1. Deviated nasal septum

2. Nasal septum deviation or deviated nasal septum (DNS) is a physical disorder of the nose involving a displacement or deflection of the nasal septum
Some degree of displacement is common. Affecting 80% of people unknowingly

3. Causes Trauma – blow to the face
Congenital disorder – compression of nose during child birth
Genetic connective tissue disorders – marfan syndrome
Pressure from massess

4. Pathophysiology
Nasal septum in the nose separates the nasal cavity into two nostrils
Normally septum lies centrally and thus the nasal passages are symmetrical
A deviated septum is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right causing obstruction of the affected nasal passage

6. Signs and symptoms
Only more severe cases of deviated septum will cause symptoms
Difficulty breathing
Infections of the sinus
Sleep apnea
Snoring
Repetitive sneezing
Facial pain
Nose bleeds
Mild to severe loss of the ability to smell

7. Diagnostic measures History collection
Physical examination – nose examination with a pen torch
X ray

8. Management In mild cases – symptomatic treatment
Medications – decongestants, antihistamines and nasal spray
Medications will relieves only the symptoms but does not correct the underlying condition
Nasal strip - A nasal strip, external nasal dilator strip or nasal dilator strip is a type of adhesive bandage with embedded plastic ribs or splints that is applied across the bridge of the nose and sides of the nostrils, to assist in keeping the airway open. 

9. Nasal inhalation

10. Remove cap form the nasal inhaler
Shake the container well
Hold the inhaler between the thumb and forefinger
Tilt the head back, slightly and insert the end of the inhaler in to the nostril, mean while close the other nostril.
Press down the container to release one dose and at the same time inhale gently
Ask the patient to hold the breath for a few seconds then breath out slowly through mouth
Withdraw the inhaler from the nostril and repeat with other nostril
Replace the cap after usage

11. Surgical management –septoplasty (1-2 hours) – complete healing occur within 2 days to 4 weeks
The surgeon makes a incision through the mucosa at the caudal end of the septal cartilage, elevates the septal mucous membranes, and separates the septal cartilage from its bony attachments and straightens it .
After that nasal septal splints made of plastic is inserted
Nose may be packed for several days to prevent hematoma formation
Complications of septoplasty –
Infection
Bleeding
Hole (perforation) of the septum
Loss of the ability to smell

15. Rhinoplasty – cosmetic surgery
A plastic surgery procedure for correcting and reconstructing the form, restoring the functions
Open and closed rhinoplasty is there
Rhinoseptoplasty – combined cosmetic and septal corrective surgery

17. Nursing management
Assess the signs of hemorrhage – excessive blood on nasal dressing, bright red vomitus, repeated swallowing(check back of throat with a pen light for blood running down throat), rapid pulse, restlessness
Assess for signs of infection- fever, elevated white blood cell count.

19. Take measures to relieve discomfort and promote effective breathing
Place patient in mid – fowler’s position to decrease local edema
Provide cool mist via face tent
Apply ice compresses over nose for 24 hours
Provide psychological support and sedation if needed
Use flashlight or penlight to examine back of throat to check packing has not slipped to back
Provide frequent oral care
Change dressing under nose as needed

20. Promote good nutrition – provide increased amount of fluid
Instruct the patient to :
Avoid blowing nose for 48 hours after packing has been removed
Avoid constipation and straining
Expect stools to be tarry
Expect face to be discolored around eyes and nose for several days