EVALUATION PERFORMA FOR SEMINAR/PRESENTATION

Name-
S.NO. CRITERIA ALLOTED MARKS OBTAINED MARKS
1. Lesson plan (organization and adequacy of content, 20
submission, planning)
2. Preparation of class 5
3. Introduction 5
4. Subject matter and depth of knowledge 5
5. A.V aids 30
6. Confidence 10
7. Language and voice 10
8. Grooming 5
9. Summary & conclusion 5
10. Punctuality 5

Total 100

Remarks:

Signature of the Supervisor:

 PEER GROUP TEACHING
ON
DISORDERS OF NOSE AND THROAT

SUBMITTED ON:
IDENTIFICATION DATA

NAME :

CLASS : M.Sc. 2nd YEAR

SUBJECT : CHILD HEALTH NURSING

TOPIC : PEER GROUP TEACHING ON DISORDERS OF NOSE AND THROAT.

DATE OF PRESENTATION :

PLACE : CLASSROOM

DURATION : 60 MINS.

METHOD OF TEACHING : LECTURE CUM DISCUSSION

SUPERVISOR :

AV AIDS : CHARTS, FLASH CARDS, POWERPOINT

GENERAL OBJECTIVES:

Group point of view:

At the end of the teaching session the group will be able to

 Gain knowledge about the topic.
 Able to assess the condition in the clinical areas.

Student teacher point of view:

 Teach the group effectively.

 Realize the cognitive functions.
 Develop and improve professional efficiency.

SPECIFIC OBJECTIVES:

- Introduce the topic.

- Discuss the common nose problems in children.
- Explain about rhinitis, its types, symptoms and management.
- Explain sinusitis, its types, symptoms and management.
- Enlist the nursing responsibilities of sinusitis.
- Explain epistaxis and its causes.
- Discuss the management and the nursing management of epistaxis.
- Discuss the disorders of throat.
- Explain pharyngitis, its causes, diagnosis and treatment.
- Discuss about tonsillitis.
- Explain about adenoidal hypertrophy.
- Enlist the clinical manifestation of adenoidal hypertrophy.
- Explain the management of adenoidectomy.
- Discuss Croup syndrome.
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 INTRODUCTION:
Children often have
a significant level of
Ear, Nose, Throat
and Upper
Respiratory
problems. Because
of their inability to
vocalise, often the
symptoms are
neglected till they
flare up into a severe
infection. While
these are treated at
the time, failure to
address the
underlying
conditions may,
leads to persistent or
frequent recurrences
of the problems.

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 Discuss the common COMMON NOSE PROBLEMS Student teacher What are the
nose problems in discusses the common common nose
children. BLOCKED NOSE AND MOUTH BREATHING nose problems in problems in
children. children?
These are relatively common symptom. Often, the cause may be obvious such
as the common cold or flu. However, if this happens regularly or remains
persistent beyond two weeks, an ENT evaluation may be necessary. Long-term
mouth breathing in a child can lead to delayed mid face development which is
permanent.
Explain about RHINITIS Student teacher What is rhinitis?
rhinitis, its types, explain about the
symptoms and rhinitis,its types,
Rhinitis is is the inflammation of the nasal mucous membrane generally
management. symptoms and
caused by viruses. management.
Bacterial rhinitis may be severe and found complicated with sinusitis,
otitis, larangopharyngitis etc. Allergic rhinitis may be found commonly
due to the inhalation of allergens like pollen, dust, mites or due to food
allergy or seasonal changes etc.

Acute Rhinitis:
It is manifested with fever, vomiting, nasal obstruction, sneezing,
sucking and breathing difficulty, mouth breathing malaise and sleep
disturbances.

Mild diarrhoea may be present with the condition. This condition may
be complicated with otitis media, bronchiolitis, bronchopneumonia,
persistent sinusitis, spasmodic laryngitis, purulent rhinitis etc.

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 Management can be done with antipyretics, decongestants, prevention of
spread of infection and cleaning of nasal secretions. Antibiotic therapy is
indicated only in presence of complications and with bacterial rhinitis.

