Sinusitis nikku

Sinusitis disease and Nursing management

1. Presented by :
Nikhil Vaishnav
M.Sc. Nursing
SINUSITIS

3. Paranasalsinusesareagroupof4
pairedairfilledspacesthatsurround
thenasalcavity.
1.Frontalsinus
2.Ethmoidsinus
3.Sphenoidsinus
4.Maxillarysinus
Theyreducetheweightoftheskull
andtheyhumidifytheinspiredair.

4. Sinusitisisaninflammationofthemucus
membraneoftheParanasalsinuses.
Pansinusitisisinfectionofmorethanone
sinus.
Rhinosinusitisisreferredtoasan
inflammatorydiseaseofthenoseor
sinuses.
Itisacommon conditionanda
complicationof5%-10%ofURIsinchildren.
Itaffects1in8adultsperyear.

5. ONTHE BASIS OF
LOCATION
ON THE BASIS OF DURATION
Frontal sinusitis Acutesinusitis( infection
lasts up to 4 weeks)
Ethmoid Sinusitis Subacutesinusitis ( lasts
between 4 -12 weeks)
Maxillary sinusitis Chronic sinusitis(more
than 12 weeks)
Sphenoid sinusitis

6. Viral infection: 90% of sinusitis. Rhinovirus, coronavirus.
Bacteria: Streptococcus pneumoniae ,H Influenza others,
Pollutants: Chemical/irritants may trigger the build of
mucus.
Fungi: Rare.

7. URIs such as common cold
Nasal polyps
Deviated nasal septum
Dental infection
Swimming

8. Smoking and Intranasal cocaine.
Tonsillar and adenoid hypertrophy.
Pregnancy, hormonal changes with puberty.
Iatrogenic factors such as mechanical ventilation, NG
tubes, nasal packing etc.

10. Common sign and symptoms are
Fever, sore throat, headache, facial
pain and pressure, malaise.
In more advance cases the symptoms
are Anosmia, Nasal congestion and
discharge, halitosis etc.

11. Maxillary sinusitis: Pain in the upper jaw.
Frontal sinusitis: Pain in the forehead.
Ethmoid sinusitis: Pain over nasal bridge.
Sphenoid sinusitis: Pain over the occiput or vertex.

12. Historytaking
Physicalexamination
Watchfulwaiting:Ifsinusitislessthan10days
withoutsymptomthenviral.Morethan10days
bacterialsinusitis.
Xrayfindingconforms.
CBC
CTscan.
Sinusradiographyshowsopacificationofthe
sinus,thickenedmucousmembrane.
Cultureandsensitivitytest

13. Treatmentdependsonthehowlong
conditionlasts.Mostacutecasesresolves
withouttreatment.
Inmostofthesinusitisantibioticsarenot
recommendedbecauseviralcauses.
Symptomatictreatmentisgiventothe
patient.

14. Antibiotics are not prescribed routinely , because
many cases of sinusitis are viral.
First line therapy at most centers is amoxicillin for
14 days.
Antibiotic therapy-Amoxyclav 625 mg(Amoxycillin
500 mg + clavulamic acid 125 mg).

17. Xylometazolinenasaldrops.
Theseareusedtoreducenasal
edema.

18. MucolyticagentssuchasGuaifenesin
andSalinelavageusedtodecreasethe
durationofsinusinfections.

19. PseudoephedrineandPhenylephrine
canbeusedfor10to14days.
Thesedrugsallowtherestorationof
normalmucociliaryfunctionand
drainage.
Thesearecontraindicatedinclients
withCardiovasculardiseasesand
competitiveathletes.

21. Theseareusedtoreducemucosal
inflammation.


22. Antihistaminesarebeneficialforreducing
osteomeatal obstructioninclientswith
allergiesandsinusitis.


23. NormalsalinesolutionirrigationsorAvaporizer
orhumidifierisusedtopreventnasalcrusting
.Thesearealsousedtomoistensecretions.

24. Antrallavageisasurgicalprocedureinwhich
acannulaisinsertedintotheopeningof
themaxillarysinusviatheinferiormeatusto
allowirrigationanddrainageofthesinus.

25. Functional Endoscopic
sinus surgery.
Nasal antrostomy
External
sphenoethmoidectomy
Caldwell –Lue
procedure.

26. ThemainobjectiveofFESSistoreestablish
thesinusventilationandMucociliary
clearance.
Itisanoutpatientsurgicalprocedureusing
localanesthesia.
Smallfiberopticendoscopesarepassed
throughthenasalcavityandintothesinus.
Itallowsthedirectvisualizationofthe
sinusesinordertoremovediseasedtissue
andtoenlargesinusOstia.

27. Possiblecomplicationsincludesnasal
bleeding,pain,scarformation.
AfterFESS,nasalpackingmaybeinserted
tominimizenasalbleeding.

29. Itisasurgicalprocedureperformedto
remove diseasedmucosa fromthe
sphenoidalorethmoidalsinus.
Asmallincisionismadeovertheethmoidal
sinusonthelateralnasalbridgeandthe
diseasedmucosaisremoved.
Nasalandethmoidalpackingtheninserted.

30. Maxillaryantrostomyisasurgicalprocedure
toenlargetheopening(ostium)ofthe
maxillarysinus.Thisallowsforfurther
surgicalinterventionwithinthemaxillary
sinuscavityaswellasimprovedsinus
drainage.


32. Caldwell-lucantrostomy—alsoknown
asRadicalantrostomy—isanoperationto
removeirreversiblydamaged mucosaof
themaxillarysinus.
Itisdonewhenmaxillarysinusitisisnot
curedbymedicationorothernon-invasive
technique.
Theapproachismainlyfromanteriorwallof
maxillabone

35. Warmcompressesapplyinthesinus
area.
Increasefluidintake
Educatethepatienttoavoidcold
environment
Promotegoodoralhygiene
Avoidsmoking
Avoidblowingnose.

36. Forthefirst24hoursaftersinussurgery
,observetheclientfornasalbleeding,respiratory
distress,orbitalandfacialedema.
Explaintheclienttoengageinminimalphysical
exercise,avoidstrenuousactivity.
Teachtheclienttosneezeonlywiththemouth
open.
Nasalsalinespraymaybestarted3to5days
afterthesurgerytomoistenthemucosa.
Anasaldrippadistapedbeneaththenaresto
absorbdrainageafternasalorsinussurgery.

38. Riskforinfectionrelatedtodisease
process.
Ineffectivebreathingpatternrelated
tonasalcongestion/discharge
Alteredcomfortrelatedtofacial
fullness,nasaldischarge.
Hyperthermiarelatedtoinflammation
process.

39. Meningitis.Osteomyelitis
Brain abscess