1. Nursing Management: Upper Respiratory Problems
Chapter 27 Overview
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Allergic Rhinitis
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3. 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.
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4. 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.
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5. 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.
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6. 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
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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
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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
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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.
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10. How to Reduce Symptoms of Allergic Rhinitis
Avoid house dust
Avoid house dust mites
Avoid pet allergens
Avoid mold pores
Avoid pollen
Avoid smoke
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Acute Viral Rhinitis
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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
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13. 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.
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14. Influenza Etiology and Pathophysiology Diagnostic Studies
Clinical Manifestations
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Influenza
Each year influenza ( flu ) causes significant morbidity and mortality
Approximately 5 to 20% Americans contract influenza each year
Influenza related deaths average about 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
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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
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17. 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
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18. 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.
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19. Clinical Manifestations
Sinusitis
Clinical Manifestations
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20. 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
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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
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Sinusitis
Fig Location of the sinuses.
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