Deviated Septum
-most common cause
-most significant problem
-general manifestations
Trauma to nose
Dryness= crusting and frequent nosebleeds
Septum appears bent to one side
Obstruction to nasal breathing
Nasal edema
Deviated Septum
-management/treatment
-medicine considerations
Nasal Septoplasty
-surgical realignment
NO aspirin or NSAIDS for 2 weeks before surgery
-bleeding risk: nose is highly vascular
Nasal Fracture
-manifestations
-complications
Epistaxis (nosebleed)
Edema
Hematoma
Raccoon eyes
Airway obstruction, epistaxis, minengeal tears, septal hematoma, cosmetic deformity
Nasal Fracture
-nursing care
Ice packs!
-help decrease bleeding via vasoconstriction
-closed or open reduction
Rhinoplasty
-indications
-bleeding precautions
Cosmetic or correction of airway obstructions
Might need nasal packing to prevent bleeding/septal hematoma (for 24hours)
Provide acetaminophen or mild opioids for pain with packing
No NSAIDS or Aspirin 2 weeks before surgery!!
Epistaxis
-how do you stop the bleeding?
-how do you prevent a staph. aureus infection?
Pinch lower nose for 10-15 mins
Gentle packing+pressure (provide pain relief)
Antibiotic therapy
Allergic Rhinitis
-patho
-2 types
Reaction of nasal mucosa to specific allergen
Intermittent: symptomatic for <4 days for <4 weeks per year (less common)
Persistent: symptomatic for >4 days and >4 weeks per year
How does allergic rhinitis present?
Runny, drippy, clear fluid
Itchy nose/eyes
Sneezing
When does allergic rhinitis cause congestion?
Chronic/untreated
Why is a skin test more accurate/effective than the RAST blood test for allergic rhinitis?
Skin Test shows the presence/potential/severity of allergic reaction
RAST Blood Test only measures the amount of antibodies for the allergen, but does not predict or confirm the reaction or source of symptoms
Ipratropium Bromide
Anticholinergic nasal spray
-for common cold, allergic rhinitis
AE: nasal dryness, irritation, nosebleeds
No systemic side effects
Diphenhydramine
First-Gen Antihistamine
-relieves acute symptoms of allergic response-works fast!
AE: crosses BBB: sedation
Anticholinergic: palpiations, dry mouth, constipation, urinary hesitancy
Avoid alcohol: depressant
Rapid onset, no tolerance
Cetirizine, fexofenadine, loratidine
Second-Gen. Antihistamines
-relieve acute symptoms of allergic response
-must be taken regularly-daily-takes a few days to work
Does not cross BBB: no sedation
Very well tolerated
Fluticasone
Corticosteroid nasal spray
-inhibits inflammatory response of allergic rhinitis
-systemic effects of steroids possible with higher than recommended doses
AE: mild irritation
Adherence important, give it 2 weeks to work
Pseudoephedrine + Phenylephrine
Oral decongestants
-better for colds than allergies
-promotes vasoconstriction to lower congestion
Contraindication: HTN, CVD, diabetes (vasoconstriction unsafe)
AE: stimulant effects
What must you include in education for your patient about Pseudoephedrine +Phenylephrine?
Pseudoephedrine
-must be bought behind the counter with an ID
Phenylephrine
-not behind the counter, but much weaker than the regular one
Oxymetazoline
Decongestant nasal spray
-better for colds than allergies
-promotes vasoconstriction, lowering congestion
-Do not use >5 days or >3 times a day
-Body becomes dependent and addicted very quickly
-Rebound congestion occurs when you try to stop taking it
Montelukast
Leukotriene receptor antagonist
-suppressed leukotrienes
-used if antihistamines unhelpful
Well tolerated, not useful for acute attacks
Acute Viral Rhinitis
-patho
-manifestations
AKA: common cold, Upper Respiratory Infection
-viral infection of upper respiratory tract
Droplet transmission
Stuffy nose/congestion, cough, white/yellow mucus, sore throat, low-grade fever, fatigue, headache
Acute Viral Rhinitis
-care
-possible complication
Rest, fluids, nutrition, antipyretics, decongestants, analgesics, antitussives, expectorants
Secondary bacterial infections may require antibiotics
Benzonatate
Antitussive medication
-anti-cough
-prescription only
-suppresses cough- only used for non-productive cough
-only take to sleep or to help a nagging cough after an illness
used for acute viral rhinitis
Guaifensen
Expectorant
-OTC
-irritates mucous membranes to release mucus and allow a productive cough to develop
used for acute viral rhinitis
Influenza A
-basic patho
-diagnosis
Highly contagious respiratory virus
Rapid flu-test
Influenza A
-manifestions/comparison to common cold
-complications
Unlike colds: very rapid and severe onset
Systemic symptoms, cough, high fever, myalgia, headache, sore throat
-usually subsides within 7 days
Secondary bacterial or viral infections can take advantage of the suppressed immune system and mucus
