrence of epistaxis?
- Increased home humidity
- Lubrication with petroleum jelly or bacitracin ointment
_____ are benign nasal tumors arising from the mucosa of the nasal passages, including the paranasal sinuses.
Nasal polyps
Nasal polyps are commonly seen in patients with what?
patients with allergic rhinitis
If you have a pt with an asthma, Aspirin intolerance, Alcohol intolerance, Nonallergic and allergic rhinitis and rhinosinusitis. What are they at risk for?
Nasal polyps
What meds can you give for Nasal polyps?
-Topical intranasal corticosteroids for 1–3 months
(also shrinks nasal mucosa and nasal polyps)
-short course of oral corticosteroids
Prednisone 6-day course using 21 [5mg] tablets: 6 tablets [30 mg] on day 1 and tapering by 1 tablet [5 mg] each day)
What is done for massive nasal polyps
Surgical removal
Recurrent nasal polyps are treated how?
Ethmoidectomy (more complete procedure)
Patient has some of theses issues what would you suspect?
(a) Clear rhinorrhea, nasal pruritus, and sneezing
(b) Turbinates mucosa of the turbinates is usually pale or violaceous (venous engorgement)
(c) Nasal polyps (boggy masses of hypertrophic mucosa) are associated with long-standing allergic rhinitis.
Eyes- Irritation, pruritus, conjunctival erythema, and excessive tearing
Associated symptoms
Cough, bronchospasm, wheezing and eczematous dermatitis
Rhinitis
DDx for rhinitis
(1) Viral rhinitis
(2) Sinusitis
(3) Influenza
(4) Mononucleosis
True.False
You need to run labs for Rhinitis
FALSE
Treatment for Rhinitis
- Topical intranasal corticosteroids (Flonase or Nasonex) for 1–3 months (also shrinks nasal mucosa and nasal polyps)
- Antihistamines (immediate, but temporary relief)
Adjunctive Treatment Measures
- Montelukast (Singulair)
- Cromolyn (Gastrocrom) - Mast cell stabilizer
Nasal saline irrigations
Referral to an allergist (subcutaneous and sublingual immunotherapy)
True/False
Patients should be reminded that there may be a delay in onset of relief of two or more weeks
True
_______ is an inflammation of the mucous membrane of one or more paranasal sinuses.
Sinusitis
PT has these issues what would you suspect?
(1) Purulent yellow-green nasal discharge or expectoration.
(2) Facial pain or pressure over the affected sinus or sinuses.
(3) Nasal obstruction.
4) Acute onset of symptoms (between 1 and 4 weeks’ duration).
(5) Associated cough, malaise, fever, and headache.
Sinusitis
What supportive therapy would you give for sinusitis
NSAIDS for pain
Oral or nasal decongestants
Intranasal corticosteroids
When are antibiotics indicated for Sinusitis
Fever, pain, purulent discharge
Symptomatic for > 10 days
What is the empiric treatment for bacterial sinusitis ?
Amoxicillin-Clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily for 5-7 days).
What is the antibiotic treatment for Severe sinusitis?
High-dose AmoxicillinClavulanate (2000 mg/125 mg extended-release orally twice daily for 7-10 days).
What antibiotic can you give for sinusitis if they have a PCN allergy or hepatic impairment?
Doxycycline (100 mg orally twice daily or 200 mg orally once daily for 5- 7 days).
When would you refer your sinusitis pt and to where
Failure to resolve after antibiotics
ENT
When would you admit a sinusitis PT?
Facial cellulitis, vision change, gaze abnormality, abscess, mental status changes
