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Disorder of Nose

This document discusses several disorders of the nose including epistaxis, rhinitis, sinusitis, nasal polyps, and deviated septum. It describes the etiology, clinical manifestations, diagnosis, and management of each condition. Epistaxis or nosebleeds can be anterior or posterior bleeds. Rhinitis can be acute like the common cold caused by viruses, or chronic due to repeated infections or allergies. Sinusitis inflammation can be acute, subacute, or chronic depending on duration and cause. Nasal polyps are benign growths that can cause obstruction. A deviated septum may be due to trauma and can require surgery to improve breathing. Management involves relieving symptoms through medications, nasal

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Sumit Yadav
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156 views31 pages

Disorder of Nose

This document discusses several disorders of the nose including epistaxis, rhinitis, sinusitis, nasal polyps, and deviated septum. It describes the etiology, clinical manifestations, diagnosis, and management of each condition. Epistaxis or nosebleeds can be anterior or posterior bleeds. Rhinitis can be acute like the common cold caused by viruses, or chronic due to repeated infections or allergies. Sinusitis inflammation can be acute, subacute, or chronic depending on duration and cause. Nasal polyps are benign growths that can cause obstruction. A deviated septum may be due to trauma and can require surgery to improve breathing. Management involves relieving symptoms through medications, nasal

Uploaded by

Sumit Yadav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

DISORDER OF NOSE

EPISTAXIS
 It is hemorrhage from the nose.
 It can be;
 A. Anterior Bleed
 Kiesselbach’s plexus vessels.
 Easy to locate and treatment.
 B. Posterior Bleed
 Larger vessels.
 Severe bleeding.
 Harder to locate and treatment.
ETIOLOGY
 Dry cracked mucosal membrane
 Trauma
 Picking
 Blunt contact
 Forceful nose blowing
 sneezing
 HTN
 Chronic infection (AFI)
 Substance abuse
 Arteriosclerosis
 Liver disease
 Chronic bleeding disorder
 Leukemia
 Hemophilia
 Anticoagulant Rx
MANAGEMENT
 Anterior
 Simple first aid
 Apply pressure for 5-10 minutes.
 Apply ice packs to nose & forehead.
 Sitting position leaning forward.
 Discourage swallowing blood.
 Medications
 Topical vasoconstrictors
 Cocaine
 Neo-Synephrine
 Adrenaline
 Nasal spray or on cotton swab held against bleeding site
CONTI...
 Sitting position leaning forward
 Chemical cauterization
 Silver nitrate
 Gelfoam
 Topical anesthetic (pre-packing)
 Tetracaine
 Lidocaine
 Cocaine
 Nasal Packing -Anterior
 Petroleum gauze.
 24-72 hours commonly
CONTI...
 Nasal Packing -Posterior
 Pack both anterior & posterior for 2-5 days.
 Monitor for hypoxemia.
 Administer oxygen as ordered.
 Frequent oral hygiene.
 Administer narcotic analgesics as ordered.
 Monitor for complications.
 Toxic shock syndrome
 Otitis media
 Sinusitis
SURGICAL MANAGEMENT
 Endoscopic Surgery
 Cauterizing bleeding vessel.
 Ligation of internal maxillary artery
NASAL POLYPS
 It is a benign grapelike growth of mucous me
mbrane. Form in areas of dependent mucous
membrane.
 Usually bilateral.
 Stem-like base makes them moveable. It may
enlarge and cause nasal obstruction.
MANAGEMENT
 Medication; - Topical corticosteroid nasal spray.
 Low-dose oral corticosteroids.
 Surgery; Polypectomy under local anesthesia.
 Nasal packing to control bleeding
 Avoid blowing nose 24-48 hours post removal of packing.
 Avoid straining at stool, vigorous coughing, strenuous ex
ercise.
 Monitor for bleeding
 Frequent swallowing
 Visible blood at back of throat
 Laser surgery to remove polyps.
 May require multiple surgeries as polyps tend to recur
DEVIATED SEPTUM
 May result from trauma
 May be present from birth
 Causes nasal obstruction
 Management
 Relief of airway obstruction.
 Repair visible deformity.
 Reshaping of nose by manipulation of septal cart
ilage by;
 Moving
 Rearranging
 Augmenting
CONTI...
 Surgery;
 Septoplasty or submucous resection.
 Rhinoplasty or surgical reconstruction of the
nose.
 Post operatively;
 Bilateral Nasal packing for 72 hours.
 Temporary plastic splint for 3-5 days.
 Swelling subsides within 10-14 days.
 Normal sensation returns within several mon
ths
RHINITIS
 It is an inflammation of the mucous membran
es of the nose.
 It has different classification;
 Based on duration, a) Acute
 b) Chronic
 Based on cause, a) Allergic rhinitis /hay feve
r /:due to allergy.
 b) Non-allergic rhinitis: following URTI (Bacte
ria and Viral).
ACUTE RHINITIS (CORYZA)OR CO
MMON COLD`
 Affects almost every one at some time and most often in th
e winter, with additional high incidence in early fall and spr
ing.
 Cause Common etiology is virus.
 Rhinovirus
 Corona virus
 Adenovirus
 Influenza virus
 Parainfluenza virus
 Echovirus
 Coxsakiervirus
 Respiratory syncytial virus (RSV), Each virus may have multi
ple strains. For example, there are over 100 strains of rhino
virus, which accounts for 50% of all colds.
CONTI...
 It is highly contagious because virus is shed for
about 2 days before the symptoms appear and a
fter 3 days of the symptom.
 Common cold spread by;
 Droplet nuclei from sneezing.
 Contaminated hand or fomites.
 Secondary invasion by bacteria may cause;
 Pneumonia
 Acute bronchitis
 Sinusitis
 Otitis media
CLINICAL MANIFESTATION
 Sneezing
 Nasal discharge (runny nose)
 Nasal obstruction
 Head ache
 Nasal congestion
 Chilliness
 Nasal itchiness
 Fever
 Shyness/nervousness
 Sore throat
 Malaise
MEDICAL MANAGEMENT
 Usually self –limiting and lasts for about 1 we
ek.
 Goal of management;
 1. To relieve symptoms
 2. Inhibit spread of the infection
 3. Reduce risk of bacterial complication
CONTI...
 Adequate fluid intake.
 Encouraging rest.
 Preventing chilling.
 Increasing intake of vitamin C.
 Using expectorants as needed.
 Warm salt-water gargles soothe the sore throat.
 Nonsteroidal anti-inflammatory agents (NSAIDs) such as aspirin or ibupr
ofen.
 Antihistamines (chlorpheniramine maleate , diphenhydramine (Benadry
l)
 Topical (nasal) decongestant ( e.g. oxymetazoline maleate (Afrin), phe
nylephrine (Neo-synephrine), pseudoephedrine (Sudafed) orally.
 Zinc lozenges may reduce the duration of cold symptoms if taken within
the first 24 hours of onset.
 Amantadine (Symmetrel) or rimantadine (Flumadine) may be prescribed
prophylactically.
 Antimicrobial agents (antibiotics) should not be used because they do n
ot affect the virus or reduce the incidence of bacterial complications.
NURSING MANAGEMENT
 Perform hand hygiene often.
 Use disposable tissues.
 Avoid crowds during the flu season.
 Avoid individuals with colds or respiratory inf
ections.
 Obtain influenza vaccination, if recommende
d (especially if elderly or diagnosed with a ch
ronic illness)
CHRONIC RHINITIS

