MANAGEMENT OF A CLIENT WITH NASAL

DISORDERS

SINUSITIS
PRESENTER-
MR.M.B.MULINDA
 SINUSES
 Behind the bones of the face there are some hollow
spaces, filled with air, which lead to the nose
cavity.
 These are known as the sinuses.
 Sinuses have the same mucous membrane lining
as the nose .
 The membrane produces a slimy secretion
(mucus), keeping the nasal passages moist.
 The mucus traps dirt particles and germs.
 SINUSITIS

 Sinusitis is the Inflammation of the mucous

membrane of any sinus, especially the paranasal.
 There are four main sets of sinuses, they are all
paired.
 The inflammation could be caused by an infection
from a virus, bacteria or fungus.
 It may also be the result of an allergic or autoimmune
reaction.
 An autoimmune reaction is when the immune system
attacks the good parts of the body.
 PATHOPHYSIOLOGY
 During sinusitis, the mucous membranes of the
nose, sinuses and throat (upper respiratory tract)
become inflamed.
 Swelling obstructs the sinus openings and prevents
mucus from draining normally, causing facial pain
and other sinusitis symptoms.
 Blocked sinuses create a moist environment that
makes it easier for infection to take hold.
 Sinuses that become infected and can't drain
become pus filled, leading to symptoms such as
thick, yellow or greenish discharge and other
symptoms of infection.
 TYPES OF SINUSES
The maxillary sinuses
 These are found In each cheekbone.
 They are the largest sinuses, also the ones that
most commonly are affected when a person has
sinusitis.
 The frontal sinuses
 These are found above the eyes, either side of the
forehead
 Ethmoid sinuses
 These sinuses are found behind the bridge of the
nose, between the eyes
 Can also be broken down into anterior and
posterior - front and back
 Sphenoid sinuses
 These are found between the upper part of the nose
and behind the eyes.
 LOCATION OF SINUSITIS
 Maxillary sinusitis - the patient feels pain or pressure
in the cheek (maxillary) area. This can be experienced as
toothache or headache.
 Frontal sinusitis - the patient feels pain and/or
pressure behind or above the eyes (frontal sinus cavity).
The pain will generally be experienced as headache.
 Ethmoid sinusitis - the patient feels pain and/or
pressure behind or between the eyes. Usually as in the
form of a headache.
 Sphenoid sinusitis - the patient usually feels pain or
pressure in the top part (vertex) of the head.
 CLASSIFICATIONS OF SINUSITIS

Acute sinusitis (acute rhinosinusitis)

 A new infection that may last up to four weeks
 causes the cavities around the nasal passages
(sinuses) to become inflamed and swollen.
 This interferes with drainage and causes mucus to
build up.
 With acute sinusitis, it may be difficult to breathe
through the nose.
 The area around the eyes and face may feel swollen,
and client may have throbbing facial pain or a
headache.
 Most often caused by the common cold.
 Treatment of acute sinusitis depends on the cause.
 In most cases, home remedies are all that's needed.
 However, persistent sinusitis can lead to serious
infections and other complications.
 SIGNS AND SYMPTOMS

 Drainage of a thick, yellow or greenish discharge

from the nose or down the back of the throat
 Nasal obstruction or congestion, causing difficulty
breathing through the nose
 Pain, tenderness, swelling and pressure around the
eyes, cheeks, nose or forehead.
 SIGNS AND SYMPTOMS

 Aching in the upper jaw and teeth

 Reduced sense of smell and taste
 Cough, which may be worse at night
 Ear pain
 Headache
 Sore throat
 halitosis
 Fatigue
 Fever
 CAUSES OF ACUTE SINUSITIS

 Viral infection. Such as the common cold.