Chronic Rhinitis:
It is mostly characterized by chronic nasal discharge. It may be
associated with adenoids, unhygienic environment, overcrowding, poor
ventilation in housing, in adequate proteins and vitamins intake in diet
and nasal allergy.

Allergic rhinitis may be present with sneezing, itching nasal blockage,

mucoid rhinnorea, postal discharge, cough, redness of conjunctiva etc.

Management:
It can be managed by nose blowing exercises, breathing exercises,
cleaning nostril, avoidance of allergy and symptomatic relief by
antihistamines, decongestant and saline nasal spray.
Explain sinusitis, its Student teacher What is sinusitis,
types, symptoms and Sinusitis explains sinusitis, its its management?
management. types, symptoms and
Inflammation of sinuses are common along with rhinitis. Maxillary and management.
ethmoid sinuses are most commonly infected in infancy and early
childhood. Frontal sinusitis may develop only after 4-5 years of age. The
common etiological organisms are S. pnumonae, H. influenzae,
B.catarrhalis and S. pyoogenes. Sinusitis can be acute or chronic.

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 Acute sinusitis
It may develop following acute coryza or viral rhinitis. It is manifested
with headache, facial pain, retro-orbital pain, fever foul breath, postnasal
discharge with persistent cough especially at night, tenderness, redness
and swelling, over the cheek or near the inner canthus of the of the eye.
The condition may be complicated with periorbital or orbital cellulitis,
chronic sinusitis, cavernous sinus thrombosis, meningitis, optic neuritis,
subdural abscess and osteomyelitis of the maxilla.

 Nasal examination shows mucous or pus on the floor of the nasal

cavity.
 Diagnosis is confirmed by X-ray of paranasal sinuses which
shows air fluid levels and complete opacification.
 CT scan can be done to detect complications.
 Nasal swab culture helps to determine the causative organism.
Management

It includes effective antibiotic therapy, decongestants, mucolytic agents,

nasal drops(ephedrine in normal saline), analgesics, steam inhalation (in
older children) more fluid intake, application of local heat.

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 Chronic sinusitis
It is mostly involved mainly the maxillary antrum and found as
complicated of acute sinusitis which develop from acute coryza. Other
contributing factors of this condition are nasal polyps infected tonsils
and adenoids, septic tooth, nasal allergic reaction , deviated nasal
septum, cystic fibrosis. Etc. The common causative organisms Staph.
aureus , Pneumococcus and Strep. viridans.

Clinical Manifestations
The clinical manifestations of chronic sinusitis includes
Recurrent attack of nasal and postnatal discharge with cough.
Nasal obstruction, sniffing, nose twitching
Mouth breathing
Epistaxis and discharge from ear may be present.

General symptoms include:

Low grade fever
Malaise
Anorexia
Fatigability
Irritability and headache.

Diagnosis:

History taking

Complete physical examination: Nasal examination reveals some

enlargement and congestion of the inferior turbinates and mucopus or
pus on the nasal floor.
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 X- rays- X-rays of the maxillary and ethmoid sinuses helps in diagnosis.
It will show opacification of the sinuses due to pus or due to thickening
of the lining membrane.

Culture and sensitivity test of nasal discharge may be done to check the
causative agent.

Management:
-Medical management:
-Prolonged antibiotic therapy.

 Supportive measures should include breathing exercise, nose

blowing, Vit. A supplements,.

 Lavage of the antrum (maxillary) followed by instillation of

antibiotic, tropical nasal corticosteroid and analgesics.

 Surgical Management: Surgical intervention may be necessary

when conservative management is unsuccessful.

 Endoscopic sinus surgery to remove the diseased tissue and nasal

antrostomy( surgical placement of an opening under inferior
turbinate) to provide aeration of the antrum and to permit exit for
purulent material may be indicated in some children.

 Correction of deviated nasal septum or removal of nasal polyp

may be needed.

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 Enlist the nursing Nursing responsibilities: Student teacher enlists What are the
responsibilities of  This includes early detection of the condition, motivating for the nursing nursing
sinusitis. appropriate treatment, encouraging for completion of the therapy responsibilities of responsibilities of
sinusitis. sinusitis?
 Follow-up, discouraging for swimming and diving in children
with URI.

