Rhinitis and Sinusitis Care Quiz

Rhinitis

• Inflammation of the nasal mucous membranes, acute, chronic, or allergic.
• Symptoms include: sneezing, nasal congestion, rhinorrhea, sore throat, watery eyes, cough, low-grade fever, headache, aching muscles, and malaise.
• Treatment includes: antipyretics, decongestants, antitussives, saline gargles, saline spray, and antihistamines.

Sinusitis

• Inflammation of the sinuses, specifically the maxillary sinus.
• Symptoms include: headache, fever, pain over the affected sinus, nasal congestion, and pressure around the eyes.
• Treatments include: saline irrigation, antibiotic therapy, vasoconstrictors, nasal corticosteroids, and surgical procedures such as Caldwell–Luc procedure and external sphenoid ethmoidectomy.

Postoperative Care for Sinus Surgery

• Monitor for repeated swallowing, which could indicate hemorrhage.
• Assess optic nerve function.
• Monitor temperature every 4 hours and check for pain over the involved sinuses.
• Administer analgesics as indicated and apply ice compresses.
• Nasal packing and dressings under nares ("moustache" or drop pad) should be in place.
• Avoid blowing the nose, lifting more than 5 to 10 lbs, and air travel for 10 to 14 days after surgery.

Pharyngitis

• Inflammation of the throat, often associated with rhinitis and other upper respiratory infections (URIs).
• Group A streptococci, causing "strep throat," is a common cause.
• Complications include: endocarditis, rheumatic fever, and glomerulonephritis.
• Highly contagious, transmission occurs through inhalation or direct contamination with droplets.
• Symptoms include: sore throat, dysphagia, fever, headache, white or exudate patch over the tonsillar area, and swollen glands.
• Management includes: throat culture, antibiotic treatment (e.g., erythromycin).

Tonsillitis and Adenoiditis

• Can be primary or secondary.
• Chronic tonsillar infection may lead to partial upper airway obstruction.
• Chronic adenoidal infection is linked to otitis media.
• Symptoms include: sore throat, difficulty swallowing, fever, malaise, enlarged adenoids causing nasal obstruction, and snoring.
• Management includes: antibiotic therapy, analgesics, saline gargles and surgical procedures such as tonsillectomy and adenoidectomy.

Pre- and Postoperative Care for Tonsillectomy and Adenoidectomy

• Perform laboratory tests including hematocrit, platelet count, clotting time, and assess for aspirin or NSAID use in client's history.
• Nursing diagnoses include: Risk for Aspiration, Risk for Impaired Tissue Integrity, and Acute Pain.

Peritonsillar Abscess

• Develops in connective tissue between tonsil and pharynx.
• Often caused by streptococcal or staphylococcal tonsillar infection.
• Symptoms include: difficulty and pain with swallowing, fever, malaise, ear pain, and difficulty talking.
• Diagnostic findings include sensitivity studies and culture.
• Treatment includes: antibiotic therapy, needle aspiration, surgical incision and drainage.
• Nursing management includes: semi-Fowler position, preventing aspiration, applying ice collar, topical anesthetics, throat irrigations, encouraging fluid intake, and observing for respiratory obstruction and excessive bleeding.

Laryngitis

• Inflammation and swelling of the mucous membrane of the larynx.
• Causes include: URIs, excessive use of voice, allergies, and smoking.
• Symptoms include: inability to speak above a whisper (aphonia), throat irritation, and dry, nonproductive cough.
• Hoarseness lasting longer than 2 weeks should prompt laryngoscopy.
• Persistent hoarseness is a potential sign of laryngeal cancer.
• Management includes: voice rest, treatment or removal of the underlying cause, and antibiotic therapy if bacterial infection is present.

Epistaxis

• Rupture of tiny capillaries in the nasal mucous membrane (Kiesselbach plexus).
• Risk factors include: trauma, systemic infections (e.g., rheumatic fever), local infections, dry nasal mucosa, hypertension, aspirin use, nasal tumors, blood dyscrasias, and cocaine abuse/inhaled drugs.
• Assessment findings involve using a nasal speculum and tongue blade to visualize bleeding.
• Management includes: direct continuous pressure, ice packs, topical vasoconstrictor, nasal packing, and surgical interventions such as cauterization, electrocautery, and balloon-inflated catheter.
• Nursing management includes: monitoring vital signs, assessing for ongoing bleeding, providing humidification, applying nasal lubricant, and advising the client to avoid vigorous nose blowing or picking.

