Week 6: Rhinosinusitis (upper airway disorder) Flashcards
Epidemiology
- symptomatic inflammation of the nasal cavity and the paranasal cavity
- also called sinusitis but rhinosinusitis is a more comprehensive term
Classification of Rhinosinusitis
-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)
Acute Rhinosinusitis
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
Pathophysiology
- 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
How does Nasal Congestion Occur?
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
Risk Factors
-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
Bacterial Species found in the cultures of Rhinosinusitis
-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
Acute Rhinosinusitis is diagnosed with 3 symptoms
- Purulent nasal discharge
- nasal obstruction
- facial pain, pressure, and fullness
Nasal Secretions in Rhinosinusitis
- yellow-green nasal discharge
- colored or cloudy in nature
Clinical Manifestations
- purulent nasal discharge, nasal obstruction, facial pain, pressure, and fullness
- other: fatigue, fever, maxillary dental pain, cough, and ear fullness or pressure
Nasal Obstruction may be reported as:
congestion, stuffiness, or blockage of nasal passages
Facial Pain, pressure, and fullness may be located..?
in the periorbital areas, anterior face, or as a diffuse or localized headache
Diagnosis
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
During a physical examination, what is the provider looking for?
signs of inflammation, tenderness, firmness, or redness
Diagnostic Procedures
- physical exam (focusing on ears, nose, throat, teeth, sinuses, and chest)
- radiographical imaging of sinuses
- computed tomography (CT)
- magnetic resonance (MRI)
Diagnostic Procedures: Radiographical Imaging
fluid; thickening of the mucous lining of the sinuses; and the presence of polyps, opacities, or foreign objects may be found indicating rhinosinusitis
Treatment is focused on
the etiology
Treatment Goal
- pain relief
- reduction of nasal mucosa inflammation
- treating infection if present
Treatments/ Medications
- antipyretics for temperature elevation
- analgesics for pain
- normal saline irrigation
- decongestants (phenylephrine)
- antibiotics (amoxicillin; first line therapy)
Normal Saline Irrigation
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
Use of Decongestants
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
Warnings for the use of Decongestants
- 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
Rhinitis Medicamentosa
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
Treatment of Rhinitis Medicamentosa
cessation of topical nasal decongestants
Complications
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
Nursing Care
- 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
Nursing Care: Assess vital signs
- temperature elevation may indicate presence of infection
- increased blood pressure may be a side effect of decongestants
Client Education
- 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
Client Education: Symptoms to report
temperature, increase in pain, change in level of consciousness, redness, or edema around the face and eyes can indicate complications of rhinosinusitis