 Bacterial infection. When an upper respiratory
tract infection persists longer than seven to 10 days.
 Fungal infection. Common in sinus abnormalities
or a weakened immune system.
 Allergies such as hay fever. Inflammation that
occurs with allergies may block the sinuses.
 Nasal polyps or tumors. These tissue growths
may block the nasal passages or sinuses.
 Deviated nasal septum— the wall between the
nostrils — may restrict or block sinus passages
 Tooth infection. A small number of cases of acute
sinusitis are caused by an infected tooth.
 Enlarged or infected adenoids in children.
Adenoids are located in the upper back part of the
throat.
 Other medical conditions. The complications of
cystic fibrosis, gastroesophageal reflux disease
(GERD) or immune system disorders may result in
blocked sinuses or an increased risk of infection
 CHRONIC BACTERIAL SINUSITIS.

 Sinusitis that lasts more than 12 weeks, or keeps

coming back.
 can be caused by many different diseases that
share chronic inflammation of the sinuses as a
common symptom
 Develops when irreversible mucosal damage
occurs due to recurrent sinusitis or from
suppurative sinusitis being untreated.
 May be caused by S.aureus and H.influenzae
 SIGNS AND SYMPTOMS

 Nasal congestion with thick, green purulent

discharge for at least 3 months.
 Fever
 Facial pain
 Lightheadedness
 general malaise
 dizziness
 aching teeth
 halitosis
 DIAGNOSTIC TESTS

 Sinus aspirate for culture and sensitivity

 CT -scan of the sinuses to determine if there is blockage
of nasal sinus drainage system,polyps, mucous plugs.
 Nasal endoscopy- involves inserting a flexible fiber-
optic tube with a light and camera at its tip into the nose
to examine the nasal passages and sinuses.
 Completely painless procedure which takes between
five to ten minutes to complete.
 FBC –leukocytosis is revealed of above 20,000/mm3
 SURGICAL MANAGEMENT

 Surgery is aimed at removing all diseased soft tissue

and bone.
 Functional Endoscopic Sinus Surgery- a
fiberoptic endoscope that illuminates and magnifies
to enter the sinus.
 Diseased tissue is located by CT-scan can be
dissected.
 The patient can either be under local or general
anaesthesia
CALDWELL-LUC SINUS OPERATION

 Also known as Radical Antrum Operation

 Treated for chronic maxillary sinusitis that cannot
be treated with antibiotics.
 Local or general anaesthesia is used.
 An incision is made through the upper lip
 Part of the anterior bony wall of the antrum
producing a permanent window, and removes all
the diseased mucosa and periosteum through the
window.
 ETHMOIDECTOMY

 Removal of ethmoid air cells

 Done to remove diseased mucosa and nasal polyps
 Three surgical approaches are performed.
 Transnasal,transantral and or external
 General or local anaesthesia may be used.
 Removal of ethmoid cells creates a single large
cavity that is packed for 24 to 48 hours.
 In transnasal approach, the surgeon uses a headlight
and operating microscope or endoscope
 In transantral ethmoidectomy,a Caldwell-Luc incision
and removes the ethmoid air cells from below.
 The external approach allows better visualization and
reduces the risks of complications such as damage to
the optic nerve and cerebrospinal fluid leak.
 Antral irrigation/Maxillary antral
puncture and Lavage

 The client is put under local anaesthesia

 A large gauge needle is inserted into the maxillary sinus
on the affected side.
 Fluid or pus is drained from the sinus.
 The sinus is then irrigated with saline solution, an
antibiotic solution, or both.
 PREOPERATIVE PREPARATIONS

 Admit the patient and do preadmission tests.

 Offer appropriate psychological care
 Find time for preoperative teachings
 Determine the patient’s understanding of the surgical
procedure and clarify any misconceptions and answer
patient’s and family questions.
 Starve patient 6 to 8 hours before surgery and explain the
reasons.
 PREOPERATIVE PREPARATIONS

 Remind the client that he will have a nasal pack 24 to

48 hours after surgery which will be slightly
uncomfortable to him.
 Ensure patient has no fever prior to surgery
 On the day of surgery, the patient should have all
paperwork and meet the anesthesiologist.
 PREOPERATIVE PREPARATIONS