 A chronic inflammation of the nasal mucosal


membrane characterized by increased nasal
mucus.
 Cause
 Repeated acute infection or allergy.
 Vasomotor rhinitis (an instability of the auto
nomic nervous system caused by stress, tensi
on , or some endocrine disorder).
 Chronic irritation by nasal drug
CLINICAL MANIFESTATION
 no acute symptom.
 nasal obstruction (stuffiness).
 pressure in the nose.
 Polyp formation .
 Vertigo
MANAGEMENT
 Nursing interventions
 The pt with allergic rhinitis is instructed to a
void allergens and irritants i.e. dusts, fumes
, odor, powder sprays.
 Proper use and administration of medication.
Obtain additional rest.
 Drink at least 2 to 32 times fluid daily.
 Use nasal spray or nose drops.
SINUSITIS

 It is an inflammation of the mucous membran


es in the sinuses.
 Sinusitis can be;
 1. Acute bacterial.
 2.Sub acute.
 3.Chronic.
ACUTE SINUSITIS
 The most common types of acute sinusitis ar
e;
 Allergic. Usually seasonal.
 Viral.
 Acute bacterial (Streptococcus pneumonia,
haemophilus influenza, beta hemolytic strep
tococcus, klebsiella pneumonia and various
anaerobic organisms).
CLINICAL MANIFESTATION
 Slowly developing pressure over the involved sinus
 General malaise
 fever
 malaise
 Systemic symptoms i.e., achiness
 Stuffy nose
 Persistent cough
 Postnasal drip
 Head ache
 Redness and itching of the eye
 Sign of tooth infection
 In acute frontal and maxillary sinusitis, pain
usually does not appear until 1 to 2 hours aft
er awakening.
 It increases for 3 to 4 hours and then become
s less severe in the afternoon and evening us
ually this is due to increased drainage as res
ult of gravity from standing during the day.
 Bloody or blood –tinged discharge from the n
ose in the first 24 to 48 hours.
 The discharge rapidly becomes thick, green,
and copious, blocking the nose.
DIAGNOSIS
 Hx.
 P/E;
 Tenderness in the involved sinus,
 Hyperemic and edematous nasal mucosa, an
d
 The turbinate's are enlarged.
 X-ray examination
 Clouded sinus and fluid level is visible.
MANAGEMENTS
 Aim is to relief a pain and shrinkage of the nasal mucosa.
 Medication - Analgesics i.e. . Ibuprofen.
 Oral decongestant pseudoephedrine.
 Antibiotics i.e., Amoxicillin for 10 days to 14 days .
 Failure of the infection to respond to amoxicillin is an in
dication for aspiration of the maxillary sinus to take spec
imen for culture and sensitivity and to remove the accum
ulated secretion.
 Acute frontal sinusitis with pain, tenderness, and edema
of the frontal or sphenoid sinus require hospitalization b/
c of risk of intracranial complication or Osteomyelitis .
 High doses of IV antibiotic nasal decongestant or by spray
is needed
CHRONIC BACTERIAL SINUSITIS
 Chronic bacterial sinusitis develops when irre
versible mucosa damage occurs.
 Damage car result from recurrent attacks of
acute sinusitis or from suppurative sinusitis e
ither being untreated or inadequately treate
d during the acute or sub acute phase.
 Etiology
 S.aureus
 H. influenza
 Anaerobes (Klebsiella)
CLINICAL MANIFESTATION
 Nasal congestion
 Thick, green purulent discharge, present for
at least 3 months
 Fever
 Facial pain
 Light headness /does not have headache
 Diagnosis
 Culture and sensitivity
MANAGEMENT
 Medication
 Decongestant.
 Antibiotic according to result of the culture.
 Nasal saline irrigation and surgery are the maj
or treatments.
 Pt. benefits from thing that increase the drain
age.
 Increasing the humidity (steam bath hot show
er, facial sauna).
 Increasing fluid intake applying local heat (ho
t wet packs).
THANK YOU

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