Nasal Obstruction

• Causes include: deviated septum, nasal polyps, and hypertrophied turbinates.
• Symptoms include: history of sinusitis, difficulty breathing out of one nostril, and frequent nosebleeds.
• Management includes: steroidal nasal spray, surgical procedures such as submucous surgical resection, septoplasty, rhinoplasty, and nose reconstruction.
• Nursing management includes: managing nasal packing, assisting with mouth breathing, positioning the client in semi-Fowler's position, monitoring vital signs, and providing oral hygiene.

Fractures of the Nose

• Caused by trauma.
• Symptoms include: swelling/edema of soft tissue, external and internal bleeding, nasal deformity, nasal obstruction, and potential cerebrospinal fluid leakage (CSF)—Dextrostix testing useful.
• Management involves applying pressure, cold compresses, and surgical intervention for complex fractures.
• Nursing management includes: elevating the head of the bed, applying ice, administering analgesics, assessing for airway obstruction, checking pupillary responses and level of consciousness, monitoring for periorbital edema, and addressing anxiety.

Laryngeal Trauma and Obstruction

• Causes include: motor vehicle accidents, blunt trauma in the neck region.
• Symptoms include: neck swelling, bruising, and tenderness, stridor, dysphagia, hoarseness, cyanosis, and hemoptysis.
• Diagnostic studies involve laryngoscopy and x-ray.
• Management focuses on securing a patent airway, potentially utilizing the Heimlich maneuver.
• Nursing management includes: monitoring for airway obstruction, assessing respiratory pattern, checking for nasal swelling and bleeding, and observing for laryngeal edema.

Obstructive Sleep Apnea

• Characterized by recurrent and frequent episodes of upper airway obstruction and reduced ventilation during sleep.
• Classifications include: central, obstructive, and complex (mixed).
• Symptoms include: loud snoring, cessation of breathing for at least 10 seconds, awakening suddenly with a loud snort, daytime fatigue, morning headache, inability to concentrate, sore throat, enuresis (bedwetting), and erectile dysfunction.
• Management includes: weight loss, smoking cessation, eliminating alcohol, using special pillows, Continuous Positive Airway Pressure (CPAP), Auto-titrating Continuous Positive Airway Pressure (APAP), Bilevel Positive Airway Pressure (BIPAP), and surgical procedures like uvulopalatopharyngoplasty and tracheostomy.
• Nursing management involves: reassurance, providing adequate instruction and explanations, connecting with self-help groups, and offering counseling.

Laryngeal Cancer

• Causes include: carcinogens like tobacco, alcohol, and pollutants.
• Symptoms include: persistent, progressive hoarseness, swelling or lump in the throat or neck, dysphagia, and weight loss.
• Diagnostic studies include: laryngoscopy, biopsy, CT, MRI, and PET.
• Management includes: chemotherapy, radiation therapy, and laryngectomy.
• Nursing management focuses on: assessing for hoarseness, dysphagia, dyspnea, burning in the throat, evaluating anxiety levels, identifying coping strategies, and supporting communication abilities.

Alternative Measures of Communication

• Used after laryngectomy:
  • Esophageal speech: Regurgitation of swallowed air used to form words with lips.
  • Artificial (electric) larynx: Throat vibrator held against the neck to project sound into the mouth.
  • Tracheoesophageal puncture (TEP): Surgical insertion of a prosthesis, such as the Blom–Singer device.
• Psychosocial issues are common, including social isolation.
• Nursing management addresses psychosocial aspects by promoting positive self-esteem, encouraging social relationships, and facilitating access to support services.

Tracheotomy and Tracheostomy

• Tracheotomy: Surgical procedure creating an opening into the trachea.
• Tracheostomy: Surgical opening into the trachea into which a tracheostomy or laryngectomy tube is inserted.
• Can be temporary or permanent.
• Nursing management involves:
  • Risk for Ineffective Airway Clearance: Monitoring vital signs, breath sounds, skin color, level of consciousness, mental status, and ensuring airway patency.
  • Risk for Infection: Monitoring the stoma, providing routine tracheostomy care, and positioning the client appropriately.
  • Risk for Ineffective Management of Therapeutic Regimen: Supporting adherence to therapeutic regimen.

Endotracheal Intubation and Mechanical Ventilation

• Uses: Respiratory difficulties, comatose clients, and general anesthesia.
• Types of mechanical ventilation: Negative pressure and positive pressure.
• Nursing management includes:
  • Monitoring vital signs, ABGs, SpO2, and mental status.
  • Assessing for confusion, agitation, and auscultating lung sounds.
  • Providing suctioning and humidification, and facilitating communication.

Rhinitis

• Inflammation of nasal mucous membranes; acute, chronic, or allergic
• Symptoms include sneezing, nasal congestion, rhinorrhea, sore throat, watery eyes, cough, low-grade fever, headache, aching muscles, and malaise
• Treatments include antipyretics, decongestants, antitussives, saline gargles, saline spray, and antihistamines

Sinusitis

• Inflammation of the sinuses; commonly affects the maxillary sinus
• Symptoms include headache, fever, pain over affected sinus, nasal congestion, and pressure around eyes
• Treatment includes saline irrigation, antibiotic therapy, vasoconstrictors, and nasal corticosteroids
• Surgical options include Caldwell–Luc procedure and external sphenoid ethmoidectomy

Postoperative Sinus Surgery Care

• Observe for repeated swallowing, which may indicate hemorrhage
• Assess optic nerve function
• Monitor temperature every 4 hours
• Administer analgesics as indicated and apply ice compresses
• Nasal packing and dressing will be in place under the nares
• Avoid blowing the nose, lifting more than 5 to 10 lb, and airplane travel for 10 to 14 days

Pharyngitis

• Inflammation of the throat; often associated with rhinitis and other upper respiratory infections
• Group A streptococci is the cause of strep throat
• Complications include endocarditis, rheumatic fever, and glomerulonephritis
• Highly contagious through inhalation or direct contamination with droplets

Pharyngitis (Continued)

• Symptoms include sore throat, dysphagia, fever, headache, white or exudate patch over the tonsillar area, and swollen glands
• Treatment includes a throat culture and antibiotic therapy, such as erythromycin

Tonsillitis and Adenoiditis

• Chronic tonsillar infection can cause partial upper airway obstruction
• Chronic adenoidal infection can lead to otitis media
• Symptoms include sore throat, difficult or pain on swallowing, fever, malaise, and enlarged adenoids
• Enlarged adenoids can cause nasal obstruction and snoring
• Treatment includes antibiotic therapy, analgesics, and saline gargles
• Tonsillectomy and adenoidectomy are surgical options

Tonsillitis and Adenoiditis (Continued)

• Nursing management includes pre- and post-operative care, lab results, and managing potential complications
• Nursing diagnoses include Risk for Aspiration, Risk for Impaired Tissue Integrity, and Acute Pain

Peritonsillar Abscess

• Develops in the connective tissue between the tonsil and pharynx
• Commonly caused by streptococcal or staphylococcal tonsillar infection
• Symptoms include difficulty and pain with swallowing, fever, malaise, ear pain, and difficulty talking
• Diagnosis is through sensitivity studies and culture

Peritonsillar Abscess (Continued)

• Treatment includes antibiotic therapy
• Surgical management options include needle aspiration, surgical incision, and drainage
• Nursing management includes semi-Fowler positioning to prevent aspiration, ice collar, topical anesthetics, throat irrigations, increased fluid intake, and observation for respiratory obstruction or bleeding

Laryngitis

• Inflammation and swelling of the mucous membrane
• Causes include upper respiratory infections, excessive use of voice, allergies, and smoking
• Symptoms include inability to speak above a whisper, aphonia, throat irritation, and dry, nonproductive cough
• Persistent hoarseness for more than 2 weeks should prompt a laryngoscopy
• Persistent hoarseness may be a sign of laryngeal cancer

Laryngitis (Continued)

• Treatment includes voice rest, addressing the underlying cause, and antibiotic therapy if bacterial
• Smoking cessation is crucial

Epistaxis

• Rupture of tiny capillaries in the nasal mucous membrane; commonly occurs in the Kiesselbach plexus
• Risk factors include trauma, systemic infections, local infections, dry nasal mucosa, hypertension, aspirin, nasal tumors, blood dyscrasias, and cocaine abuse
• Assessment includes using a nasal speculum and tongue blade to visualize bleeding

Epistaxis (Continued)

• Treatment includes direct continuous pressure, ice packs, topical vasoconstrictors, and nasal packing.
• Surgical management options include cauterization, electrocautery, and balloon-inflated catheter
• Nursing management requires monitoring vital signs, assessing for continued bleeding, providing humidification and nasal lubricant, and avoiding vigorous nose blowing or picking