 The patient should only take the medicication

approved by the surgeon and anesthesiologist.
 Obtain signed consent form prior to surgery.
 Prepare the patient physically such as shaving
moustache and cleansing the skin.
 POST OPERATIVE CARE
 If general anaesthesia is used, admit the patient to
the ward and ensure patent airway.
 Position the client on the side to facilitate drainage of
secretions.
 This position also prevents swelling of the surgical
side and aspiration of bloody drainage
 Keep the mucous membrane moist and ensure the
room is humidified to prevent drying of secretions.
 POST OPERATIVE CARE

 Elevate the head of the bed to mid- Fowler’s position

to prevent oedema and promote drainage as soon as
the client recovers from anaesthesia.
 Apply ice compresses over the nose or maxillary or
frontal sinuses for a few hours after surgery to help
reduce swelling in the operative area,constrict blood
vessels,reduce bleeding and relieve pain.
 POST OPERATIVE CARE

 The nurse to monitor any excessive bleeding from the

nose i.e. frequent swallowing is a clue
 Monitor for decreased visual acuity especially diplopia
which indicates damage to the optic nerve or muscles of
the globe of the eye.
 Monitor for pain over involved sinus, which may indicate
infection or inadequate drainage
 Monitor for elevated temperature
 Encourage mouth washes to prevent halitosis
 POST OPERATIVE CARE

 After sinus surgery, most patients can go home

accompanied by a friend or relative;
 Emphasize on the importance of bed rest with the
head elevated .
 use of an ice pack wrapped in a towel to stop any
bleeding that commonly occurs.
 Recovery may take about 3 to 5 days;
 POST OPERATIVE CARE

 Health teaching after surgery should include;

 Pain management due to swelling and secretions in
the sinus
 Advise client to use Fowler's position in bed
 Client to avoid blowing the nose usually 3 to 4 days
after surgery or 2 weeks if Caldwell-Luc operation
was done.
 If the client feels congestion or fluid in the nose he
can gently sniff back the fluid and spit it onto the
tissue.
 POST OPERATIVE CARE

 Advise client not to bend over and not to lift heavy

objects as these put excessive pressure on the
surgical site.
 Promote measures that prevent constipation
 as straining can cause bleeding.
 Advise client not to chew on affected side until
incision heals in caldwell-Luc operation
 Use caution with oral hygiene to avoid injury to the
incision.
 POST OPERATIVE CARE

 Patients should take their prescribed medications

and avoid any strenuous activities until cleared to do
so by the surgeon.
 Follow-up care is critical for recovery
 Client to keep all appointments and follow
instructions in regard to removing nasal packing
and especially instructions on nasal irrigation
 POST OPERATIVE CARE

Notify the surgeon for;

 excessive bleeding
 fever greater than 38.6 C that persists even with the
use of antipyretics
 sharp pain or headache not responsive to
medications
 increased swelling of nose or eyes and thin clear
fluid draining from the nose.
 TAKING CARE OF DRAINAGE

 Drainage after surgery may increase accompanied by

small amount of bright red bleeding.
 This is normal and may continue for a week.
 A small dressing will be placed beneath the nose to
absorb any drainage
 Advise the client to change the dressing several times
each day.
 TAKING CARE OF DRAINAGE

 After initial bloody drainage stops, a thicker

yellowish green drainage may continue for several
weeks.
 Counsel the client on breathing difficulties as a result
of swollen mucous membrane and emphasize on
keeping head elevated during sleep and use of extra
pillows.
 This position reduces swelling and allows better
drainage of nasal secretions.
 Self-monitoring at home

 Self-care and prevention of complications include;

maximizing moisture in the nose, avoid allergens,
colds and the flu.
 Report signs of infection such as fever and purulent
discharge to surgeon
 Expect tarry stools from swallowed blood for a few
days
 Client to take prophylactic antibiotics as prescribed.
 Complications of surgery

 Numbness of the lip or upper teeth due to damage to

the infraorbital nerve.
 Haemorrhage
 Infection
 Optic nerve damage
 Cerebrospinal fluid leak