Nursing Management: Upper Respiratory Problems Chapter 27 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Allergic Rhinitis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

What is Allergic Rhinitis Reaction of nasal mucosa to a specific allergen. Can be divided into intermittent and persistent Intermittent means the symptoms are present less that four days per week or four weeks per year. Persistent means the symptoms are present more than four times per week or more than four weeks per year. Attacks of intermittent usually occurs in the spring or fall and are usually caused by allergy to pollen , flowers and grass Environment triggers such as pet saliva, dust mites, mold, cockroaches usually causes symptoms of allergic rhinitis. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Sensitization to an Allergen Initial exposure to the allergen production of IgE mast cells and basophils release histamines, prostaglandins and leukotriens sneezing, itching , rhinorrhea and moderate congestion. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Clinical Manifestations of Allergic Rhinitis Initial exposure Sneezing, watery eyes and nose: altered sense of smell, nasal turbinates appear pale, boggy and swollen, sinusitis, Chronic exposure Headaches, congestion, pressure, nasal polyps, cough, hoarseness and snoring. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing and Collaborative Management: Allergic Rhinitis Avoiding triggers Maintain a diary of times when the allergic reactions occur. Medical Management Anti histamines Ex benadryl ( causes drowsiness, important to let patients know). Intranasal corticosteroids Leukotrien receptor antaganists Immunotherapy ( allergy shots) – exposure to small amount of known allergens through frequent injections Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy CORTICOSTEROIDS Nasal spray – baclomethasone, rhinocort, flonase, nasonex and nasocort Mechanism of action Inhibit inflammatory response Low systemic absorption Side effects Mild transient nasal burning Localized fungal infections – candida albicans Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy Mast cell stabilizers Nasal spay Cromolyn spray Mechanism of action Inhibit degranulation of sensitized mast cells, which occurs after exposure to specific antigens Side Effects Minimal side effects – nasal irritation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy Leukotrienes receptor antagonists and inhibitors Antagonists Zafirlukast, montelukast ( singular) Mechanism of Action Antagonize leukotriene activity and inhibit airway edema and broncho constriction and decreasing inflammatory process. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

How to Reduce Symptoms of Allergic Rhinitis Avoid house dust Avoid house dust mites Avoid pet allergens Avoid mold pores Avoid pollen Avoid smoke Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acute Viral Rhinitis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acute viral rhinitis Common cold or acute coryza Spread by airborne droplets Virus can survive in an inanimate objects for upto 3 days Frequency of infection increases in the winter Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing management of viral rhinitis Rest, fluids, proper diet, antipyretics, and analgesics Complications include : otitis media, tonsillitis, lung infection, Frequent hand washing and avoiding crowds during winter months is recommended for people with chronic illnesses. Nasal spray should not be used more than three days to prevent rebound congestion from occurring. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Influenza Etiology and Pathophysiology Diagnostic Studies Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Influenza Each year influenza ( flu ) causes significant morbidity and mortality Approximately 5 to 20% Americans contract influenza each year Influenza related deaths average about 36000 each year in the united states Deaths are largely preventable with vaccination of high risk groups Influenza viruses are classified as A, B and C. only A and B causes significant illness in humans Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Influenza cont.. The type A H1N1 which is the swine flu Influenza is communicable through droplet, contact, and inhalation Virus has an incubation period of 1 to 4 days Clinical manifestations Cough, fever and myalgia accompanied by headache and sore throat. Most common complication of influenza is pneumonia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Types of influenza immunization Inactivated vaccine – given by injection, approved for people 6 months or older, residence of nursing homes, people who are immuno-compromized, and pregnant women Live attenuated influenza vaccine – given by nasal spray, approved for healthy people 2 to 49 years, only to non pregnant, healthy people Flu vaccines are contraindicated if: allergic to eggs or history of guillian barre syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Influenza / nursing management Supportive care directed towards relief of symptoms and prevention of secondary infections Antiviral treatments: amantadine, rimantadine, zanamivir, tamiflu. These drugs shorten the course of influenza. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Clinical Manifestations Sinusitis Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Clinical manifestations Allergies are the precipitation cause of sinusitis Pain over the effected area Purulent nasal drainage Congestion Fever and malaise Enlarged turbinates Headaches Confirmed by X ray or CT scan Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing management Avoid and environmental control of allergies Antibiotics if greater than 7 days First line treatment is Amoxicillin If symptoms do not resolve , start broad spectrum antibiotics such as Bactrim Decongestants to promote drainage. Nasal corticosteroids to decrease inflammation antihistamines Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sinusitis Fig. 27-2. Location of the sinuses. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.