 Teaching about prevention of the condition and its complication,

moving to dry climate, increasing humidity and fluid intake and
local heat should be emphasized.
Explain epistaxis Epistaxis Student teacher Explain what is
and its causes explains about epistaxis and its
epistaxis causes.
Epistaxis or nose bleeding is common in children. Bleeding occurs
usually from anteroinferior portion of the cartilaginous nasal septum due
to rich capillary vasculature in this zone known as little's area or
Kiesselbach's plexus.

Causes:
The common causes of epistaxis in children are major trauma, nose-
picking and vigorous nose blowing or rubbing.

Other local causes of epistaxis are foreign body in nose, nasal injury,
nasal polyp, rhinitis (allergic, acute, chronic), nasal diphtheria,
Nasopharyngeal tumours or vascular malformations (haemangioma,
telangiectasia), etc.

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 There are systemic causes which may result in epistaxis. These include
leukaemia, haemophilia, thrombocytopenia, DIC, rheumatic fever,
typhoid fever, acute infections, ingestion of aspirin, hypertension,
tuberculosis, leprosy, solar radiation, cirrhosis, nephritis, vitamin ‘K’
deficiency, scurvy, etc.

Epistaxis may occur on adolescent girls during puberty.

It may also occur in hot summer months and due to excessive emotional
stress and strain.

Discus the Management of epistaxis.

management and Student teacher What is
the nursing  It should include first aid measures like digital pressure for 10 to discuss the management and
management of 15 minutes by pinching the nose to stop bleeding and bending management and nursing
epistaxis. forwards, in comfortable position, loosing cloths and giving nursing management management of
reassurance. of epistaxis. epistaxis?

 The child should be instructed to avoid nose picking, forceful

blowing and sneezing. Splashing cold water and cold compress
over the nose bridge are helpful.

 Persistent nose bleed may require local application of

vasoconstricting agent (epinephrine) and nasal packing with
gauze or gelfoam pack, as it may be anterior, posterior, or
combined (anterior and posterior) nasal bleeding.

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  Recurrent epistaxis can be managed by chemical (silver nitrate)
or electrocautery.

 Application of antibiotic ointment for lubrication and for

prevention of infection may he needed. control of allergic
reactions, detection and management of systemic causes and
bleeding disorders to be done appropriately.

 Details family history and history of illness to he obtained and

necessary investigations to he performed.

 Blood transfusion may be necessary in some children with

epistaxis.

Nursing Management:

 Nursing measures should include continuous monitoring of vital

signs, bleeding, hypoxia, respiratory difficulty and nasal packing.

 Teaching the parents and family members about measures to stop

epistaxis and immediate medical help are also important.

 Instructions to be given to the parents to apply lubricant to nasal

septum twice daily to reduce dryness and to avoid nasal blowing
or picking nose after nose bleed.

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  Preventive measures of foreign body in the nose, nasal injure and
solar radiation to be explained.
Need for management of local and systemic cause of epistaxis should be
informed and emphasized.

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 Discuss the DISORDERS OF THROAT Student teacher What are the
disorders of throat. discusses about the disorders of throat?
The disorders and diseases of throat can be found as congenital or disorders of throat.
acquired problems. Congenital anomalies of throat include cleft palate,
laryngomalacia, laryngeal webs, cysts and haemangiomas.

Acquired problems are mainly inflammatory, i.e. pharyngitis, tonsillitis,

adenoids, laryngitis and epiglottitis. Throat injury may occur
accidentally with stick, pen, sharp objects or may found as external cut
injury especially during kite-flying with sharp thread as laryngotracheal
cut.

Pharyngitis
Explain pharyngitis, Pharyngitis is commonly termed as sore throat which involves Student teacher What is
its causes, diagnosis inflammation of pharynx and tonsils. Inflammation of soft palate and explains about its pharyngitis, its
and treatment. causes, diagnosis and causes, diagnosis
lymphoid follicles of palate also may present with the condition.
treatment. and treatment?
Laryngitis may occur in extension of this inflammation. Pharyngitis
commonly occur after one year of age.

