Week 6: Rhinosinusitis (upper airway disorder)

Question 1

Epidemiology

Answer 1

• symptomatic inflammation of the nasal cavity and the paranasal cavity
• also called sinusitis but rhinosinusitis is a more comprehensive term

Question 2

Classification of Rhinosinusitis

Answer 2

-based on duration of symptoms and includes acute, subacute, and chronic
>acute (less than 4 weeks)
>subacute (4 to 12 weeks)
>chronic (more than 12 weeks)

Question 3

Acute Rhinosinusitis

Answer 3

etiology as acute bacterial rhinosinusitis (ABRS) or viral rhinosinusitis
-viral upper respiratory infections that spread to the paranasal sinuses are the cause of most acute rhinosinusitis, which then can lead to bacterial infections

Question 4

Pathophysiology

Answer 4

• infection and inflammation of the paranasal sinuses, the four paired air-filled spaces that surround the nasal cavity
• maxillary, frontal, sphenoid, and ethmoid sinuses
• inflammation of the nasal passages cause vasodilation, increased blood flow, and vascular permeability, reducing the size of the nasal passages

Question 5

How does Nasal Congestion Occur?

Answer 5

as a result of swelling of the nasal turbinates, bony structures along the nasal passages that aid in maintaining moisture and trapping airborne particles
-results in obstruction of nasal airflow

Question 6

Risk Factors

Answer 6

-viral upper respiratory infections that spread to paranasal sinuses
-deviated nasal septum
-trauma to the nose
-tumors
>the last 3 can interfere with nasal drainage and contribute to the development

Question 7

Bacterial Species found in the cultures of Rhinosinusitis

Answer 7

-Streptococcus pneumoniae
-Haemophilus influenzae
-Moraxella catarrhalis
>lack of nasal airflow and increased drainage of nasal secretions provide the medium for bacterial growth
>Staphylococcus aureus and anaerobics can also cause rhinosinusitis

Question 8

Acute Rhinosinusitis is diagnosed with 3 symptoms

Answer 8

1. Purulent nasal discharge
2. nasal obstruction
3. facial pain, pressure, and fullness

Question 9

Nasal Secretions in Rhinosinusitis

Answer 9

• yellow-green nasal discharge

- colored or cloudy in nature

Question 10

Clinical Manifestations

Answer 10

• purulent nasal discharge, nasal obstruction, facial pain, pressure, and fullness
• other: fatigue, fever, maxillary dental pain, cough, and ear fullness or pressure

Question 11

Nasal Obstruction may be reported as:

Answer 11

congestion, stuffiness, or blockage of nasal passages

Question 12

Facial Pain, pressure, and fullness may be located..?

Answer 12

in the periorbital areas, anterior face, or as a diffuse or localized headache

Question 13

Diagnosis

Answer 13

based on physical examination and starts with the completion of a history and physical exam focusing on the ears, nose, throat, teeth, sinuses, and chest

• during physical examination, the provider is looking for signs of inflammation, tenderness, firmness, or redness
• vital sign assessment to identify temperature elevation

Question 14

During a physical examination, what is the provider looking for?

Answer 14

signs of inflammation, tenderness, firmness, or redness

Question 15

Diagnostic Procedures

Answer 15

• physical exam (focusing on ears, nose, throat, teeth, sinuses, and chest)
• radiographical imaging of sinuses
• computed tomography (CT)
• magnetic resonance (MRI)

Question 16

Diagnostic Procedures: Radiographical Imaging

Answer 16

fluid; thickening of the mucous lining of the sinuses; and the presence of polyps, opacities, or foreign objects may be found indicating rhinosinusitis

Question 17

Treatment is focused on

Answer 17

the etiology

Question 18

Treatment Goal

Answer 18

• pain relief
• reduction of nasal mucosa inflammation
• treating infection if present

Question 19

Treatments/ Medications

Answer 19

• antipyretics for temperature elevation
• analgesics for pain
• normal saline irrigation
• decongestants (phenylephrine)
• antibiotics (amoxicillin; first line therapy)

Question 20

Normal Saline Irrigation

Answer 20

has local effects that reduce symptoms in acute rhinosinusitis

• the patient pours or sprays normal saline into one nostril; it flows through the nasal cavity and pours out the other nostril
• beneficial in the removal of infectious debris, bacteria, allergens, and inflammatory mediators

Question 21

Use of Decongestants

Answer 21

helpful in reducing obstruction of the osteomeatal complex (the bony structures around the drainage openings of the sinuses), facilitating drainage of sinuses
-action: vasoconstriction to reduce stiffness

Question 22

Warnings for the use of Decongestants

Answer 22

• patients with hypertension; due to decongestants action of vasoconstriction to reduce stiffness, which can increase blood pressure
• topical or sprays, if used for more than 3 days, may result in a rebound nasal congestion when discontinued; rhinitis medicamentosa

Question 23

Rhinitis Medicamentosa

Answer 23

a rebound nasal congestion when topical decongestants or sprays are discontinued after a 3 days use

• the name for the rebound nasal congestion
• results in nasal congestion without rhinorrhea or sneezing and is known as rebound rhinitis or chemical rhinitis

Question 24

Treatment of Rhinitis Medicamentosa

Answer 24

cessation of topical nasal decongestants

Question 25

Complications

Answer 25

if left untreated: -meningitis -encephalitis -orbital cellulitis -orbital abscess -osteomyelitis -sepsis -subdural abscess >orbital cellulitis and orbital abscess occur from the transfer of sinus infection to the area surrounding the eye >In the setting of chronic sinus infection, bacteria can affect facial bones causing osteomyelitis >meningitis and subdural abscess occur when bacteria pass through the meninges

Question 26

Nursing Care

Answer 26

- assess vital signs; temperature elevation and increased blood pressure - physical examination of mouth, nose, and face - percussion of sinuses - administer medications as prescribed; normal saline irrigation, decongestants, and antibiotics

Question 27

Nursing Care: Assess vital signs

Answer 27

- temperature elevation may indicate presence of infection | - increased blood pressure may be a side effect of decongestants

Question 28

Client Education

Answer 28

- increase fluid intake and rest - symptoms to report - complete all antibiotics - limit use of decongestant nasal sprays to less than 4 days to avoid rebound congestion - proper use of normal saline rinse

Question 29

Client Education: Symptoms to report

Answer 29

temperature, increase in pain, change in level of consciousness, redness, or edema around the face and eyes can indicate complications of rhinosinusitis