Sinusitis-Laryngitis Flashcards
A condition characterized by the inflammation of the mucus membrane lining the sinuses
Sinusitis
May either be a bacterial infection or secondary to a viral exposure
Sinusitis
What are the two types of Sinusitis?
Acute sinusitis
Chronic Sinusitis
What are the most common causes of Acute Sinusitis?
Allergy and bacterial infection
Damage to the mucusa of the sinuses are reversible
Acute sinusitis
Chronic sinusitis may result from?
untreated acute sinusitis
Damage to the mucosa of the sinuses are irreversible
Chronic Sinusitis
What are the manifestations of Sinusitis?
o Facial pain and headache
o Swollen upon inspection and tender upon palpation
o Toothaches if the maxillary sinuses are affected
o Headache for frontal and ethmoid sinuses
o Mucoid nasal discharge
o Nasal congestion
o Orbital edema or edema over the affected sinus
o Pain over the infected sinus
o Cough and sore throat
o Inability to smell
o Lack of appetite
o Fever
o Body malaise
o WBC increased
What are the two most common presenting symptoms of sinusitis?
Facial pain and headache
What are the diagnosis for sinusitis?
history and physical exam
Sinus X-rays
Computed tomography scanning
Upon physical examination of patient having sinusitis, what will you do?
Percussion = tenderness to palpation over the infected sinus area
The sinuses are percussed using the?
Transillumination
This decrease in the transmission of light
Transillumination
What is detected during sinus x-rays?
detect sinus opacity, mucosal thickening, bone destruction, and air-fluid levels.
It is the most effective diagnostic tool for sinusitis
computed tomography scanning
what is the other use of computed tomography scanning?
used to rule out other local or systemic disorders, such as tumor, fistula, and allergy.
Treatment fir sinusitis
o Administration of antibiotics (oral for simple sinusitis and IV for diffused)
o Humidification with a vaporizer to help drain the sinuses
If the sinusitis does not respond to antibiotics, what surgical intervention may be required?
Functional Endoscopic Sinus Surgery (FESS)
Anthral Irrigation
Caldwell-Luc Surgery
What surgical intervention for sinusitis uses a fiberoptic endoscope is used to disect nasal tissue?
FESS
what are the complications of FESS?
Complications:
o Nasal bleeding
o Orbital hematoma
o Injury to the optic nerve which may lead to blindness
What do you call the sharp metal that is inserted through anthrum into the lateral wall of the nose into the sinus, in anthral irrigation?
trocar
other term for caldwell-luc surgery?
radical anthrum surgery
Caldwell-Luc Surgery is indicated for?
chronic maxillary sinusitis
This surgical intervention for sinusitis is done when antibiotic treatment is no longer effective
Caldwell-Luc Surgery
During Caldwell-Luc Surgery, what is the point of entry and what does it produce?
An incision is made under the upper lip (point of entry), above the lateral incisor teeth and part of
the bony anthrum is removed, producing a permanent window allowing drainage and removal of
the deceased mucosa and periosteum
What are the Nursing Considerations for Sinusitis?
• Instruct patient not to chew on the affected side until the incision heals
• Instruct client to observe caution when performing oral hygiene
• Instruct client to avoid wearing dentures for about 10 days after the surgery
• Avoid blowing nose for at least 2 weeks
o Avoid sneezing or keep the mouth open when sneezing
Pharyngitis is commonly known as?
soar throat
it is an inflammation of the pharynx, resulting in a sore throat.
pharyngitis
This is a symptom rather than a condition
pharyngitis
What are the risk factors of pharyngitis?
Viral and/or bacterial infections
allergies
dry indior air and chronic mouth breathing
muscle strain
GERD
Manifestations of Pharyngitis
MANIFESTATIONS
• Sore throat
• Dry, scratchy throat
• Pain when swallowing
• Pain when speaking
• Other symptoms may be present, depending on the cause. These include:
o Fatigue
o Malaise
o muscle aches
o headache and fever — especially with the flu or other viral infections
Diagnosis of Pharyngitis
• physical exam
o ex: allow the client to swallow
• laryngoscopy (scope exam in a clinic) to assess for all the possible causes of pharyngitis.
Treatment for Viral pharyngitis
❖ salt water gargles
❖ pain relievers
❖ extra fluids to help alleviate the symptoms.
Treatment for Bacterial pharyngitis
antibiotics
treatment for fungal pharyngitis
antifungal medications
it detects what bacteria is causing the infection so they’ll know what kind of antibiotic should be given to the patient.
culture sensitivity test
predisposing factor of rheumatic heart disease
GABHS
treatment for strep throat
prompt antibiotic therapy
strep throat can sometimes cause?
kidney problems and rheumatic fever, which can damage the heart
valves.
Inflammation of the vocal cords can alter the way the vocal cords come together and vibrate, causing
voice changes.
Laryngitis
Laryngitis can be?