Common causative organisms are viruses (adenovirus, enterovirus,

parainfluenzae virus, EB virus, etc.) in about 80 to 90 percent. Bacterial
infection may occur especially with group 'A' beta haemolytic
streptococci, S. aureus, H. influenza, etc.
Viral pharyngitis is characterized by nonexudative erythema of pharynx,
tenderness of cervical lymph glands, fever, malaise, anorexia,
hoarseness of voice, cough, nasal discharge and nasal obstruction.

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 Bacterial (streptococcal) pharyngitis is manifested by bilateral tonsillar
hypertrophy, erythema, whitish exudate headache, vomiting, abdominal
discomfort, fever and dysphagia due to sore throat.

Diagnosis

Throat examination shows diffused congestion of the tonsils and its

pillars with petechiae over the soft palate. Anterior cervical
lymphadenopathy is commonly present. Diagnosis is confirmed by
throat swab culture.

Management of pharyngitis includes warm saline gargles(in order

children) analgesics, antitussive, antipyretics, steam inhalation, extra
fluid intake, liquid or soft diet and oral hygiene.
Streptococcal pharyngitis should be treated with antibiotics (penicillin,
amoxicillin, erythromycin cephalosporin) for 10 to 15 days.
Student teacher What is tonsillitis?
Tonsillitis
Discuss tonsillitis discusses about
tonsillitis.
Inflammation of tonsillitis are common in children and may be found as
acute or less frequently as chronic cases. The most important organism
is group -A beta streptococcus hemolyticus. Other organisms are H.
influenzae. Spread of infection may occur in nursery, schools and
dormitories.

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 Acute tonsillitis

Acute tonsillitis may be classified as follows –

1. Catarrhal tonsillitis: usually present with URI and measles. It is
least severe form and manifested as redness and sore throat.
2. Follicular tonsillitis: there is involvement of crypts with discrete
yellow patches of exudate on tonsils and enlargement of regional
glands.
3. Parenchymatous tonsillitis- There is a congestion and swelling in
the entire organ.
4. Peri-tonsillar abscess-(Quinsy) It may develop in bacterial
tonsillitis. The child may be present with trismus and muffled
voice with poor oral intake, severe pain on swallowing and
opening mouth, high fever, offensive breath, enlarged cervical
lymph glands and otalgia.
On examination of throat, unilateral bulge in the soft palate and
peritonsillar region with uvular deviation to the opposite side are
seen.

The clinical features of acute tonsillitis are:

 Present with abrupt onset of pain in the throat which may radiate
to the ears.
 Painful swallowing with fever, shivering and convulsions may
occur especially in younger children.
 Tonsils may look remarkably red and congested.

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 Management:

Management of acute tonsillitis may done with bedrest, isolation from

other children to prevent spread of infection, soft or liquid diet,
analgesics and antipyretics.

Systemic antibiotics (penicillin) should be administered parentally for 7

days. Other antibiotics (erythromycin, cephalexin) can be given. Hot
saline gargle or gargles with aspirin in solution may be useful.
Analgesics lozenges in the early stage is helpful.

Chronic tonsillitis

Repeated attack of tonsillitis may be frequently found in children. In

results in scaring over the crypts leading to retention of infected
materials within the tonsils. The clinical manifestations are more
generalized than the local features. The child may present with recurrent
sore throat and tiredness.

Other features may include poor food intake, vomiting, bad smell in
breath(halitosis), abdominal pain, swallowing and breathing difficulties,
dryness and irritation in throat. Respiratory difficulties and chronic
hypoxemia with pulmonary hypertension may develop.

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 This condition with peritonsillar abscess, retro tonsillar abscess and
failure to thrive.

On examination, the child looks sick and throat congested. Crypts of

tonsils appear spongy and purple material may be found on pressure on
crypts. Tonsils may become smaller in size due to fibrosis. Enlargement
of cervical lymph glands may be seen.

Management:

The management of chronic tonsillitis is done with tonsillectomy. It is

indicated, if any medical treatment is unsuccessful and there is severe
hypertrophy of tonsils.
It is basically advised in more than two consecutive years.
Explain about Student teacher What is adenoidal
Adenoidal Hypertrophy
adenoidal explains about hypertrophy?
hypertrophy. adenoidal hypertrophy
Adenoids are diffused lymphoid tissue and follicles in the roof and
posterior wall of the nasopharynx. It is called as pharyngeal tonsils.
Adenoids cause more problem than tonsils in the first four years of life.
Hypertrophy to adenoids mass may almost fill the vault of the
nasopharynx and block the air passage, (through the nose) and obstruct
the eustachian tube.

