Nasal polyps (2)

1. Nasal polyp OPTHALMOLOGY & OTORINOLARYNGOLOGY NURSING DNC 206

2. Understand the Definition of Nasal Polyp Know the Statistic / incidence of Nasal Polyp List the Etiology/Risk factors Nasal Polyp Know the Clinical manifestations of Nasal Polyp Know the Complications of Nasal Polyp Know the Diagnostic tests of Nasal Polyp Know the Prevention of Nasal Polyp Explain the Nursing management of Nasal Polyp Know the Medical management of Nasal Polyp Know the Nursing care plan for Nasal Polyp Know the Prognosis of Nasal Polyp Explain the Health Education for Nasal Polyp Summary In the end of this presentation, students will able to… Objective

3. Non – cancerous growth (benign) Develop on the lining of the passages at sinuses Growth : -small growth (may cause no problem) -big growth(cause many complications) Come in many sizes and shapes. (1998-2010 Mayo Foundation for Medical Education and Research (MFMER), 20 th February,2009) definition Nasal polyp…

4. Common in adult . Rare in children. 4 times are common in men than women. 1 and 20 out of every 1000 people will develop Nasal Polyp. (www.mayoclinic.com/health/nasal -polyps/ds00498) incidence

5. Triggering factors Viral infections, bacterial infections, allergies, fungus, chronic inflammation, asthma, chronic sinus infections, hayfever , sinusitis. Allows fluid to build up in the cells of nose and sinuses. Over time, as gravity pulls on these fluid- filled cells. Nasal polyp developed. Proliferation of fibroblasts And myoblasts pathophysiology

6. Etiology

7. Sinusitis Viral and bacterial infection

8. Allergic rhinitis ( hayfever ) Chronic inflammation

9. Asthma Allergic fungal sinusitis Allergies

10. Risk factors

11. Cystic fibrosis Aspirin sensitivity Asthma Allergic fungal sinusitis

12. Churg –Strauss Syndrome Age- common in adult Family history

13. Z z z z Runny nose Mouth breathing Snoring Shape of face may change Clinical manifestations

14. Persistent stuffiness and facial discomfort Decreased/ no sense of smell a nd taste Nasal obstruction

15. Complications Obstructive sleep apnea

16. Altered facial structure Bleeding

17. DIAGNOSTIC TESTs

18. CT Scan of Nasal cavity Physical examination

19. Nasal endoscopic Test for cystic fibrosis

20. Manage allergies and asthma Avoid irritants Practice good hygiene Clean and humidify your home and surrounding Use nasal rinse or nasal lavage preventions

21. Medical/ surgical management

22. Fluticasone (Flonase.Veramyst) Budesonide (Rhinocort) Flunisolide (Nasarel) Prednisone (either alone or with nasal spray) NASAL CORTICOSTEROID

23. To reduce inflammation NASAL SPRAY

24. Surgical management POLYPECTOMY Removed using a small mechanical suction device or a microdebrider. ENDOSCOPIC SINUS SURGERY Procedure to remove the nasal polyp

25. Endoscopic Sinus surgery/ Polypectomy of the Nasal Polyp

26. nursing management

27. Pre operative care of patient undergo Polypectomy. Physical examination. Taking vital signs as baseline data. Inform or explain to patient and family members about the procedure. Ensure the consent form is signed.

28. Make sure case note, blood result, and CT Scan film are ready. Ask patient to change his/ her clothes to OT gown. Shaving if necessary (moustache). Tell patient to stop taking medicine that can lead to severe bleeding. E.g aspirin.

29. Ask patient to fasting 6-8 hours before procedure. Ensure that patient has already past motion and urine.

30. Post operative care.. Monitor patient’s vital signs properly. Observe any complications such as bleeding and infections. Administer analgesic drugs as prescribed by doctor. Inform doctors if any abnormalities detect. Examples : inflammation

31. Assess patient’s conditions ~ take patient’s level of pain. (pain scale)

32. Removing the polyps makes easier to breath through nose. Nasal polyps can return Treatment and surgery does not always improve lost sense of smell. prognosis

33. nursing Care plan

34. NURSING DIAGNOSIS GOALS NURSING INTERVENTION EVALUATION Low self-esteem due to altered facial structure Patient will improved his self-esteem slowly. -Suggest patient to wear a mask. -Explain to the patient that the polyps will shrink after the inflammation treated and polyps will removed by surgical management. Patient’s self-esteem slowly improved.

35. NURSING DIAGNOSIS GOALS NURSING INTERVENTION EVALUATION Anxiety due to growth of the polyps Patient will verbalize less anxiety -Administer an anti-inflammatory drugs to reduce the polyps as prescribed by doctor. -Provide patient an information about nasal polyps. -Let patient express his feeling regarding the disease. Patient verbalized less anxiety

36. NURSING DIAGNOSIS GOALS NURSING INTERVENTION EVALUATION Risk for bleeding related to patient nose care. Prevent from bleeding. -advise patient not to digging his nose or blowing too hard because it will cause trauma/ bleeding. Bleeding prevented.

37. Nursing Diagnosis Goals Nursing intervention Evaluation Pain related to the surgery. Patient will verbalize less pain -administer patient an analgesic drug such as tramadol and voltaren according to doctor’s order. - Assess patient’s pain with pain scale Patient verbalized less pain.

38. Health education Advise patient to compliant with medication given and not to take herbs that are not recommended by doctor. Follow up review ~ condition of the nasal cavity after surgery done. ~detect any infection or inflammation.

39. Avoid any irritants that can develop back the nasal polyps such as dust, infection, etc. Advice patient not to injured to the surgery area such as.. ~digging ~blowing

40. Summary Nasal polyp is not a disease. It caused by many triggering such as viral and bacterial infections, allergies, and fungus. Nasal polyps are commonly developed in adult. The common causes of nasal polyp are aspirin sensitivity, asthma, cystic fibrosis, and allergic fungal infection.

41. Nasal polyps can manifest complications such as chronic sinus infection, bleeding, altered facial structures and others. Nasal polyps can return after surgery.

42. REFERENCES Bachert C, Van Cauwenberge p.Nasal Polyps and Sinusitis. In: Adkinsaon NF, Yunginger JW, Busse ww,et,eds . Middleton’s Allergy, Principles and Practice, 6 th ed Philadelphia , Morby ; 2003:1421-1436 Lewis, Heitkemper , Dirksen, O’Brian, Bucher. Medical-surgical Nursing. Assessment and management of clinical problems . Page 541.International edition. Mayo Clinic Staff, 1998-2010 Mayo Foundation for Medical Education & Research(MFMER) (www.mayoclinic.com /health/nasal-polyps/ds00498) Pl Dhingra , Disease of ear,nose and throat. Fourth edition 2007. Elsevier, A division of Reed Elsevier India private limited . Seth Schwartz, MD, MPH, Otolaryngologist, Bachert C, Gevaert P, Van Cauwenberge P.Nasal polyps and rhinosinusitis . In:Adkinson NF Jr.,Bochner BS , Busse WW, Holgate ST,Lemaske RF Jr.,eds. Middleton’s Allergy:Principles and Practice .7 th edition.Philadelphia,Pa;Mosby Elsevier;2008:chap 56