Nasal Obstruction

• Obstruction of the nasal passage due to a deviated septum, nasal polyps, or hypertrophied turbinates
• Symptoms include a history of sinusitis, difficulty breathing out of one nostril, and frequent nosebleeds
• Treatment includes steroidal nasal spray
• Surgical options include submucous surgical resection, septoplasty, rhinoplasty, and nose reconstruction

Nasal Obstruction (Continued)

• Nursing management includes nasal packing, assisting with mouth breathing, placing the patient in a semi-Fowler position, and monitoring vital signs

Fractures of the Nose

• Result from trauma
• Symptoms include swelling/edema of soft tissue, external and internal bleeding, nasal deformity, nasal obstruction, and potential cerebrospinal fluid leakage
• Treatment includes pressure application and cold compresses
• Surgical management is necessary for complex fractures

Fractures of the Nose (Continued)

• Nursing management includes elevating the head of the bed, applying ice, administering analgesics, and assessing for airway obstruction, pupillary responses, level of consciousness, and periorbital edema

Laryngeal Trauma and Obstruction

• Results from motor vehicle accidents or blunt trauma in the neck region
• Symptoms include neck swelling, bruising, and tenderness; stridor; dysphagia; hoarseness; cyanosis; and hemoptysis
• Diagnosis is confirmed through laryngoscopy and x-ray
• Treatment includes ensuring a patent airway, performing the Heimlich maneuver, and potential mechanical ventilation

Laryngeal Trauma and Obstruction (Continued)

• Nursing management includes monitoring vital signs, assessing respiratory patterns, and observing for nasal swelling, bleeding, and laryngeal edema

Obstructive Sleep Apnea

• Recurrent episodes of upper airway obstruction and reduced ventilation during sleep
• Classifications include central, obstructive, and complex (mixed)
• Symptoms include loud snoring, cessation of breathing for at least 10 seconds, awakening suddenly with a loud snort, daytime fatigue, morning headache, inability to concentrate, sore throat, enuresis, and erectile dysfunction

Obstructive Sleep Apnea (Continued)

• Treatment includes weight loss, smoking cessation, alcohol elimination, and special pillows
• Non-invasive ventilation options include continuous positive airway pressure (CPAP), auto-titrating continuous positive airway pressure (APAP), and bilevel positive airway pressure (BIPAP)
• Surgical management options include uvulopalatopharyngoplasty and tracheostomy
• Nursing management involves reassurance, providing adequate instructions and explanations, and referring patients to self-help groups and counseling

Laryngeal Cancer

• Causes include carcinogens such as tobacco, alcohol, and pollutants
• Symptoms include persistent, progressive hoarseness; swelling or lump in the throat or neck; dysphagia; and weight loss
• Diagnosis is confirmed through laryngoscopy, biopsy, CT scan, MRI, and PET scan
• Treatment includes chemotherapy, radiation therapy, and laryngectomy

Laryngeal Cancer (Continued)

• Nursing management includes assessing for hoarseness, dysphagia, dyspnea, burning in the throat, anxiety level, coping strategies, and ability to communicate

Alternative Measures of Communication (Following Laryngectomy)

• Esophageal speech utilizes the regurgitation of swallowed air to form words with the lips
• An artificial (electric) larynx is a throat vibrator held against the neck to project sound into the mouth
• Tracheoesophageal puncture (TEP) involves the surgical insertion of a prosthesis, like the Blom–Singer device

Alternative Measures of Communication (Continued)

• Psychosocial issues such as social isolation are common after laryngectomy
• Nursing management focuses on promoting positive self-esteem, encouraging social relationships, and providing support services

Tracheotomy and Tracheostomy

• Tracheotomy is a surgical procedure that creates an opening in the trachea
• Tracheostomy is a surgical opening in the trachea that allows the insertion of a tube (either temporary or permanent)
• Nursing management focuses on maintaining a patent airway, preventing infection, and ensuring proper therapeutic regimen management

Tracheotomy and Tracheostomy (Continued)

• Nursing diagnoses include Risk for Ineffective Airway Clearance, Risk for Infection, and Risk for Ineffective Management of Therapeutic Regimen

Endotracheal Intubation and Mechanical Ventilation

• Endotracheal intubation inserts a tube directly into the trachea. It's used to support breathing during emergencies or surgical procedures
• Mechanical ventilation assists with breathing. Types include negative pressure and positive pressure ventilation
• Nursing management involves monitoring vital signs, ABGs, SpO2, and mental status.
• It also includes assessing for signs of confusion, agitation, auscultating breath sounds, suctioning and humidifying the airway, and facilitating communication