Recurrent throat infection, poor nasal and oral hygiene, allergy and poor
ventilation at house are the etiological factors of chronic adenoiditis and
hyperplasia of adenoids. It may also be associated with tonsillitis.

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 Enlist the clinical Clinical manifestations. Student teacher enlists What are the
manifestation of the clinical clinical
adenoidal Nasal block, mouth breathing and even opening during daytime. manifestations of manifestations of
hypertrophy. adenoidal hypertrophy. adenoidal
hypertrophy?
 Other manifestations are:
 Dry mouth and lips
 Persistent rhinitis
 Chronic nasal discharge
 Pharyngitis
 Snoring at night
 Nasal speech
 Offensive breath
 Impaired taste
 Harassing cough
 Hearing deficient
 Chronic otitis media
 The condition may be complicated with apnoeic spells, arterial
hypertension and cor-pulmonale.

Diagnosis:
The diagnosis of adenoid hypertrophy is confirmed by digital palpation,
indirect visualization with pharyngeal mirror or fibreoptic bronchoscope
and pharyngeal X-ray along with careful history of illness and physical
examination .

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 Explain the Management: Student teacher What is the
management of explains the management of
adenoidectomy. The management of the condition is done with the adenoidectomy to management of management of
relief the symptoms to improve the condition of the child’s health. adenoidectomy. adenoidectomy
This surgical intervention is contraindicated in URI and presence of cleft
palate.

Tonsillectomy and adenoidectomy may be performed together or

separately.

Postoperative care

-Postoperative care following tonsillectomy and adenoidectomy should

provide attention for the assessment of bleeding from the site of
operation.

-They should be placed in comfortable prone position, head turned to

one side allowing to drainage from mouth and pharynx. The airway
clearance adequate fluid intake, application of ice colour, analgesics,
alkaline mouth wash and liquid diet should be provided.

-Spicy, hot and rough foods should be avoided.

-Milk and milk cream products should be avoided because they tend to
increase mucous secretion and may be good source of infections.

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 -Reducing child fear, relieving parental anxiety and teaching the parents
about home-based care with necessary precautions for prevention of
complications are important aspect of nursing intervention.

Discharge advice:

Following tonsillectomy and adenoidectomy should include the

following-
 Rest up to one week
 Soft non-irritating foods with more amount of water intake.
 Allowing normal diet and normal activities at two weeks
operation.
 Discouraging frequent coughing and throat clearing.
 Avoid contact with infected persons.
 Maintain oral hygiene and general cleanliness.
 Avoid gargling, only rinsing mouth or mouth wash is allowed.
 Avoid straw to drink any liquid which may injure the operation
site.
 Practice nose breathing rather than mouth breathing.
 Avoid overcrowding and dusty place for few weeks.
 Take prescribed medications.
 Contact medical help in bleeding and pain in throat of ear and
attend regular follow up.

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 Discuss Croup Croup syndrome. Student teacher What is Croup
syndrome. discusses about Croup syndrome?
Croup refers to the inflammation of the larynx characterized by crocking syndrome
cough, stridor, hoarseness, cold and fever.

Dyspnoea, cyanosis and restlessness may also develop. Laryngitis

usually present may also present with infection of surrounding tissue.
Croup is the common term used for those infection.

Croup syndromes are the infections of supraglottis, glottis, subglottis

and trachea. It includes the following:
 Acute laryngotracheobronchitis(subglottic croup)
 Acute spasmodic laryngitis (pseudomembranous croup)
 Acute epiglottic (supraglottic croup).

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 Summary:

We have discussed about the common disorders of such as blocked nose,

rhinitis, epistaxis its causes diagnosis and its management.
We have also discussed about the disorders of throat such as pharyngitis,
tonsillitis, adenoidal hypertrophy and Croup syndrome, its clinical
features, diagnosis and its management.

Conclusion:

I hope all have understood the topic.

BIBLIOGRAPHY: