LESSON PLAN

ON
SINUSITIS
SUBJECT ---- MEDICAL & SURGICAL NURSING

PREPARED BY-

KHUSHI VERMA

NURSING TUTOR
IDENTIFICATION DATA

NAME : Khushi verma

TOPIC : SINUSITIS

PLACE : Lecture Hall

DURATION : 45-50 minutes

METHODS OF TEACHING : Lecture-cum-discussion

LANGUAGE : English and Hindi

A.V AIDS : flash cards, pamphlet, booklet, blackboard, ppt

PREVIOUS KNOWLEDGE OF GROUP : GROUP HAS PREVIOUS KNOWLEDGE ABOUT SINUSITIS.

GENERAL OBJECTIVES: At the end of the presentation, the students will be able to understand and gain adequate
knowledge about SINUSITIS.
SPECIFIC OBJECTIVES: At the end of the presentation, students will be able to:

 Introduce Sinusitis.
 Define Sinusitis.
 List out the classifications of sinusitis.
 Enlist the causes and risk factors of sinusitis.
 Explain about the pathophysiology of sinusitis.
 Discuss the clinical manifestations of sinusitis.
 Enumerate the diagnostic evaluations of sinusitis.
 Explain the management of sinusitis.
 Describe the complications.
S.N TIME SPECIFIC CONTENT TEACHIN STUDEN A-V AIDS EVALUTAIO
O OBJECTIVE G T N
ACTIVITY ACTIVITY
1. 2min. To introduce INTRODUCTION Lecture Listening blackboard What is the
about sinusitis. cum introduction
▸ Paranasal sinuses are a group discussion of sinusitis?
of 4 paired air filled spaces that
surround the nasal cavity.
1. Frontal sinus
2. Ethmoid sinus
3. Sphenoid sinus
4. Maxillary sinus
▸ They reduce the weight of the
skull and they humidify the
inspired air.

2. 3min. To define DEFINITION Lecture Listening Pamphlet What is the

sinusitis.  Sinusitis is an cum definition of
inflammation of the discussion sinusitis?
mucus membrane of the
Paranasal sinuses.
 Pansinusitis is infection
of more than one sinus.
 Rhinosinusitis is referred
to as an inflammatory
disease of the nose or
 sinuses.
 It is a common condition
and a complication of
5%-10% of URIS in
children.
 It affects 1 in 8 adults per
year.

3. 3min. To list out the CLASSIFICATION Lecture Listening Pamphlet What is the
classification of ON THE BASIS OF cum classification
sinusitis. LOCATION: discussion of sinusitis?
1. Frontal sinus
2. Ethmoid sinus
3. Maxillary sinus
4. Sphenoid sinus

ON THE BASIS OF
DURATION:
1. Acute sinusitis (infection
lasts up to 4 weeks)
2. Subacute sinusitis (lasts
between 4-12 weeks)
3. Chronic sinusitis (more
4. than 12 weeks)
4. 2min. To enlist the ETIOLOGY Lecture Listening Pamphlet What are the
etiological  Viral infection: 90% of cum causes of
causes of sinusitis. Rhinovirus, discussion sinusitis?
sinusitis. coronavirus.
 Bacteria: Streptococcus
pneumonia, H Influenza
others,
 Pollutants:
Chemical/irritants may
trigger the build of
mucus.
 Fungi: Rare.

5. 2min. To enlist the RISK FCATORS Lecture Listening Pamphlet What are the
risk factors of  URIS such as common cum risk factors of
sinusitis. cold discussion sinusitis?
 Nasal polyps
 Deviated nasal septum
 Dental infection
 Swimming
 Smoking and Intranasal
cocaine.
 Tonsillar and adenoid
hypertrophy.
 Pregnancy, hormonal
changes with puberty.
 latrogenic factors such as
 mechanical ventilation,
NG tubes, nasal packing
etc.

6. 3min. To explain the PATHOPHYSIOLOGY Lecture Listening Pamphlet How can you
pathophysiolog Acute infection cum explain the
y of sinusitis. discussion pathophysiolo
Destroys normal ciliated gy of
epithelium sinusitis?

Impairs drainage from sinus

Pooling & stagnation

Of secretions

Persistence of infection

Mucosal changes-loss of cilia,

edema, polyp formation etc.
leads to SINUSITIS

7. 2min. To discuss the CLINICAL Lecture Listening Flash cards What are the
clinical MANIFESTATIONS cum clinical
manifestations o Common sign and discussion manifestation
of sinusitis. symptoms are Fever, sore s of sinusitis?
throat, headache, facial
 pain and pressure,
malaise.

o In more advance cases

the symptoms are
Anosmia, Nasal
congestion and discharge,
halitosis etc.

SIGNS & SYMPTOMS

ACCORDING THE
CLASSIFICATION
o Maxillary sinusitis: Pain
in the upper jaw.
o Frontal sinusitis: Pain in
the forehead.
o Ethmoid sinusitis: Pain
over nasal bridge.
o Sphenoid sinusitis: Pain
over the occiput or
vertex.

DIAGNISTIC
8. 3min. To enumerate EVALUATION Lecture Listening Pamphlets What are the
the diagnostic cum diagnostic
evaluations of  History taking discussion evaluations of
 sinusitis.  Physical examination sinusitis?
 Watchful waiting: If
sinusitis less than 10 days
without symptom then
viral. More than 10 days
bacterial sinusitis.
 X ray finding conforms.
 CBC
 CT scan.
 Sinus radiography shows
opacification of the sinus,
thickened mucous
membrane.
 Culture and sensitivity
test

MEDICAL MANGEMENT
9. 10min To explain the Lecture Listening Booklet What are the
. medical  Treatment depends on cum medical
management of the how long condition discussion management
sinusitis. lasts. Most acute cases of sinusitis?
resolve without
treatment.
 In most of the sinusitis
antibiotics are not
recommended because
 viral causes.
 Symptomatic treatment
is given to the patient.

