Nursing management of patient withSINISITIS

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. 
Sinusitis is an inflammation of the mucus membrane of the Paranasal sinuses.
Rhino- sinusitis is referred to as an inflammatory disease of the nose or sinuses.
Pansinusitis is infection of more than one sinus. It affects 1 in 8 adults per year.
It is a common condition and a complication of 5%-10% of URIs in children.Viral infection: 90% of sinusitis. Rhinovirus, corona virus.
Bacteria: Streptococcus pneumoniae ,H Influenza others, Pollutants: Chemical/irritants may trigger the build of mucus.
Fungi: Rare.
URIs such as common cold Nasal polyps Deviated nasal septum Dental infection Swimming
Smoking and Intranasal cocaine.
Tonsillar and adenoid hypertrophy.
Pregnancy, hormonal changes with puberty.
TYPES�
 On the basis of location and on the basis of duration
Frontal sinusitis
Acute sinusitis( infection lasts up to 4 weeks)
Acute sinusitis usually starts with cold-like symptoms such as a runny, stuffy nose and facial pain. It may start suddenly and last 2 to 4 weeks.
Subacute sinusitis usually lasts 4 to 12 weeks.

Chronic sinusitis symptoms last 12 weeks or longer.
Recurrent sinusitis happens several times a year.
Pansinusitis affects all the sinuses in your head – not just the common one or two.
Ethmoidal Sinusitis -Subacute sinusitis ( lasts between 4 -12 weeks)
Maxillary sinusitis -Chronic sinusitis(more than 12 weeks)
Sphenoidal sinusitis
MANAGEMENT�
Symptomatic treatment is given to the patient.
Treatment depends on the how long condition lasts.
Most acute cases resolve without treatment.
Antibiotics are not prescribed routinely, because many cases of sinusitis are viral.
First line therapy at most centres is Amoxicillin for 14 days.

Antibiotic therapy- Amoxiclav 625 mg(Amoxicillin 500 mg + clavulanic acid 125 mg).
These are used to reduce nasal edema.
Xylometazoline nasal drops.
Mucolytic agents such as Guaifenesin and Saline lavage used to decrease the duration of sinus infections.
These are contraindicated in clients with cardiovascular diseases and competitive athletes.
These drugs allow the restoration of normal mucociliary function and drainage.

Pseudoephedrine and Phenylephrine can be used for 10 to 14 days.
These are used to reduce mucosal inflammation by relieving nasal congestion.
Antihistamines are beneficial for reducing osteo-meatal obstruction in clients with allergies and sinusitis.
Normal saline solution irrigations or a vaporizer or humidifier is used to prevent nasal crusting .
These are also used to moisten secretions.

SURGICAL MANAGEMENT�
  Antral lavage -is a surgical procedure in which a cannula is inserted into the opening of the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus.

Functional Endoscopic sinus surgery
It is an outpatient surgical procedure using local anesthesia.
The main objective of FESS is to re-establish the sinus ventilation and Mucociliary clearance.
After FESS

1. Prepared By:-Prof. Blessy Thomas Vice Principal FNCON,SPN SINUSITIS

2. INTRODUCTION

3. ANATOMY AND PHYSIOLOGY

4. DEFINITION Sinusitis  is an  inflammation,  or swelling, of the tissue lining the  sinuses .  Sinusitis is an inflammation of the mucus membrane of the Paranasal sinuses. Rhino- sinusitis is referred to as an inflammatory disease of the nose or sinuses. Pansinusitis is infection of more than one sinus.

5. INCIDENCE It affects 1 in 8 adults per year. It is a common condition and a complication of 5%-10% of URIs in children

6. CAUSES Viral infection: 90% of sinusitis. Rhinovirus, corona virus. Bacteria: Streptococcus pneumoniae ,H Influenza others, Pollutants: Chemical/irritants may trigger the build of mucus. Fungi: Rare. URIs such as common cold Nasal polyps Deviated nasal septum Dental infection Swimming Smoking and Intranasal cocaine. Tonsillar and adenoid hypertrophy. Pregnancy, hormonal changes with puberty.

7. Iatrogenic factors such as mechanical ventilation, NG tubes, nasal packing etc. Immune system deficiencies or medications that suppress the immune system.

8. TYPES  On the basis of location and on the basis of duration Frontal sinusitis Acute sinusitis( infection lasts up to 4 weeks) Acute sinusitis usually starts with cold-like symptoms such as a runny, stuffy nose and facial pain. It may start suddenly and last 2 to 4 weeks. Subacute sinusitis usually lasts 4 to 12 weeks.