Acute (short-term) = <3weeks
Chronic (long-term) = >3 weeks
often a mild and self-limiting condition that typically lasts for a period of 3 to 7 days
Acute laryngitis
is a temporary condition caused by overusing the vocal cords. It can also be caused by an infection
acute laryngitis
What are the causes of acute laryngitis?
o viral infections
o straining your vocal cords by talking or yelling
o bacterial infections
o drinking too much alcohol
What are the viral infections that causes acute laryngitis?
rhinovirus, parainfluenza virus, respiratory syncytial virus, coronavirus,
adenovirus, and influenza are all potential etiologic agents
The condition lasts for over 3 weeks and is caused by prolonged exposure to one of the risk factors
Chronic laryngitis
results from long-term exposure to irritants. It’s usually more severe and has longer-lasting effects than acute laryngitis.
Chronic laryngitis
What are the causes of chronic laryngitis? and how?
o frequent exposure to harmful chemicals or allergens
o acid reflux – can damage the larynx
o frequent sinus infections — it travels and affects the adjacent organs
o smoking or being around smokers
o overusing your voice
o low-grade yeast infections caused by frequent use of an asthma inhaler
o Cancer, paralysis of the vocal cords, or changes in vocal cord shape as one age can also cause
persistent hoarseness and sore throats.
TRUE OR FALSE: Initial symptoms of acute laryngitis are usually “abrupt” in “onset” and “worsen over two or three days”, though may persist up to a week without treatment
TRUE
Manifestations of Laryngitis
o Change in quality of voice, in later stages there may be a complete loss of voice (aphonia)
o Discomfort and pain in the throat, particularly after talking
o Dysphagia, odynophagia (if present, exercise caution - may hint at additional pathology)
o Dry cough
o General symptoms of dryness of throat, malaise, and fever
o Frequent throat-clearing – one sign of throat filling
o Early voice fatigue or loss of vocal range
What are the diagnosis for laryngitis
History and physical examination
Formal voice analysis and fiberoptic laryngoscopy
Stroboscopy
Imaging or Laboratory Studies
Culture
What diagnosis procedure for laryngitis can be used to confirm the diagnosis in cases that are refractory to treatment or otherwise convoluted?
Formal voice analysis and fiberoptic laryngoscopy
Stroboscopy reveals what?
asymmetry, aperiodicity, and reduced mucosal wave
patterns.
This diagnosis procedure for laryngitis are not required unless….
Imaging or laboratory studies
unless an atypical pathogen or neoplasm are
suspected.
This may be indicated for diagnosis of laryngitis if patient has….
culture
has exudate in the oropharynx or vocal cords
Treatment/Management of Laryngitis
Voice Rest
Steam Inhalation
Avoidance of Irritants
Dietary Modification
In laryngitis, this is the single most important factor.
Voice Rest
Why do use of voice during laryngitis is prohibited?
it results in incomplete or delayed recovery
What should you instruct the patient if she/he needs to speak?
use a confidential voice - normal phonatory voice at low volume without whispering or projecting
Inhaling humidified air enhances…
moisture of the upper airway and helps in the removal of secretions and exudates.
Why should the patient avoid smoking and alcohol if he/she has laryngitis?
It delays prompt resolution of the disease process
In laryngitis, this treatment/management is recommended for patients with GERD?
dietary restriction
For patients with laryngitis, when he/she is advised for dietary restriction, what should be avoided?
caffeinated drinks
spicy foods
Fatty foods
chocolate
peppermint
avoidance of late meals - have meal at least 3 hours before sleeping
also advice patient to drink plenty of water
Medications for laryngitis
antibiotics
oral antifungal agents
Mucolytics
lifestyle and dietary modification
anti-reflux medications
TRUE OR FALSE: Antibiotics prescription for an otherwise healthy patient with acute laryngitis is currently unsupported; however for high-risk patients and patients with severe symptoms antibiotics may be given.
True
For patients with laryngitis, if there is a presence of identifiable gram stain and culture, what should be given as medication?
narrow-spectrum antibiotics
For patients with fungal laryngitis, what medication should be given?
oral antifungal agents (fluconazole)
For how many weeks oral antifungal agents is required?
for 3 weeks period, and may be repeated if needed
Oral antifungal agents as medication for fungal laryngitis should be reserved for patients with….
confirmed fungal infection via “laryngeal examination and/or culture”
For patients with laryngitis, what will you give to clear secretions?
Mucolytics (gauifenesin)
anti reflux medications is indicated for..
patients with LPR-related laryngitis
what medications suppress acid production and is effective against GERD?
H2 receptor and proton pump blocking agents
what is the most effective medication for LPR
proton pump inhibitors
How many doses is required for proton pump inhibitors to be effective?
require higher dose or twice-daily dosing
Give Nursing Diagnosis for Inflammatory disorders
• Ineffective airway clearance related to excessive mucus production secondary to retained secretions and
inflammation
• Acute pain related to upper airway irritation secondary to an infection
• Impaired verbal communication related to physiologic changes and upper airway irritation secondary to
infection or swelling
• Deficient fluid volume related to increased fluid loss secondary to diaphoresis associated with a fever
• Deficient knowledge regarding prevention of upper respiratory infections, treatment regimen, surgical
procedure, or postoperative care