Antibiotic therapy:
- Antibiotics are not
prescribed routinely,
because many cases of
sinusitis are viral.
- First line therapy at most
centers is amoxicillin for
14 days.
- Antibiotic therapy-
Amoxyclav 625mg
(Amoxycillin 500 mg
+ clavulamic acid
125mg).

Antipyretics
- Paracetamol
Analgesics
- Ibuprofen
Nasal Decongestants
- Xylometazoline nasal
drops
- These are used to reduce
nasal edema.
 Mucolytics
- Mucolytic agents such as
guaifenesin and saline
lavaf=ge used to decrease
the duration of sinus
infections.
Oral alpha-adrenergic
vasoconstrictors
- Pseudoephedrine and
Phenylephrine can be
used for 10 to 14 days.
- These drugs allow the
restoration of normal
mucociliary function and
drainage.
- These are contraindicated
in clients with
Cardiovascular diseases
and competitive athletes.
Corticosteroid nasal spray
- Antihistamines are
beneficial for reducing
osteomeatal obstruction
in clients with alleregies
and sinusitis.
Antral irrigation or sinus
lavage
 - Antral lavage is a surgical
procedure in which a
cannula is inserted into
the opening of the
maxillary sinus via the
inferior meatus to allow
irrigation and drainage of
the sinus.

SURGICAL
10. 8 min. To explain MANAGEMENT Lecture Listening Booklet What are the
surgical 1. Functional Endoscopic cum surgical
management of sinus surgery. discussion management
sinusitis. 2. Nasal antrostomy: of sinusitis?
3. External
sphenoethmoidectomy
4. Caldwell -Lue procedure.

FUNCTIONAL
ENDOSCOPIC SINUS
SURGERY
 The main objective of
FESS is to re-establish
the sinus ventilation and
Mucociliary clearance.
  It is an outpatient surgical
procedure using local
anesthesia.
 Small fiberoptic
endoscopes are passed
through the nasal cavity
and into the sinus.

 It allows the direct

visualization of the
sinuses in order to
remove diseased tissue
and to enlarge sinus
Ostia.

 Possible complications
includes nasal bleeding,
pain, scar formation.

 After FESS, nasal

packing may be inserted
to minimize nasal
bleeding.

EXTERNAL
SPHENOETHMOIDECTOM
Y
 It is a surgical procedure
performed to remove
diseased mucosa from the
sphenoidal or ethmoidal
sinus.
 A small incision is made
over the ethmoidal sinus
on the lateral nasal bridge
and the diseased mucosa
is removed.
 Nasal and ethmoidal
packing then inserted.

NASAL ANTROSTOMY
 Maxillary antrostomy is a
surgical procedure to
enlarge the opening
(ostium) of the maxillary
sinus. This allows for
further surgical
intervention within the
maxillary sinus cavity as
well as improved sinus
drainage.
CALDWELL LUC
ANTROSTOMY
 Caldwell-luc antrostomy
-also known as Radical
antrostomy is an
operation to remove
irreversibly damaged
mucosa of the maxillary
sinus.
 It is done when maxillary
sinusitis is not cured by
medication or other non-
invasive technique.
 The approach is mainly
from anterior wall of
maxilla bone.

Caldwell Luc-surgical
procedure-
 Can be performed under
LA/Sedation/GA.
 Semilunar incision in
buccal vestibule (canine
to second premolar).

 Mucoperiosteal flap
 raised.

 Opening (antro-stomy) is
made in anterior wall of
Max. Sinus using
chisel/gouges/drill &
enlarged sufficiently
using rongeurs.

 Antral lining is curetted

and antrum debrided and
irrigated.

 Iodoform ribbon
gauze/nasal antrostomy if
required.

 Closure done with 3-0

silk.

NURSING MANAGEMENT
11. 5min. To explain Lecture Listening blackboard What are the
nursing  Warm compresses apply cum nursing
management of in the sinus area. discussion management
sinusitis.  Increase fluid intake. for sinusitis?
 Educate the patient to
 avoid cold environment.
 Promote good oral
hygiene.
 Avoid smoking.
 Avoid blowing nose.
 For the first 24 hours
after sinus surgery,
observe the client for
nasal bleeding,
respiratory distress,
orbital and facial edema.
 Explain the client to
engage in minimal
physical exercise, avoid
strenuous activity.
 Teach the client to sneeze
only with the mouth
open.
 Nasal saline spray may be
started 3 to 5 days after
the surgery to moisten the
mucosa.
 A nasal drip pad is taped
beneath the nares to
absorb drainage after
nasal or sinus surgery.
 NURSING DIAGNOSIS
4min. ▸ Risk for infection related to Lecture Listening
disease process. cum
▸ Ineffective breathing pattern discussion
related to nasal congestion /
discharge
▸ Altered comfort related to
facial fullness, nasal discharge.
▸ Hyperthermia related to
inflammation process.

COMPLICATIONS
12. 3min. To describe the  Meningitis.
complications  Osteomyelitis Lecture Listening Pamphlets What are the
of sinusitis.  Brain abscess cum complications
discussion of sinusitis?