9. Chronic sinusitis symptoms last 12 weeks or longer. Recurrent sinusitis happens several times a year. Pansinusitis affects all the sinuses in your head – not just the common one or two. Ethmoidal Sinusitis - Subacute sinusitis ( lasts between 4 -12 weeks) Maxillary sinusitis - Chronic sinusitis( more than 12 weeks) Sphenoidal sinusitis

10. PATHOPHYSIOLOGY Due to etiological factors Entry of micro-organism inside the nasal mucosa and sinus cavities Inflammatory response Destroys normal ciliated epithelium Impairs drainage from sinuses Pooling & stagnation of secretions Mucosal changes , loss of cilia , edema, polyp formation etc Clinical manifestations

11. CLINICAL MANIFESTATIONS ACUTE SINUSITIS A stuffy or blocked nose A thick white, yellow, or green discharge from the nose Pain in the teeth Pain or pressure in the face. This often feels worse when a person bends forward. Fever Coughing Trouble smelling Ear pressure or fullness Headache Bad breath Tiredness

12. Chronic Sinusitis Symptoms May have these symptoms for 12 weeks or more: Feeling of congestion or fullness in your face Nasal obstruction or nasal blockage Pus in the nasal cavity Fever Runny nose or discoloured postnasal drainage

13.  Bad breath Tooth pain. Sore throat Headache Facial pain In more advance cases the symptoms are Anosmia, Nasal congestion and discharge, halitosis etc. Maxillary sinusitis : Pain in the upper jaw. Frontal sinusitis : Pain in the forehead Ethmoid sinusitis : Pain over nasal bridge. Sphenoid sinusitis : Pain over the occipital or vertex.

14. DIAGNOSTIC MEASURES Physical examination History taking Culture and sensitivity test Sinus radiography shows opacification of the sinus, thickened mucous membrane. CT scan. CBC X ray finding conforms. Watchful waiting: If sinusitis less than 10 days without symptoms then it can be viral sinusutis . More than 10 days bacterial sinusitis.

15. MANAGEMENT Symptomatic treatment is given to the patient. Treatment depends on the how long condition lasts. Most acute cases resolves without treatment. Antibiotics are not prescribed routinely , because many cases of sinusitis are viral. First line therapy at most centres is Amoxicillin for 14 days.

16. Antibiotic therapy- Amoxiclav 625 mg(Amoxicillin 500 mg + clavulanic acid 125 mg). These are used to reduce nasal edema. Xylometazoline nasal drops. Mucolytic agents such as Guaifenesin and Saline lavage used to decrease the duration of sinus infections. These are contraindicated in clients with Cardiovascular diseases and competitive athletes. These drugs allow the restoration of normal mucociliary function and drainage.

17. Pseudoephedrine and Phenylephrine can be used for 10 to 14 days. These are used to reduce mucosal inflammation by relieving nasal congestion. Antihistamines are beneficial for reducing osteo-meatal obstruction in clients with allergies and sinusitis. Normal saline solution irrigations or a vaporizer or humidifier is used to prevent nasal crusting . These are also used to moisten secretions.

18. SURGICAL MANAGEMENT   Antral lavage -is a surgical procedure in which a cannula is inserted into the opening of the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus.

19. Functional Endoscopic sinus surgery It is an outpatient surgical procedure using local anesthesia. The main objective of FESS is to re-establish the sinus ventilation and Mucociliary clearance. After FESS , nasal packing may be inserted to minimize nasal bleeding It allows the direct visualization of the sinuses in order to remove diseased tissue and to enlarge sinus Ostia. Small fibro-optic endoscopes are passed through the nasal cavity and into the sinus.

20. A small incision is made over the ethmoidal sinus on the lateral nasal bridge and the diseased mucosa is removed from the sphenoidal or ethmoidal sinus. Nasal and ethmoidal packing then inserted. Possible complications includes nasal bleeding, pain, scar formation.

21. Maxillary antrostomy It is a surgical procedure to enlarge the opening (ostium) of the maxillary sinus. This allows for further surgical intervention within the maxillary sinus cavity as well as improved sinus drainage. The approach is mainly from anterior wall of maxilla bone It is done when maxillary sinusitis is not cured by medication or other non-invasive technique.

22. Caldwell- luc antrostomy Caldwell- luc antrostomy —also known as Radical antrostomy— is an operation to remove irreversibly damaged mucosa of the maxillary sinus.

23. NURSING MANAGEMENT Avoid blowing nose. Avoid smoking Promote good oral hygiene Educate the patient to avoid cold environment Increase fluid intake Warm compresses apply in the sinus area. Explain the client to engage in minimal physical exercise, avoid strenuous activity. For the first 24 hours after sinus surgery, observe the client for nasal bleeding, respiratory distress, orbital and facial edema. A nasal drip pad is taped beneath the nares to absorb drainage after nasal or sinus surgery. Nasal saline spray may be started 3 to 5 days after the surgery to moisten the mucosa. The client to sneeze only with the mouth open.

24. NURSING DIAGNOSIS  Hyperthermia related to inflammation process. Impaired comfort related to facial fullness, nasal discharge. Ineffective breathing pattern related to nasal congestion/discharge. Risk for infection related to disease process.  (Meningitis, Osteomyelitis , Brain abscess)

25. CONCLUSION

26. ASSIGNMENT Nursing care plan on Sinusitis

27. BIBLIOGRAPHY Smeltzer SC, et al. Brunner and Siddharth's Textbook of Medical-Surgical Nursing, 11th edition. Lippincott Williams & Wilkins, 2007. Chintamani and Mrinalini Mani Textbook of Medical-Surgical Nursing, Elsevier India; 3rd edition 2018 Javed Ansari And Davinder Kaur, Concise Course In Medical Surgical Nursing ‎ 1 st edition, Vikas and company ,P V publications 2017